Form 1 New Aud FG Attachment A Screnner

Public reporting burden for this collection of information is estimated to average 6 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648*). Do not return the completed form to this address.

Screener Script for Focus Groups

Hello, I’m [RECRUITER FIRST AND LAST NAME] and I’m calling from [RECRUITMENT FIRM]. We are a consumer research organization. I’m calling because you expressed interest in participating in a study. This study is funded by the National Institutes of Health and will inform the creation of health education materials. If you qualify, you will receive a payment of $75 for your participation. The focus group will be held in person in [CITY, STATE] the week of [MONTH, DAY]. The session will be about 90 minutes in length.

Does this sound like something you would be interested in?

_____Yes

_____No  TERMINATE

Great. Let's find out if you qualify. My questions should only take a few minutes. Any information you provide will be kept private. You can stop at any time or skip any question. I will ask you some questions about you – such as your education level and racial/ethnic background – to ensure we include a variety of people.

Would you like to proceed?

_____Yes

_____No  TERMINATE

1. [Age] How old are you? ____ (fill in)

If younger than 25 years old  TERMINATE

If 36 years old or older  TERMINATE

2. [Market research employee] Do you or an immediate family member work for a market research company, an advertising agency, a public relations firm, or in communications?

_____Yes  TERMINATE

_____No

3. [Market research participant] Have you participated in an interview or focus group in which you were asked your opinions regarding a product, a service, or advertising within the past 3 months?

_____Yes  TERMINATE

_____No

4. [Health care expert] Do you work in public health or health care?

_____Yes  TERMINATE

_____No

5. [Native language] Are you comfortable speaking and reading entirely in English?

_____Yes

_____No  TERMINATE

Now a few questions related to your health.

6. [Eye Doctor Visit] When was the last time you saw an eye doctor?

_____Within the last year TERMINATE

_____Within the last 2 years TERMINATE

_____It’s been more than 2 years CONTINUE

_____Never CONTINUE

_____Don’t know / Not sure CONTINUE 

7. [Smoking] Do you smoke every day, some days, or not at all?

_____Every day CONTINUE [assign to higher-risk group]

_____Some days CONTINUE [assign to higher-risk group]

_____Not at all CONTINUE

 

8. [Medical Condition] Which, if any, of the following conditions have you been told by a doctor or nurse that you have…?

_____High blood pressure CONTINUE [assign to higher-risk group]

_____Diabetes CONTINUE [assign to higher-risk group]

_____Pre-diabetes CONTINUE [assign to higher-risk group]

_____Obesity CONTINUE [assign to higher-risk group]

_____None of the above CONTINUE

_____Don’t know / Not sure CONTINUE

9. [Family Medical Condition] Do you have a parent or sibling who has been told by a doctor or nurse that they have any of the following conditions?

_____Blindness or severe vision loss CONTINUE [assign to higher-risk group]

_____High blood pressure CONTINUE [assign to higher-risk group]

_____Diabetes CONTINUE [assign to higher-risk group]

_____None of the above CONTINUE [assign to lower-risk group]

_____Don’t know / Not sure  TERMINATE

 

Additional Demographic Items

10. [Work Environment] Which, if any, of the following apply to you?

_____I spend most of the day on a computer

_____I spend most of my day outdoors

_____I spend most of my day on a farm

_____I spend most of my time around tools and machinery

_____I spend some or all of my day around dangerous fumes or chemicals

_____None of the above

11. [Gender] What is your gender?

_____Male

_____Female

_____Something else

12. [Education] What is the highest level of education you have completed?

_____Less than high school

_____High school diploma or GED

_____Some college

_____Technical school or trade school (like real estate, childcare, plumbing, electrical)

_____College degree

_____Graduate or professional degree

13. [Ethnicity] Are you of Latino or Hispanic origin?

_____Yes

_____No

14. [Race] Which category best describes your race?

_____White

_____Black or African American

_____American Indian or Alaska Native

_____Asian or Pacific Islander

_____Something else

15. [Income] What is your yearly household income?

_____Less than $15,000

_____$15,000 to $29,999

_____$30,000 to $44,999

_____$45,000 to $59,999

_____$60,000 to $74,999

_____$75,000 to $89,999

_____$90,000 or more

_____Prefer not to answer

16. [Marital/Parent Status] Which category best describes you?

_____Single with no children

_____Single with children

_____Married with no children

_____Married with children

Termination Script

(Use for participants who don’t meet the criteria.)

Thank you for answering all of my questions. As I mentioned, we are recruiting people from different backgrounds. Unfortunately, we have already recruited several individuals with similar characteristics. Again, thank you for your time.

Confirmation Script

(Use for participants who do meet the criteria.)

Thank you for your time and interest in this study. May we schedule you for one of the sessions? [Share available time slots for the “higher-risk” or “lower-risk” groups.]

We will contact you a few days before to confirm your scheduled time. If something comes up and you will not be able to participate, please call [NAME AND NUMBER] as soon as possible.