Form 0920-20PT Recruitment Screener_Consumer

ATTACHMENT 1a: RECRUITMENT SCREENER

OMB No. 0920-0572

Exp. Date 08/31/2021

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 8 minutes per response. 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: OMB-PRA 0920-0572.

A 90-Minute Focus Group With

Non-U.S.-Born Men and Women

About Tuberculosis*

[*NOTE TO RECRUITER: Do NOT reveal to potential focus group participants that the topic of this study is tuberculosis. We do NOT want any participants to do any personal research that may otherwise lead to altered responses regarding their knowledge of and experience with tuberculosis before the focus group discussion.]

RECRUITMENT SCREENER

Introduction

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

We want to talk with men and women born in countries outside of the United States about how CDC can better reach people with important health information. This focus group will take place virtually, using a computer, phone, and web camera.

The session will last approximately 90 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. CDC is not interested in any of your personal information. In appreciation of your time, you will be given a financial incentive of $75. To see if you qualify to participate, we need to ask you a few questions. These questions will take less than 10 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.

Eligibility Questions

[RECRUIT 9 TOTAL PARTICIPANTS PER FOCUS GROUP. WE WILL SEAT 7 PARTICIPANTS. IF MORE THAN 7 PARTICIPANTS SHOW, WE WILL EXCUSE THEM. INDIVIDUALS WHO ARE EXCUSED WILL STILL RECEIVE THE INCENTIVE.]

Audience	Greater Los Angeles, CA	Houston, TX	New York City
Filipino	1 group (age 40-64)		1 group (age 20-39)
Indian		1 group (age 40-64)	1 group (age 20-39)
Vietnamese	1 group (age 40-64)	1 group (age 20-39)
Chinese	1 group (age 20-39)		1 group (age 40-64)
Mexican	1 group (age 40-64)	1 group (age 20-39)
Guatemalan	1 group (age 20-39)	1 group (age 40-64)
Total by Location	5 groups	4 groups	3 groups
Total Groups	12 groups

ALL PARTICIPANTS IN ANY ONE FOCUS GROUP MUST BE FROM THE SAME COUNTRY OF ORIGIN.

1. RECORD SEX:

Male		RECRUIT 3-4 MALES AND 3-4 FEMALES
Female	

2. Have you or your partner or spouse ever worked or volunteered for any of the following types of organizations?

Marketing, advertising or public relations agency or department		THANK AND TERMINATE
Health care facility, such as a hospital, HMO, doctor’s office, or clinic		THANK AND TERMINATE
Professional medical association, pharmaceutical, or drug company		THANK AND TERMINATE
City, state or other type of health department		THANK AND TERMINATE
Other health-related organization, school, or agency (such as a nursing school, local AIDS organization, American Cancer Society)		THANK AND TERMINATE

3. What is your age? [RECORD EXACT AGE:________; DO NOT READ LIST]

19 or younger		THANK AND TERMINATE
20 to 39		RECRUIT FOR YOUNGER GROUP
40-64		RECRUIT FOR OLDER GROUP
65 or older		THANK AND TERMINATE

4. In what country were you born?

China		CONTINUE FOR CHINESE GROUPS
Guatemala		CONTINUE FOR GUATEMALAN GROUPS
India		CONTINUE FOR INDIAN GROUPS
Mexico		CONTINUE FOR MEXICAN GROUPS
The Philippines		CONTINUE FOR FILIPINO GROUPS
Vietnam		CONTINUE FOR VIETNAMESE GROUPS
Other:		THANK AND TERMINATE

5. How long have you lived in the United States? [RECORD EXACT NUMBER OF YEARS:________; DO NOT READ LIST]

Less than 5		RECRUIT A MIX FOR HALF IN THE OLDER GROUP AND HALF IN THE YOUNGER GROUP
5 to less than 10 years	
10 to less than 15 years		RECRUIT A MIX FOR HALF IN THE OLDER GROUP AND HALF IN THE YOUNGER GROUP
15 to less than 20 years	
20 years or more	

6. How well do you speak English? DO NOT TERMINATE ON THIS QUESTION, REGARDLESS OF ANSWER.

Very well		CONTINUE FOR INDIAN AND FILIPINO
Well	
Not well		CONTINUE FOR MEXICAN, GUATEMALAN, VIETNAMESE, AND CHINESE
Not at all	

7. Do you speak fluent English, fluent…[IF Q4=GUATEMALA OR MEXICO] SPANISH, [IF Q4=CHINA] MANDARIN, [IF Q4=INDIA] HINDI, [IF Q4=VIETNAM] VIETNAMESE, [IF Q4=THE PHILIPPINES] TAGALOG, or both?

Fluent English only		CONTINUE FOR INDIAN AND FILIPINO GROUPS
Fluent Spanish only		CONTINUE FOR MEXICAN OR GUATEMALAN GROUPS
Fluent Mandarin only		CONTINUE FOR CHINESE GROUPS
Fluent Hindi only		THANK AND TERMINATE
Fluent Vietnamese only		CONTINUE FOR VIETNAMESE
Fluent Tagalog only		THANK AND TERMINATE
Both		CONTINUE FOR ALL

8. Which language do you prefer to speak at home, English or [IF Q4=GUATEMALA OR MEXICO] SPANISH, [IF Q4=CHINA] MANDARIN, [IF Q4=INDIA] HINDI, [IF Q4=VIETNAM] VIETNAMESE, [IF Q4=THE PHILIPPINES] TAGALOG? RECRUIT A MIX OF PREFERENCE FOR INDIAN AND FILIPINO GROUPS

English		CONTINUE FOR INDIAN AND FILIPINO GROUPS
Spanish		CONTINUE FOR MEXICAN AND GUATEMALAN GROUPS
Mandarin		CONTINUE FOR CHINESE GROUPS
Hindi		CONTINUE FOR INDIAN GROUPS
Vietnamese		CONTINUE FOR VIETNAMESE
Tagalog		CONTINUE FOR FILIPINO GROUPS
Both		CONTINUE FOR INDIAN AND FILIPINO GROUPS

9. About how many hours per week do you watch, listen to, or read information in the media in [IF Q4=GUATEMALA OR MEXICO] SPANISH, [IF Q4=CHINA] MANDARIN, [IF Q4=INDIA] HINDI, [IF Q4=VIETNAM] VIETNAMESE, [IF Q4=THE PHILIPPINES] TAGALOG? Media includes things such as TV, radio, newspapers, magazines, social media, and websites.

Less than 5 hours per week		THANK AND TERMINATE
5-9 hours per week		CONTINUE
10-14 hours per week		CONTINUE
15-20 hours per week		CONTINUE
21+ hours per week		CONTINUE

10. What type of health insurance do you have, if any?

A plan through your employer/work or your spouse’s employer/work (private insurance)		RECRUIT A MIX OF PRIVATE INSURANCE 3-4
A plan I purchased myself directly from a health insurance company	
A plan I purchased myself through [CA: Covered California]; [NY: NY State of Health]; [Texas: HealthCare.gov]		CONTINUE
Medicare		RECRUIT A MIX OF PUBLIC INSURANCE 1-2
Medicaid [note to recruiter if applicable: MediCal is California’s Medicaid program; NY State of Health is New York’s Medicaid program]	
Tricare or Tricare for Life	
The Veterans Administration (VA)
Some other government program:__________	
Uninsured/I do not have health insurance		RECRUIT A MAX OF 1 UNINSURED
Other. Please specify: ____________	

11. Where do you typically receive your medical care?

A doctor’s office		RECRUIT A MIX
A clinic or health center (including a “Federally Qualified Health Center” [FQHC] or community health clinic [CHC])	
A health department	
Urgent care	
A hospital emergency room	
A hospital outpatient department	
The Veterans Administration (VA) clinic	
A holistic or alternative medicine provider	
Other. Please specify: ____________		RECORD AND CHECK WITH KRC

12. Does the place where you typically receive your medical care have healthcare providers (doctors, nurses, etc.) that share your culture and speak your native language?

Yes, share my culture and speak my native language		RECORD
Yes, but only share my culture		RECORD
Yes, but only speak my native language		RECORD
No, the place where I receive care does not have healthcare providers that share my culture or speak my native language		RECORD

13. Have you ever been tested for any of the following?

Tuberculosis disease, commonly known as TB, or latent tuberculosis infection		CONTINUE
HIV		CONTINUE
Hepatitis A, B, and/or C		CONTINUE
Measles		CONTINUE
Smallpox		CONTINUE
None of these		CONTINUE

14. Have you ever been treated for any of the following? Treatment does not include any vaccines you may have had.

Tuberculosis disease or infection		THANK AND TERMINATE
HIV		CONTINUE
Hepatitis A, B, and/or C		CONTINUE
Measles		CONTINUE
Smallpox		CONTINUE
None of these		CONTINUE

15. Which of the following best describes your highest level of education?

No formal schooling		RECRUIT THE FOLLOWING NUMBER OF PARTICIPANTS WITH LESS THAN A COLLEGE DEGREE: GUATEMALA AND MEXICO: 5-6 CHINA AND PHILIPPINES: 4-5 INDIA: 1-3 VIETNAM: 4-5
Less than high school/some high school, no diploma	
High school graduate or GED	
Some college or technical school	
4-year college degree		RECRUIT THE FOLLOWING NUMBER OF PARTICIPANTS WITH A COLLEGE DEGREE OR ABOVE: GUATEMALA AND MEXICO: 1-2 CHINA AND PHILIPPINES: 2-3 INDIA: 4-5 VIETNAM: 2-3
Post-graduate studies or advanced degree (Master’s or higher)	

16. What is your total annual household income including all sources of income in your home?

Less than $25,000		MEXICO AND GUATAMELA: 4-5 CHINA AND VIETNAM: 3-4 INDIA: 1-3 PHILIPPINES: 3-3
$25,000 - $49,999	
$50,000 - $74,999		MEXICO AND GUATAMELA: 2-3 CHINA AND VIETNAM: 5-6 INDIA: 5-6 PHILIPPINES: 4-5
$75,000 - $99,999	
$100,0000 or more	

INVITATION

Thank you for answering my questions. As I mentioned, we respect your privacy and understand this information is confidential. We would like to invite you to participate in a 90-minute virtual discussion session with other people born in [INSERT COUNTRY: MEXICO, GUATEMALA, INDIAN, VIETNAM, CHINA, OR THE PHILIPPINES] about health information. If you agree to participate, you will receive a financial incentive of $75 as a token of appreciation for your time. All of your feedback will be confidential, reported in the aggregate only, never in association with your name or identity. To make sure we capture your remarks accurately, we will audio and video-record the discussion. The purpose of the recording is to make sure we report accurately, but without any personally identifying information.

The groups are virtual, meaning that you can participate from the comfort of your home, but you will need to be in front of a computer with internet access so you can review information, as well as on a telephone. To better simulate an in-person group, you would also need to be visible to the other participants via web camera. If you do not have a web camera on your computer that streams images in real time or a web camera, we will send you an external one. Someone will call you before the group to help you get set up with the webcam and make sure all the technology needed for the discussion is working properly.

Is this something you are interested in and comfortable with?

Yes	
No		THANK AND TERMINATE

INDIAN AND FILIPINO ONLY: Additionally, the entire discussion will take place in English. Are you comfortable with having a 90-minute discussion in English and is this something you are interested in?

Yes		Share date and time of session
No		THANK AND TERMINATE

ALL OTHERS: Additionally, the discussion will take place in [INSERT LANGUAGE: SPANISH, MANDARIN OR VIETNAMESE]. Is this discussion something you are interested in and comfortable with?

Yes		Share date and time of session
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. Before your scheduled session, we will send you a confirmation text and/or email with all the required logistical and technology information. And, we will call you the day before the discussion session to make sure that your computer, web camera and phone are working properly.

If you wear reading glasses or use 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 _____________.