FDA Caregiver Study
Phase 2 – Dyad Interview Participant Screener
Hello, my name is _______________ and I’m from [name of company]. I’m calling on behalf of RTI International, a non-profit research organization, about a research study. I’m not selling or promoting any product.
The purpose of this study is to learn more about how people and their spouses/partners discuss health issues with one another. We will be conducting several interviews on this topic. To see if you are eligible, I’d like to ask you some questions. If you are eligible and choose to participate, all of your comments will be kept private and we will reimburse you $75 per person at the end of the focus group.
May I continue?
Yes CONTINUE
No [Thank respondent and end call.]
CORE ELIGIBILITY CRITERIA
What year were you born?
_____ |
1996 or earlier CONTINUE 1997 or later TERMINATE |
Do you currently have a spouse or partner who lives with you?
Yes |
|
CONTINUE |
No |
|
TERMINATE |
In a typical week, how many days per week does your spouse/partner live in the same residence as you? [Goal is to exclude individuals whose spouse lives separately (e.g., military deployments).]
_____ |
4 days or more CONTINUE 3 days or less TERMINATE |
Would you and your spouse/partner both be available to participate in a joint interview for this study? We would need both of you to be physically present at the same time.
Yes |
|
CONTINUE |
No |
|
TERMINATE |
Have you ever been diagnosed by a doctor with any of the following health conditions? [Read options below]
High Blood Pressure |
|
CONTINUE |
Chronic Pain |
|
CONTINUE |
Asthma |
|
CONTINUE |
Acid Reflux |
|
CONTINUE |
Depression |
|
CONTINUE |
None of the above |
|
CONTINUE |
Has your spouse/partner ever been diagnosed by a doctor with any of the following health conditions? [Read options below]
High Blood Pressure |
|
SEE BELOW |
Chronic Pain |
|
SEE BELOW |
Asthma |
|
SEE BELOW |
Acid Reflux |
|
SEE BELOW |
Depression |
|
SEE BELOW |
None of the above |
|
SEE BELOW |
SEGMENTATION:
|
What is your current occupation?
|
Healthcare Provider (e.g., Physician, Nurse, Counselor) TERMINATE Pharmaceutical Employee TERMINATE All Other Occupations CONTINUE |
What is your sex?
Male |
|
CONTINUE |
Female |
|
CONTINUE |
SCREEN FOR A MIX |
What is the highest level of education you have attained?
Less than high school |
|
CONTINUE |
High school graduate (or GED) |
|
CONTINUE |
Some college or technical school (No degree) |
|
CONTINUE |
College graduate (2- or 4-year degree) |
|
CONTINUE |
Some graduate school (No degree) |
|
CONTINUE |
Graduate school degree |
|
CONTINUE |
SCREEN FOR A MIX |
Which of these racial groups best describes you? [Read options below]
White |
|
CONTINUE |
Black / African American |
|
CONTINUE |
American Indian or Alaskan Native |
|
CONTINUE |
Asian |
|
CONTINUE |
Native Hawaiian or Pacific Islander |
|
CONTINUE |
Other |
|
CONTINUE |
SCREEN FOR A MIX |
Are you or your spouse/partner currently taking any prescription drugs for asthma?
Yes |
|
CONTINUE |
No |
|
CONTINUE |
SCREEN FOR A MIX |
Interview Invitation:
Thank you for answering all of my questions. Based on your responses, you appear eligible to participate in our study and join one of our interviews.
Each interview will last about 90 minutes and should be very interesting. No one will try to sell you anything, and no one will call you later because you participated. We will reimburse you and your spouse/partner a total of $150 ($75 per person) at the end of the interview for your time and participation. We can invite only a few couples to take part, and if it’s okay, we would like to record the discussion. Can I schedule your participation?
The interviews will take place on [DATES AND TIMES TBD]. Which date and time would work best for you?
Your participation in this study is very important. If for some reason you will not be able to attend, please let us know right away. You can call us anytime at [insert phone number], and if we are not here, please leave a message.
Closing for Ineligible Participants:
I’m sorry, but you are not eligible for this study. There are many possible reasons why people are not eligible. These reasons were decided earlier by the researchers. However, thank you for your interest in this study and for taking the time to answer our questions today.
Participant Information
NAME: ________________________________________________________
SPOUSE/PARTNER NAME: ________________________________________________
ADDRESS: ________________________________________________________
CITY: ________________________________________________________
ZIP CODE: ________________________________________________________
EMAIL: ________________________________________________________
SPOUSE/PARTNER EMAIL: _____________________________________________________
What is the best time to reach you? What is the best telephone number to reach you at that time?
BEST TIME TO BE REACHED: ________________________________________
BEST PHONE NUMBER: ______________
Is there another time and number we can try if we miss you?
ALTERNATE PHONE NUMBER:
Recruiter: ____________________
OMB Control No. xxxx Expiration date: xx/xx/xx
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | FDA Online Study |
Author | Jackie Amoozegar |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |