0920-0840 Screener Healthcare Provider

E2: Provider Eligibility Screener

Form Approved

OMB No. 0920-0840

Exp. Date 10/31/2021

1. 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.

DSTDP Website Usability Testing

Eligibility Screener

HEALTHCARE PROVIDERS

Recruitment Overview

• 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.

Recruitment Script/Questions

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

1. 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.]

2. 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.]

3. 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]

4. 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.]

5. 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.]

6. What is your age? _____

7. How would you describe your gender?

• Male

• Female

• Prefer to self-describe: ______________________

8. Would you say you work in an urban, suburban, or rural community?

• Urban

• Suburban

• Rural

9. In which type of setting do you primarily work?

• Private practice

• Public health clinic

• Both equally [do not disqualify]

• Other: __________________ [do not disqualify]

10. 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.]

11. 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.

12. What is your first name?

Name: _____________________________________________

13. What is your email address?

Email address: _____________________________________________

14. ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­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.