Form 1 Recruitment screener

OMB Control #: 0925-0648

Expiration: 06/30/2024

NATIONAL INSTITUTE ON AGING

Five 90-Minute Mini Focus Groups With

Individuals Aged 50 and Older Segmented by Race/Ethnicity

Paperwork Reduction Act Burden Disclosure Statement: Public reporting burden for this collection of information is estimated to average 10 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 current 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.

RECRUITMENT SCREENER

RECRUITMENT OVERVIEW
Mini Focus Group #	Quantity of Recruits	Eligibility Criteria
Mini Focus Group #1: Black/African American Adults 50+	Recruit 4 participants, to virtually “seat” 3-4.	Must be Black/African American Must speak/read English fluently Must be 50 years of age or older
Mini Focus Group #2: Hispanic/Latino Adults 50+	Recruit 4 participants, to virtually “seat” 3-4.	Must be Hispanic/Latino Must speak/read English fluently Must be 50 years of age or older
Mini Focus Group #3: Asian Adults 50+	Recruit 4 participants, to virtually “seat” 3-4.	Must be Asian Must speak/read English fluently Must be 50 years of age or older
Mini Focus Group #4: White Adults 50+	Recruit 4 participants, to virtually “seat” 3-4.	Must be White Must speak/read English fluently Must be 50 years of age or older
Mini Focus Group #5: American Indian/Alaska Native Adults as well as Native Hawaiian or Other Pacific Islander Adults A50+	Recruit 4 participants, to virtually “seat” 3-4.	Must be Native American/Alaska Native or Native Hawaiian/Other Pacific Islander Must speak/read English fluently Must be 50 years of age or older
RECRUIT A DIVERSE MIX OF PARTICIPANTS ACROSS GENDER, AGE, ANCESTRY, EDUCATION, INCOME, GEOGRAPHY, AS POSSIBLE.

Introduction

Hello, my name is _______________ and I’m calling from _________________about an upcoming focus group sponsored by the National Institute on Aging, also known as NIA. NIA is an Institute of the National Institutes of Health (“NIH”) and a part of the U.S. Department of Health and Human Services. Its mission is to support and conduct research on aging, as well as share information about aging and advances in research with the public.

NIA is interested in conducting a virtual focus group with men and women 50 years of age and older from across the country.

The focus group will last approximately 90 minutes and take place over Zoom. To maintain participants’ privacy, we will use first names only (no last names) during the discussion and your name will not be used in any research materials. As a “thank you” for your time, you will be given a token of appreciation. To see if you qualify to participate, we need to ask you a few questions. These questions will take less than 10 minutes.

Eligibility Questions

TO ACCOUNT FOR POSSIBLE NO-SHOWS, RECRUIT 4 TOTAL PARTICIPANTS FOR EACH FOCUS GROUP, TO VIRTUALLY “SEAT” 3-4 IN EACH.

Which of the following best describes your race? (Choose one or more.)

( ) American Indian or Alaska Native  [Recruit 2 for focus group #5]

( ) Asian  [Recruit 4 for focus group #3]

( ) Black or African American  [Recruit 4 for focus group #1]

( ) Native Hawaiian or Other Pacific Islander [Recruit 2 for focus group #5]

( ) White  [Recruit 4 for focus group #4]

Which of the following best describes your ethnicity? (Choose one)

( ) Hispanic or Latino [Recruit 4 for focus group #2]

( ) Not Hispanic or Latino

RECRUIT 3-4 PARTICIPANT FOR EACH RESPECTIVE MINI FOCUS GROUP.

How would you describe your ancestry/cultural origin? (e.g., Vietnamese, Chinese, Filipino, Guatemalan, Cuban, Mexican)

_________________________

RECRUIT A MIX OF ANCESTRY/CULTURAL ORIGIN PER EACH FOCUS GROUP AS POSSIBLE.

Confirm the participant can speak English fluently.

( ) Yes ( ) No THANK AND DISMISS.

How comfortable would you say you would feel SPEAKING with a group of people only in ENGLISH?

( ) Very comfortable

( ) Comfortable

( ) Neither comfortable or uncomfortable (neutral) THANK AND DISMISS.

( ) Uncomfortable THANK AND DISMISS.

( ) Very uncomfortable THANK AND DISMISS.

( ) I don’t know THANK AND DISMISS.

During the discussion, you will be asked to READ some materials in ENGLISH and share your opinions about them with a group of people that you do not know. How comfortable would you say you are reading in English?

( ) Very comfortable

( ) Comfortable

( ) Neither comfortable or uncomfortable (neutral) THANK AND DISMISS.

( ) Uncomfortable THANK AND DISMISS.

( ) Very uncomfortable THANK AND DISMISS.

What is your current age________? 

IF UNDER 50, THANK AND DISMISS.

RECRUIT A MIX OF AGES 50 YEARS OF AGE AND OLDER.

Record sex:

( ) Male

( ) Female

( ) Other; please specify: _______________________________

RECRUIT A MIX.

Which of the following best describes your highest level of education?

( ) No formal schooling

( ) Less than high school/some high school, no diploma

( ) High school graduate or GED

( ) Some college or technical school

( ) Four-year college degree

( ) Postgraduate studies or advanced degree (master’s or higher)

RECRUIT A MIX.

In what state do you live? ___________________

( ) Northeast: Connecticut, Massachusetts, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont

( ) South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia

( ) Midwest: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, North Dakota, Nebraska, Ohio, South Dakota, Wisconsin

( ) West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, New Mexico, Nevada, Oregon, Utah, Washington, Wyoming

RECRUIT A MIX.

Which of the following best describes the area that you live in:

( ) Rural

( ) Urban

( ) Suburban

( ) Native American/American Indian Reservation

RECRUIT A MIX.

What is your total annual household income?

( ) Less than $25,000

( ) $25,000 to $49,999

( ) $50,000 to $74,999

( ) $75,000 or more

RECRUIT A MIX.

Do you have access to an internet-connected computer with a working video camera that you can use for this discussion?

( ) Yes

( ) No DISMISS; HOWEVER, THANK THEM FOR THEIR TIME AND EXPLAIN THAT AN INTERNET-CONNECTED COMPUTER WITH A WORKING VIDEO CAMERA IS NEEDED FOR THE DISCUSSION, AS THE PROJECT TEAM WILL BE ASKING FOR FEEDBACK ON A MATERIAL, WHICH PARTICIPANTS WILL NEED TO BE ABLE TO LOOK AT DURING THE DISCUSSION. THE PROJECT TEAM ALSO ENCOURAGES PARTICIPANTS TO TURN THEIR VIDEO CAMERAS ON DURING THE DISCUSSION, BUT THIS IS NOT A REQUIREMENT.

Do you have an active email address that you can access before the discussion?

( ) Yes

( ) No DISMISS; HOWEVER, THANK THEM FOR THEIR TIME AND EXPLAIN THAT THE PROJECT TEAM WILL BE EMAILING PARTICIPANTS A MATERIAL BEFORE THE START OF THE DISCUSSION. PARTICIPANTS WILL NEED TO BE ABLE TO ACCESS/OPEN THE MATERIAL DURING THE FOCUS GROUP.

[Suggested language when terminating a call:]
“Thank you very much for your time today. We are looking to recruit a wide variety of participants for this project. Unfortunately, we have filled participant slots with your background. However, we thank you for your interest.”]

INVITATION

Thank you for answering my questions. We would like to invite you to participate in a 90-minute virtual focus group with 2-3 other participants. The session will be conducted over Zoom. During the first 15 minutes of the focus group, you’ll be asked to read a material. We will email this material to you ahead of time, but you do not need to read it until the discussion begins. Please make sure you bring your reading glasses, if needed. If you agree to participate, you will receive a token of appreciation for your time. Please note, the discussion will be recorded for report writing purposes; however, your name will never be used in the report. Additional focus group “ground rules” will be shared at the start of the discussion. Your participation is completely voluntary, and you are always free to leave the discussion at any time.

Are you interested and able to participate?

( ) Yes; SCHEDULE ON Month Day, 2021 at x:xx a.m./p.m. -- x:xx a.m./p.m.

( ) No THANK AND DISMISS.

FOR SCHEDULED PARTICIPANTS:

Your discussion has been scheduled for Month Day, 2021 at x:xx a.m./p.m. -- x:xx a.m./p.m. We will email you the Zoom discussion link and the reading material two days before your focus group begins. Please remember you do not need to read the material ahead of the discussion. You will be given 15 minutes of “quiet time” during the focus group to read the document.

We will [SELECT BASED ON PARTICIPANT PREFERENCE: call you on the phone, send a text, and/or email you] the day before, and the day of, the focus group discussion to remind you about the upcoming session.

If you wear reading glasses, please remember to wear those. Also, please make sure you join the focus group from your computer, and not your smartphone.

If you must cancel, please let us know immediately, so we can find someone to take your place. My name is ___________ and you can reach me at _____________.

We ask that you join the discussion about 10 minutes before the focus group start time to make sure you can connect properly.

Thank you!