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 Antifungal Therapeutic Drug Monitoring
FINAL: January 10, 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 your profession. [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 |
Urban infectious disease physicians |
8 |
2 |
Rural infectious disease physicians |
8 |
3 |
Hospital or infectious disease pharmacists |
8 |
Screening Questions
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) |
|
|
Pharmacist (hold a PharmD) |
|
REQUIRED FOR PHARM. GROUP |
Nurse Practitioner |
|
TERMINATE ALL |
Physician Assistant |
|
TERMINATE ALL |
Other (Please specify) |
|
TERMINATE ALL |
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 |
IF MD OR DO 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 |
IF MD OR DO Of those hours, what percentage is dedicated to adult care?
50% or more |
|
CONTINUE |
Less than 50% |
|
TERMINATE ALL |
IF PharmD On average, how many hours per week do you spend in clinical patient care? RECORD ACTUAL HOURS
20+ hours |
|
CONTINUE |
Less than 20 hours |
|
TERMINATE ALL |
Do you have a medical specialty in infectious diseases?
Yes |
|
REQUIRED FOR PHYSICIAN GROUPS |
No |
|
TERMINATE IF PHYSICIAN IF PHARMACIST, CONTINUE |
Which best describes your work setting?
Hospital-based clinic or practice |
|
RECRUIT MIX WITHIN EACH GROUP |
Urgent care or immediate care clinic |
|
|
Community health center |
|
|
Solo practice |
|
|
Primary care or specialty clinic |
|
|
Single specialty group practice |
|
|
Multi-specialty group practice |
|
|
Hospital-based emergency department |
|
TERMINATE ALL |
Other (specify) |
|
RECORD, CONSULT KRC |
IF HOSPITAL-BASED Is your hospital setting an academic medical center or teaching hospital?
TERMINATE PHARMACISTS IF NEITHER IS YES:
(1) SPECIALITY IN INFECTIOUS DISEASES
(2) WORK IN HOSPITAL-BASED CLINIC OR PRACTICE
PHARMACIST GROUP: RECRUIT MINIMUM 3 EACH (CAN BE BOTH AND COUNT TOWARD MIN FOR BOTH):
(1) SPECIALITY IN INFECTIOUS DISEASES
(2) WORK IN HOSPITAL-BASED CLINIC OR PRACTICE
Do you work at or are you affiliated with any of the following?
A public health department |
|
TERMINATE ALL |
Pharmaceutical company or research lab |
|
TERMINATE ALL |
None of the above |
|
Here is a list of topics related to infectious diseases. 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
Antifungal therapeutic drug monitoring |
|
ALL MUST SAY VERY OR SOMEWHAT FAMILIAR |
Mpox, also called monkeypox |
|
CONTINUE (DUMMY TOPICS TO MASK SUBJECT OF THE GROUPS) |
Guillain-Barré syndrome |
|
|
Healthcare-associated infections |
|
In which state do you work? RECORD STATE
Northeast |
|
MAX 4 IN ANY ONE REGION PER GROUP |
South |
|
|
Midwest |
|
|
West |
|
How would you describe the location where you work?
Urban |
|
CONTINUE |
Suburban |
|
|
Small town |
|
|
Rural |
|
URBAN: REQUIRED FOR URBAN PHYSICIAN GROUP
RURAL: REQUIRED FOR RURAL PHYSICIAN GROUP
What is the ZIP code of your primary work setting? RECORD ZIP
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
Are you…? MARK ALL THAT APPLY
Female |
|
RECRUIT MIX WITHIN EACH GROUP |
Male |
|
|
Transgender, non-binary, or another gender |
|
|
Prefer not to answer/Decline |
|
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 |
Are you of Hispanic, Latino, or Spanish origin?
Yes |
|
CONTINUE |
No |
|
What is your race? Choose 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 you will review could include reading, so it is best 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
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Laura Koehler |
File Modified | 0000-00-00 |
File Created | 2025-05-19 |