E2: Provider Eligibility Screener
Form Approved
OMB No. 0920-0840
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.
Participants should be recruited for 25 individual interviews (IDIs):
ROLE AND SETTING |
NUMBER OF INTERVIEWS |
Lead Providers |
10 interviews
|
Support Providers
|
10 interviews
|
STD Specialists |
5 interviews
|
“Lead providers” are those who are primarily responsible for patient care and may include these roles: physicians, physician assistants, and nurse practitioners. “Support providers” are those who support patient care and may include these roles: nurses, health educators, or others who play a significant health education role.
All must:
Deal with STD prevention, testing, or treatment at least sometimes in their work. (“Specialists” are those who deal exclusively with STD prevention, testing, or treatment.)
Be likely to use the internet to access the type of content and information found on the DSTDP website.
Be able to access the DSTDP website on a computer.
IDIs should include a mix of participants who:
Are male and female (gender)
Are different ages
Work in different types of communities (urban, suburban, rural)
Work in different settings (private, public)
Have a range of familiarity with the DSTDP website, including some that are very familiar (repeat or core users). All “Specialists” may be somewhat or very familiar with the DSTDP website.
15 providers will participate in interviews using moderator guide A. 10 additional providers will participate in interviews using moderator guide B.
Thank you for responding to our announcement. We are holding individual interviews to gather feedback on the section of the Centers for Disease Control and Prevention website that addresses sexually transmitted diseases or STDs. We are talking with healthcare providers, public health professionals, and members of the populations disproportionately affected by STDs. This is an opportunity to contribute to public health.
The interviews will take place over the phone and online and will last no more than 30 minutes. We are offering a $100 online gift card to say “thank you” for participating in the discussion.
Core Eligibility Questions
Can I ask you a few questions to see if you qualify to be interviewed? This will only take a few minutes. If not, is there a better time to call you back?
Yes
No [End: Thank you for your time. Have a good day.]
How much do you deal with STDs in your work?
Not at all [End: Thank you for your time. We are only able to recruit people who deal with STDs in their work.]
Sometimes
Often
Exclusively; only treat STDs [Recruit for “Specialist” slots.]
Which job title describes you best?
Physician (lead)
Physician assistant (lead)
Nurse practitioner (lead)
Nurse (support)
Health educator (support)
STD specialist
Other [Determine if fits into “Lead” or “Support” categories]
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, both
No [End: Thank you for your time. You won’t be able to participate without that.]
How likely are you to use the internet to research STD testing, prevention, or treatment for your work?
Not likely [XX] [End: Thank you, but we can only accept participants likely to use the internet for this.]
Somewhat likely
Very likely
Questions to Achieve Mix of Characteristics
[Use the following series of questions to recruit a mix of important characteristics.]
What is your age? _____
How would you describe your gender?
Male
Female
Prefer to self-describe: ______________________
Would you say you work in an urban, suburban, or rural community?
Urban
Suburban
Rural
In which type of setting do you primarily work?
Private practice
Public health clinic
Both equally [do not disqualify]
Other: __________________ [do not disqualify]
How familiar are you with the section of the Centers for Disease Control and Prevention (CDC) website on STDs?
Not familiar
Somewhat familiar
Very familiar
RECRUITER INSTRUCTIONS: Using the attached recruitment grids, determine best fit for each potential interview slot. If participant fits into a slot, continue with Q11. [Otherwise, thank and end the interview.]
Could you participate in a call (that will last 30 minutes) and view a 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 to remind you, and also when we send your $100 online gift card after you participate? This information will never be shared with the government or anyone outside our evaluation team and will be kept separately from your feedback allowing us to maintain confidentiality and anonymity.
What is your first name?
Name: _____________________________________________
What is your email address?
Email address: _____________________________________________
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: Lead Provider
Age* |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Urban |
Private |
Not familiar |
|
Interview 2: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Suburban |
Private |
Not familiar |
|
Interview 3: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Rural |
Public |
Not familiar |
|
Interview 4: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Urban |
Public |
Somewhat familiar |
|
Interview 5: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Suburban |
Private |
Very familiar |
|
Interview 6: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Rural |
Private |
Somewhat familiar |
|
Interview 7: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Urban |
Public |
Very familiar |
|
Interview 8: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Suburban |
Public |
Not familiar |
|
Interview 9: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Rural |
Private |
Not familiar |
|
Interview 10: Lead Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Urban |
Private |
Not familiar |
|
Interview 11: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Suburban |
Public |
Somewhat familiar |
|
Interview 12: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Rural |
Public |
Very familiar |
|
Interview 13: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Urban |
Private |
Somewhat familiar |
|
Interview 14: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Suburban |
Private |
Very familiar |
|
Interview 15: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Rural |
Public |
Not familiar |
|
Interview 16: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Urban |
Public |
Not familiar |
|
Interview 17: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Suburban |
Private |
Not familiar |
|
Interview 18: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Rural |
Private |
Somewhat familiar |
|
Interview 19: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Urban |
Public |
Very familiar |
|
Interview 20: Support Provider
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Suburban |
Public |
Somewhat familiar |
|
Interview 21: STD Specialist
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Rural |
Private |
Very familiar |
|
Interview 22: STD Specialist
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Urban |
Public |
Somewhat familiar |
|
Interview 23: STD Specialist
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Suburban |
Private |
Very familiar |
|
Interview 24: STD Specialist
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
female |
Rural |
Public |
Somewhat familiar |
|
Interview 25: STD Specialist
Age |
Gender |
Urbanicity |
Setting |
Website |
Participant First Name |
|
male |
Urban |
Private |
Very familiar |
|
*Recruit a mix of adult ages, as possible.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Phelps, Tiffani L. (CDC/DDID/NCHHSTP/DSTDP) |
File Modified | 0000-00-00 |
File Created | 2021-01-14 |