Form 0920-0840 Screener Adult

E1: Adult Audience Eligibility Screener

Form Approved

OMB No. 0920-0840

Exp. Date 10/31/2021

DSTDP Website Usability Testing

Eligibility Screener

ADULT POPULATIONS disproportionately affected by STDs

Public reporting burden of this collection of information is estimated to average 10 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 0920-0840.

Recruitment Overview

• Participants should be recruited for 18 individual interviews (IDIs):

TYPE	EDUCATION LEVEL
	High School or Less	Some College or More
18-24*	3 interviews	3 interviews
MSM	3 interviews	3 interviews
Pregnant Women	3 interviews	3 interviews

*18 to 24-year-old groups will be skewed to over-represent younger participants.

• All participants should:

• Have had sexual contact in the past year

• Be likely to use the internet to access health information

• Be able to access the DSTDP website on a computer.

• Interviews should include a mix of participants who are of different:

• Ages within the range

• Races/ethnicities

• Types of communities (urban, suburban, rural)

• Gender (18 to 24-year-old group only).

• Only one participant per household can be included in the evaluation.

Recruitment Script/Questions

Thank you for responding to our announcement. We are holding individual interviews to gather feedback on a section of the website of the Centers for Disease Control and Prevention (or the CDC), a government health agency. The website section is about sexually transmitted diseases or STDs. We are talking with members of the public about the website. This is an opportunity to contribute to the way the public receives information about health, specifically STDs.

The interviews will take place over the phone and online and will last an hour and 15 minutes. We are offering a $40 online gift card to say “thank you” for participating in the discussion.

Core Eligibility Questions

1. Can I ask you a few questions to see if you qualify to be interviewed? This will take just a few minutes. If not, is there a better time to call you back?

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

Some of the questions are sensitive, but you always can choose not to answer, and we will simply end the call.

2. Do you have access to a computer with high-speed internet access so you can view and click around a website during the interview?

• Yes,

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

3. How likely are you to use the internet to learn about health topics?

• Not likely [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

• Somewhat likely

• Very likely

4. What is the highest level of education you have completed so far? The options are “high school or less,” “some college,” or “college graduate or more.”

• High school or less

• Some college

• College graduate or more [For data collection only, group with “Some college or more.”]

5. Is anyone else in your household already participating in this study?

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

_________________________________________________

18-24

6. What is your age?

• Younger than 18 [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.] [

• 18-24

• 25+ [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

7. Have you had sex in the past year? Sex includes vaginal, anal, and oral sex, and other types of intimate physical contact using hands, fingers, or sex toys. 

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

[Skip to Question 13]

MSM

8. What is your age?

• Younger than 18 [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

• 18 or older

9. In terms of gender, do you currently identify as male?

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

10. Have you had any intimate sexual contact with another man in the past year? By that we mean anal sex, oral sex, and other types of intimate physical contact using hands, fingers, mouths, or sex toys. 

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

[Skip to Question 14]

PREGNANT WOMEN

11. What is your age?

• Younger than 18 [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

• 18 or older

12. Are you currently pregnant?

• Yes

• No [End after 2 more questions: Unfortunately, you don’t qualify for the study. We appreciate your time. Have a good day.]

[Skip to Question 13]

________________________________________________

Questions to Achieve Mix of Characteristics

[Use the following series of questions to recruit a mix of important characteristics.]

13. How would you describe your gender?

• Male

• Female

• Prefer to self-describe: ______________________

14. Which of the following categories best describes your racial/ethnic identity?

• White/Caucasian

• Black/African American

• American Indian or Alaska Native

• Asian

• Hispanic/Latino

• Hawaiian or Other Pacific Islander

• Or something else?

15. Would you say you live in a/an __________community?

• Urban

• Suburban

• Rural

RECRUITER INSTRUCTIONS: Using the attached recruitment grids, determine best fit for each potential participant. If participant fits into an interview, continue with Q16. Otherwise, thank them and end interview.

16. Could you participate on a call (that will last no more than an hour and 15 minutes) and view the website on a computer in a quiet place on [exact date/time or a range]?

• Yes

• No [End]

Preferences and Honorarium

Can you tell me your first name and email address to use when we send you reminder about the interview and your $40 online gift card after you participate? This information will not be shared with anyone outside our evaluation team and will be kept separately from your feedback allowing us to maintain confidentiality and anonymity.

17. What is your first name?

Name: _____________________________________________

18. What is your email address?

Email address: _____________________________________________

19. ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­What is the best telephone number to reach you?

Telephone #: ___________________________

Thanks for agreeing to participate! Please mark your calendar for [date/time]. The number to call is XX. The web address is XX. Just as a reminder, you will have to join from a quiet place where you can participate for up to an hour on the telephone (landline is best) and on a computer with internet access. We also will be emailing you these details. If you cannot make the interview for some reason, please contact me as soon as possible. My number is XX. Thanks again. We appreciate your input.

RECRUITMENT GRIDS

Interview 1: 18-24; HS or less

Age*	Gender	Urbanicity**	Race/Ethnicity***	Participant First Name
18	male	Urban

Interview 2: 18-24; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
18	female	Suburban

Interview 3: 18-24; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Rural

Interview 4: 18-24; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
18	female	Urban

Interview 5: 18-24; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
18	male	Suburban

Interview 6: 18-24; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Rural

Interview 7: MSM; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Urban

Interview 8: MSM; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Suburban

Interview 9: MSM; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Rural

Interview 10: MSM; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Urban

Interview 11: MSM; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Suburban

Interview 12: MSM; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	male	Rural

Interview 13: Pregnant; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Urban

Interview 14: Pregnant; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Suburban

Interview 15: Pregnant; HS or less

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Rural

Interview 16: Pregnant; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Urban

Interview 17: Pregnant; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Suburban

Interview 18: Pregnant; Some college or more

Age	Gender	Urbanicity	Race/Ethnicity	Participant First Name
	female	Rural

* Age: Recruit a mix of adult ages, except for when 18-years-old specified.

** Urbanicity categories include: Urban, Suburban, and Rural. Recruitment must include at least one from each category with a preference towards two from each for balance.

*** Race/Ethnicity categories include: White/Caucasian, Black/African American, American Indian or Alaska Native, Asian, Hispanic/Latino, and Hawaiian or Other Pacific Islander. Recruitment must include one Black, one Hispanic, and one White for each of the three adult audiences. However, there should be representation of all race/ethnicities across all the groups.