Appx A - Screener_9_8_23

OMB Control Number:
Expiration date: xx/xx/xxxx

Appendix A – Screening Questionnaire

Consumer Labeling Research Focus Groups

Note: The market research facility maintains a list of individuals who have been screened for limited literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) assessment, so it won’t be necessary to screen for limited literacy.

Hello, this is _____________ from [facility], a local market research firm. May I please speak to_____________?

(Hello, this is _____________ from [facility], a local market research firm.) We are working with RTI, a nonprofit research organization, and the U.S. Department of Agriculture, or USDA, on a research study about cooking and would like to include your opinions. We are holding a discussion on [date] with a small group of people like yourself. The discussion group starts at [time] and will be in person at our facility located in [XXXXX]. It will last up to 1.5 hours and will be audio- and video-recorded. The discussion group is for research purposes only and is in no way sales related.

If you participate in this discussion group, you will receive a $75 gift card and a free gift as a token of our appreciation. First, however, I need to ask you a few questions to see if you qualify for the study.

1. Which of the following best describes your level of cooking experience for preparing meals at home …? (Read list.)

No experience Thank & terminate.

Very little experience (Only recruit for the English Beginner Cooks groups.)

Some experience

A lot of experience

2. In the past 30 days, which of the following have you prepared at home …? (Read list and select all that apply.) Thank & terminate if #1 or #2 is not selected.

1. Meals made with raw beef or pork

2. Meals made with raw chicken or turkey

3. Meals made with seafood

4. Vegetarian dishes

5. None of the above (Do not read.)

3. Have you ever cooked professionally?

Yes Thank & terminate.

No

4. Have you ever taken a ServSafe training or other food safety class?

Yes Thank & terminate.

No

5. In the past 5 years, have you or any member of your household worked for any of the following: (Read list.)

Market research, advertising, or public relations firm Thank & terminate.

Restaurant or other foodservice industry Thank & terminate.

Food processing plant or other food industry Thank & terminate.

The Food and Drug Administration, U.S. Department of Agriculture, Centers for Disease Control and Prevention, or state agencies that oversee food safety Thank & terminate.

None of the above (Do not read.)

6. In the past 5 years, have you or any member of your household worked as a doctor, nurse, dietitian, or other healthcare professional?

Yes Thank & terminate.

No

7. Are you the parent or guardian of any children aged 5 years or younger living in your household?

Yes (Eligible for Parents of Young Children group.)

No

8. Which of the following statements apply to you? (Read list and select all that apply. Recruit for Caregiver group if #3 AND #1 OR #2 are selected.)

1. I am the parent or guardian of one or more children aged 17 years or younger living in my household.

2. I am the parent or guardian of an adult child (aged 18 or older) who lives in my household or another location and help support them financially.

3. I help provide care for an adult aged 50 or older, for example, a parent or in-law, who lives in my household or another location.

4. None of the above (Do not read.)

9. [IF RECRUITING FOR THE ENGLISH-SPEAKING HISPANIC GROUPS]
   Which of the following best describes your family situation? (Read list.)

Spanish is the only language spoken by members of this household Recruit for English-Speaking Hispanics

Spanish is the language most often spoken by members of this household, but English is also spoken Recruit for English-Speaking Hispanics

Members of this household speak Spanish and English almost equally Thank & terminate.

English is the language most often spoken by members of this household, but Spanish is also spoken Thank & terminate.

English is the only language spoken by members of this household Thank & terminate.

10. What is the last grade of school you completed? (Read list. Recruit a mix to show per group that reflects local population.)

High school graduate or less, including GED

Technical or vocational school

Some college, but do not have a degree

Associate’s or 2-year degree

College or 4-year degree

Postgraduate degree

11. Which of the following categories best describes your age? (Read list.)

Under 18 Thank & terminate.

18 to 24

25 to 35

36 to 45

46 to 55

56 to 64

65+ (Eligible for Older Adults group.)

12. Are you …? (Read list. Recruit a mix to show per group that reflects local population.)

Hispanic or Latino

Not Hispanic or Latino

13. What is your race? Please select one or more. (Read list. Recruit a mix to show per group that reflects local population.)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

14. How do you currently describe yourself? (Read list. Recruit mix.)

Male

Female

Transgender female

Transgender male

Other

Prefer not to answer

15. For study purposes, the group discussion will be audio- and video-recorded. During the discussion, no sensitive questions will be asked. Are you okay with us recording your participation in the discussion?

Yes

No Thank & terminate.

16. During the group discussion, you will be asked to review written materials and offer your opinions; therefore, I need to ask whether you have a medical or non-medical condition that hinders your ability to read and/or understand written materials.

Yes Thank & terminate.

No

Great! You qualify for our study. The discussion group is on [date] at [time] and will last up to 1.5 hours. For your time and opinions, you will receive a $75 gift card and a free gift.

17. Would you like to participate in the group discussion at [time] on [date]?

Yes

No Thank & terminate.

Great! May I please have your email address to send you a confirmation letter with directions before the group discussion? (If no email) may I please have your mailing address? (Verify address and phone number.)

Thank you. That’s all the questions I have today. Please arrive at least 15 minutes before the start of the group to ensure you have time to sign in and get a meal/snack. If you arrive 15 minutes early, your name will go into a drawing to win an extra $25 gift card. You must be signed in at that time to be eligible for the drawing.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0xxx and the expiration date is 0x/xx/20xx. The time required to complete this information collection is estimated to average 1.5 hours 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.

If needed:
If you have any questions about the study, you may contact Peyton Williams of RTI at 1‑800‑334‑8571, extension 27046.