Recruitment Screener

Attachment A: Recruitment Screener Form Approved

OMB Control No.: 0920-1154

Expiration date: 03/31/2026

Antimicrobial Resistance Message Testing Data Collection Project

Project Screener [Focus Groups & In-Depth Interviews]

Centers for Disease Control and Prevention (CDC)

Antimicrobial Resistance Coordination & Strategy Unit (ARX)

Hi, my name is [Name] from [Panel Provider] working for C.E.K. & Partners a market research firm located in Atlanta, Georgia, representing CATMEDIA, a marketing firm located in Tucker, Georgia, and the Centers for Disease Control and Prevention (CDC).

We are working on a project about health messages and ideas for future advertisements, social media posts and fact sheets, and would like to include your opinions. We are seeking to learn about your experiences, understanding and feedback on potential health communications regarding antimicrobial resistance related to infections/diseases. At the end of the project, your feedback will be provided to CDC, however your name will not be included.

If you qualify and wish to participate, we will invite you to participate in a [recruiter to select]:

• 30-minute one-on-one interview, we will offer you a [$ 75.00] digital prepaid gift card as a token of appreciation for your time.

• 60-minute focus group, we will offer you a [$125.00] digital prepaid gift card as a token of appreciation for your time.

To see if you qualify, we will need to ask a few questions about your job and location status, as well as basic information about you, such as your race/ethnicity, age, education, and gender identity.

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Your participation is voluntary, and you can stop at any time. There is no direct benefit to you for participating in the screening questions, but this is a unique opportunity to make a valuable public health contribution to your community.

We will let you know in the next few days if you were selected for one of the virtual [focus groups or one-on-one interviews]. If you are selected to participate, you will be asked to complete a technology check at least one day prior to your scheduled date that will take about 15 minutes, and then participate in [a 60-minute focus group or 30-minute one-one one interview]. Your participation, including the time on this screener (10-min), the time for the technology check (15-min), and the time for the virtual focus group (60-min) (or interview (30-min)) will take no more than 85 minutes of your time total. If you are not selected for one of the virtual interviews, we will not contact you again.

If you have any questions about the interviews, you may contact the project staff through:

Telephone: [Insert Panel Provider]

Email: [Insert Panel Provider]

Okay, let’s get started

1. Do you consent to participate in this short screening survey?

1. Yes → [Continue to Q2]

2. No → [Does NOT Qualify, proceed to “Disqualify Script”]

2. Are you comfortable speaking English?

1. Yes → [Continue to Q3]

2. No → [Does NOT Qualify, proceed to “Disqualify Script”]

3. Are you, yourself, able to read and understand text presented digitally on a device screen whether a tablet, laptop, or smart phone, or desktop computer?

1. Yes → [Continue to Q5]

2. No → [Continue to Q4]

4. Will you be able to have an assistant join you during the research session to help you read the content of the materials presented? Your assistant would not receive any compensation from [insert panel provider], C.E.K, CATMEDIA, or CDC (your assistant would not be considered a project participant).

1. Yes → [Continue to Q5]

2. No → [Does NOT Qualify, proceed to “Disqualify Script”]

5. Are you or any of family members employed by any of these organizations:

1. Centers for Disease Control and Prevention (CDC) → [Does NOT Qualify, proceed to “Disqualify Script”]

2. Centers for Medicare and Medicaid Services → [Continue to Q6]

3. A pharmaceutical company → [Continue to Q6]

4. A marketing research company → [Does NOT Qualify, proceed to “Disqualify Script”]

5. An advertising agency → [Does NOT Qualify, proceed to “Disqualify Script”]

6. Do you have a device (tablet, laptop, or smart phone, or desktop computer) with a strong internet connection that provides access to virtual meeting tools using both audio and video like the Zoom technology platform?

1. Yes → [Continue to Q7]

2. No → [Does NOT Qualify, proceed to “Disqualify Script”]

7. To help the interviewer get an accurate record of your responses during the interview session, the session will be recorded. Would you be willing for both the audio and video to be recorded during your session?

a. Yes → [Continue to Q8]

b. No → [Does NOT Qualify, proceed to “Disqualify Script”]

Note to recruiter: Check the below quotas before continuing.

Participant Category	Number of Focus Groups	N (min/max)	Method of Virtual Data Collection
Ages 21-30 general population	2 (n=4, n=5)	9	Focus Group, IDI
Ages 31-40 general population	2 (n=4, n=5)	9	Focus Group, IDI
Ages 41-50 general population	2 (n=4, n=5)	9	Focus Group, IDI
Ages 51-60 general population	2 (n=4, n=5)	9	Focus Group, IDI
Ages 61-70 general population	2 (n=4, n=5)	9	Focus Group, IDI
Total number of focus groups and participants	10 groups	N=45	Focus Group, IDI

8. What is your age?

1. Under 21 → [Does NOT Qualify, proceed to “Disqualify Script”]

2. 21-30 → [Continue to Q9]

3. 31-40 → [Continue to Q9]

4. 41-50 → [Continue to Q9]

5. 51-60 → [Continue to Q9]

6. 61-70 → [Continue to Q9]

7. 71 or older → [Does NOT Qualify, proceed to “Disqualify Script”]

8. Does not want to share their age → [Does NOT Qualify, proceed to “Disqualify Script”]

9. What state do you currently live in?

1. Nebraska → [Does NOT Qualify, proceed to “Disqualify Script”]

2. Iowa → [Does NOT Qualify, proceed to “Disqualify Script”]

3. Tennessee → [Does NOT Qualify, proceed to “Disqualify Script”]

4. Alabama → [Does NOT Qualify, proceed to “Disqualify Script”]

5. Illinois → [Does NOT Qualify, proceed to “Disqualify Script”]

6. New York → [Does NOT Qualify, proceed to “Disqualify Script”]

7. Louisiana → [Does NOT Qualify, proceed to “Disqualify Script”]

All other 43 U.S. states would qualify.

_________________________________________________

10. What race and/or ethnicity do you consider yourself?

[Multiple response allowed (a-c)]

Ethnicity

a. Hispanic or Latino

b. Not Hispanic or Latino

c. Prefer not to answer

[Multiple response allowed (a-f)]

Race (select all that apply)

a. American Indian or Alaska Native

b. Asian

c. Black or African American

d. Native Hawaiian or Other Pacific Islander

e. White

f. Prefer not to answer

[To establish demographics: No disqualifiers, but aim for a balanced mix.]

11. What is your highest level of education?

1. Not a high school graduate

2. High school graduate

3. Some college

4. College graduate (e.g., Bachelor’s degree)

5. Post college graduate (e.g., Master’s degree)

[To establish demographics: No disqualifiers, but aim for a balanced mix.]

12. Are you:

1. Female

2. Male

3. Transgender, non-binary, or another gender

4. Prefer not to answer

[To establish demographics: No disqualifiers, but aim for a balanced mix.]

Great, thank you for answering those questions.

[Qualify Script – Meets criteria]

Congrats! You have qualified for one of the virtual [focus groups or one-on-one interviews]. We will contact you to let you know if you’re invited to participate in an interview and provide details.

If you participate and complete the session, you’ll receive [select relevant incentive for study]

• $125.00 as a token of appreciation for your participation in the focus group!

• $75.00 as a token of appreciation for your participation in the one-one-one interview!

→ Recruitment agency has contact information for participants on file; proceed with contact for consent form and scheduling.

[Disqualify Script – Does not meet criteria]

Those are all the questions I have for you today. Unfortunately, you do not qualify to participate in our study.

Thanks for your time and have a great day!

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Public reporting burden of 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 CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-1154