Focus Group Screener

WS-CDC ARX – DFWED Focus Group Screener

Form Approved

OMB Control No.: 0920-1154

Expiration date: 03/31/2026

Antimicrobial Resistance Communications and Media Support Services

Focus Group Screener for Providers on Endemic Mycoses

FINAL: January 3, 2024

Introduction

Hello. My name is ________ and I’m calling from _________, an independent communications firm.

You indicated that you are interested in participating in a group discussion, conducted virtually, to discuss your practices and opinions regarding some diseases and conditions. [DO NOT DISCLOSE THE EXACT TOPIC OF DISCUSSION BEFORE THE INTERVIEW.] The discussion will last up to 1 hour and 30 minutes. The sole sponsor of this activity is the Centers for Disease Control and Prevention (CDC).

I have a few questions to start. But first, to maintain participants’ confidentiality, we will use first names only during the interview and your name will not be used in any study materials. CDC will not receive any personally identifying information that you provide. We will be asking you a few questions to ensure we are recruiting a variety of people, but the information will not be associated with your specific name.

IF TERMINATED DURING SCREENING PROCESS, READ: I’m sorry, we already have enough individuals in that category. Thank you very much for your time.

INTERVIEWER INSTRUCTION: If individual expresses concern at any point during the screening process, please note their concern and reassure them appropriately. Remind them that their answers and participation will be completely confidential.

Name: _______________________________________________________

Address (residence): _______________________________________________________

City, State, Zip: _______________________________________________________

Phone: _______________________________________________________

Email: _______________________________________________________

Recruiter: _______________________________________________________

SEPARATE CONTACT SHEET FROM THE REST OF THE SCREENER AND SHRED AT THE END OF THE PROJECT.

Recruit Summary

Group	Audience	Number to Recruit
1	Primary care physicians	8
2	Primary care physician assistants (PAs) & nurse practitioners (NPs)	8
3	Urgent care physicians	8
4	Urgent care PAs and NPs	8
5	Emergency care physicians	8
6	Emergency care PAs and NPs	8

Screening Questions

1. Are you a...?

Medical Doctor (hold an MD)		REQUIRED FOR PHYSICIAN GROUPS MAX 2 DO PER PHYSICIAN GROUP
Doctor of Osteopathic Medicine (hold a DO)
Physician Assistant (PA)		REQUIRED FOR PA/NP GROUPS MAX 5 EITHER TYPE PER GROUP
Nurse Practitioner (NP)
Pharmacist (hold a PharmD)		TERMINATE ALL
Other (Please specify)		TERMINATE ALL

2. In which state do you practice? RECORD STATE, RECRUIT MIX

Northeast		MAX 4 IN ANY ONE REGION PER GROUP
South
Midwest
West*

*MAXIMUM 2 PER GROUP IN ANY OF ALASKA, COLORADO, HAWAII, IDAHO, OREGON, MONTANA, WYOMING. (PRIORITY FUNGAL INFECTIONS OF BLASTOMYCOSIS, COCCIDIOIDOMYCOSIS, AND HISTOPLASMOSIS ARE NOT ENDEMIC TO THESE STATES.)

3. Is direct patient care one of your primary responsibilities? (Direct contact with patients for the purpose of diagnosis, treatment, and monitoring)

Yes		CONTINUE
No		TERMINATE ALL

4. On average, how many hours per week do you spend in direct patient care? RECORD ACTUAL HOURS

20+ hours		CONTINUE
Less than 20 hours		TERMINATE ALL

5. Of those hours, what percentage is dedicated to adult care?

50% or more		CONTINUE
Less than 50%		TERMINATE ALL

6. What is your medical specialty?

Primary care, internal medicine, or family medicine		CONTINUE
Emergency medicine
Urgent care
Something else (please specify)

7. Which of the following best describes your practice setting?

Hospital-based clinic or practice		CONTINUE
Hospital emergency department
Urgent care or immediate care clinic
Community health center
Solo practice
Primary care
Specialty clinic
Single specialty group practice
Multi-specialty group practice
Other (specify)

8. IF HOSPITAL-BASED CLINIC OR HOSPITAL-BASED EMERGENCY DEPARTMENT Is your hospital setting an academic medical center or teaching hospital?

Yes		CONTINUE
No

PRIMARY CARE GROUPS:

• MUST HAVE “PRIMARY CARE, INTERNAL MEDICINE, OR FAMILY MEDICINE” AS SPECIALTY

• SETTING MUST NOT BE “HOSPITAL BASED-EMERGENCY DEPARTMENT” OR “URGENT CARE OR IMMEDATE CARE CLINIC”

• RECRUIT MIX OF OTHER SETTINGS WITHIN EACH GROUP

• RECRUIT 1-2 FROM ACADEMIC MEDICAL CENTER OR TEACHING HOSPITAL PER GROUP

URGENT CARE GROUPS:

• MUST HAVE “URGENT CARE OR IMMEDIATE CARE CLINIC” AS SETTING

EMERGENCY CARE GROUPS:

• MUST HAVE “EMERGENCY MEDICINE” AS SPECIALTY

• MUST HAVE “HOSPITAL-BASED EMERGENCY DEPARTMENT” AS SETTING

• RECRUIT MIN 1-2 FROM ACADEMIC MEDICAL CENTER OR TEACHING HOSPITAL PER GROUP

9. Do you work at or are you affiliated with any of the following?

Pharmaceutical company or research lab		TERMINATE ALL
None of the above		CONTINUE

10. Are you able to order diagnostic tests?

Yes		CONTINUE
No		TERMINATE ALL

11. Are you required to report diagnoses or tests to your local or state health department?

Yes		CONTINUE
No

12. IF NP OR PA: Do you have prescribing authority?

Yes		CONTINUE
No		TERMINATE ALL

13. Here is a list of some diseases or infections. How familiar are you with each of the following as they relate to your work? Are you very familiar, somewhat familiar, or not familiar? RANDOMIZE ORDER, RECORD ANSWER FOR EACH

Coccidioidomycosis (valley fever)		RECRUIT 2-3 PER GROUP WHO ARE NOT FAMILIAR WITH ALL 3 OF THESE. RECRUIT 5-6 WHO ARE VERY / SOMEWHAT FAMILIAR WITH 1 OR MORE.
Histoplasmosis
Blastomycosis
Latent tuberculosis		CONTINUE (DUMMY TOPICS TO MASK SUBJECT OF THE GROUPS)
Diphtheria
Rubella

14. Have you ever screened or tested patients for any of the following before? RANDOMIZE ORDER, RECORD YES/NO ANSWER FOR EACH

Coccidioidomycosis (valley fever)		RECRUIT 2-3 PER GROUP WHO SAY YES TO ANY OF THESE THREE
Histoplasmosis
Blastomycosis
Latent tuberculosis		CONTINUE (DUMMY TOPICS TO MASK SUBJECT OF THE GROUPS)
Diphtheria
Rubella

15. How often do you diagnose or empirically treat community-acquired pneumonia, or CAP, in your patients?

Often		CONTINUE
Occasionally
Rarely
Never		TERMINATE ALL

16. How many times within the past three months have you participated in a focus group or one-on-one interview related to your professional expertise? DO NOT READ LIST

None		CONTINUE
1 or more		TERMINATE ALL

17. How would you describe the location where you work?

Urban		RECRUIT MIX WITHIN EACH GROUP
Suburban
Small town
Rural

18. Are you…? MARK ALL THAT APPLY

Female		RECRUIT MIX WITHIN EACH GROUP
Male
Transgender, non-binary, or another gender
Prefer not to answer/Decline

19. What is your age? RECORD EXACT AGE; DO NOT READ LIST

39 or younger		RECRUIT MIX WITHIN EACH GROUP
40-49
50-59
60 or older		MAX 3 PER GROUP

20. Are you of Hispanic, Latino, or Spanish origin?

Yes		CONTINUE
No

21. What is your race? Select all that apply.

American Indian or Alaska Native		CONTINUE
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Prefer not to answer/Decline

RECRUIT MINIMUM 2 WHO ARE HISPANIC, LATINO, SPANISH, OR NON-WHITE PER GROUP

Invitation

Thank you for answering all of my questions. As I mentioned, we respect your privacy and understand this information is confidential, and we will not disclose this information to anyone. We asked these questions because we want to speak with a wide variety of people who can review important information and provide their feedback. Based on your answers to the questions, we would like to invite you to participate in a virtual focus group that will last approximately 90 minutes. During the virtual discussion, you will need to have a reliable internet connection and use a desktop or laptop computer.

You will receive $75 as a token of appreciation for your participation, which will be provided to you after you complete the discussion.

All of your feedback will be confidential, reported in the aggregate only, never in association with your name or identity. To make sure we capture your remarks accurately, we will record the interview. The purpose of the audio recording is to make sure we report accurately, but without any personally identifying information. Is this something you are interested in and comfortable with?

Yes		CONTINUE
No		THANK AND TERMINATE

The discussion is virtual, meaning that you can participate from the comfort of your home or office. You will not need to come to a facility and can meet us from wherever you are, but you will need to be in front of a computer or tablet with internet access. The information or materials you will review could include reading and visual content, so we request that you do not participate using a cell phone. You will also have to be in a quiet place. Someone will call you before the interview to make sure all the technology needed for the interview is working properly. Is this focus group something you are interested in and comfortable with?

Yes		CONTINUE
No		THANK AND TERMINATE

CONFIRM DATE AND TIME OF FOCUS GROUP

Please provide the best telephone number to reach you:

RECORD PHONE NUMBER

Please indicate how you would like us to confirm with you:

PHONE OR EMAIL, RECORD EMAIL IF PREFERENCE

SEPARATE THE LAST PAGE (CONTACT SHEET) AND SHRED AT THE END OF THE PROJECT

Public reporting burden of this collection of information is estimated to average 5 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