Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Appendix A - _Focus Group Screener Guide

Focus Groups on TeamSTEPPS® for Long-Term Care Curriculum

OMB: 0935-0179

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Agency for Healthcare Research and Quality

TeamSTEPPS® for Long-Term Care – Focus Group Screener



Background information


Candidates will be screened to ensure that participants fall into the necessary range of professional roles within the long-term care field. Questions about gender, age, race and ethnicity, and professional and academic backgrounds are included in the screener to achieve representation across diverse groups when possible.

Candidates selected to participate in the focus group study will receive an honorarium of either $80, $120, or $250 based on their professional role.


Screener script and questions


Hello, my name is ______, and I’m calling from ____________, a private research organization. This is not a sales call.


I’m calling because my company will be conducting focus groups in your area to test training materials to help staff in long-term care facilities communicate more effectively. We’ve called you because you work in the field, and we’d like to ask you a few questions to see if you qualify for one of our groups. If you are chosen and agree to participate, you will be compensated for your time. May we continue?


Are you familiar with the Agency for Healthcare Research and Quality (AHRQ)?


  1. YES


    • In what way are you familiar with this agency? Have you ever been employed by AHRQ?


      • Yes /* TERMINATE */

      • No

  1. NO


Are you familiar with TeamSTEPPS®?


  1. YES


  • Was your general impression of the curriculum favorable in terms of helping to improve your teamwork and communication skills?

  • In what environment or setting did you encounter the curriculum?

  • Which, if any, of the TeamSTEPPS tools did you implement?


  1. NO


  • Is there another tool or training curriculum that you have used to help improve your teamwork and communication skills? Please provide the name of the resource, if possible.


I’m now going to ask some questions about your background. Please note that all responses are strictly confidential and will be used only to make comparisons in our findings in the final report. No personally identifiable information will be kept.


Is your name ____________?


What is your address? [Or confirm address if on file.]


In which of these age groups do you fall? Please stop me when I get to your age group.


  1. 17 and under /* TERMINATE */

  2. 18 to 24

  3. 25 to 34

  4. 35 to 44

  5. 45 to 54

  6. 55 to 64

  7. 65 and over


[Ask or verify] What is your gender identity?

    1. Male

    2. Female

    3. Other /* SPECIFY*/

    4. Prefer not to answer


What is your racial or ethnic background?

/* MULTIPLE RESPONSES PERMITTED */


If respondent needs clarification or guidance, use the following prompts:

  1. American Indian or Alaska Native

  2. Asian

  3. Black or African-American

  4. Hispanic or Latino

  5. Native Hawaiian or other Pacific Islander

  6. White

  7. Other /* SPECIFY */

  8. Prefer not to answer


Academic/professional questions


Now I’ll ask a few questions about your academic and professional background. Again, note that all responses are strictly confidential and will be used only to make sure that we have the right mix of participants in our focus groups. No personally identifiable information will be kept.


What is your job title?


If professional:


  • What degrees and/or certifications do you have?


If non-professional:


  • Do you have any certifications or degrees? If so, what are they?


  1. YES


  • When did you receive your certification?


  1. NO


For all:


  • What is the highest level of schooling that you completed?


  1. Some high school

  2. High school diploma or GED

  3. Some college

  4. Two-year (associate) college degree

  5. Four-year (bachelor’s) college degree

  6. Some graduate school

  7. Master’s degree

  8. Doctoral degree (Ph.D., Ed.D., M.D., D.O., D.D.S., J.D., etc.)


  • Are you currently working toward a specific degree or certification? If so, which one?


What is the name of your current employer (organization)?


What responsibilities are associated with your role in that organization?


How long have you held that level of responsibility (at any LTC facility, past or present)?


  1. Less than 5 years

  2. 5­ to 15 years

  3. 16 years or more


Closing statement


Our focus groups will be held at _____________________. Would you be able to get to that location?


  1. Yes

  2. No /* TERMINATE */


Individual focus groups will be held in the afternoon and the evening on ________ — what time of day would fit best with your work schedule?


  1. Morning (what hours?)

  2. Afternoon (what hours?)

  3. Evening (what hours?)


Thank you for your time today. We will be contacting you in the next three to four days to let you know whether you’ve been chosen to participate. What is the best way for us to reach you with the information about the location, the date and time, and other details?


  • [If by phone, collect number: _______________] What is the best time to call you?


  • [If by email, collect address: ___________________]






Additional information (if asked)


  • During the focus group, we will ask for your opinions of our materials, and I assure you that nothing you say will be used for any other purpose.

  • Participants will be compensated. (Tell the person being called only the amount for his/her position.)


  • $80 for CNAs

  • $120 for non-physician LTC professionals

  • $250 for physicians


  • The focus groups are being conducted on behalf of the Agency for Healthcare Research and Quality (AHRQ), an agency within the U.S. Department of Health and Human Services.



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