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OMB Control Number: 0990-0281
ODPHP Generic Information Collection Request: Prevention Communication and Formative Research
Audience Research to Inform Physical Activity Guidelines Strategic Communication
Attachment A:
ODPHP Physical Activity Guidelines, 2nd Edition
Phone Screener for Focus Groups (English)
Research Instrument
June 21, 2017
Submitted to:
Sherrette Funn
Office of the Chief Information Officer
U.S. Department of Health and Human Services
Submitted by:
Frances Bevington
Strategic Communication and Public Affairs Advisor
Office of Disease Prevention and Health Promotion
U.S. Department of Health and Human Services
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0281. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
ODPHP will partner with a recruitment firm to conduct recruitment for focus groups.
To secure 8 participants for each focus group, we will over-recruit by 2 participants per group. ODPHP has already translated the phone screener into Spanish in order to recruit Spanish-speaking participants (OMB Packet — Attachment D).
Hello, I’m [RECRUITER FIRST AND LAST NAME] and I'm calling from [RECRUITMENT FIRM]. We are an independent consumer research organization. We are not selling or promoting any product or service. I am calling you because you expressed interested in participating in a focus group about how to help people be more physically active. This is a study funded by the U.S. Department of Health and Human Services. You will receive a payment of $75 for your participation. We would like to hear your opinion. The discussion group will last 90 minutes. My questions will only take a couple of minutes.
Does this sound like something you would be interested in?
_____ Yes
_____ No TERMINATE
Great. Let’s find out if you qualify. I have a few questions to ask you. At some point, I may end the questions if you do not meet the requirements for the group. This has nothing to do with you; we simply want to include a variety of people in each discussion group. Is it OK if I ask you a few questions?
_____ Yes
_____ No TERMINATE
Before we begin, I’d like to let you know that all information you provide will be private. Your help is voluntary, and you do not have to answer every question. If you would rather not answer a question, let me know and you can skip it. You can stop at any time.
Gender
What is your gender?
_____ Male
_____ Female
_____ Other
_____ Choose not to answer
Age
Now I am going to give you a few age ranges. Please stop me when I reach the group you are in.
_____ Younger than 34 years old TERMINATE
_____ Between 35 and 44 years old
_____ Between 45 and 54 years old
_____ Between 55 and 64 years old
_____ 65 years old or older TERMINATE
Is Spanish the primary language spoken in your home?
_____Yes
_____No
Parental Status
Are you a parent of an adolescent? [Adolescent is defined as being 12-17 years of age]
_____ Yes
_____ No
Stages of Change Classification
Next I’m going to ask you some questions about how often you are physically active. Physical activity is anything that gets your body moving.
How often do you get physical activity for at least 30 minutes a day?
_____ Never (0 days per week)
_____ Rarely (1 day per week)
_____ Sometimes (2-3 days per week)
_____ Often (4-5 days per week) TERMINATE ACTION/MAINTENANCE STAGES
_____ Almost always (6 days per week) TERMINATE ACTION/MAINTENANCE STAGES
_____ Always (7 days per week) TERMINATE ACTION/MAINTENANCE STAGES
Within the next month, do you plan to start getting more physical activity than you do now?
_____ Yes PREPARATION STAGE
_____ No
Within the next 6 months, do you plan to start getting more physical activity than you do now?
_____ Yes CONTEMPLATION STAGE
_____ No TERMINATE PRECONTEMPLATION OR MAINTENANCE STAGES
[If the participant is a parent, ask questions 8 through 10. Otherwise, skip to question 11.]
How often does your child get physical activity for at least 1 hour a day? If you have more than one child, please answer separately for each child.
[If at least 1 child meets the criteria below, recruit the participant.]
_____ Never
_____ Rarely
_____ Sometimes
_____ Often
_____ Almost always TERMINATE
_____ Always TERMINATE ACTION/MAINTENANCE STAGES
Within the next month, do you plan to encourage your child to get more physical activity than he or she does now?
_____ Yes PREPARATION STAGE
_____ No
Within the next 6 months, do you plan to encourage your child to get more physical activity than he or she does now?
_____ Yes CONTEMPLATION STAGE
_____ No TERMINATE PRECONTEMPLATION OR MAINTENANCE STAGES
Educational level
What is the highest level of education you have completed?
_____ Did not attend school
_____ Some years of school, but did not go to high school (1 to 8 years of school)
_____ Some high school, but did not finish (9 to 12 years)
_____ High school diploma or GED
_____ Some college
Race/Ethnicity
Are you of Hispanic or Latino origin?
____ Yes
____ No
Which category best describes your race?
____ White
____ Black or African American
____ American Indian or Alaska Native
____ Asian or Pacific Islander
____ Other
Income level
What is your yearly household income?
____ Less than $20,000
____ $20,000 to $34,999
____ $35,000 to $49,999
____ $50,000 to $74,999
____ $75,000 to $99,999
____ $100,000 to $149,999
____ $150,000 to $199,999
____ $200,000 or more
[Recruit a mix of participants for the focus group types and locations below]
|
Baltimore, MD |
Chicago, IL |
Las Vegas, NV |
Total |
Adults (General) |
|
|
|
|
English |
1 |
1 |
2 |
4 |
Spanish |
1 |
1 |
|
2 |
Parents of Adolescents |
|
|
|
|
English |
1 |
1 |
1 |
1 |
Total FG |
3 |
3 |
3 |
9 |
TERMINATION SCRIPT
Thank you for answering all of my questions. We are recruiting people from different backgrounds and unfortunately, we have already recruited several individuals with similar characteristics as yours. Again, thank you for the time.
INVITATION SCRIPT
(USE IF INDIVIDUAL MEETS RECRUITING CRITERIA)
Thank you for answering all of my questions so far.
The group discussions will take place on [DATE, TIME, LOCATION]. Are you able to attend on one of these days and times? Which ones?
____ Yes
____ No TERMINATE
During the group, you will be asked to read several materials and share your opinion. Would you feel comfortable reading the materials and discussing them with others?
____ Yes
____ No TERMINATE
Great. As I said, the group discussion will take about 90 minutes of your time. The group will be both fun and informative. No one will try to sell you anything. No one will call on you as a result of your participation. You will receive a payment of $75 for your participation. This is an important project and your opinions will help the U.S. Department of Health and Human Services to promote healthy lifestyles. We hope you will be part of it.
Do you agree to participate in one of the discussion groups?
____ Yes
____ No TERMINATE. Thank you for speaking with me.
CONTINUATION SCRIPT
(USE FOR INDIVIDUALS WHO QUALIFY AND AGREE TO PARTICIPATE)
Let me just mention a couple of more things:
If you use glasses for reading or watching TV, please be sure to bring them with you, since you will be asked to read several things.
We cannot provide babysitting services, so it will not be possible for you to bring any children with you.
If someone comes with you to the discussion group, they will not be able to join in the group. They will need to wait for you outside the room.
Only one person from the same family will be able to participate in the discussion groups.
We can only invite a limited number of people to be in the groups. May we schedule you for one of the groups?
We will call you a few days before the group to remind you of the date and time. If you will not be able to participate, please call [NAME AND NUMBER] to let us know as soon as possible, so we can ask someone else. We need to have a certain number of people for each group.
NAME: _________________________________________________
ADDRESS: _________________________________________________
CITY: _________________________________________________
ZIP CODE: _________________________________________________
PHONE: (DAY) _____________________________________
(EVENING) _____________________________________
(FAX) _____________________________________
(EMAIL) _____________________________________
SCHEDULED FOR: _________________________________________________
Recruiter: ____________________________________ Date: _______________
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jaya Mathur |
File Modified | 0000-00-00 |
File Created | 2021-01-22 |