Form 1 Recruitment screener

ATTACHMENT 1: RECRUITMENT SCREENER

Form Approved

OMB No. 0925-0648

Exp. Date 05/2021

Paperwork Reduction Act Burden Disclosure Statement: Public reporting burden for 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: 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.

Six 60-Minute Online/By Phone Triad Focus Groups With

Persons Diagnosed With

Temporomandibular Disorders (TMD)*

[*Note to recruiter: A temporomandibular disorder (TMD) may also be referred to as a temporomandibular joint disorder or “TMJ.”]

RECRUITMENT SCREENER

Spring 2020

Introduction

Hello, my name is _______________ and I’m calling from _________________about an upcoming focus group sponsored by the National Institute of Dental and Craniofacial Research, also known as the NIDCR. The NIDCR is an Institute of the National Institutes of Health (“NIH”) and a part of the U.S. Department of Health and Human Services. Its mission is to improve dental, oral, and craniofacial health.

We want to talk with men and women who have been diagnosed with a temporomandibular disorder (TMD), also commonly called “TMJ.” This focus group will take place virtually, either by internet-connected computer, or by phone if you do not have access to an internet-connected computer.

Before you participate in the discussion, you will be asked to read a 20-page brochure on TMD/TMJ. The brochure will be mailed to you at least one week before the discussion.

The focus group will last approximately 60 minutes. To maintain participants’ privacy, we will use first names only (no last names) during the discussion and your name will not be used in any study materials. As a “thank you” for your time, you will be given a token of appreciation. To see if you qualify to participate, we need to ask you a few questions. These questions will take less than 10 minutes.

Eligibility Questions

TO ACCOUNT FOR POSSIBLE NO-SHOWS, RECRUIT 4 TOTAL PARTICIPANTS PER TRIAD (3-PERSON) FOCUS GROUP. [WE WILL ACCEPT ALL PARTICIPANTS WHO JOIN A DISCUSSION, INCLUDING THE 4^TH “OVERRECRUITED” PARTICIPANT.]

ALL PARTICIPANTS IN ANY ONE TRIAD FOCUS GROUP MUST BE OF THE SAME SEX AND FALL WITHIN THE SAME EDUCATION LEVEL RANGE AS DESCRIBED IN THE TRIAD SEGMENTATION APPENDIX OF THIS SCREENER (PAGE 8).

Confirm the participant is 18 years of age or older and record age: ____

RECRUIT A MIX OF AGES, AS POSSIBLE. IF YOUNGER THAN 18 YEARS, THANK AND DISMISS.

Record Sex:

( ) Male

( ) Female

( ) Other; please specify: _______________________________

RECRUIT 16 FEMALES FOR 4 TRIAD FOCUS GROUPS AND 8 MALES FOR 2 TRIAD FOCUS GROUPS.

1. Do you have a temporomandibular disorder (TMD), also commonly called “TMJ” (temporomandibular joint disorder)?

( ) Yes

( ) No THANK AND DISMISS

RECRUIT ONLY PARTICIPANTS WHO HAVE TMD/TMJ.

2. In what year were you diagnosed with TMD or TMJ?

( ) 2020

( ) 2019

( ) 2018

( ) 2017

( ) 2016

( ) 2015

( ) 2014 or earlier THANK AND DISMISS

RECRUIT ONLY PARTICIPANTS WHO HAVE BEEN DIAGNOSED WITH TMD/TMJ BETWEEN 2015 AND 2020.

Questions 3 and 4 are intended to confirm participant eligibility (i.e., each participant must have been diagnosed with TMD/TMJ by a healthcare professional).

3. Who told you that you have TMD or TMJ?

( ) A dentist

1. If a dentist, was it a general dentist or a dental specialist? ____________

   1. What kind of dental specialist? ____________

( ) A dental hygienist

( ) A physician/doctor

1. If a physician, what type of doctor? ­­­­­­____________

( ) A physician assistant

( ) A nurse (any nurse professional)

( ) An alternative or complementary medicine provider

( ) Other. Please specify ____________________

THANK AND DISMISS ANY PARTICIPANT THAT SAYS THEY DIAGNOSED THEIR TMD/TMJ THEMSELVES.

4. Have you ever received at least one recommendation OR treatment for your TMD/TMJ from a healthcare provider?

RECRUIT ONLY PARTICIPANTS WHO ANSWER YES TO THIS QUESTION.

( ) Yes

1. If yes, what types of recommendations and/or treatments have you received for TMD/TMJ specifically?

   1. Self-care practices (i.e., eating soft foods; applying ice packs; avoiding extreme/repetitive jaw movements; learning techniques for relaxing/reducing stress; practicing gentle jaw stretching and relaxing exercises)

   2. Pain medications (i.e., anti-inflammatory medications; muscle relaxants; anti-depressants)

   3. Bite splint or bite guard

   4. Botox®

   5. Orthodontics to change the bite

   6. Crown and bridge work to balance the bite

   7. Occlusal adjustments (grinding down the teeth)

   8. Repositioning splints (orthotics)

   9. Surgery

   10. Implants (i.e., replacement of jaw joints with artificial implants)

   11. Other. Please specify ________________

( ) No THANK AND DISMISS

RECRUIT A MIX OF TREATMENTS, AS POSSIBLE.

5. Are you a dentist or dental hygienist?

( ) Yes THANK AND DISMISS

( ) No

RECRUIT ONLY PARTICIPANTS WHO ARE NOT IN THE DENTAL/DENTAL HYGIENIST FIELD.

6. Do you work with people who have TMD/TMJ or is TMD/TMJ a topic that you deal with in your job?

( ) Yes THANK AND DISMISS

( ) No

RECRUIT ONLY PARTICIPANTS WHO DO NOT DEAL WITH TMD/TMJ AS PART OF THEIR PROFESSION.

7. Are you a member of the TMJ Association?

( ) Yes

1. If yes, when did you become a member of the TMJ Association?

   1. Within the last 12 months

   2. Within the last 1 to 2 years

   3. Within the last 2 to 5 years

   4. More than 5 years ago THANK AND DISMISS

2. Do you serve in a leadership position for the TMJ Association?

   1. Yes THANK AND DISMISS

   2. No

( ) No

RECRUIT UP TO 6 PARTICIPANTS FROM THE TMJ ASSOCIATION WHO HAVE BECOME MEMBERS WITHIN THE LAST FIVE YEARS. GIVE PREFERENCE TO THE NEWEST MEMBERS. DO NOT RECRUIT MEMBERS WHO SERVE IN A LEADERSHIP POSITION.

8. Are you a member of a TMD/TMJ organization that is NOT the TMJ Association?

( ) Yes; What organization(s)? _______________________

1. Do you serve in a leadership position in that/those group(s)?

   1. Yes THANK AND DISMISS

   2. No

( ) No

RECRUIT ONLY PARTICIPANTS WHO DO NOT SERVE IN A LEADERSHIP POSITION FOR A TMJ-RELATED ORGANIZATION.

9. Are you a member of a TMD/TMJ support group?

( ) Yes; What support group(s)? _______________________

1. Do you serve in a leadership position in that/those group(s)?

   1. Yes THANK AND DISMISS

   2. No

( ) No

RECRUIT ONLY PARTICIPANTS WHO DO NOT SERVE IN A LEADERSHIP POSITION FOR A TMJ-RELATED SUPPORT GROUP.

10. Which of the following best describes your highest level of education?

(     ) No formal schooling

(     ) Less than high school/some high school, no diploma

(     ) High school graduate or GED

(     ) Some college or technical school THANK AND DISMISS

(     ) 4-year college degree

(     ) Post-graduate studies or advanced degree (master’s or higher)

RECRUIT 3 TRIAD FOCUS GROUPS WITH NO MORE THAN A HIGH SCHOOL DEGREE AND 3 TRIAD FOCUS GROUPS WITH 4-YEAR COLLEGE DEGREE OR HIGHER. DISMISS PARTICIPANTS WITH SOME COLLEGE OR TECHNICAL SCHOOL. WITHIN EACH TRIAD, RECRUIT AS MUCH OF A MIX OF EDUATION LEVELS, AS POSSIBLE.

11. Which of these best describes your ethnicity (choose one)?

(     ) Hispanic or Latino

(     ) Not Hispanic or Non-Latino

RECRUIT A MIX, AS POSSIBLE.

12. Which of these best describes your race (choose one or more)?

( ) American Indian or Alaska Native

( ) Asian

( ) Black or African American

( ) Native Hawaiian or Other Pacific Islander

( ) White

RECRUIT A MIX, AS POSSIBLE.

12. In what state do you live? ___________________

( ) a. Northeast: Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

( ) b. South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia

( ) c. Midwest: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota, Wisconsin

( ) d. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, Washington, Wyoming

RECRUIT A MIX, AS POSSIBLE.

12. Which of the following best describes the area that you live in:

(     ) Rural

(     ) Urban

(     ) Suburban

(    ) Native American/American Indian Reservation

RECRUIT A MIX, AS POSSIBLE.

[Suggested language when terminating a call:
“Thank you very much for your time today. We are looking to recruit a wide variety of participants for this project. Unfortunately, we have filled participant slots with your background. However, we thank you for your interest.”

INVITATION

Thank you for answering my questions. We would like to invite you to review a brochure on temporomandibular disorders (TMD/TMJ) and participate in a 60-minute virtual (online/by phone) discussion session with 2 to 3 other participants who also have TMD/TMJ. If you agree to participate, you will receive a token of appreciation for your time. Please note, the discussion will be recorded for report writing purposes; however, your name will never be used in the report writing. Additional details regarding your rights as a participant will be provided via an informed consent form.

Are you interested and able to participate?

( ) Yes; SCHEDULE ON Month Day, 2020 at x:xx a.m./p.m. -- x:xx a.m./p.m.

( ) No; THANK AND DISMISS

Do you have access to an internet-connected computer that you can use for this discussion? (It’s okay if you do not have internet access. This questions simply ensures the project team provides you with the right details for connecting to the focus group (e.g., internet link or phone number).

( ) Yes

( ) No

RECORD SO THE PROJECT TEAM CAN PROVIDE THE CORRESPONDING INSTRUCTIONS FOR JOINING THE CONVERSATION (WEBEX LINK AND PHONE NUMBER OR PHONE NUMBER ONLY).

FOR SCHEDULED PARTICIPANTS:

Your discussion has been scheduled for Month Day, 2020 at x:xx a.m./p.m. -- x:xx a.m./p.m. We will email you the discussion link and/or phone number¹.

Before your scheduled session, we invite you to read the brochure, “Temporomandibular Disorders.” We will FedEx this brochure to you at least one week before the discussion. There will be instructions that accompany the brochure. You are encouraged to make comments right on the brochure and circle any words in the brochure that are confusing or difficult to understand.

At what address would you like me to mail the brochure to you? [Only the participant recruitment firm will see this information. All other project team members will not see this information.]

We will call you on the phone, send a text, and/or email the week of the focus group discussion to confirm your attendance. And, we will also communicate with you the day before the discussion session as a reminder.

If you wear reading glasses, please remember to wear those. Also, please make sure you have the brochure near you during the discussion so that you can refer to it.

If you must cancel, please let us know immediately, so we can find someone to take your place. My name is ___________ and you can reach me at _____________.

We ask that you join the discussion at least 10 minutes prior to the focus group start time.

Thank you!

APPENDIX: TRIAD SEGMENTATION

	Gender	Education Level	Other Criteria
TRIAD #1	3 Females Diagnosed With TMD/TMJ + 1 overrecruit	No More Than a High School Degree	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TRIAD #2	3 Females Diagnosed With TMD/TMJ + 1 overrecruit	No More Than a High School Degree	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TRIAD #3	3 Females Diagnosed With TMD/TMJ + 1 overrecruit	4-Year College Degree or Higher	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TRIAD #4	3 Females Diagnosed With TMD/TMJ + 1 overrecruit	4-Year College Degree or Higher	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TRIAD #5	3 Males Diagnosed With TMD/TMJ + 1 overrecruit	No More Than a High School Degree	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TRIAD #6	3 Males Diagnosed With TMD/TMJ + 1 overrecruit	4-Year College Degree or Higher	Mix States/U.S. Regions Mix Urban/Rural/Suburban Mix Race/Ethnicity Mix Age Mix Treatment Methods
TOTAL 6 Triads With 18 to 24 Participants Total	16 Females Diagnosed With TMD/TMJ 8 Males Diagnosed With TMD/TMJ	12 No More Than a High School Degree 12 4-Year College Degree or Higher

1If a participant does not have an email address, the recruiter will verbally provide the phone number for participating. Participants do *not* need a computer or internet access to participate; a telephone is sufficient for participation.

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