Nutrition Education and Promotion Toolkit for Teens - Focus Group Testing

Attachment A OMB No. 0584-0524

Exp. Date 06/30/2016

Attachment A

Focus Group Student Participant

Qualifying Questionnaire

Teen Nutrition & Physical Activity

Name (parent or guardian): _________________________________________________________

Address _________________________________________________________

City, State, Zip: _________________________________________________________

Phone: _________________________________________________________

Email: _________________________________________________________

Interviewer: _________________________________________________________

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 0584-0524. The time required for high school students and their parents or guardians to complete this information collection is estimated to average 5 minutes (.08 hours) and 10 minutes (.17 hours), respectively, per response. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

SITE-SPECIFIC RECRUITMENT CRITERIA:

	Albuquerque, NM	Detroit, MI	Huntsville, AL	Washington, DC Metro Area	Riverside, CA
FOCUS GROUP #1	Hispanic female	African American female	Caucasian female	African American male	Mixed race\ Mixed gender
FOCUS GROUP #2	Hispanic male	Mixed race mixed gender	Mixed race mixed gender	Mixed race mixed gender	Caucasian male

Address person who answers the phone:

Hello, my name is __________________. I’m calling from ________________ and KRC Research. KRC Research is an independent opinion research company that specializes in conducting third party research. We are working on behalf of the U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) to develop health education materials that focus on nutrition and physical activity. Specifically, we are conducting research on the topic of food, nutrition, healthy eating, and physical exercise. To understand this subject, it is important that we talk to high school students and their parents. Is there anyone in your household who is currently the parent or guardian of a teenager who is in the 10^th, 11^th, or 12^th grades?

IF YES: May I speak with that person to see if they are interested and if their teenager qualifies to participate in the research project?

IF NO: Thank and end call.

Address Parent:

Hello, my name is __________________. I’m calling from ________________ and KRC Research. KRC Research is an independent opinion research company that specializes in conducting third party research. We are working on behalf of USDA/FNS to develop health education materials that focus on nutrition and physical activity. Specifically, we are conducting research on the topic of food, nutrition, healthy eating, and physical activity. To understand this subject, we are holding small discussion groups, sometimes called “focus groups,” with 10^th, 11^th, and 12^th graders to hear their opinions on the topic.

KRC is conducting these discussion groups with students for USDA/FNS to hear from students directly about their ideas and interests. The information will help FNS to develop interesting and engaging lesson plans for high school students.

Each discussion group will include 8 to 10 students, and will last two hours. The groups in your area will be held in a professional research facility at [location] on [date, time].

If your teenager qualifies for and participates in one of our discussion groups, he or she will receive a cash payment of $75 for his or her participation.

Would you be willing to have your child participate?

Yes		CONTINUE
No		TERMINATE

Thank you. I need to ask you a few questions to see if your child qualifies. There are specific guidelines for this study and these questions help us to determine if your child is the type of student we’re looking for.

1. First, please confirm that I am speaking to the parent or guardian of the child.

Yes		CONTINUE
No		ASK TO SPEAK WITH PARENT OR GUARDIAN AND BEGIN SCREENER AGAIN, IF NOT AVAILABLE, SCHEDULE A TIME TO CALL BACK OR ASK FOR CURRENT CONTACT INFORMATION.

2. Do you have any children living in your household who are currently in the 10^th, 11^th, or 12^th grades? [IF YES: CONFIRM GRADE AND NUMBER OF CHILDREN IN EACH GRADE.]

Yes	10th grade		CONTINUE
	11th grade	
	12th grade	
No			TERMINATE

3. Is/are your high school student(s) a girl(s) or a boy(s)?

Girl		SEE SITE-SPECIFIC RECRUITMENT CRITERIA
Boy	

4. How many people currently live in your household? Please include yourself, all other adults, and all children under 18 years old. [DO NOT READ LIST]

One		TERMINATE
Two		CONTINUE
Three	
Four	
Five	
Six	
Seven	
Eight or more	

5. To make sure we are speaking to a wide range of people, please tell me your total household income last year, before taxes, including all earnings and other income sources from everyone in your household. [WRITE IN INCOME, DETERMINE IF RESPONDENT IS SNAP QUALIFIER USING TABLE BELOW. RECRUIT MAJORITY OF PARTICIPANTS WHO QUALIFY FOR SNAP BASED ON THE CORRESPONDING YEARLY INCOME IN CHART. AMONG THOSE WHO DO NOT QUALIFY FOR SNAP, RECRUIT A DIVERSE MIX OF INCOMES].

LIKELY SNAP QUALIFIER 		WRITE IN INCOME:______________________
	IF HOUSEHOLD SIZE IS…	RESPONDENT QUALIFIES FOR SNAP IF HOUSEHOLD INCOME IS APPROX. 185% OF THE 2015 FEDERAL POVERTY LEVEL
	2 people	$29,100 or less
	3 people	$36,630 or less
	4 people	$44,130 or less
	5 people	$51,640 or less
	6 people	$59,160 or less
	7 people	$66,660 or less
	8 people or more	$74,170 or less
NOT LIKELY SNAP QUALIFIER 

Terrific, thank you very much. As I mentioned, if your child qualifies, as part of this research project, KRC’s team of researchers will host a two-hour focus group at a professional research facility where your teenager will be in a group with other students near her or his age.

Students should arrive at the research facility 30 minutes before the start of the group to check in with the host and KRC’s research assistant. If they have a smartphone or tablet, they should bring it with them. During this check-in time, students will participate in a 15 minute pre-group exercise. The pre-group exercise will involve briefly looking at a website on food and nutrition from a smartphone or tablet. KRC will also have tablets on hand for students to use.

The group will start on time, and it will be led by an adult researcher who is a professional group moderator, and a research assistant. The moderator will explain how the discussion group works, and students will introduce themselves to the group. The moderator will lead the discussion by asking the group questions about food, nutrition, and exercise and will show the group some information and ideas to get their feedback. The discussion is not a test, and there are no right or wrong answers. We are simply interested in teen views on healthy living and how to make learning about this topic fun and engaging. We welcome all opinions and ideas, and every child will be treated with respect.

This focus group is voluntary, meaning that with your permission, your son or daughter has the choice to participate or not. If your child qualifies, details about the time, date, and location of the discussion group will also be provided to you in a follow up email and/or call.

Finally, in accordance with Privacy Act provisions, System of Record Notice USDA/FNS-8, FNS Studies and Reports, published in the Federal Register on 4/25/1991 at 56 FR 19078, covers personal information collected under this study and identifies safeguards for the information collected.

6. Prior to the discussion, you will receive a parent/guardian consent form via postal mail or email, which needs to be completed and signed. The printed, signed form can be returned in advance via postal mail or delivered by your teen at the time of the focus group. A signed consent form is required for participation. Are you comfortable with allowing your child to participate in this focus group discussion?

Yes		CONTINUE
No		TERMINATE

6. Would you rather receive the parent/guardian consent form via postal mail or email? If received via email, you will need to print the form in order to complete and sign it.

Prefer to receive consent form via postal mail		CONTINUE
Prefer to receive consent form via email		CONTINUE

6. In order to determine fully if your teen qualifies for the study, I have a few more questions. Is your child available to speak to me right now? Feel free to listen in on the call if you like. If your teen isn’t available now, when can we arrange to call back and what is the best number to reach them?

Yes		CONTINUE
No		SCHEDULE TIME FOR CALLBACK Alternative Phone Number if needed

Ask adult the child’s name and record:______________________________________

Address Child:

Hi, my name is ____________________ and I’m from ____________________. KRC Research is an independent opinion research company that specializes in conducting third party research. As your [parent/guardian] might have mentioned, we are working on behalf of USDA/FNS to develop health education materials that focus on nutrition and physical activity. We want to talk with teens about their eating and physical activity habits. We’ll be holding a discussion with other teens to talk about this topic and if you are part of the group, you will be paid for your participation. May I ask you a few questions to determine if you qualify to participate?

6. [RECORD GENDER, DO NOT ASK]

Male		SEE SITE-SPECIFIC RECRUITMENT CRITERIA
Female	

6. What grade are you in this year? [CONFIRM GRADE.]

10th		CONTINUE, RECRUIT A MIX
11th	
12th	
Other		TERMINATE

6. What school do you attend? __________________________________________________ [RECORD NAME OF SCHOOL]

6. How old are you? ____________ [RECORD AGE]

6. Are you of Hispanic, Latino or Spanish culture or origin?

Yes		SEE SITE-SPECIFIC RECRUITMENT CRITERIA
No	

6. Which of the following best describes your race? You may select one or more of the following.

American Indian or Alaska Native		SEE SITE-SPECIFIC RECRUITMENT CRITERIA
Asian	
Black or African American	
Native Hawaiian or Other Pacific Islander	
White	

6. How interested are you personally in each of the following topics?

Art, music, theater	Very interested Somewhat interested Not too interested Not at all interested	CONTINUE RECRUIT A MIX OF NUTRITION LEVELS
Reading	Very interested Somewhat interested Not too interested Not at all interested
Writing	Very interested Somewhat interested Not too interested Not at all interested
Foreign language	Very interested Somewhat interested Not too interested Not at all interested
Math	Very interested Somewhat interested Not too interested Not at all interested
Science	Very interested Somewhat interested Not too interested Not at all interested
Social studies	Very interested Somewhat interested Not too interested Not at all interested
Health/nutrition	Very interested Somewhat interested Not too interested Not at all interested
Physical exercise	Very interested Somewhat interested Not too interested Not at all interested
Other: _______________	Very interested Somewhat interested Not too interested Not at all interested

6. What do you like to do in your free time and why?

FOR OMB - Purpose to see how well student can articulate thoughts

If student can provide an articulate and thoughtful answer		CONTINUE
If student has trouble answering question		TERMINATE

6. Are you comfortable speaking with a group in English about what type of foods you like, and your nutrition, and exercise habits?

Yes		CONTINUE
No		TERMINATE

6. Do you regularly speak any other languages besides English in your home? [IF YES:] What other language(s) do you speak in your home?

Yes [RECORD LANGUAGE: ____________________]		CONTINUE [HISPANIC GROUPS: 3-4 SHOULD SPEAK SPANISH AT HOME]
No	

INVITE TO GROUP

Thanks for talking with me today! I appreciate it.

With your parent or guardian’s consent, we would like you to participate in a discussion group with 8-10 other high school students your age. The conversation will be about food, nutrition, and physical activity.

The discussion will take place on [INSERT DATE/TIME] at [INSERT LOCATION].

Are you interested in participating?

IF YES: CONFIRM DATE AND TIME; INFORM THAT DETAILS ABOUT THE TIME, DATE, AND LOCATION OF THE DISCUSSION GROUP WILL BE PROVIDED TO THE PARENT/GUARDIAN IN A FOLLOW-UP EMAIL AND/OR CALL. THE CONSENT FORM WILL BE EMAILED OR MAILED PER PARENT/GUARDIAN’S CHOICE ABOVE. THE CONSENT FORM WILL BE COMPLETED, SIGNED AND RETURNED EITHER VIA POSTAL MAIL PRIOR TO THE TIME OF THE DISCUSSION GROUP OR THE TEEN WILL BRING IT TO THE DISCUSSION GROUP TO ENSURE PARTICIPATION.

IF NO: THANK AND TERMINATE.

INSTRUCTIONS FOR THOSE TERMINATED OVER THE COURSE OF GOING THROUGH THE SCREENER: Thank you for your time today and enjoy the rest of your day.

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