Web Usability Study for CDC's Radiation Emergencies Website

Form approved
OMB No: 0920-1050
Expiration Date: 6/30/2019

Attachment B: Public Screening Instrument

Public

• Recruitment: Recruit 18 participants for in-person interviews in Atlanta, GA.

• Incentive: $30 for each participant

• Duration: 60 minutes for each interview

Summary Table

Interview	Location	Date/Time	Audience	PC OR Tablet/Phone
1	Atlanta, Georgia	TBD	Public	PC
2	Atlanta, Georgia	TBD	Public	PC
3	Atlanta, Georgia	TBD	Public	PC
4	Atlanta, Georgia	TBD	Public	PC
5	Atlanta, Georgia	TBD	Public	PC
6	Atlanta, Georgia	TBD	Public	PC
7	Atlanta, Georgia	TBD	Public	PC
8	Atlanta, Georgia	TBD	Public	PC
9	Atlanta, Georgia	TBD	Public	PC
10	Atlanta, Georgia	TBD	Public	Tablet or Phone
11	Atlanta, Georgia	TBD	Public	Tablet or Phone
12	Atlanta, Georgia	TBD	Public	Tablet or Phone
13	Atlanta, Georgia	TBD	Public	Tablet or Phone
14	Atlanta, Georgia	TBD	Public	Tablet or Phone
15	Atlanta, Georgia	TBD	Public	Tablet or Phone
16	Atlanta, Georgia	TBD	Public	Tablet or Phone
17	Atlanta, Georgia	TBD	Public	Tablet or Phone
18	Atlanta, Georgia	TBD	Public	Tablet or Phone

Good evening. My name is __________________ and I am calling from _______________, a market research firm. Today we are talking with people as part of a study for the Centers for Disease Control and Prevention. We are not selling anything. We have a few brief questions that will take no more than 10 minutes of your time, and if you qualify and are interested, we will invite you to take part in a discussion group with other people in your area that will take place at a later date.

[Terminate screener as soon as recruiting staff realizes the person does not speak or understand English]

[IF RESPONDENT INDICATES THAT THIS IS NOT A GOOD TIME, SCHEDULE A CALL BACK TIME]

[IF NO, THANK YOU and HANG UP]

Call back date/time: _____________________

1. Have you participated in a focus group, in-depth interview, telephone survey, and/or online survey in which you were asked your opinions regarding a product, a service, or advertising within the past six months?

01 Yes [THANK AND TERMINATE]

02 No

2. Do you, or does any member of your household or immediate family work:

1. For a market research company

02 For an advertising agency or public relations firm

03 In the media (TV/radio/newspapers/magazines)

04 As a healthcare professional (doctor, nurse, pharmacist, dietician, etc.)

1. As an employee of:

• U.S. Department of Health and Human Services

• State or local health department

• Department of Homeland Security

• State or local emergency management agency

• Nuclear power plant

5. As a radiation safety officer, health physicist or other radiation-related occupation

[IF YES TO ANY, THANK AND TERMINATE]

1. In which of the following categories does your age fall?

01 under 18 years of age [THANK AND TERMINATE]

02 18-24 years of age

03 25-34 years of age

04 35-44 years of age

05 45-54 years of age

06 55-64 years of age

07 65-74 years of age

08 75 years of age or older [THANK AND TERMINATE]

[DOCUMENT ON GRID]

[RECRUIT A MIX ACROSS THE 18 PARTICIPANTS]

3. What is the highest level of education you have completed?

01 Grade school [THANK AND TERMINATE]

02 Less than high school graduate/some high school [THANK AND TERMINATE]

03 High school graduate or completed GED

04 Some college or technical school

05 Received four-year college degree

06 Some post graduate studies

07 Received advanced degree

08 Other: _____________________

[DOCUMENT ON GRID]

[RECRUIT A MIX ACROSS THE 18 PARTICIPANTS]

3. Are you comfortable with using a PC? Smartphone? A tablet?

01 PC- YES (RECRUIT 9)

02 Smartphone-YES (RECRUIT 5)

03 Tablet-YES (RECRUIT 4)

04 IF NO TO 1-3 [THANK AND TERMINATE]

3. What sex were you assigned at birth, on your original birth certificate?

01      Male

2. Female

3. Prefer not to answer

[DOCUMENT ON GRID]

[RECRUIT ABOUT A 50/50 MIX ACROSS THE 18 PARTICIPANTS]

3. Please indicate your race and/or ethnic background

7a. Race:

01_ American Indian or Alaska Native

02_ Asian

03_ Black or African American

04_ Native Hawaiian or Other Pacific Islander

05_ White

06_ Don’t know/Not sure (Do Not Read)

07_ Refuse (Do Not Read)

08_Other (Do Not Read)

7b. Ethnicity:

01_ Hispanic or Latino

02_ Not Hispanic or Latino

03_ Don’t know/Not sure (Do Not Read)

04_ Refuse (Do Not Read)

[RECRUIT A MIX ACROSS THE 18 PARTICIPANTS]

[DOCUMENT ON GRID]

3. Number of children (under the age of 18) living in your household?

01 None

02 1-2 children

03 3-4 children

04 5 or more children

[RECRUIT A MIX ACROSS THE 18 PARTICIPANTS]

[DOCUMENT ON GRID]

[NOT A SCREENING CRITERION]

Those are all of my questions. You do qualify for our interview and we would like to invite you to join us on _______ at ______ AM/PM. The discussion will last about 60 minutes. In appreciation for your time, you will be given a $30 gift card at the time of the interview.

Are you willing to participate?

01 yes

02 no

The location of the interview will be at [INSERT FACILITY’s ADDRESS].

Prior to the start of the interview, you will receive an information sheet with such information as sponsorship of the study and who to contact for more information. If after we hang up, you have a question about this group discussion or decide you can’t participate, please contact me at ________________.

Name_________________________________________________________________

Email: ________________

Day Number_________________________Night Number_____________________

CDC estimates the average public reporting burden for this collection of information as 10 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1050)