Screener

Att 1. Participant Screener

OMB No. 0920-1009

Expiration Date: 02/29/2020

Public reporting burden of this collection of information is estimated to average 10 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-1009).

Hello, my name is ______________ and I am calling from _________, a professional market research firm. I am not selling anything. Today we are talking with people as part of a project being held by User Insight. The project will focus on gathering feedback on a tool created by the Centers for Disease Control and Prevention (CDC). May I ask you a few questions to see if you are eligible to participate-this will take about 10 minutes?

[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: _____________________

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

1. Do you use/access the internet?

   1. Yes

   2. No [THANK AND TERMINATE]

2. How would you rate yourself as an Internet user?

   1. Novice

   2. Moderately skilled

   3. Expert

RECRUIT A MIX.

3. Which of the following best describes your employment status?

   1. Employed Full-Time [MUST MENTION FOR ALL NON-STUDENT QUOTAS]

   2. Employed Part-Time

   3. Currently Unemployed

   4. Retired

   5. Student [SKIP TO Q.12]

   6. Other (Specify):_________________________________

4. Do you currently work for one of the following?

a. Healthcare or Public Health Organization

b. College or university or other education system

c. News/ media organization

d. Other [CLASSIFY AS GENERAL PUBLIC. SKIP TO NOTE BEFORE Q.10 IF A REMOTE INTERVIEW. OTHERWISE SKIP TO Q.14]

CHECK QUOTAS ON PAGE 3.

5. Which of the following health data topics, if any, do you research as part of your job responsibilities?

   1. Chronic Diseases

   2. Cancer

   3. Infectious Diseases

   4. Unintentional Injuries

   5. Violence-related Injuries

   6. Other (Specify):______________________ [CONSULT WITH PROJECT MANAGER]

   7. None of the above

RECRUIT A MIX OF TOPICS.

6. Which websites, if any, do you regularly visit to find information on health or injury related topics? [DO NOT READ LIST]

____________________________________________________________

7. What is your current job title? ______________________________________

8. What organization/company do you work for? _________________________

• Recruit 10-14 Healthcare or Public Health Professionals

• Recruit 10-14 Researchers/ Educators/ Students/ General Public

• Recruit 10-14 Journalists/ Reporters/ Other Media Professionals

9. How many years have you worked in your field? ______________[RECRUIT A MIX. MUST MENTION 1+ YEARS TO CONTINUE. OTHERWISE, THANK AND TERMINATE.]

[ASK Q.10-11 FOR REMOTE INTERVIEWS ONLY. OTHERWISE, SKIP TO Q.14]

10. In what state, city, and zip code do you currently live? ____________________________________ [INCLUDE A NATIONAL REPRESENTATION]

1. West Coast

2. East Coast

3. South

4. North

5. Midwest

11. How would you describe the area in which you work/go to school?

    1. Rural

    2. Suburban

    3. Urban

RECRUIT A MIX.

[ASK Q.12-13 IF A STUDENT ONLY. OTHERWISE, SKIP TO Q.14]

12. Which of the following health data topics, if any, do you research as part of your current studies /curriculum?

    1. Chronic Diseases

    2. Cancer

    3. Infectious Diseases

    4. Unintentional Injuries

    5. Violence-related Injuries

    6. Other (Specify):______________________ [CONSULT WITH PROJECT MANAGER]

    7. None of the above

RECRUIT A MIX OF TOPICS.

13. Which websites, if any, do you regularly visit to find information on health and injury related topics? [DO NOT READ LIST]

____________________________________________________________

14. ASSESS AND VERIFY ABILITY TO SPEAK AND UNDERSTAND ENGLISH

Those are all of my questions. You do qualify for our interviews and we would like to invite you to join us on _______ at ______ PM. The interview will last about 60 minutes and will be audio taped. In appreciation for your time, you will be given $40 in the form of a VISA Gift Card.

Are you willing to participate?

a. Yes [COLLECT CONTACT INFORMATION]

b. No [THANK AND TERMINATE]

If after we hang up, you have a question about the interview or decide you can’t participate, please contact me at ________________.

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