AttK - Moderator Version Prediscussion Sheet

Pre-Discussion Information Sheet—Moderator Version

Form approved

OMB No. 0920-0800

Exp. Date 11/30/2011

Public reporting burden of this collection of information is estimated to average 30 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 D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0800)

Moderator: “To get started today we would like you to take a moment and give us some background information about yourself and respond to a series of questions about three demo radio messages that I will play for you shortly.

Let’s begin. I’m first going to ask you some questions about yourself. Please listen carefully as I read aloud each of the questions and answers on the paper in front of you. You will record your own responses to each question right on your paper. Remember that our discussion and what you record on this paper will be maintained in a secure manner and that there are no right or wrong answers.”

PART 1: GENERAL QUESTIONS (10 minutes)

Please do not write your full name on this form.

1. What is your date of birth? (Month/Day/Year)

1. What is your highest education level completed?

• 6th Grade or less

• 7th – 8th Grade

• 9th – 11th Grade

• 12th Grade without a High School diploma

• 12th Grade with a High School diploma

• GED

• Some college

• Associate degree

• Completed college (4 year degree)

3. What is your employment status? (Check all that apply)

Full-time Part-time Presently not employed outside the home, looking for work Presently not employed outside the home, not looking for work

Student Laid Off On Strike Disabled

4. What do you do for a living? What is your occupation/profession?

5. How often do you listen to the radio?

• Never or rarely

• 1-2 days a week

• 3-4 days a week

• 5-6 days a week

• Every day

6. Do you listen to the radio when you are________ (Check all that apply)?

• In the car

• At work

• At home

• Some other place

7. During what time of the day do you most often listen to the radio?

• In the mornings (5am-12pm)

• In the afternoons (12pm-6pm)

• In the evenings (7pm-12am)

8. On which days of the week are you most likely to listen to the radio? (Check all that apply)

Monday Tuesday Wednesday Thursday

Friday Saturday Sunday

9. Which of the following types of radio stations do you usually listen to? (Check all that apply)

• Talk Stations

• Music Stations

• AM

• FM

10. During the past 30 days, which of the following have you listened to at least 3 times a week? (Check all that apply)

Alternative		Gospel		Pop
Ambient		Hip Hop		Punk
African		Heavy Metal		Rap
Bluegrass		Hard Rock		Reggae
	Blues		Instrumental		R & B
	Caribbean		Jazz		Rock
	Classical		Latin		Salsa
	Christian		Musical		Trance
	Country		New Age
	Disco		Oldies
	Folk		Opera

11. When you listen to the radio, which station or stations do you listen to most often?

Write in station dial location(s) and name(s):

12. When you listen to the radio, how do you access the radio stations that you listen to?

• Using the Internet

• On a handheld device

• On a stand-alone radio

• On a car radio

• Other: _______________

13. Please indicate below from which of the following sources do you usually get information about health services in your community and how often.

Television	Always	Sometimes	Rarely	Never
Radio	Always	Sometimes	Rarely	Never
Newspapers	Always	Sometimes	Rarely	Never
Magazines	Always	Sometimes	Rarely	Never
Internet	Always	Sometimes	Rarely	Never
Doctor visits	Always	Sometimes	Rarely	Never
Church or religious organizations	Always	Sometimes	Rarely	Never
Friends	Always	Sometimes	Rarely	Never
Family members	Always	Sometimes	Rarely	Never
Other:_________________	Always	Sometimes	Rarely	Never

PART 2: Post-PDIS Radio Message Testing

(Discussion guided by the Moderator)

(30 minutes in total for PDIS and Moderator Guide radio message testing)

Moderator: “I am going to play for you 3 radio advertisements that CDC has developed to educate African American women like you about breast cancer and breast cancer screening. After I play each ad, please listen carefully as I read aloud each of the questions and answers on the paper in front of you. You will record your own responses on the paper.

Then I will ask you some additional questions about the main messages in the radio ad. Remember that our discussion and what you record on this paper will be maintained in a secure manner and that there are no right or wrong answers.”

PART 2a: RADIO MESSAGE ONE

[Moderator: Play the first radio advertisement and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?

• Yes

• No

2. Did you like the music that was used in the radio advertisement?

• Yes

• No

3. Did you learn anything new from this radio advertisement?

• Yes

• No

If yes, what did you learn?

4. After hearing this radio advertisement would you call your doctor or health department about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

5. After hearing this radio advertisement would you contact a family member or friend about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

Refer to Moderator Guide to ask additional questions (questions 17 through 22 in the guide).

PART 2b: RADIO MESSAGE TWO

[Moderator: Play the second radio message and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?

• Yes

• No

2. Did you like the music that was used in the radio advertisement?

• Yes

• No

3. Did you learn anything new from this radio advertisement?

• Yes

• No

If yes, what did you learn?

4. After hearing this radio advertisement would you call your doctor or health department about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

5. After hearing this radio advertisement would you contact a family member or friend about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

Refer to Moderator Guide to ask additional questions (questions 17 through 22 in the guide).

PART 2c: RADIO MESSAGE THREE

[Moderator: Play the last radio message and ask the following questions.]

1. Did you like the voices that were used in the radio advertisement?

• Yes

• No

2. Did you like the music that was used in the radio advertisement?

• Yes

• No

3. Did you learn anything new from this radio advertisement?

• Yes

• No

If yes, what did you learn?

4. After hearing this radio advertisement would you call your doctor or health department about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

5. After hearing this radio advertisement would you contact a family member or friend about getting screened for breast cancer (or getting a mammogram)?

• Yes

• No

Refer to Moderator Guide to ask additional questions (questions 17 through 22 in the guide).

Go back to the Moderator Guide to complete the “Closing” section.

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