OMB CONTROL NO.: 0584-0611
EXPIRATION DATE: 11/30/2025
OMB BURDEN STATEMENT: This information is being collected to assist the Food and Nutrition Service in developing a National Outreach Campaign to increase awareness of the health and nutrition benefits associated with specific programs. This is a voluntary collection and FNS will use the information to meet the needs and understand the mindsets of current program participants, as well as those individuals who are eligible but do not participate. This collection does not request any personally identifiable information under the Privacy Act of 1974. 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 0584-0611. The time required to complete this information collection is estimated to average .25 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-0611). Do not return the completed form to this address.
Attachment A-1 Focus Group Screener (English)
(WIC Participants)
GROUP 1: WIC Participant (Q9), Pregnant (Q2b), Mix of races/ethnicities (Q4), Ages 18-34 (Q5), English-speaking (Q10-Q11), Mix of locality (Q17)
GROUP 2: WIC Participant (Q9), Mom of child 0 to <5 yrs. (Q2a), English-speaking (Q12-Q13), Mix of races/ethnicities (Q4), Ages 18-34 (Q5), English-speaking (Q10-Q11), Mix of locality (Q17)
GROUP 3: WIC Participant (Q9), Pregnant or Mom of child 0 to < 5 yrs. (Q2a-Q2b), Black adult (Q4), Ages 18-34 (Q5), English-speaking (Q10-Q11), Mix of locality (Q17)
GROUP 4: WIC Participant (Q9), Pregnant or Mom of child 0 to <5 yrs. (Q2a-Q2b), Hispanic/Latina (Q3), Ages 18-34 (Q5), English-speaking (Q10-Q11), Mix of locality (Q17)
All groups recruit 10 to seat six.
Hello, My name is_______________________, and I am calling from Edge Research, a research company in CITY/LOCATION. We are calling on behalf of the United States Department of Agriculture (USDA) Food and Nutrition Service (FNS) to ask for your participation in a discussion about how USDA can best communicate nutrition information to people like you. Your participation is voluntary and as a token of our appreciation, we will provide $75 as an incentive for your participation in a 2-hour discussion on this subject. There are no penalties if you chose not to participate. This feedback session will be private, which means that nothing that you say will be seen by anyone other than qualified researchers working on this project, except as otherwise required by law. Your responses will be combined with others and you will never be personally identified.
Are you interested in participating?
IF NO: Thank you and have a great day/evening.
IF YES: Great! First, I need to ask you a few questions to find out if your background meets the needs of this study.
Before the questions, I need to inform you about the process.
It will take approximately 15 minutes to complete the questions. In accordance with the Paperwork Reduction Act of 1995, the valid OMB control number for this information collection is 0584-0611. If you have comments on any aspect of this information collection, there is a mailing address to send comment to USDA. Would you like that address? [IF YES: U.S. Department of Agriculture, Food and Nutrition Services, Braddock Metro Center II, 1320 Braddock Place, Alexandria, VA 22314, ATTN: PRA (0584-0611).]
Are you: Mark all that apply.
Female
Male [THANK AND TERMINATE]
Transgender,
non-binary, or another gender
HOLD
IF SELECT OPTION 3
Are you the parent or legal guardian of a child 4 years old or younger who lives with you, even part-time?
Yes, parent/legal guardian [MUST SELECT TO CONTINUE FOR GROUPS 2, 3, 4]
No [SKIP TO Q2B]
2a. How old is the child (are the children) who lives (live) with you? Select all that apply
Newborn to less than 3 months
3 to less than 6 months
6 months to less than 9 months
9 months to less than 1 year
1 year to less than 2 years
2 years to less than 3 years
3 years to less than 4 years
4 years to less than 5 years
____ RECORD NUMBER OF CHILDREN UNDER 5 YEARS OF AGE IN HOUSEHOLD.
FOR GROUP 1, RECRUIT UP TO HALF A MIX OF AGES ABOVE, AND HALF NO OTHER CHILDREN
FOR GROUPS 2-4, RECRUIT A MIX OF ALL AGES NOTED ABOVE
RECRUIT A MIX OF NUMBER OF CHILDREN IN HOUSEHOLD
2b. Are you currently pregnant or trying to become pregnant within the next year?
Trying to become pregnant within next year [THANK AND TERMINATE IF Q2=2]
Currently pregnant [MUST SELECT TO CONTINUE FOR GROUP 1, SEE BELOW FOR GROUPS 3 AND 4]
No, none of these [THANK AND TERMINATE IF Q2=2]
FOR GROUP 1 MUST BE CURRENTLY PREGNANT
FOR GROUP 2, NO PARTICIPANTS CAN BE PREGNANT
FOR GROUPS 3 and 4 RECRUIT AT LEAST 2 PER GROUP WHO ARE CURRENTLY PREGNANT
Are you Hispanic or Latino?
Yes, Hispanic or Latino. [PLEASE ENTER DETAILS BELOW]
___ Mexican ____ Puerto Rican _____ Salvadoran
___ Cuban ____ Dominican _____ Guatemalan
___ Additional response provided by the respondent, specified here:_______________
[CONTINUE SCREEN FOR ALL GROUPS; MUST SELECT ONE OPTION IN 1) ABOVE FOR GROUP 4]
No, not Hispanic or Latino
Prefer not to answer
Which of the following best describes your race or ethnicity? Select all that apply. [ACCEPT MULTIPLE RESPONSES AND ENTER DETAILS BELOW]
American Indian or Alaska Native
____ Navajo Nation
____ Blackfeet Tribe of Blackfeet Indian Reservation of Montana
____ Native Village of Barrow Inupiat Traditional Government
____ Nome Eskimo Community
____ Aztec
____ Maya
____ Additional response provided by the respondent, specified here:_______________
Asian
____ Chinese ____ Asian Indian ____ Filipino
____ Vietnamese ____ Korean ____ Japanese
____ Additional response provided by the respondent, specified here:_______________
Black or African American [MUST SELECT TO CONTINUE FOR GROUP 3]
____ African American ____ Jamaican ____ Haitian
____ Nigerian ____ Ethiopian ____ Somali
____ Additional response provided by the respondent, specified here:_______________
Middle Eastern or North African
____ Lebanese ____ Iranian ____ Egyptian
____ Syrian ____ Iraqi ____ Israeli
____ Additional response provided by the respondent, specified here:_______________
Native Hawaiian or Other Pacific Islander
____ Native Hawaiian ____ Samoan ____ Chamorro
____ Tongan ____ Fijian ____ Marshallese
____ Additional response provided by the respondent, specified here:_______________
White
____ English ____ German ____ Irish
____ Italian ____ Polish ____ Scottish
____ Additional response provided by the respondent, specified here:_______________
Prefer not to answer [EXCLUSIVE; THANK AND TERMINATE: Based on the requirements of the study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]
GROUPS 1 AND 2 – MIX OF RACE/ETHNICITES (Q3=1 or (Q3=2 AND Q4=1 thru 6))
GROUP 3 – BLACK ADULTS ONLY (Q4=3)
GROUP 4 – HISPANIC/LATINA ADULTS ONLY (Q3=1)
Please stop me when I come to the category that includes your age.
Under 18 [THANK AND TERMINATE: Based on the requirements of the study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]
18 – 24
25 – 29
30 – 34
35 – 49 [THANK AND TERMINATE]
50 – 64 [THANK AND TERMINATE]
65 – 74 [THANK AND TERMINATE]
75 or older [THANK AND TERMINATE]
GROUPS 1 – 4 MUST BE 18-34 YEARS OF AGE (Q5 = 2,3,4; RECRUIT A MIX)
Please select the category that best represents your living situation:
Live in parent/guardian’s home
Live in dorm/group home
Live with spouse/significant other
Live with children/other family members [CHECK AGAINST PARENT Q2]
In your household, who is responsible for making choices regarding the food you and your household eats?
I am primarily responsible for making choices regarding the food I/my household eats
I share responsibility for making choices regarding the food I/my household eats
Someone else is primarily responsible for making choices regarding the food I/my household eats [THANK AND TERMINATE]
How many people live with you regularly and make up your “household” including yourself? Your household is everyone who lives in your home (including children) and shares income and household expenses (bills, food, etc.). Your household may include people who are related to you and people who are not. Here are some examples of people who you should include in your household in order to answer this question: Read list:
Non-married adult such as a boyfriend, girlfriend, fiancé or domestic partner or former spouse
Your child who lives with you most of the time and their other parent some of the time
Student away at school if you provide financial support to them
Your parent if they live with you and provide financial support
Foster children under the age of 5
Active service member away from home
A person to whom you provide financial assistance and usually lives with you but is now living in an institution such as a treatment facility, prison, group home, domestic violence shelter, or residential hospital.
RECORD NUMBER OF PEOPLE IN HH, BASED ON THIS DEFINITION, INCLUDING THE RESPONDENT: _____
What was your approximate annual household income for 2023, before taxes, from all sources? This includes salaries, Social Security, pension, interest, and investment earnings. If you don’t know the exact number, your best guess is fine. ___________[NUMERIC 0-99999999; REQUIRED]
Household size |
Annual Income |
1 |
$25,142 |
2 |
$33,874 |
3 |
$42,606 |
4 |
$51,338 |
5 |
$60,070 |
6 |
$68,802 |
7 |
$77,534 |
8 |
$86,266 |
9 |
$94,998 |
10 |
$103,730 |
11 |
$112,462 |
12 |
$121,194 |
13 |
$129,926 |
14 |
$138,658 |
ALL MUST BE <= 185% of poverty guidelines OR Q9=SNAP, TANF, AND/OR MEDICAID if not a WIC participant. IF RESPONDENT PARTICIPATES IN WIC BUT HHI IS ABOVE 185% OF POVERTY GUIDELINES, HOLD FOR REVIEW
How familiar are you with each of the following programs?
Very familiar
Somewhat familiar
Not too familiar
Never heard of/don’t know
[RANDOMIZE]
“SNAP” or the Supplemental Nutritional Assistance Program. It is sometimes referred to and formerly known as “Food Stamps”
“WIC” or the Special Supplemental Nutrition Program for Women, Infants, and Children
“TANF” or Temporary Assistance for Needy Families
The National School Lunch Program
Medicaid
“CHIP” or the Children's Health Insurance Program
Do you currently participate in any of the following programs? Select all that apply.
[RANDOMIZE]
“SNAP” or the Supplemental Nutritional Assistance Program. It is sometimes referred to and formerly known as “Food Stamps”
“WIC” or the Special Supplemental Nutrition Program for Women, Infants, and Children MUST SELECT WIC TO QUALIFY FOR ALL GROUPS
“TANF” or Temporary Assistance for Needy Families
Medicaid
“CHIP” or the Children's Health Insurance Program
None of these
MAX 4 PER GROUP WHO SELECT SNAP, TANF, AND/OR MEDICAID IN ADDITION TO WIC
[ADDITIONAL SCREEN FOR HISPANIC PARTICIPANTS (Q3=1)]
What language do you usually speak at home?
Only Spanish
Mostly Spanish
Spanish and English equally
Mostly English
Only English [SKIP TO “RESUME ASKING ALL” QUESTION]
Thinking of your media habits, including television, the internet, social media, radio, and print newspapers and magazines, would you say you use …
Only Spanish language media
Mostly Spanish language media
Spanish and English language media equally
Mostly English language media
Only English language media
IF EQUAL OR MOSTLY ENGLISH ON BOTH (Q12=3-5 and Q13=3-5), QUALIFIES FOR ENGLISH-SPEAKING HISPANIC GROUP 4.
[ASK IF Q2a = 1, 2, 3, 4, 5]
How do you currently feed your child who is 2 years of age or younger? Select all that apply.
Breastfeeding (including pumping)
Formula/Breast-milk substitutes
Pureed food (for example foods with a smooth, soft texture such as applesauce or jarred baby food)
Solid food or finger food (for example, banana)
Other, please describe: ______________ [HOLD FOR EDGE REVIEW]
RECRUIT A MIX OF BREASTFEEDING AND NOT BREASTFEEDING
[ASK IF Q14 DOES NOT EQUAL 1]
Have you ever breastfed your child who is 24 months of age or younger?
Yes
No
RECRUIT A MIX OF BREASTFEEDING AND NEVER BREASTFED
RESUME ASKING ALL
For each statement, please tell me whether you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the statement.
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Don’t know/Not sure
[RANDOMIZE]
I am confident in my ability to make nutritious eating choices
I know where to find/purchase nutritious foods near me
I eat whatever I want, whenever I want
I wish I knew more about healthy eating
RECRUIT FOR A MIX OF ATTITUDES/LIFESTYLE
TERMINATE IF Q16C = 1 AND Q16D = 4
In what type of community do you live? [CONFIRM AGAINST ZIP CODE. RECRUIT A MIX]
Urban, which is inside a city
Suburban, which is just outside of a city [RECRUIT NO MORE THAN 2 PER GROUP]
Small town or Rural, which is farther outside of a city, like in the country
RECRUIT A MIX FOR GROUPS 1, 2, 3, 4 TO EXTENT POSSIBLE
In
what state do you live? [DROPDOWN LIST]
RECRUIT
MIX ACROSS STATES TO EXTENT POSSIBLE
What is your zip code? __ __ __ __ __ __ __ [NUMERIC, RECORD]
The discussion we are recruiting for is virtual, meaning that you can participate from the comfort of your own home, but you would need to be in front of a device with internet access, in a quiet place. Please make sure and confirm that you can be in a quiet place and can commit to the full 2 hours without many interruptions. To better simulate a discussion, you would also need to be visible to the interviewer via a web camera. [IF BREASTFEEDING: It is okay to breastfeed or pump, if needed, during this time and you can step away from the camera while doing so or turn your camera off.] Someone will call you before the group to help you get set up the webcam and make sure all the technology needed for the discussion is working properly.
This is for research purposes only, and all of your feedback during the group would be anonymous and confidential, and the remote connection is safe and secure. To thank you for participating in this study, we will give you $75 gift card at the end of the group.
Is this something you are interested in and comfortable with?
Yes
No [THANK AND TERMINATE]
Now, just a couple of questions about your technology usage.
How would you describe your comfort level with using the internet?
Very comfortable
Somewhat comfortable
Neutral
Not that comfortable [THANK AND TERMINATE]
Not comfortable at all [THANK AND TERMINATE]
Not sure [THANK AND TERMINATE]
What type of device will you be using to participate?
Computer/laptop
Tablet
Phone
IF Q22=1 OR 2 (USING COMPUTER OR TABLET)
Do you have a high-speed internet connection that you can use while participating in this research?
Do you have a webcam on your computer, laptop, tablet, or smartphone that you can use for the discussion?
Yes CONTINUE
No PLEASE HOLD FOR EDGE REVIEW, IDEALLY ALL RESPONDENTS HAVE WEBCAMS
What is the best time to reach you for a Technology Check?
RECORD:____________________
Thank you for completing the screening questions. As I mentioned previously, you have been invited to participate in a small discussion group regarding how USDA can best communicate about nutrition information to people like you. Your participation means that you would participate in the 2-hour discussion that will be held on DATE/TIME/LOCATION. As a token of our appreciation, you will receive a $75 gift card upon completion of the group.
Would you still like to participate?
[If Respondent seems uncomfortable, explain, “This information will be used only to send you a confirmation and details for the group.” Record contact information.]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Liana Gainsboro;Adam Burns;Lydia Redway;Jon Kulok |
File Modified | 0000-00-00 |
File Created | 2024-10-26 |