genIC Request Form

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)

Message and material testing for the Be Antibiotics Aware (BAA) campaign for consumer audiences. The
other HMTS package is distinctly aimed at testing material for healthcare provides (HCPs).
2. Study Population: (Discuss study population and explain how they will be selected/recruited.)

1) Healthy adults who use urgent care, 2) community dwelling older adults, 3) caregivers of adult LTC
residents, and 4) Spanish-speaking women. Professional recruitment firms will contact individuals, and
use screeners to determine eligibility, availability, and interest. See attachment A for more detail.
Respondent characteristics:
Number of subject: 40 - 64

Number of males:

15 - 24

Age range: 26 years or older

Number of females: 25 - 40

Racial/ethnic composition: 100% Hispanic/Latina for Spanish-speaking women, ages 26-64 years; n/a for o
Special group status: (e.g., risk group, health care providers)
Type of group(s): Healthy adults who use urgent care, community dwelling older
adults, caregivers of adult LTC residents; Spanish-speaking wome
Geographic location(s): Tennesee; Louisiana; Missouri; Georgia; Texas

3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

Participants will receive a $50 gift card (or cash) in appreciation for their participation in the focus group
discussion. The incentive is based on their participation in a 75-minute, in-person focus group discussion.
In addition, participants will be asked to arrive 15 minutes earlier to check-in and review/sign the informed
consent form. See attachment B for justification of the proposed incentive.

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Other (describe):

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no):

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)

The Be Antibiotics Aware campaign seeks to optimize antibiotic prescribing and use, in order to improve
patient safety and combat antibiotic resistance, by raising knowledge, increasing awareness and motivating
behavior change among targeted consumers.

6. Category of time sensitivity: (Please check one below)
Health emergency:
Time-limited audience access:
Press coverage correction:
Time-limited congressional/administrative mandate:
Trend Tracking
Ineffective existing materials due to historical event/social trends:
7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
Each year in the US, 2 million people become infected with antibiotic-resistant bacteria and at least 23,000
of these individuals die as a result of their infections (CDC, 2013). Many bacteria have become resistant to
more than one type or class of antibiotic. Inappropriate use and misuse of antibiotics fuel resistance that
compromises the effectiveness of these drugs for future use. Public education is needed to increase
awareness and understanding of appropriate antibiotic use and the consequences of misuse.

8. Number of burden hours requested: 129 hours

BURDEN HOURS
No. of
Participation
Respondents Time

Category of Respondent

Burden

Potential respondents (estimate)

400

5 min

33

Focus group participants (includes sign-in and discussion)

64

90 min

96

Totals

464

9. Are you using questions from the approved question bank?

129

Yes

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)
16c, 1d, 4d, 6d, 12d, 29d, 33d, 61d, 64d, 69d, 74d, 110d, 120d, 2e, 4e, 5e, 6e, 7e, 12e, 16e, 65e

*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation: 6433
2. OADC confirmation of time-sensitivity:
Yes:
No:

Dawn B. Griffin
Project Officer
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