NICHD Safe to Sleep® Campaign Healthy Native Babies (HNB) Focus Group Guides

OMB Number: 0925-0643

Expiration Date: 10/31/2017

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Safe to Sleep In-Person Focus Groups

Participant Recruitment Screener

--Focus Groups with Service Providers--

We are conducting five (5) in-person focus groups, or talking circles, with service providers who care for Native pregnant or postpartum women, or infants under one year of age and their families in Northern Tier Indian Health Services Areas. The focus groups, or talking circles, will inform the next phase of the Healthy Native Babies Project, which is part of the safe infant sleep campaign implemented by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health. We will be talking about infant health issues. We are not selling or promoting any product or service. Everyone who participates in the focus group will receive $40 as a token of appreciation for their time. The focus group will last 120 minutes (2 hours). The discussion will be audio-recorded and information you provide will not be disclosed to anyone but the investigators conducting the study, except as otherwise required by law. First names only will be used during the discussion. In the final summary report, neither your individual name, nor the tribe or organization you work for, will be connected to a comment you make during the discussion. To see if you qualify to participate in the focus group discussion, we need to ask you a few questions. These questions will take less than five minutes.

RECRUIT 10-12 TOTAL PARTICIPANTS FOR 1 FOCUS GROUP (8-10 PARTICIPANTS WILL BE SEATED; ALL PARTICIPANTS WHO SHOW, EVEN THOSE WHO ARE EXCUSED, WILL RECEIVE THE INCENTIVE).

Check gender: _____ Male _____ Female

1. Do you regularly provide services for any of the following: pregnant or postpartum women, infants one year of age or younger, or parents of infants one year of age or younger?

_____ Yes

_____ No  Terminate

2. Are the majority of your clients or patients American Indian or Alaska Native?

_____ Yes

_____ No  Terminate

3. What type of work are you currently employed in?

____Public Health Nursing

____Community Health Representative

____WIC

____Other Home Visiting (Healthy Start)

____OBGYN or Labor and Delivery

____Pediatrics

____Health Education and Promotion

____Behavioral Health

____Injury Prevention

____Child Care or Early Childhood Education

____Child Welfare, Protective Services, or Social Services

____Other Law Enforcement

____Other: _______________________________

4. How long have you been in this field?

_____ 0-5 years

_____ 5-10 years

_____ 10-15 years

_____ 15-20 years

_____ More than 20 years

5. What is your highest level of education?

_____ High School Diploma or GED

_____ Some College

_____ Associate’s or Technical Degree without a license (e.g., MA, NA)

_____ Bachelor’s Degree or Technical Degree with license (e.g., LPN, RN, BSN)

_____ Graduate or Professional Degree (e.g., MD, PA, CNM, MPH, MSW)

INCLUDE PROVIDERS WITH A MIX OF EDUCATION LEVELS, WITH AN EMPHASIS ON THOSE WITH AND WITHOUT PROFESSIONAL EDUCATION/LICENSE.

6. Which of the following categories best describes your ethnic background?      

____ Not Hispanic or Latino

____ Hispanic or Latino

____ Intentionally withheld

7. Which of the following categories best describes your racial background?

____ American Indian or Alaska Native

____ White

____ Black or African American

____ Asian

____ Native Hawaiian or Other Pacific Islander

____ Intentionally withheld

ENSURE AT LEAST HALF OF FOCUS GROUP PARTICIPANTS ARE AMERICAN INDIAN/ALASKA NATIVE.

[Use the following language when terminating a call:
“Thank you very much for your time today. We are looking to recruit a wide variety of service providers from across the Indian Health Service Northern Tier to help with this study. Unfortunately, we have filled participant slots with your specific characteristics. Again, thank you for your interest.”]

INVITATION

Thank you for answering our questions. We would like to invite you to participate in an in-person focus group discussion, or talking circle, with other service providers to hear your thoughts on safe infant sleep. If you agree to participate you will receive $40 in appreciation for your time.

1. Are you willing to participate?

( ) Yes SCHEDULE

( ) No THANK AND TERMINATE

FOR SCHEDULED PARTICIPANTS:

What is your name? __________________________

What is the best telephone number to reach you? ________________________

We will contact you again, the day before the in-person focus group discussion, as a reminder.

^ Public reporting burden for this collection of information is estimated to average 5 minutes, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0643). Do not return the completed form to this address.