Revised - Formative Research to Develop Educational Materials for Parents, Caregivers, and Child Care Providers of Children Ages 2-5 (Individuals/Households)

Attachment A: Screener: Parent/Caregiver Triad (English)

Page 9

OMB# 0584-0524

Exp: 09/30/2019

Attachment A: Screener: Parent/Caregiver Triad (English)

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 to complete this information collection is estimated to average 5 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.

BACKGROUND (DO NOT READ TO RECRUITEES)

We are recruiting groups of parents/caregivers within Bronx County, New York, Miami-Dade County, Florida and Gwinnett County, Georgia. The triad (small group) research we are recruiting for is intended to provide comprehensive feedback on the messaging, format, and images of the Nibbles for Health Newsletters (CACFP) materials (herein referred to as “Newsletters”).

We aim to achieve a mix of triads with Child and Adult Care Food Program (CACFP) child care centers and family child care home environments, who will be recruited with input from providers at participating sites. Triads will be further segmented by language (English or Spanish) in each market.

RECRUIT 5 RESPONDENTS PER TRIAD FOR 3 TO SHOW

Table 1: Triad Research Details with Parents/Caregivers

PROPOSED LOCATION (County/State)
	Bronx/NY	Miami-Dade/FL	Gwinnett/GA	Total
Triads of Parents/caregivers
English	2	2	2	6
Spanish	2	2	2	6
Total	4	4	4	12

START READING SCRIPT HERE:

Hello, my name is ________ from _______. We are looking for people to participate in a small group discussion related to children’s health sponsored by the U.S. Department of Agriculture/Food and Nutrition Service. The group will take approximately 90 minutes and will be held in person on __________ ^­­­­­­at [location]. Incentive for Participation: You will receive $50 in the form of a Visa or MasterCard gift card to show our appreciation for your participation in this important study.”

1.	First, when was the last time you participated in a research study? This includes online surveys, telephone surveys, etc.
		Within the past 6 months	TERMINATE
		7 to 12 months ago	ASK Q2
		Never	SKIP TO Q3

2.	What was the topic of the discussion that you participated in? RECORD ANSWER ______________________
	TERMINATE IF CHILDCARE, NUTRITION, OR HEALTHCARE

3.		Does anyone in your household or immediate family work in nutrition, public health, or dietetics?
			Yes			TERMINATE
			No
4.	Do you take care of at least one child between the ages of 2 - 5?
			Yes
			No		TERMINATE

5.		Does the child/children that you care for have any food allergies or intolerances?
			Yes		TERMINATE
			No
6.	How many children in this age range do you take care of? ______

7.	What are the age range(s) for the child/children that you care for? [RECORD MULTIPLE ANSWERS IF MORE THAN ONE CHILD. TERMINATE IF NO RESPONSES FOR AGE 2, AGE 3-4, OR AGE 5]
		Under Age 2
		Age 2		SOFT QUOTA OF 1 PER MARKET SOFT QUOTA OF 1 PER TRIAD
		Age 3-4
		Age 5
		Age 6 and over

8.	What is your relationship to the child/children? (READ LIST)
		Parent			CONTINUE
		Other Caregiver			CONTINUE

□ IF Caregiver, What is your relationship (Grandparent, uncle or aunt, friend of parent, etc.)? Please specify _______________________

9.	Is the child (children) that you care for attending a family child care home or child care center?
			Family Child Care Home			CONTINUE (AT LEAST 1 TRIAD PER MARKET)
			Child Care Center			CONTINUE
10.		Do you prepare or plan meals or handle food for the child/children?
			No			TERMINATE
			Yes			CONTINUE

11.	What is the last grade of school you completed? (READ LIST)
		Less than High School	CONTINUE
		High School	CONTINUE
		Vocational school/Technical school	CONTINUE
		Some College	CONTINUE
		College	CONTINUE
		Post-graduate degree	CONTINUE
		Refused/NA	CONTINUE

12.	Which of the following groups includes your age? (READ LIST)
		Under 18	TERMINATE
		18 to 35	CONTINUE
		36 to 45	CONTINUE
		46 to 55	CONTINUE
		56 or older	CONTINUE (SOFT QUOTA OF AT LEAST 1 IN EACH MARKET)
	Refused/NA		TERMINATE

13.	Please confirm the gender with which you identify (READ LIST):
		Male	SOFT QUOTA OF 1 PER MARKET
		Female
		Other (please specify: ________)

14.	How many people are currently living in your household? __________

15.	What is your total annual household income in 2016 before taxes? (This includes the combined income for everyone who lives in your home.) (READ LIST. TERMINATE IF HOUSEHOLD SIZE/INCOME EXCEED CACFP ELIGIBILITY GUIDELINES)
		Under $22,311
		$22,312 - $30,044
		$30,045 - $37,777
		$37,778 - $45,510
		$45,511 - $53,243
		$53,244 - $60,976
		$60,977 - $68,704
		$68,710 - $76,442

16A.	Which of the following best describes your ethnicity? (READ LIST)
		Hispanic or Latino	CONTINUE
		Not Hispanic or Latino	CONTINUE

16B.	Which of the following best describes your race? (select one or more) (READ LIST)
		American Indian or Alaskan Native	CONTINUE
		Asian	CONTINUE
		Black or African American	CONTINUE
		Native Hawaiian or Other Pacific Islander	CONTINUE
		White or Caucasian	CONTINUE

16C.	Is Spanish your primary language?
		Yes	RECRUIT 100% for 1 Triad Bronx, NY; 1 Triad for Miami-Dade, FL; 1 Triad for Gwinnett, GA.
		No	RECRUIT 100% for 3 Triad Bronx, NY; 3 Triad for Miami-Dade, FL; 3 Triad for Gwinnett, GA.

17.	We would like you to participate in a small group discussion on child nutrition. The discussion will be held in person on _________ at ____AM/PM at [location]. The discussion will take approximately 90 minutes and you will receive a $50.00 Visa or MasterCard gift card to cover any costs that you incur by participating in the research.
		Would you like to attend?
		Yes	CONTINUE AND RECRUIT
		No	TERMINATE AND THANK

Name: _____________________________________________

Address: _____________________________________________

City: _________________ State: _________ Zip: _________

Telephone: ____________________________________________

E-mail: ____________________________________________

CIRCLE ONE:

DATE: _____________ ____AM or ____ PM

GEOGRAPHY (CIRCLE ONE):

Bronx Gwinnett Miami-Dade