Form 0920-1154 Focus Group Screener for Consumers, Including Parents

WS-CDC ARX 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 Consumers, Including Parents

May 10, 2024 V1

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 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 and 30 minutes. This activity is supported by the U.S. Centers for Disease Control and Prevention and focus groups 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 focus group 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

Group	Audience	Number to Recruit
1	Adults age 20-59, not college graduates*	8
2	Adults age 20-59, college graduates*	8
3	Adults age 60+, not college graduates*	8
4	Adults age 60+, college graduates*	8
5	Parents of children age 0-6, not college graduates	8
6	Parents of children age 0-6, college graduates	8

* Groups 1-4 must not include individuals with children age 0-6, to differentiate from Groups 5-6

Screening Questions

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

Under 20		TERMINATE ALL
20-29		CONTINUE
30-39
40-49
50-59
60-69
70+

2. What sex were you assigned at birth, on your original birth certificate?

Male		CONTINUE
Female
Unknown

3. How do you describe your current gender? You can select all that apply.

Male		MIN 3 PER GROUP
Female		MIN 3 PER GROUP
Transgender		CONTINUE
Something else

4. IF Q1 RESPONSE DOES NOT MATCH Q2 RESPONSE Just to confirm, you were assigned [Q2 RESPONSE] at birth and now you describe yourself as [Q3 RESPONSE]. Is that correct?

Yes		CONTINUE
No		REPEAT Q1 and Q2

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

Northeast		RECRUIT A MIX
South
Midwest
West

6. Do you, a spouse or partner, or a child work in any of the following fields, or have any of these individuals worked in these fields in the past?

Market research, communications, or public relations		TERMINATE ALL
Health care or public health
Pharmaceuticals, health sciences, or medical device manufacturing
Federal or state government
Animal health (veterinary care)
Ownership of agricultural or food animal production business
None of the above		CONTINUE

7. Are you a parent or full-time guardian of at least one child under 18 years old?

Yes		CONTINUE
No

8. IF PARENT OF CHILD UNDER 18 How old is your child who is under 18 years old? If you have more than one child in this age range, please share all ages. RECORD EXACT AGE(S)

0-6		PARENTS GROUPS: REQUIRED ADULTS 20-59 AND 60+ GROUPS: EXCLUDE
7-17		CONTINUE

9. IF A PARENT OF A CHILD AGE 0-6 Are you the primary or co-primary health decision maker for your child (or children) who is 6 years old or younger?

Yes		PARENTS GROUPS: REQUIRED
No		TERMINATE ALL
Don’t know

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

Less than high school graduate		NO COLLEGE GRAD GROUPS: REQUIRED
High school graduate or completed GED
Technical or vocational degree
Four-year college degree		COLLEGE GRAD GROUPS: REQUIRED
Postgraduate or professional degree

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

Urban		RECRUIT A MIX
Suburban
Small town
Rural		MIN 2 PER GROUP

12. What is your race and/or ethnicity? Select all that apply. MULTISELECT

American Indian or Alaska Native For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.		RECRUIT A MIX
Asian For example, Chinese, Asian Indian, Filipino, Vietnamese, Korea, Japanese, etc.
Black or African America For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.
Hispanic or Latino For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.
Middle Eastern or North African For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.
Native Hawaiian or Pacific Islander For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.
White For example, English, German, Irish, Italian, Polish, Scottish, etc.

RECRUIT MINIMUM 3 TOTAL WHO SELECT SOMETHING OTHER THAN WHITE PER GROUP

13. What best describes your current employment status?

Employed, full-time		PARENTS AND ADULTS 20-59 GROUPS: MIN 5 PER GROUP
Employed, part-time
Student		CONTINUE
Homemaker
Retired
Unemployed

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

Less than $20,000		MINIMUM 3 PER GROUP
$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		MINIMUM 3 PER GROUP
$80,000 to less than $90,000
$90,000 to less than $100,000
$100,000 or more
Prefer not to answer/Decline		TERMINATE

15. 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

16. 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 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 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 discussion. 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 will 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 focus group to make sure all the technology needed for the discussion 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