0920-24DM In-Depth Interview Screener for Consumers with Previous

WS-CDC ARX IDI Screener

Form Approved

OMB Control No.: 0920-1154

Expiration date: 03/31/2026

Antimicrobial Resistance Communications and Media Support Services

In-Depth Interview Screener for Consumers with Previous Antimicrobial-Resistant Infections

February 20, 2024 V4

Introduction

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

You indicated that you are interested in participating in a one-on-one research interview, conducted virtually, to discuss your experiences and opinions regarding a health topic. [DO NOT DISCLOSE THE EXACT TOPIC OF DISCUSSION BEFORE THE INTERVIEW.] The discussion will last up to 1 hour. This activity is supported by the U.S. Centers for Disease Control and Prevention and interviews are being conducted by their contractual partner KRC Research.

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 participation is voluntary, and both 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

Audience	Number to Recruit
Adults with past bacterial or fungal antimicrobial-resistant infection	3

Screening Questions

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

Under 18		TERMINATE ALL
18-29		CONTINUE
30-39
40-49
50-59
60+

2. How do you currently describe yourself? Mark all that apply.

Female		RECRUIT MIX
Male
Transgender
I use a different term [free-text]
Prefer not to answer/decline

3. In what city and state do you live? RECORD CITY & STATE, ALSO CODE TO TABLE

Northeast		RECRUIT A MIX
South
Midwest
West

4. Do you, a spouse or partner, or a child work in any of the following fields?

Market research, communications, or public relations		TERMINATE ALL
Health care or public health
Pharmaceuticals, health sciences, or medical device manufacturing
Federal or state government
None of the above		CONTINUE

5. Have you been diagnosed with any infections by a healthcare professional in the past three years?

Yes		CONTINUE
No		TERMINATE ALL

6. Which of the following were you diagnosed with in the past three years? SHOW/READ IN RANDOM ORDER; RECORD ALL THAT APPLY

A bacterial infection		MUST SELECT EITHER TO CONTINUE
A fungal infection
A viral infection, caused by a virus and including examples such as colds, the flu, COVID-19, norovirus, shingles, chickenpox, and hepatitis		TERMINATE IF ONLY SELECTIONS
A parasitic infection
Don’t remember or don’t know

7. Were you prescribed an antibiotic or antifungal drug for the bacterial or fungal infection(s) you were diagnosed with?

Yes		CONTINUE
No		TERMINATE ALL

8. At any point, did a healthcare provider determine and tell you that the bacterial or fungal infection was resistant to the drug(s) prescribed, meaning it was an antimicrobial-resistant infection—in other words, a drug-resistant infection?

Yes		CONTINUE
No		TERMINATE ALL

9. Please provide the name or your best description of the type of antimicrobial-resistant infection you were diagnosed with.

RECORD

CONTINUE, KRC TO REVIEW

10. If you were to have a different infection in the future, would you be willing to take an antibiotic or antifungal drug if it was recommended by a healthcare professional?

Yes		CONTINUE
No		TERMINATE ALL

11. Which of the following best describes the area where you live?

Urban		RECRUIT A MIX
Suburban
Small town
Rural

12. Are you…?

Hispanic or Latino		CONTINUE
Not Hispanic or Latino
Prefer not to answer/Decline

13. 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 1 WHO IS HISPANIC OR LATINO OR NON-WHITE

14. What is the highest level of education you have completed?

Less than high school graduate		RECRUIT A MIX
High school graduate or completed GED
Technical or vocational degree
Four-year college degree
Postgraduate or professional degree

15. What best describes your current employment status?

Employed, full-time		RECRUIT A MIX
Employed, part-time
Student
Homemaker
Retired
Unemployed

16. Which of the following includes your total annual household income for the last year?

Less than $20,000		MINIMUM 1
$20,000 to less than $30,000
$30,000 to less than $40,000
$40,000 to less than $50,000
$50,000 to less than $60,000
$60,000 to less than $70,000
$70,000 to less than $80,000		CONTINUE
$80,000 to less than $90,000
$90,000 to less than $100,000
$100,000 or more
Prefer not to answer/Decline		TERMINATE

17. Are you currently covered by any of the following types of health insurance or health coverage plans?

Insurance through a current or former employer or union of yourself or another family member		CONTINUE
Insurance purchased directly from an insurance company by you or another family member
Medicare, for people 65 or older, or people with certain disabilities
Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
TRICARE or other military health care
Indian Health Service
Any other type of health insurance or health plan SPECIFY
Do not have health insurance coverage

18. How many times within the past three months have you participated in a focus group or one-on-one research interview? DON’T READ LIST

None		CONTINUE
1 or more		TERMINATE ALL

Invitation

Thank you for answering all 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 provide their opinions and experiences. Based on your answers to the questions, we would like to invite you to participate in a virtual interview that will last approximately 60 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 and will never be reported in association with any personally identifying details like your name. 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 interview something you are interested in and comfortable with?

Yes		CONTINUE
No		THANK AND TERMINATE

CONFIRM DATE AND TIME OF INTERVIEW

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