2 Attachment 2 Focus Group Participant Screener

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

20160324 Attachment 2__FocusGroup_ParticipantScreener_FinalDraft

Discussion on Teen Organ Donors

OMB: 0915-0212

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Screener

Focus Groups on Teen Donation


Summary of recruiting specifications

Mix of boys and girls, aged 15-17

Currently attending high school

Support organ donation and are not (and have never been) registered organ donors

Half with and half without a driver’s license

Have not been in a focus group/paid interview in the past six months



(RECRUIT 12 PER GROUP, 24 TOTAL)

1. Good morning/afternoon/evening, my name is __________ and I’m calling from ______. I am not selling anything nor will you be asked to sign up for or purchase anything. We are recruiting people to participate in a paid focus group discussion. The focus group will last two hours. All participants will be paid $__ for their time. If you are eligible for the study, would you be interested in participating?

  1. Yes (CONTINUE)

  2. No (THANK AND END)


Note whether the respondent is male or female and recruit a mix.

  1. Male

  2. Female


Thanks. I need to ask you a few questions to see if you qualify.


2. Thinking about organ donation, do you strongly support, support, oppose, or strongly oppose organ donation?

  1. Strongly support (CONTINUE)

  2. Support (CONTINUE)

  3. Oppose (THANK AND END)

  4. Strongly Oppose (THANK AND END)


3. Are you currently a registered organ donor, either by registering at the DMV, on a donor card, or on an organ donor registry?

  1. Yes (THANK AND END)

  2. No (CONTINUE)


4. Now, I need to ask you some basic information. Which category best describes your age? ____

  1. Under 15 (THANK AND END)

  2. 15-17 (CONTINUE)

  3. 18 or older (THANK AND END)


5. What is your current grade?

  1. 9th

  2. 10th

  3. 11th

  4. 12th

  5. Other, not in school (THANK AND END)

Recruit a mix.


6. What is the name of your high school? _____________

[No more than two from one high school.]


7. Do you have a driver’s license?

  1. Yes (SKIP TO Q9)

  2. No (CONTINUE)

Recruit a mix.


8. When you get your driver’s license, how likely do you think you are to register as an organ donor?

  1. Definitely, will register (THANK AND END)

  2. Probably will register

  3. May register

  4. Definitely, will not register

  5. Not sure/haven’t thought about it


9. We want to make sure we represent different ethnic and racial groups in our study. Would you describe yourself as… ?

  1. Hispanic or Latino/Latina (CONTINUE)

  2. Not Hispanic or Latino/Latina (CONTINUE)


10. Next, would you describe yourself as…?

  1. White (CONTINUE)

  2. Black or African American (CONTINUE)

  3. American Indian or Alaskan Native (CONTINUE)

  4. Asian (CONTINUE)

  5. Native Hawaiian or Other Pacific Islander (CONTINUE)

Recruit a mix.


11. Have you ever participated in a focus group or participated in a paid research interview?

  1. Yes (CONTINUE)

  2. No (SKIP TO Q13)


12. How recently did you participate in this focus group or paid discussion? [OPEN-ENDED]

  1. Within the past six months (THANK AND END)

  2. More than six months ago (CONTINUE)


13. Thank you. We are conducting focus groups on the topic of organ donation. The discussion will last two hours. We will pay you $__ as a way of thanking you for participating. Would you be interested in participating?

  1. No (THANK AND END)

  2. Yes (CONTINUE)


14. Great! We would like to send you a message to confirm your participation in this study, and we will also call you the day before to remind you. Can you please provide me with your …?

NAME:

E-MAIL ADDRESS:

PHONE NO:

** Double check spelling of name and read back phone and e-mail to confirm ***


14. It is very important that you let us know right away if you will not be able to attend this discussion so that we may have time to find a replacement. Will you call us at [phone] if for some reason you cannot attend? [WAIT FOR AN ANSWER]


Thank you for your time and for agreeing to participate!

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleFocus Group Screener
AuthorChristine Brittle
File Modified0000-00-00
File Created2021-01-25

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