Recruitment Screener

ATTACHMENT 2B: PARENT/CAREGIVER RECRUITMENT SCREENER

Form Approved

OMB No. 0920-0840

Paperwork Reduction Act Statement: The public reporting burden for this information collection has been estimated to average 8 minutes per response, including the time to review instructions and respond to questions. 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 0920-0840.

Exp. Date 10/31/2021

A 90-Minute Focus Group About

Adolescent Health with Parents and Caregivers

RECRUITMENT SCREENER

Spring 2019

Introduction

Hello, my name is _______________ and I’m calling from _________________about an upcoming research 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, safety and security.

We want to talk with parents and caregivers of middle and high school youth about how the CDC can better reach them with important health information. This focus group will take place in-person at a research facility in [insert city name].

The session will last approximately 90 minutes. To maintain participants’ privacy, we will use first names only during the discussion and your name or personal information will not be used in any research materials.

In appreciation for your time, you will be given a token of appreciation. To see if you qualify to participate, we need to ask you a few questions. These questions will take less than 10 minutes.

Eligibility Questions

RECRUIT 11 TOTAL PARTICIPANTS PER FOCUS GROUP [WE WILL SEAT 9 PARTICIPANTS. IF MORE THAN 9 PARTICIPANTS SHOW, WE WILL EXCUSE THEM. INDIVIDUALS WHO ARE EXCUSED WILL STILL RECEIVE THE TOKEN OF APPRECIATION].

Confirm that the individual speaks English clearly. _____

Record: _____ Male _____ Female

RECRUIT A MIX OF MALES AND FEMALES, IF POSSIBLE.

1. Are you a parent or primary caregiver of at least 1 student in middle or high school (sixth through twelfth grades) with whom you live at least half-time?

(     ) Yes

2. (     ) No THANK AND DISMISS.

3. In what grade is your student (or students, if you have multiple children) currently enrolled?

4. (     ) Sixth grade

5. (     ) Seventh grade

6. (     ) Eighth Grade

7. (     ) Ninth grade

8. (     ) Tenth grade

9. (     ) Eleventh grade

10. (     ) Twelfth grade

RECRUIT A MIX OF GRADES, AS POSSIBLE.

11. What is your student’s sex (or students, if you have multiple children)?

(     ) Male Specify number of each as needed: _____

(     ) Female Specify number of each as needed: _____

RECRUIT A MIX OF GENDERS, AS POSSIBLE.

12. What is your relationship to the student(s)?

(     ) Parent

(     ) Step-parent

(     ) Other family member

(     ) Guardian (e.g. foster parent)

THIS QUESTION IS FOR BACKGROUND; WE DO NOT NEED A MIX.

13. What type of school does your student attend? ______________ (open text box)

14. How old are you? ______

10. THIS QUESTION IS FOR BACKGROUND; WE DO NOT NEED A MIX.

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

(     ) Less than high school/some high school, no diploma

(     ) High school graduate or GED

(     ) Some college or technical school

(     ) 4-year college degree

(     ) Post-graduate studies or advanced degree (master’s or higher)

RECRUIT A MIX OF EDUCATION LEVELS, AS POSSIBLE. PLEASE LIMIT TO NO MORE THAN ONE ADVANCED DEGREE PER FOCUS GROUP.

16. Are you Hispanic, Latino/a, or Spanish Origin?

(     ) Yes

(     ) No

17. What is your race? (One or more categories may be selected)

(     ) White

(     ) Black or African American

(     ) Asian

(    ) American Indian or Alaska Native

(     ) Native Hawaiian or Other Pacific Islander

RECRUIT A MIX OF RACES AND ETHNICITIES, AS POSSIBLE.

18. What is your total annual household income (pre-taxes)?

(     ) Less than $25,000

(     ) $25,000 to $49,999

(     ) $50,000 to $74,999

( ) $75,000 to $99,999

(     ) $100,000 to $149,999

(     ) $150,000 or more

RECRUIT A MIX OF INCOMES, AS POSSIBLE.

19. What is your city and state? ________________

RECRUIT A MIX OF GEOGRAPHIC LOCATIONS WITHIN THE VICINITY OF THE FACILITY, AS POSSIBLE.

12a. What type of geographic area do you live in?

(     ) Urban (city)

(     ) Suburban

(     ) Rural (the country)

(     ) Other. Please specify: ____________________

[Suggested language when terminating a call:
“Thank you very much for your time today. We are looking to recruit a wide variety of participants to help with this CDC study. Unfortunately, we have filled participant slots with your background. However, we thank you for your interest in this study.”

INVITATION

Thank you for answering my questions. We would like to invite you to participate in a 90-minute in-person discussion session with other parents and caregivers from [insert state]. If you agree to participate, you will receive a token of appreciation for your time.

Are you interested and able to participate?

( ) Yes; SCHEDULE ON Month Day, 2019 at x:xx a.m./p.m. -- x:xx a.m./p.m.

( ) No; THANK AND DISMISS.

Will you be able to drive or take public transportation/ridesharing services to a research facility location in _____[INSERT CITY NAME]______?

( ) Yes, I will drive

( ) Yes, I will use public transportation or a ridesharing service

( ) No; THANK AND DISMISS.

FOR SCHEDULED PARTICIPANTS:

The focus group discussion has been scheduled on Month Day, 2019 from 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. We will also call you the day before the discussion session as a reminder.

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

Thank you!

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