Appendix
C: Screening Questionnaires for
Set 2 Focus Groups: Raw or
Undercooked Meat or Poultry Products
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 0583-XXXX and the expiration date is XX/XX/201X. The time required to complete this information collection is estimated to average 8 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.
Focus
Groups on Chicken Livers
Final Screening Questionnaire
[Location]
[Date, Time]
Name: |
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Address: |
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City: |
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State: |
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Zip: |
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Home Phone: |
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Work Phone: |
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Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?
(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization, and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a discussion on [date] with a small group of people like yourself. The discussion group starts at [time]. It will last no longer than 1.5 hours and will be audio- and video-recorded. The discussion group is for research purposes only and is in no way sales related.
If you participate in this discussion group, you will receive $75 Visa gift card and a free gift as a token of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.
Record Gender — Do not ask. Recruit at least 2 to 3 males to show per group.
Male
Female
How many times a week do you prepare and cook meals at home for you and your family? Would you say…? (Read list.)
Less than once a week Thank & terminate.
Once or twice a week Thank & terminate.
About three times a week Thank & terminate.
Four or more times a week
Are you currently a vegetarian or vegan; that is, you do not eat any meat and poultry?
Yes Thank & terminate.
No
We want to talk with people who like to eat certain foods. Which of the following superfoods have you eaten in the past month…? (Read list.)
Avocados
Blueberries
Salmon
Beets
Quinoa
Sweet potatoes
None of the above [Do not read]
In
the past 12 months, have you eaten any of the following foods that
were prepared outside the home either at a restaurant, a specialty
store, or butcher?
Read list. Recruit if chicken
livers or pâté
checked. Recruit at least 5 to show per
group.
Pancetta
Buffalo meat
Duck sausage
Beef tongue
Chicken livers
Chicken liver pâté
None of the above [Do not read]
In the past 12 months, have you prepared at home any of the following foods for you or your family to eat? Read list.
Pancetta Skip Q6
Buffalo meat Skip Q6
Duck sausage Skip Q6
Beef tongue Skip Q6
Chicken livers
Chicken liver pâté
None of the above [Do not read] Skip Q6
People
cook chicken livers differently. You may sauté or fry them in
a pan or use them to make pâté.
Whichever way you prepare them, do you usually cook
them so they are still pink in the middle or so they are no longer
pink in the middle?
Recruit if Q5 = chicken livers
or pâté
checked AND Q6 = “still pink in the middle.” Recruit
at least 5 to show per group.
Still pink in the middle Recruit
No longer pink in the middle
RECRUITING NOTES:
If Q4 AND Q5 ≠ chicken livers or chicken liver pâté, thank & terminate.
If Q5 = chicken livers or chicken liver pâté but Q6 “no longer pink in the middle”, thank & terminate.
What is the last grade of school you completed? (Read list)
High school graduate or less, including GED
Some college or 2-year degree
4-year college degree
Postgraduate degree
Have you ever cooked professionally?
Yes Thank & terminate.
No
Have you ever taken a ServeSafe training or other food safety class?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for a market research, advertising, or public relations firm?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a restaurant or other foodservice industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a food processing plant or other food industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for the federal government?
Yes Thank & terminate.
No
Have you participated in a focus group or paid research discussion group in the past 6 months?
Yes Thank & terminate.
No
Which of the following categories best describes your age? (Read list)
Under 18 Thank & terminate.
18 to 24
25 to 34
35 to 44
45 to 59
60+
Are you…?
Hispanic or Latino
Not Hispanic or Latino
What is your race? Please select one or more. (Read list)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
18. For study purposes, the group discussion will be audio- and video-recorded. During the discussion, no sensitive questions will be asked. Are you okay with us recording your participation in the discussion?
Yes
No Thank & terminate.
19. Finally, during the group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.
Yes Thank & terminate.
No
Great! You qualify for our study. The discussion group is on [date] at [time] and will last no longer than 1.5 hours. For your time and opinions, you will receive a $75 honorarium and a free gift.
20. Would you like to participate in the group discussion at [time] on [date]?
Yes
No Thank & terminate.
Great! May I please have your e-mail address to send you a confirmation letter with directions before the group discussion? [If no email,] may I please have your mailing address? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please arrive at least 15 minutes before the start of the group to ensure you have time to sign in and to get a meal/snack. If you arrive 15 minutes early, your name will go into a drawing to win an extra $50 Visa gift card. You must be signed in at that time to be eligible for the drawing.
Read
if necessary:
If you have any questions about
the study, you may contact Katherine Kosa of RTI at 1‑800‑334‑8571,
extension 23901.
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 0583-XXXX and the expiration date is XX/XX/201X. The time required to complete this information collection is estimated to average 8 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.
Focus
Groups on Raw Kibbeh
and Similar Dishes
Final Screening Questionnaire
[Location]
[Date, Time]
Name: |
|
||||||
Address: |
|
||||||
City: |
|
State: |
|
Zip: |
|
||
Home Phone: |
|
Work Phone: |
|
||||
Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?
(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization, and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a discussion on [date] with a small group of people like yourself. The discussion group starts at [time]. It will last no longer than 1.5 hours and will be audio- and video-recorded. The discussion group is for research purposes only and is in no way sales related.
If you participate in this discussion group, you will receive $75 Visa gift card and a free gift as a token of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.
Record Gender — Do not ask. Recruit at least 2 to 3 males to show per group.
Male
Female
How many times a week do you prepare and cook meals at home for you and your family? Would you say…? (Read list.)
Less than once a week Thank & terminate.
Once or twice a week Thank & terminate.
About three times a week Thank & terminate.
Four or more times a week
Are you currently a vegetarian or vegan; that is, you do not eat any meat and poultry?
Yes Thank & terminate.
No
We want to talk with people who like to eat certain foods. Which of the following superfoods have you eaten in the past month…? (Read list.)
Avocados
Blueberries
Salmon
Beets
Quinoa
Sweet potatoes
None of the above [Do not read]
4a. We are interested in hearing from people who like to eat traditional Middle Eastern dishes. In the past 12 months, have you eaten any of the following foods? Read list.
Falafel (fa-la-ful)
Kafta (calf-ta)
Kibbeh (kib-ba), Kibbeh nayeh (kib-ba niya), or Lebanese steak tartare Recruit if 4b = raw or sometimes raw and sometimes cooked
Kitfo (key-vo) Recruit if 4b = raw or sometimes raw and sometimes cooked
Gored (gord-gord) Recruit if 4b = raw or sometimes raw and sometimes cooked
Tere siga (tear sa-ga) Recruit if 4b = raw or sometimes raw and sometimes cooked
None of the above [Do not read] Thank & terminate.
4b. Was the meat in this dish/these dishes served raw or cooked?
Raw Recruit
Cooked Thank & terminate.
Sometimes raw and sometimes cooked [Do not read] Recruit
4c. Did you prepare this dish/dishes at home or eat it at a restaurant?
Prepared at home Recruit at least 5 to show per group.
Restaurant Recruit at least 5 to show per group.
What is the last grade of school you completed? (Read list)
High school graduate or less, including GED
Some college or 2-year degree
4-year college degree
Postgraduate degree
Have you ever cooked professionally?
Yes Thank & terminate.
No
Have you ever taken a ServeSafe training or other food safety class?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for a market research, advertising, or public relations firm?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a restaurant or other foodservice industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a food processing plant or other food industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for the federal government?
Yes Thank & terminate.
No
Have you participated in a focus group or paid research discussion group in the past 6 months?
Yes Thank & terminate.
No
Which of the following categories best describes your age? (Read list)
Under 18 Thank & terminate.
18 to 24
25 to 34
35 to 44
45 to 59
60+
Are you…?
Hispanic or Latino
Not Hispanic or Latino
What is your race? Please select one or more. (Read list)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
16. For study purposes, the group discussion will be audio- and video-recorded. During the discussion, no sensitive questions will be asked. Are you okay with us recording your participation in the discussion?
Yes
No Thank & terminate.
Finally, during the group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.
Yes Thank & terminate.
No
Great! You qualify for our study. The discussion group is on [date] at [time] and will last no longer than 1.5 hours. For your time and opinions, you will receive a $75 honorarium and a free gift.
Would you like to participate in the group discussion at [time] on [date]?
Yes
No Thank & terminate.
Great! May I please have your e-mail address to send you a confirmation letter with directions before the group discussion? [If no email,] may I please have your mailing address? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please arrive at least 15 minutes before the start of the group to ensure you have time to sign in and to get a meal/snack. If you arrive 15 minutes early, your name will go into a drawing to win an extra $50 Visa gift card. You must be signed in at that time to be eligible for the drawing.
Read
if necessary:
If you have any questions about
the study, you may contact Katherine Kosa of RTI at 1‑800‑334‑8571,
extension 23901.
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 0583-XXXX and the expiration date is XX/XX/201X. The time required to complete this information collection is estimated to average 8 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.
Focus
Groups on Raw Meat Sandwiches and Similar Dishes
Final Screening
Questionnaire
[Location]
[Date, Time]
Name: |
|
||||||
Address: |
|
||||||
City: |
|
State: |
|
Zip: |
|
||
Home Phone: |
|
Work Phone: |
|
||||
Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?
(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization, and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a discussion on [date] with a small group of people like yourself. The discussion group starts at [time]. It will last no longer than 1.5 hours and will be audio- and video-recorded. The discussion group is for research purposes only and is in no way sales related.
If you participate in this discussion group, you will receive $75 Visa gift card and a free gift as a token of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.
Record Gender — Do not ask. Recruit at least 2 to 3 males to show per group.
Male
Female
How many times a week do you prepare and cook meals at home for you and your family? Would you say…? (Read list.)
Less than once a week Thank & terminate.
Once or twice a week Thank & terminate.
About three times a week Thank & terminate.
Four or more times a week
Are you currently a vegetarian or vegan; that is, you do not eat any meat and poultry?
Yes Thank & terminate.
No
We want to talk with people who like to eat certain foods. Which of the following superfoods have you eaten in the past month…? (Read list.)
Avocados
Blueberries
Salmon
Beets
Quinoa
Sweet potatoes
None of the above [Do not read]
In the past 12 months, have you prepared at home any of the following foods for you or your family to eat? Read list. Recruit at least 5 to show per group.
Raw ground beef sandwiches, sometimes called cannibal meat, tiger meat, or wildcat meat sandwiches
Steak or beef tartare
Other raw ground beef dish
None of the above [Do not read]
In the past 12 months, have you ordered and eaten any of the following foods at a restaurant? Read list. Recruit at least 5 to show per group.
Raw ground beef sandwiches, sometimes called cannibal meat, tiger meat, or wildcat meat sandwiches
Steak or beef tartare
Other raw ground beef dish
None of the above [Do not read]
***If both Q4 and Q5 = None of the above, thank & terminate***
What is the last grade of school you completed? (Read list)
High school graduate or less, including GED
Some college or 2-year degree
4-year college degree
Postgraduate degree
Have you ever cooked professionally?
Yes Thank & terminate.
No
Have you ever taken a ServeSafe training or other food safety class?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for a market research, advertising, or public relations firm?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a restaurant or other foodservice industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a food processing plant or other food industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for the federal government?
Yes Thank & terminate.
No
Have you participated in a focus group or paid research discussion group in the past 6 months?
Yes Thank & terminate.
No
Which of the following categories best describes your age? (Read list)
Under 18 Thank & terminate.
18 to 24
25 to 34
35 to 44
45 to 59
60+
Are you…?
Hispanic or Latino
Not Hispanic or Latino
What is your race? Please select one or more. (Read list)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
17. For study purposes, the group discussion will be audio- and video-recorded. During the discussion, no sensitive questions will be asked. Are you okay with us recording your participation in the discussion?
Yes
No Thank & terminate.
Finally, during the group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.
Yes Thank & terminate.
No
Great! You qualify for our study. The discussion group is on [date] at [time] and will last no longer than 1.5 hours. For your time and opinions, you will receive a $75 honorarium and a free gift.
Would you like to participate in the group discussion at [time] on [date]?
Yes
No Thank & terminate.
Great! May I please have your e-mail address to send you a confirmation letter with directions before the group discussion? [If no email,] may I please have your mailing address? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please arrive at least 15 minutes before the start of the group to ensure you have time to sign in and to get a meal/snack. If you arrive 15 minutes early, your name will go into a drawing to win an extra $50 Visa gift card. You must be signed in at that time to be eligible for the drawing.
Read
if necessary:
If you have any questions about
the study, you may contact Katherine Kosa of RTI at 1‑800‑334‑8571,
extension 23901.
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 0583-XXXX and the expiration date is XX/XX/201X. The time required to complete this information collection is estimated to average 8 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.
Focus
Groups on Raw/Undercooked Hamburgers
Final Screening
Questionnaire
[Location]
[Date, Time]
Name: |
|
||||||
Address: |
|
||||||
City: |
|
State: |
|
Zip: |
|
||
Home Phone: |
|
Work Phone: |
|
||||
Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?
(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization, and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a discussion on [date] with a small group of people like yourself. The discussion group starts at [time]. It will last no longer than 1.5 hours and will be audio- and video-recorded. The discussion group is for research purposes only and is in no way sales related.
If you participate in this discussion group, you will receive $75 Visa gift card and a free gift as a token of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.
Record Gender — Do not ask. Recruit at least 2 to 3 males to show per group.
Male
Female
How many times a week do you prepare and cook meals at home for you and your family? Would you say…? (Read list.)
Less than once a week Thank & terminate.
Once or twice a week Thank & terminate.
About three times a week Thank & terminate.
Four or more times a week
Are you currently a vegetarian or vegan; that is, you do not eat any meat and poultry?
Yes Thank & terminate.
No
We want to talk with people who like to eat certain foods. Which of the following superfoods have you eaten in the past month…? (Read list.)
Avocados
Blueberries
Salmon
Beets
Quinoa
Sweet potatoes
None of the above [Do not read]
People like to eat their foods cooked in different ways. When cooking hamburgers at home made with ground beef, how do you usually cook them for yourself? Would you say…?
Rare
Medium Rare
Medium Thank & terminate.
Medium well Thank & terminate.
Well done Thank & terminate.
Do not cook hamburgers made with ground beef [Do not read] Thank & terminate.
What is the last grade of school you completed? (Read list. Recruit a mix to show per group.)
High school graduate or less, including GED
Some college or 2-year degree
4-year college degree
Postgraduate degree
Have you ever cooked professionally?
Yes Thank & terminate.
No
Have you ever taken a ServeSafe training or other food safety class?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for a market research, advertising, or public relations firm?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a restaurant or other foodservice industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked in a food processing plant or other food industry?
Yes Thank & terminate.
No
In the past 5 years, have you or any member of your household worked for the federal government?
Yes Thank & terminate.
No
Have you participated in a focus group or paid research discussion group in the past 6 months?
Yes Thank & terminate.
No
Which of the following categories best describes your age? (Read list. Recruit a mix to show per group.)
Under 18 Thank & terminate.
18 to 24
25 to 34
35 to 44
45 to 59
60+
Are you…?
Hispanic or Latino
Not Hispanic or Latino
What is your race? Please select one or more. (Read list)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
16. For study purposes, the group discussion will be audio- and video-recorded. During the discussion, no sensitive questions will be asked. Are you okay with us recording your participation in the discussion?
Yes
No Thank & terminate.
Finally, during the group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.
Yes Thank & terminate.
No
Great! You qualify for our study. The discussion group is on [date] at [time] and will last no longer than 1.5 hours. For your time and opinions, you will receive a $75 honorarium and a free gift.
Would you like to participate in the group discussion at [time] on [date]?
Yes
No Thank & terminate.
Great! May I please have your e-mail address to send you a confirmation letter with directions before the group discussion? [If no email,] may I please have your mailing address? [Verify address and phone number.]
Thank you. That’s all the questions I have today. Please arrive at least 15 minutes before the start of the group to ensure you have time to sign in and to get a meal/snack. If you arrive 15 minutes early, your name will go into a drawing to win an extra $50 Visa gift card. You must be signed in at that time to be eligible for the drawing.
Read
if necessary:
If you have any questions about
the study, you may contact Katherine Kosa of RTI at 1‑800‑334‑8571,
extension 23901.
| File Type | application/msword |
| File Title | Information Collection Request |
| Author | OPPDE/FSIS |
| Last Modified By | SYSTEM |
| File Modified | 2018-03-12 |
| File Created | 2018-03-12 |