Key Informant Consent and Interview Guide

Form Approved

OMB No. 0920-XXXX

Exp. Date:

Public Reporting burden of this collection of information is estimated at 30 minutes per response, 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 CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NW, MS D-74, Atlanta, GA 30333; Attn: PRA (0920-XXXX).

Older Adult Safe Mobility Assessment Tool Development:

Key Informant Consent and Interview

Introduction

Hi, I’m __________ from ResearchWorks, and we’re conducting research on behalf of the Centers for Disease Control and Prevention on how to help older adults protect their ability to get places as they age. Thank you for agreeing to this interview today, and as a reminder, this is NOT a sales call. We are developing a product that allows older adults to complete a written self-assessment of their mobility now and gives them tips and resources on how to protect and maintain their abilities as they age. We are speaking with you today because you are an expert in your community, and we’re looking for your insights on a few key areas of the research we plan to do with older adults in your community. This interview will take about 15 minutes, and you will be provided with a thank you gift for participating in our study, which I will tell you more about in a moment

First, I need to read to you some background on this study and ask for your consent to participate in this interview:

All information collected in this research will remain secure. We will take notes and make an audio recording of our interview so that we can create a report, and that data will be kept in locked cabinets, separated from your name in order to keep it secure. For the purposes of reporting results from our research, the information you provide will be grouped with data that others provide, and your name will not be used for any reason. Your voice recording will not be played to others besides the research team without your written permission.

This study is not designed to help you personally; rather the research team hopes to use your and several other peoples’ opinions to make improvements to our research plan. Risks of your participation in this brief interview are expected to be minimal in nature because topics are focused on your opinions of our development of a resource that can help people protect their ability to get places they need to go as they age. You are free to ask questions or withdraw from participation at any time and without penalty, and I can provide you with the lead investigator’s contact information at any time upon your request.

Do you have any questions at this time?

Do you verbally consent to participate in this interview and agree to continue with our conversation? [IF NO] Would there be another time that would be more convenient for you? [IF YES, SCHEDULE FOLLOW UP SCREENING.]

Interview Questions

1. Just for our reference, would you please briefly describe your background with older adults or mobility in your area,

   1. Probe: Service provider? Community member?

2. Thinking about your community, what would you say are the top 2 or 3 challenges that older adults over 60 experience when they try to get where they want to go on a daily basis?

   1. What infrastructure barriers (e.g. side walks, stop lights)

   2. What environmental barriers (e.g. pollution)

   3. What transportation barriers? (e.g. lack of public transportation)

   4. Socio-economic status?

   5. Social support structures? (e.g. churches or nonprofits)

3. What are the top 3 or 4 resources the elderly use in your area?

   1. Transportation (if any)

   2. Medical clinics

   3. Care givers (name of organization)

We are going to be conducting research with older adults in your community in a few weeks. One way we’ll do that is by doing what’s called an “intercept” where we locate ourselves at a popular location where we’re likely to find older adults, and we’ll ask them to participate in a quick conversation on the spot, and we’ll offer them a small gift card as a thank you. Another way will be to do a focus group in the community. With that in mind…

4. Are there key providers or organizations in your community that we should definitely reach out to, so that the older adults they serve are included in this study?

5. Where do you think would be optimal places for us to recruit older adults into our study?

6. In your area, is there a particular place that has a higher population of the elderly?

   1. A hang out spot? (e.g. community locations, coffee shops)

   2. Specific neighborhood?

7. What do you think will motivate older adult consumers to partake in our study?

   1. Incentives? Donations to a charity? Particular location of the focus group?

8. Are their any barriers in reaching this population in your community that you know of?

9. Is there anything else you’d like to add that may be helpful for us to know in conducting this research?

Thank and Close