Eligibility Screener for Focus Group

GenIC Clearance for CDC/ATSDR

Formative Research and Tool Development

Food Safety Communication Evaluation: Assessing Food Safety Messages, Knowledge, and Attitudes

Attachment 1 - Eligibility Screener (FGD)

Contact: Sara Bresee, MPH

Office of the Director

Division of Foodborne, Waterborne, and Environmental Diseases

Centers for Disease Control and Prevention

1600 Clifton Road, NE

Atlanta, Georgia 30333

Phone: (404) 639.3371

Email: [email protected]

Form Approved

OMB No. 0920-1154

Exp. Date: 3/31/26

Screening/Eligibility Form for Focus Groups

(form to be read and conducted by recruiter)

CDC estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 CDC/ATSDR CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1154).

1. Are you comfortable speaking and reading in English?

   1. Yes [ELIGIBLE; CONTINUE]

   2. No [INELIGIBLE; STOP]

   3. Don’t Know [INELIGIBLE; STOP]

2. Which of the following food activities do you contribute to in your household?

• Preparing or cooking food or meals

• Grocery shopping

1. One or both [ELIGIBLE; continue to Q4]

2. Neither [INELIGIBLE; STOP]

3. What is your age? [Record age.]

   1. Age 18–64 years [ELIGIBLE; CONTINUE TO Q4]

   2. Age 65-75 [ELIGIBLE; SKIP TO Q6]

   3. Age <18 years [INELIGIBLE; STOP]

   4. Refused [INELIGIBLE; STOP]

4. Have you participated in any focus group, interview, telephone survey, or online survey in which you were asked your opinions about a product, a service, or advertising within the past six months?

   1. No [ELIGIBLE; CONTINUE]

   2. Yes [INELIGIBLE; STOP]

5. Have you participated in any research studies about cooking in the past 4 years?

   1. No [ELIGIBLE; CONTINUE]

   2. Yes [INELIGIBLE; STOP]

6. Have you worked in any of the following areas within the past 2 years?

• market research

• graphic design or website design

• advertising or public relations

• media (TV/radio/newspapers/magazines/social media)

• healthcare (e.g., doctor, nurse, pharmacist, dietician, etc.)

• federal government

1. No [ELIGIBLE; CONTINUE]

2. Yes [INELIGIBLE; STOP]

7. Have you cooked or worked professionally in a food preparation role in the past 3 years?

   1. No [ELIGIBLE; CONTINUE]

   2. Yes [INELIGIBLE; STOP]

8. Have you received any type of food safety training, such as ServSafe, in the past 3 years?

   1. No [ELIGIBLE; CONTINUE]

   2. Yes [INELIGIBLE; STOP]

The discussion we would like you to participate in will take place on the computer.  The next few questions will involve technology – please answer these questions considering the computer you will be using to join the focus group. 

9. Do you currently have access to high-speed (define minimum speed) internet – again considering the location and computer you will be joining the discussion from?

[    ] Yes

[    ] No TERMINATE

10. What type of computer will you be using?

[ ] Laptop

[ ] Desktop

[ ] I do not have access to a laptop or desktop -TERMINATE

11. Do you currently have a working webcam on your computer (whether built in or plug in)?

[ ] Yes – Built In

[ ] Yes – External

[  ] No- TERMINATE

12. Do you have access to an active email account?

[    ] Yes – RECORD CAREFULLY ________________________________________

[    ] No TERMINATE

This account is where we will send your confirmation email with important instructions on how to join the session.

13. What internet browser do you use (e.g., Internet Explorer, Chrome, Safari, Firefox, Edge)?   ________________________________________

Internet Explorer is NOT supported at all. Only continue with the respondent if they are willing to download a compatible browser. Chrome, Firefox, Edge, and Safari are compatible. All others, hold and check with the client.

If Internet Explorer is their answer: Would you be willing to download another browser to use for the test/live session?

[ ] YES- CONTINUE

[ ] NO- TERMINATE

ELIGIBILITY CHECK:

□ Yes □ No

Date: Initials:

Highly Sensitive/Any User (No encryption)

Highly Sensitive/Any User (No encryption)

Highly Sensitive/Any User (No encryption)

Highly Sensitive/Any User (No encryption)