Form 0920-0572 Focus Group Screener

ATTACHMENT D: RECRUITMENT SCREENER

OMB No. 0920-0572

Exp. Date 8/31/2021

Paperwork Reduction Act Statement: Public reporting burden of this collection of information 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. 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0572.

RECRUITMENT SCREENER ADMINISTERED IN-PERSON OR BY PHONE

A 120-Minute Focus Group With

Parents of Children Age 10 to 17 years: RECRUIT 10 PER GROUP

Group	Location	Date	Time	Segment: Parents or Caregivers of…
1	Miami, FL (Spanish language)	Thurs., June 4, 2020	5:30 to 7:30 pm	Younger children (10-13 years) + parents of mixed genders
2			8:00 to 10:00 pm	Older children (14-17 years) + parents of mixed genders
3	Chicago, IL (English language)	Mon., June 8, 2020	5:30 to 7:30 pm	Younger children (10-13 years) + parents of mixed genders
4			8:00 to 10:00 pm	Older children (14-17 years) + parents of mixed genders

Introduction

Hello, my name is _______________ and I’m calling from _________________about an upcoming project sponsored by the Centers for Disease Control and Prevention (also known as the “CDC”). The CDC is a federal government agency whose aim is to protect the public’s health.

We want to talk with parents of children ages 10 to 17 years about how the CDC can better reach people with important health information. This focus group will take place in-person at a facility in [Miami][Chicago].

The session will last approximately 120 minutes. To maintain participants’ confidentiality, we will use first names only during the discussion and your name will not be used in any study materials. In appreciation of your time, you will be given a financial incentive. To see if you qualify to participate, we need to ask you a few questions. These questions will take about 8 minutes.

IF TERMINATED DURING SCREENING PROCESS READ: I’m sorry, we already have enough participants in that category. Thank you very much for your time.

INTERVIEWER INSTRUCTION: If respondent expresses concern at any point during the screening interview, please note their concern and reassure them appropriately. Remind them that their participation is voluntary and their answers will be completely confidential.

1. What sex were you assigned at birth, on your original birth certificate?

Female	
Male	

2. How do you describe your gender identity?

Female	 RECRUIT 5-6 FEMALES
Male	 RECRUIT 4-5 MALES
Male-to-female transgender (MTF)
Female-to-male transgender (FTM)
Other gender identity: SPECIFY

3. Do you consider yourself Hispanic or Latino/a? [MIAMI - RECRUIT MUST RESPOND YES]

Yes	 MIAMI: RECRUIT 10; CHICAGO, RECRUIT 2
No	 MIAMI: TERMINATE
Preferred not to answer	 MIAMI: TERMINATE

4. What is your race? Are you… [CHICAGO – RECRUIT A MIX]

(READ THE FIRST 5 OPTIONS LISTED BELOW AND TELL THE RESPONDENTS THEY CAN SELECT ONE OR MORE OF THE FOLLOWING; DO NOT READ “PREFERRED NOT TO ANSWER/DON’T KNOW/NOT SURE”- THOSE RESPONSES ARE ONLY BACKUP OPTIONS)

White or Caucasian	 CHICAGO RECRUIT 4-5
Black or African-American	 CHICAGO RECRUIT 2-3
American Indian or Alaska Native	
Native Hawaiian or Other Pacific Islander	
Asian	 CHICAGO RECRUIT 1-2
Don’t Know/Not Sure [DO NOT READ]	
Prefer not to answer [DO NOT READ]	

5. In what year were you born? [RECORD ON THE LINE BELOW. MUST BE BORN BETWEEN 1959 AND 1998 (AGE 21-60)]; RECRUIT A MIX.

___________________________________________________________________________________

6. Are you a parent or another individual who is primarily responsible for the daily care and rearing of one or more children age 10 to 17 living within your household?

Yes	
No	 TERMINATE

7. How many of the children you are responsible for within your household are between the ages of 10 and 17? [MUST BE AT LEAST ONE. RECORD NUMBER ON THE LINE BELOW]

___________________________________________________________________________________

8. What is the highest grade of school you completed? [AT LEAST HALF OF EACH GROUP MUST BE HIGH SCHOOL GRADUATE OR LESS]

Less than high school	
Some high school	
High school graduate or GED	
Some college or associates degree	 LIMIT TO 5 IN CHICAGO AND 3 IN MIAMI
College graduate	 TERMINATE
Post-graduate degree	 TERMINATE

9. [IF CHICAGO] Do you speak fluent English?

Yes	
No	 TERMINATE

10. [IF MIAMI] Where does your family originate from? [RECRUIT A MIX]

United States / 50 states plus DC and other Territories (USVI, Guam, Samoa, Northern Mariana Islands)	 WRITE IN:____________
United States / Puerto Rico	
Argentina	
Bolivia	
Chile	
Colombia	
Costa Rica	
Cuba	
Dominican Republic	
Ecuador	
Guatemala	
Honduras	
Mexico	
Nicaragua	
Panama	
Paraguay	
Peru	
Uruguay	
Venezuela	
Spain	
Other: write in____________________	

11. [IF MIAMI] Where were you born?

United States / 50 states plus DC and other Territories (USVI, Guam, Samoa, Northern Mariana Islands)	 WRITE IN:____________
United States / Puerto Rico	
Argentina	
Bolivia	
Chile	
Colombia	
Costa Rica	
Cuba	
Dominican Republic	
Ecuador	
Guatemala	
Honduras	
Mexico	
Nicaragua	
Panama	
Paraguay	
Peru	
Uruguay	
Venezuela	
Spain	
Other: write in____________________	

12. [IF BORN OUTSIDE U.S.] For how long have you lived in the U.S.?

Less than 10 years	
More than 10 years	 TERMINATE

13. [IF MIAMI] Do you speak fluent English, Spanish, or Both?

English only	 TERMINATE
Spanish only	
Both Spanish and English	

14. [IF MIAMI] What is the main language you speak in your home with your family and the children you are primarily responsible for?

English	 TERMINATE
Spanish	
Both [DO NOT READ]	

15. [IF MIAMI] In which language do you read, watch, or listen to the news, television, movies, and other media?

Mainly English	 TERMINATE
Mainly Spanish	
Both [DO NOT READ]	

16. [IF MIAMI] Which one of these statements best describes you? READ:

I understand, speak, and read English better than I understand, speak, and read SPANISH	 TERMINATE
I understand, speak, and read SPANISH better than I understand, speak and read English	
DO NOT READ: I understand, speak, and read both languages equally	

The following questions are about the child or children between the ages of 10 and 17 that you are responsible for within your household.

[RECRUIT PARENTS OF CHILDREN WITH A MIX OF AGE, GENDER, SCHOOL, AND GRADE]

17. Beginning with your youngest, what are the age, or ages, of your child or children? [RECORD IN GRID BELOW FOR EACH CHILD.]

18. Beginning with your youngest, what is the gender, or genders, of your child or children? [RECORD IN GRID BELOW FOR EACH CHILD.]

19. Beginning with your youngest, what type of school does your child, or children, attend—do they attend public school, private school, public charter school, home school, or another type of school? [RECORD IN GRID BELOW FOR EACH CHILD. TERMINATE ALL BUT PUBLIC OR PUBLIC CHARTER SCHOOL]

20. Beginning with your youngest, what grade is your child, or children, currently enrolled in? [4^th to 12^th grade] RECORD IN GRID BELOW FOR EACH CHILD.]

Child #	Age of Child	Gender	Type of School	Grade
1
2
3
4
5
6

21. The remainder of our questions will be about you. These questions are to make sure we represent a broad range of people in this focus group. Which of the following best describes your marital status?

Married and living together	
Partnered and living together	
Separated or divorced	
Single, never married	
Widowed	
Refused [OK to continue if otherwise qualifies]	

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

Full-time employment	
Part-time employment	
Unemployed	
Stay-at-home parent or homemaker	
Student	
Retired	
Refused [OK to continue if otherwise qualifies]	

23. Please stop me when I read the range that includes your total annual household income…

Less than $10,000	
$10,000 to under $15,000	
$15,000 to under $25,000	
$25,000 to under $35,000	
$35,000 to under $50,000	
$50,000 to under $65,000	
$65,000 to under $75,000	
$75,000 to under $100,000	
$100,000 to under $150,000	
$150,000 or more	
Refused [OK to continue if otherwise qualifies]	

24. Have you participated in a focus group within the past three months?

No	
Yes	 TERMINATE

25. Do you, or does any member of your household or immediate family, work for:

A market research company	 TERMINATE
an advertising agency or public relations firm	 TERMINATE
The media (TV, radio, newspapers, magazines, virtual communications channels)	 TERMINATE
The CDC or local public health department	 TERMINATE
As a K to 12th grade teacher	 CONTINUE

INVITATION TO PARTICIPATE

Thank you for answering my questions. We would like to invite you to participate in a focus group discussion. The discussion will last approximately two hours.

This research is voluntary and the only purpose is to hear your feedback to help improve communications. We will use first names only. Your comments during the group will be confidential and not identified with your name. The discussion will be audio and video recorded and transcribed for the research team’s use in preparing an accurate report of what we heard to the CDC.

You will receive [$75] as a token of appreciation for your time after the group.

Is this something you are interested in and comfortable with?

Yes	
No		THANK AND TERMINATE

FOR MIAMI: The discussion will take place in Spanish. Are you comfortable with reading and communicating with a group in Spanish?

Yes	
No		THANK AND TERMINATE

FOR SCHEDULED PARTICIPANTS:

The discussion has been scheduled on Month Day, 2020 at x:xx a.m./p.m. -- x:xx a.m./p.m. Does this time work for your schedule?

Before your scheduled session, we will send you a confirmation text and/or email. And, we will call you the day before the discussion session as a reminder. CONFIRM CONTACT INFORMATION:

 Telephone: ( __ ) __________

 Email: @

If you wear reading glasses or using a hearing aid, please remember to bring those to the focus group discussion session. Some of our activities will involve reading.

If you must cancel, please let us know immediately, so we can find someone to take your place. My name is ___________ and you can reach me at _____________.

We ask that you arrive at least 20 minutes before the start of the focus group discussion.

If you have any questions, please call the project recruitment coordinator for this project at INSERT NAME OF RECRUITMENT COORDINATOR

Thank you!

SEPARATE THIS CONTACT SHEET FROM THE REST OF THE SCREENER

AND SHRED AT THE END OF THE STUDY