5 20170303 Attachment 5__FocusGroup_ParticipantScreener (E

OMB Number 0915-0212 - Expiration date 05/31/2018

Screener

Focus Groups with 50+

Summary of recruiting specifications

Mix of men and women, aged 50-80

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

Use the Internet at least monthly

Not in poor health

Have not been in a focus group/paid interview in the past 6 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 regarding organ donation. The focus group will last 2 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 or have you ever been a registered organ donor, this includes registering at any Department/Division of Motor Vehicles, 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. 49 and under (THANK AND END)

2. 50-59 (CONTINUE)

3. 60-69 (CONTINUE)

4. 70-80 (CONTINUE)

5. 81 or older (THANK AND END)

Recruit a mix of ages.

5. What is the highest grade you have completed in school? [READ LIST IF NECESSARY]

1. 8th grade or less (CONTINUE)

2. Some high school (grades 9, 10, or 11) (CONTINUE)

3. High school graduate or GED (High school equivalency) (CONTINUE)

4. Some college/2-year college/technical school/associate degree (CONTINUE)

5. College graduate (LIMIT 3)

6. Some graduate school/post-graduate degree (LIMIT 2)

Recruit a mix of education levels.

6. What is your current work status? Are you currently:

1. Working full-time (CONTINUE)

2. Working part-time (CONTINUE)

3. Self-employed (CONTINUE)

4. Not in the labor force (CONTINUE)

5. Retired (CONTINUE)

Recruit a mix of work status.

7. How would you describe your health status overall? Would you say you are:

1. In excellent health (CONTINUE)

2. In good health (CONTINUE)

3. In fair health (CONTINUE)

4. In poor health (THANK AND END)

8. How often do you use the internet for things like reading the news, shopping, or checking email?

1. Daily (CONTINUE)

2. Several times a week (CONTINUE)

3. Weekly (CONTINUE)

4. Monthly (CONTINUE)

5. Less than monthly or never (THANK AND END)

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 6 months (THANK AND END)

2. More than 6 months ago (CONTINUE)

13. Thank you. We are conducting focus groups on the topic of organ donation. The discussion will last 2 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 ***

15. It is very important that you let us know right away if you will not be able to attend this discussion so that we 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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