Focus Group 10-Day Letter (Request for Approval 0920-0222 18QO)

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

February 16, 2018

Margo Schwab, Ph.D.

Office of Management and Budget

725 17th Street, N.W.

Washington, DC 20503

Dear Dr. Schwab:

The staff of the NCHS Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER), (OMB No. 0920-0222, Exp. Date 07/31/2018) plans to evaluate a new set of contact and messaging materials developed by NCHS’ Division of Health and Nutrition Examination Surveys (DHNES) for the household screening and interview portion of the National Health and Nutrition Examination Survey (NHANES) (OMB # 0920-0950, Exp. Date 12/31/2019).

Like a number of other national probability based face-to-face surveys, NHANES has been experiencing a decline in response rates. To address this decline, a non-response team was assembled to identify areas for improvement. Five areas were identified, namely: outreach, advance protocol and participant incentives, refusal conversion, non-response bias analyses, and survey design. For outreach, DHNES collaborated with the CDC Office of the Associate Director for Communications (OADC) to develop a social media campaign and new interactive materials to enroll selected participants. In addition to a planned field test (which is not covered under this approval request), CCQDER and DHNES are planning on conducting a series of focus groups designed to explore how potential respondents understand and react to these materials.

The protocol for these focus groups is found in Attachment 1, and the procedure for these discussions conforms to the techniques that have been described in CCQDER’s generic OMB clearance package (No. 0920-0222, Exp. Date 07/31/2018). Briefly, there are two collections of materials we are interested in discussing during the groups: the current NHANES contact materials (see Attachment 7) and a set of proposed postcard-sized letters designed to replace the current materials (see Attachment 8). Within these new materials, there are two types of refusal postcards: a card featuring “scratch-off” areas that highlight the benefits of participating in NHANES, and a text-only card that features the phase “You’re a leader.” In order to limit framing, our initial plan for structuring the groups (in regards to these refusal postcards) will be:

1. Two groups: Discuss the current material first and then only the “scratch off” postcard

2. Two groups: Discuss the current material first and the only the text-only postcard

3. Two groups: Discuss both the “scratch-off” and the text-only postcard, but none of the current material

4. Two groups: Discuss all the materials

In addition to the refusal postcards, the initial plan is to show all the groups the new advance postcard, intro letter, and a YouTube video (https://youtu.be/3RMzExODRas). As is typical for focus group-based projects, as we progress through the groups, we may decide to change the focus of some of the groups in order to get more information on specific aspects of the messages and the participants’ reactions towards them.

We propose to recruit up to 64 English speaking adults (aged 18 and over) from a variety of racial and educational backgrounds for a series of focus groups. We will also aim to have a roughly even distribution of men and women in the groups. Given the fact that NHANES is a population study, and the marketing material under examination will be provided across the NHANES sample, the recruitment for this project will not focus on any one specific subgroup, but instead will attempt to pull in participants from a wide range of backgrounds. The newspaper advertisement/flyer used to recruit respondents is shown in Attachment 2. The minute screener used to determine eligibility of individuals responding to the newspaper advertisements/flyers is shown in Attachment 3. Note that wording of the template has been approved and is contained within our umbrella package. Only project specific information has been added to the document. It is anticipated that as many as 100 individuals may need to be screened in order to recruit 64 focus group participants.

The focus groups will be conducted by CCQDER staff members with participants for up to 90 minutes per focus group. Focus groups will be conducted in the Questionnaire Design and Evaluation Research Laboratory as well as at off-site locations. All groups conducted in the Questionnaire Design and Evaluation Research Laboratory will be video and audio recorded to allow researchers to review the behaviors and body language of the respondents. Groups conducted off-site will only be audio recorded. These recordings will allow researchers to ensure the quality of their notes. Due to the group nature of the discussions, in the rare case that a study participant initially agrees to audio or video recording during the telephone screening, but changes their mind and checks “no” to allowing the focus group to be recorded on the informed consent document the focus group will proceed with audio recording with the other participants, and the individual who changed his or her mind will be released. They will still receive the remuneration. Individuals who select “yes” for allowing the audio recording on the informed consent form, but “no” for retaining the recording for future research (final text before signatures on informed consent form), will be allowed to participate in the study. In this case, the recording for the focus group will be treated as though all members of the group answered “no” to this question, and the file will be destroyed at the end of the project.

After participants have been briefed on the purpose of the study and the procedures that CCQDER routinely takes to protect human subjects, participants will be asked to read and sign an Informed Consent document (Attachment 4). Only project specific information has been added to the document. Participants will also be asked to fill in their demographic characteristics on the Respondent Data Collection Sheet (Attachment 5). This document is contained in our umbrella package. The burden for completion of this form is captured in the focus group.

The facilitators will then ask each participant to confirm that he/she understands the information in the Informed Consent, and then state that we would like to record the focus group. The recorder will be turned on once it is clear that the procedures are understood and agreed upon

After the focus group, participants will be given the thank-you letter (document contained in umbrella package) signed by Charlie Rothwell, the Director of NCHS (Attachment 6), a copy of the informed consent document, and $50. Please note that we will not be asking for Special Consent for Expanded Use of Video and Audio Recordings with this project, again because of the group nature of the study.

Extreme care will be taken with all recordings and paperwork from the focus groups conducted off-site. Recordings and identifying paperwork will be stored in a secured travel case until returned to NCHS, at which point they will be transferred to the usual secured locked storage cabinets.

We propose giving participants $50 incentives, which is our standard incentive for focus groups. It is slightly higher than the standard incentive for cognitive interviews due to the increased limitations placed on scheduling group interviews as compared to individual ones. In total, for this project, the maximum respondent burden will be 105 hours. A burden table for this project is shown below:

Form Name	Number of Participants	Number of Responses/ Participant	Average hours per response	Response Burden (in hours)
Screener	100	1	5/60	9
Focus Group	64	1	1.5	96

Attachments (6)

cc:

V. Buie

T. Richardson

DHHS RCO

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