Form Screener Questionaire

CPSC Warning Label Comprehension and Interpretation by Consumers for Children’s
Sleep Environments
SCREENER – Focus Groups
SECTION 1: INTRODUCTION
Hello, my name is ____________, and I am calling on behalf of Fors Marsh Group, an
independent research firm, working with a federal public health agency. We will be conducting
focus groups about sleeping products for a federal public health agency. Focus groups will last
about 90 minutes. Those who participate will receive $75 as a thank you for taking part in the
study.
[REPEAT INTRO IF CALL WAS TRANSFERRED]
May I ask you a few questions to see if you are qualified to participate in the study?

Yes

[

]

[CONTINUE]

No

[

]

[THANK
END]

AND

Great! Before we begin, you should know that there are no wrong answers to the questions I’m
going to ask you. You also don’t have to answer any questions if you don’t want to. If an answer
leads to me ending the call, that is because we are looking for a diverse set of people and we may
already have enough similar candidates for this study. Any questions before we begin?

1

SECTION 2: SCREENER AND DEMOGRAPHIC QUESTIONS
PLEASE USE THE TERMINATION LANGUAGE BELOW FOR ANY RESPONSE
THAT LEADS TO THE ANSWER OPTION “[THANK AND END]”.
TERMINATION LANGUAGE: Thank you for taking the time to answer these
questions. Unfortunately, based on the responses you provided, you do not meet
the specifications we are looking for in this study. I appreciate your time and have
a good morning/afternoon/evening.

1. In the past five years, have you or a member of your immediate family worked in any
of the following fields, companies, or organizations?
A market research or marketing
[ ]
company

[THANK AND
END]

A health care company

[ ]

[THANK AND
END]

[ ]

[THANK AND
END]

Children’s product manufacturer

[ ]

[THANK AND
END]

Refused

[ ]

[CONTINUE]

Childcare
(e.g.,
employee, nanny)

daycare

2. Which of the following currently applies to you? You can select more than one answer.
I am married.

[ ]

I have children.

[

]

I have
grandchildren.

[

]

I live alone.

[

]

I am single.

[

]

I
live
with
[
roommates.

]

ONLY CONTINUE TO Q3 IF YES TO
CHILDREN OR GRANDCHILDREN. IF
NO TO CHILDREN OR
GRANDCHILDREN, THANK AND
END.

2

[ ]

Refused

[THANK AND END]

3. How old is your youngest [children/grandchildren]?

FOR GRANDPARENTS, RECORD AGE OF CHILDREN AND GRANDCHILDREN.
IF CHILD OR GRANDCHILD BETWEEN 2 – 11 MONTHS, GO TO Q4. IF CHILD
OR GRANDCHILD IS OLDER THAN 11 MONTHS, THANK AND END.

4. How old will your [child/grandchild] be in June 2020?
months old
Age ranges for eligibility:
2 – 5 months
6 – 11 months
If <2 months or >11 months, [THANK AND END]
IF ELIGIBLE, AND PARENT, GO TO Q5
IF ELIGIBLE AND GRANDPARENT, GO TO Q8
5. Are you a primary guardian of your child (/children)?

Yes

[ ]

[CONTINUE] GO TO Q6

No

[ ]

[THANK AND END]

Refused

[ ]

[THANK AND END]

3

6. Do you have any other children?
Yes

[ ]

[CONTINUE] GO TO Q7

No

[ ]

[CONTINUE] GO TO Q12

Refused

[ ]

[CONTINUE] GO TO Q12

7. How old are your other children?
years old
GO TO Q12
___________________________________________________________________________
8. How often does your grandchild (/do your grandchildren) visit you or do you visit them?

My
grandchild[ren]
visit[s] a couple
times a month.
My
grandchild[ren]
visit[s] once a
week.

[ ]

[THANK AND END]

CONTINUE TO Q9
[

]

My
grandchild[ren]
visit[s] a couple
times a year.

[ ]

Refused

[ ]

[THANK AND END]

[THANK AND END]

9. When your grandchild[ren] visit[s], are they under your supervision?
Yes

[ ]

[CONTINUE] GO TO Q10

No

[ ]

[THANK AND END]
4

Refused

[ ]

[THANK AND END]

10. Do you have any other grandchildren?
Yes

[ ]

[CONTINUE] GO TO Q11

No

[ ]

[CONTINUE] GO TO Q12

Refused

[ ]

[CONTINUE] GO TO Q12

11. How old are your other grandchildren?
years old

12. When, if ever, was the last time you participated in a marketing research or survey
research study?

Within the past three months

[ ]

[THANK AND
END]

More than three months ago

[ ]

[CONTINUE]

Never

[ ]

[CONTINUE]

Refused

[ ]

[CONTINUE]

13. In order to participate, you will need to consent to be audio and video recorded during
the focus group. Are you willing to be audio and video recorded?
Yes
No

[ ]

[CONTINUE]

[ ]

[THANK AND
END]

5

READ: Great. I have a few last questions to ensure that we speak to a variety of people during
our focus groups.
14. What is your gender?

Male

[ ]

Female

[ ]

Refused

[ ]

[CONTINUE]

15. What is your age?
years old

Note to recruiter: Please record age-range category.
18–24 years old

[ ]

25–34 years old

[ ]

35–44 years old

[ ]

45–54 years old

[ ]

55–64 years old

[ ]

65–74 years old

[ ]

75 years or older

[ ]

Refused

6

[CONTINUE]

16. Which of the following categories includes your race? You may select one or more races.

American Indian or Alaska Native

[ ]

Asian

[ ]

Black or African American

[ ]

Native Hawaiian or other Pacific Islander

[ ]

White

[ ]

Some other race [Record]

[ ]

Refused

[ ]

[CONTINUE]

17. Are you Hispanic or Latino?
Yes

[ ]

No

[ ]

Refused

[ ]

[CONTINUE]

18. In your household/when your grandchild is at your house, who typically puts your
[children/grandchildren] to bed?
Myself

[ ]

Spouse

[ ]

Other

[ ]

Refused

[ ]

[CONTINUE]

19. In your household, are you the primary purchaser of your [children’s/grandchildren’s]
nursery products?

7

Yes

[ ]

No

[ ]

Refused

[ ]

[CONTINUE]

SECTION 3: INVITATION TO PARTICIPATE IN FOCUS GROUP
Thank you for taking the time to speak with me today. We would like to invite you to
participate in a focus group. The focus group will be audio/video-recorded. You may not
participate in this study if you are not willing to be recorded.
The focus group will be scheduled for the week of X and will last approximately 90
minutes.
Your opinions are very important to us. In appreciation for your participation, you will be
given $75 in the form of ___________ (e.g., gift card, voucher, etc.).
People who have been invited previously to participate in this type of project have found
the experience to be enjoyable and informative.

Are you interested in participating in this study?

Yes

[ ]

> CONTINUE

No

[ ]

> TERMINATE

READ: Great! If you would like to provide your email address, I can send you a confirmation
with address and time. Otherwise, do you have a pen and paper? I can provide the information to
you now.
Email address
[

] Open ended

8

Focus group breakdown and size:

Caregiver Status

Infant Age

# of Focus Groups

1

Grandparents

2 to 5 months

2

2

Grandparents

6 to 11 months

2

3

Parents

2 to 5 months

2

4

Parents

6 to 11 months

2

9