Attachment B
Screening and Recruiting Questionnaire
OMB No. 0930-0196
Expiration Date: 09/30/16
Public Burden Statement: 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. The OMB control number for this project is 0930-0196. Public reporting burden for this collection of information is estimated to average 0.8 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, MD 20857.
Screener for Concept Testing
“Talk. They Hear You” PSA aimed Parents/caregivers with children 9 to 15
For each group, recruit 12 participants in anticipation of 10 to show.
PARTICIPANTS SELECTION CRITERIA
Be parents or caregivers of children 9 to 15 years old
Parents live with their children at least part time
Parents with multiple children in the age group may qualify for one age group only
Parents/caregivers need to be 18 and older
Each group needs a mix of three segments (per quotas listed below, table 1):
Parents/caregivers with children 9 to 11 years old
Parents/caregivers with children 12 to 13 years old
Parents/caregivers with children 14 to 15 years old
Additionally, each group needs an overall mix of (quotas listed below, table 1)
Mix of males and females
Mix of racial/ethnic groups
Mix of educational levels
Mix of income levels
EXCLUSION CRITERIA
Individuals who do not have children 9 to 15 years old
Individuals who have children ages 9 to 15, but do not live with them/no contact with them
Individuals who have children younger than 9 years old and older than 15 years old
Individuals who do not speak English
Recruitment Objectives
Recruit 12 parents/caregivers of children aged 9 to 15 (to get ten participants per group) who are willing and available to participate in a FGD session of 90 minutes, preferable at evening hours.
PARTICIPANTS’ QUOTA DISTRIBUTION
|
FG1 |
FG2 |
FG3 |
FG4 |
TOTAL |
||||
|
|
|
|
|
|
||||
|
WDC (Metropolitan area) |
San Diego, California |
Milwaukee, Wisconsin |
Albuquerque, New Mexico |
4 |
||||
Gender |
|
|
|
|
|
||||
Female |
5 |
5 |
5 |
5 |
20 |
||||
Male |
5 |
5 |
5 |
5 |
20 |
||||
Children’s Age |
|
|
|
|
|
||||
9–11 |
3 |
4 |
3 |
3 |
13 |
||||
12–13 |
4 |
3 |
3 |
4 |
13 |
||||
14–15 |
3 |
3 |
4 |
3 |
13 |
||||
Racial/Ethnic group |
|
|
|
|
|
||||
American Indian, Alaska Native; Native Hawaiian other Pacific Islander |
* |
* |
* |
3 |
3 |
||||
Asian |
2 |
3 |
2 |
|
7 |
||||
Black/African American |
3 |
2 |
3 |
1 |
9 |
||||
White |
3 |
3 |
3 |
3 |
12 |
||||
Hispanic/Latino |
2 |
2 |
2 |
3 |
9 |
||||
Talked about UAD with peers (other parents) |
|
|
|
|
|
||||
Yes |
7 |
7 |
7 |
7 |
28 |
||||
No |
3 |
3 |
3 |
3 |
12 |
||||
Education |
|
|
|
|
|
||||
No HS diploma, nor GED |
1 |
1 |
1 |
1 |
4 |
||||
HS graduate |
3 |
3 |
3 |
3 |
12 |
||||
Some college or tech school |
3 |
3 |
3 |
3 |
12 |
||||
College/Tech grad |
2 |
2 |
2 |
2 |
8 |
||||
Post-graduate |
1 |
1 |
1 |
1 |
4 |
||||
Language |
|
|
|
|
|
||||
English dominant |
7 |
7 |
7 |
7 |
28 |
||||
Bilingual ENG/SPA |
3 |
3 |
3 |
3 |
12 |
||||
Income |
|
|
|
|
|
||||
|
Attempt a mix of income levels per group |
||||||||
|
|
|
|
|
|
||||
*if screened replace 1 with 1 of the higher numbers on any racial/ethnic group.
SCREENING QUESTIONNAIRE
Hello. My name is ___________________. I work at _____ (organization’s name
We are interested in taking with Hispanic/Latino parents and caregivers who live at least part time with their children ages 9 to 15. The purpose of these conversations is to obtain ideas for a TV spot (called a “PSA”) about underage drinking. As we are beginning the development of this product, we want your participation in the reviewing some concepts that have been developed. We would like to hear from parents about their opinions, suggestions, and concerns about the proposed concepts, to make them more relevant and appealing for this target population.
Are you interested in participating in this group session?
⃝ Yes ⃝ No [if No, terminate: “Thank you very much for your time. Have a good day/evening, goodbye.”]
Are you available to participate in a 90-minute session during the week of:
[September TBA - includes dates and time for each city.]
⃝ Yes ⃝ No [if No, terminate “Based on your availability, we cannot include you this time. Thank you for your interest.”]
Recruiter: I am going to ask you some questions that will indicate whether you qualify to participate in this discussion group.
Are you the mother/father or primary caregiver of a child between the ages of 9 and 15?
⃝ Yes - Mother/Father [CONTINUE]
⃝ Yes - Primary caregiver [CONTINUE]
⃝ No - [Thank and terminate.]
What age is/are your children? [Recruiter: Do not read. Mark in the appropriate range.]
⃝ 9–11
⃝ 12–13
⃝ 14–15
[If a potential participant has multiple children, select a mother/father only for one age group. Please refer to the quota for each city.]
Are you of Hispanic, Latino, or Spanish origin?
⃝ Yes - [CONTINUE]
⃝ No - [CONTINUE]
What is your race? Select all that apply. [Do not read, wait for the response.]
⃝ American Indian/Alaska Native
⃝ Asian
⃝ Black/African American
⃝ Native Hawaiian/Other Pacific Islander
⃝ White
Please select which option describes you best.
⃝ I only speak English. [CONTINUE]
⃝ I am an English-dominant speaker. [CONTINUE]
⃝ I am a Spanish-dominant speaker. [Thank and terminate]
⃝ I am bilingual in English and Spanish. [CONTINUE, but check quota for each city.]
Gender: ⃝ Female ⃝ Male
[Attempt to recruit five females and five males by group.]
Age [recruit a mix – wait for response]
⃝ 18–28
⃝ 29–39
⃝ 40–50
⃝ 51–60
⃝ 61+
[Record actual age ________]
Have you talked with other parents about underage drinking?
⃝ Yes
⃝ No
[Attempt to recruit a mix of participants who have and who have not talked with their peers about underage drinking.]
What is the highest degree or level of education you have completed?
⃝ No high school diploma, nor GED
⃝ HS graduate or GED
⃝ Some college or tech school
⃝ College/Tech graduate
⃝ Postgraduate
[Attempt to recruit participants with a mix of educational. Please refer to the quota for each city.]
Income [recruit a mix – wait for response]
⃝ Unemployed
⃝ $1,000 - $20,000
⃝ $21,000 - $45,000
⃝ $46,000 - $70,000
⃝ $71,000 - $100,000
⃝ $101,000 – 150,000
⃝ $151,000 – and above
[Attempt to recruit participants with a mix of income levels]
Recruiter: “Thank you for answering these questions. If you are selected as a group discussion participant, you will receive a call from me, or/and an e-mail to confirm your participation, and to be informed of the venue, date, and time of the group discussion session. Could you please provide us with information about the best way to contact you?”
Name: _____________________________________________________________________
E-mail: _________________________________Phone/Mobile: _______________________
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Screener for Focus Groups for Gatlinburg Department of Tourism |
| Author | Luz Amparo Pinzon |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |