Form 1 Fatherhood Screener Comm Check

OMB Control Number: 0970-0401

Expiration Date: 5/31/2018

SCREENER

March TBD, 2016

Focus Groups

Detroit and New York

Recruit 7 to seat 5—6

Each Group 1.5hrs and IDIs 45 minutes

Configuration of Groups and IDIs
Mini Groups
	Detroit	New York	Total
Full Time Dads	1-Mixed race/ethnicity 1- Hispanic (Spanish dominant)	1-Mixed race/ethnicity	3
Non-Custodial and Partial Custody	1-Mixed race/ethnicity	1- Mixed race/ethnicity 1-Hispanic (Spanish dominant)	3
Total	3	3	6
In-Depth Interviews (IDIs)
Full Time Dads	1-Mixed race/ethnicity	1-Mixed race/ethnicity	2
Non-Custodial and Partial Custody	1 Mixed race/ethnicity 1-Hispanic (Spanish dominant)	2-Hispanic (1 Spanish dominant)	4
Total	3	3	6

Hello, my name is _________ from XYZ Research. Today, we are interested in talking with dads across the US about their daily routines, family activities and attitudes about being a dad. Is there a dad in your household?

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 75.5 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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.

If no dad present, thank and terminate

If there is a dad present, continue with screening questions

1.

Have you ever participated in a research discussion group, focus group or one on one interview?

1. Yes [ ] CONTINUE

2. No…………………….........……………...[ ] SKIP TO Q3.

2b.

When was the last time you participated in a research discussion group, focus group, or one on one interview?

RECORD ANSWER IF WITHIN THE PAST 6 MONTHS,
THANK AND TERMINATE.

2C.

How many focus group discussions or one on one interviews have you participated in in the past 12 months?

None 1 SKIP TO Q3

1 2 SKIP TO Q3

2 or more 2 TERMINATE

2D. What was the topic of discussion during the interview had in the last 12 months

Automobiles 1 CONTINUE

Household products 2 CONTINUE

Beauty products 3 CONTINUE

Fatherhood/family matters 4 TERMINATE

Weight loss 5 CONTINUE

Food products 6 CONTINUE

Other…………………………………………………………..….7 CONTINUE

IF THEY MENTION Fatherhood/Family matters TERMINATE

3. How many children do you have that are under the age of 18 years of age?

RECRUIT A GOOD MIX

( ) One……………….CONTINUE

( ) Two to three…CONTINUE

( ) Four or more…CONTINUE

( ) None………………TERMINATE

3a. How old are your children?______ _______ _____ _____ _____ _____

AT LEAST ONE CHILD MUST BE BETWEEN 3 AND 17--GET A GOOD MIX OF AGES

4. Are any of your children disabled or have special needs?

( ) Yes

( ) No

LIMIT TO NO MORE THAN ONE DAD WITH DISABLED CHILDREN PER GROUP

5. What do you consider to be your ethnic background?

Caucasian or white 1 SKIP TO Q6

African American 2 SKIP TO Q6

Hispanic or Latino 3 CONTINUE

Asian 4 SKIP TO Q6

Other_____________ 5 SKIP TO Q6

Refused 6 TERMINATE

5ª. ¿Dígame, en qué idioma prefiere hablar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.

(Tell me, which language do you prefer speaking?) READ LIST. ACCEPT ONLY 1 RESPONSE.

Español / Spanish	Consider for Spanish Dominant Group
Español e inglés por igual Spanish and English equally	CONTINUE
Inglés / English	CONTINUE
Otro idioma / Another language	Terminar / Terminate

5b. ¿Qué idioma habla usted la mayor parte del tiempo en su hogar? LEER LISTA. ACEPTAR SOLO UNA RESPUESTA.

(Which language do you speak at home most of the time?) READ LIST. ACCEPT ONLY 1 RESPONSE.

Unicamente español Only Spanish	Consider for Spanish Dominant Group
Español más que inglés Spanish more than English	Consider for Spanish Dominant Group
Español e inglés por igual Spanish and English equally	CONTINUE
Inglés más que español English more than Spanish	CONTINUE
Unicamente inglés Only English	CONTINUE
Otro idioma / Another language	Terminar / Terminate

If Hispanics are functionally bilingual or English dominant recruit for the General Market Groups BUT Limit 2-Hispanics per group. Ensure they are VERY COMFORTABLE speaking English. Respondents who are more comfortable speaking Spanish recruit for the Spanish Dominant groups

6. Where do your children reside? RECRUIT GOOD MIX.

IF RESPONDENT IS UNSURE HOW TO ANSWER, CAN CLARIFY THAT WE WOULD LIKE TO KNOW WHERE THE CHILD SPENDS THE MAJORITY OF HIS/HER TIME

( ) With me and my spouse/significant all the time

( ) With me, no spouse/significant other all the time

IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS CUSTODIAL DAD-SKIP TO Q8

( ) With my spouse/significant other most or all of the time

( ) With some other family member most or all of the time

IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS

NON-CUSTODIAL DAD – ASK Q7

( ) Sometimes with my spouse/significant other sometimes with me

( ) Sometimes with some other family member sometimes with me

IF EITHER OF ABOVE ANSWERS ARE CHECKED, QUALIFIES AS

PARTIAL CUSTODY DAD – ASK Q7

**NOTE: NEED TO DISCUSS WITH MODERATOR HOW TO QUALIFY DADS IF THEY LIVE WITH ONLY SOME OF THEIR CHILDREN**

ENSURE THAT NON-CUSTODIAL/PARTIAL CUSTODY GROUPS HAVE A GOOD MIX OF PARTIAL AND NON-CUSTODIAL DADS

7. You indicated that your children don’t reside with you. How often would you say you spend time with your children?

( ) Less than once a month – TERMINATE

( ) Once a month

( ) Two-four times a month

( ) Five times or more a month

RECRUIT FOR NON-CUSTODIAL/PARTIAL CUSTODY DAD GROUP

8. What is your current marital status? RECRUIT GOOD MIX

( ) Single

( ) Married

( ) In a committed relationship/live with significant other

( ) Divorced

( ) Separated

( ) Widowed

9. Are currently employed outside the home or attending school/college? Would you say you: RECRUIT GOOD MIX

( ) Work full time (40+ hours a week) – ASK OCCUPATION QUESTION

( ) Work part time (less than 40 hours a week) – ASK OCCUPATION QUESTION

( ) Student

( ) Not currently employed

( ) Retired

10. What is your present occupation? ______________________________

TERMINATE IF THEY MENTION: MARKETING, ADVERTISING, MARKET RESEARCH, SOCIAL WORK, FAMILY SERVICES AND RELATED OCCUPATIONS

What is your current, annual approximate household income?

RECRUIT GOOD MIX OF INCOME

( ) Under $10,000 CONTINUE

( ) $10,000 to $20,999 CONTINUE

( ) $21,000 to $29,999 CONTINUE

( ) $30,000 to $39,999 CONTINUE

( ) $40,000 to $49,999 CONTINUE

( ) $50,000 to $59,999 CONTINUE

( ) $60,000 and above CONTINUE

SKEW LOWER INCOME: 3-4 out of 7 should be below $30k-rest fall naturally

11. Into which of the following age brackets do you fall? RECRUIT GOOD MIX OF AGES

( ) 17 or Younger -- TERMINATE

( ) 18-24

( ) 25-34

( ) 35-39

( ) 40-45

( ) 46-49

( ) 50+TERMINATE

12. What is your educational background? RECRUIT GOOD MIX

( ) Less than HS

( ) HS Grad (HS diploma, GED, or equivalent)

( ) Some College

( ) College Graduate

( ) Master’s Degree

ARTICULATION QUESTION:

If you could go anywhere in the world to visit and money was no object, where would you go and what would you do there?

INVITATION

We would like to invite you to a group (or one on one interview) discussion. The discussion will last about 1.5hrs (or 45 minutes for IDIs) on [INSERT DATE/TIME/LOCATION]. We don’t have anything to sell you and are only interested in your honest opinions. To thank you for your cooperation, we will give you a gift of $XX in cash

The groups will be small. If you agree to attend it is very important that we be able to count on you. May we count on your participation?

Can we count on your participation?

1	Yes	Continue
2	No	TERMINATE

We’d like to send a confirmation letter and a map with directions. May I have your name and the address? May I have your daytime phone so we can call to make sure you received the letter?

Respondent’s Name
Address
City, State Zip
Daytime Phone		Best time to call:

Thank you. I have a couple of final things to explain. First, it would be best if you did not bring a friend or spouse or children, as there isn’t room to accommodate them. Also, we’d like you to come early, but not too early. If you could come 10 to 15 minutes in advance, you can have some snacks and refreshments and your wait won’t be long before we begin. Do you have questions?

If you use eyeglasses for reading printed materials, please bring them with you. Also, under research industry rules, you will be asked to provide proof of identification, so please bring ID with you.

Please call us here at [FACILITY NAME] at [PHONE NUMBER] if you have questions.

Upon confirmation all respondents are to be re-screened

Confirmed : ________________ Date confirmed: ____________________

• For groups -- No Pairs may be close relatives or reside in the same household.

• Using your own good judgment, we expect verbal, out-going respondents.

• Respondents are to arrive at least 15 minutes prior to scheduled group.