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

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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