Attachment B_Screener

Data To Support Social and Behavioral Research as Used by the Food and Drug Administration

Attachment B_Screener

OMB: 0910-0847

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OMB Control No.: 0910-0847

Expiration Date: 02/28/2026

Part 1: Online Eligibility Screener



According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The time required to complete this information collection is estimated to average 5 minutes per response, including the time for reviewing instructions and completing and reviewing the collection of information.


Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden, to PRAStaff@fda.hhs.gov.

Thank you for your interest in this study sponsored by the U.S. Food and Drug Administration (FDA). Please answer the following questions to see if you are eligible to participate in an in-person interview about social media prescription drug information. This will take about 5 minutes. You may skip any question you are not comfortable answering, but if you do not answer all questions, we may not be able to determine whether you are eligible for the study.

If you’re eligible for the interview, you will have to drive to the study location in Raleigh-Durham in the {neighborhood} area. The interview will last about 60 minutes, and you will receive a $75 e-gift card within 2-3 business days of completion of your interview.

All your responses will be kept secure to the extent permitted by law.


[WILLING]

  1. Are you willing to answer a few questions to see if you are eligible to participate in the study?

  • Yes – CONTINUE to Q2

  • No – TERMINATE AND GO TO END SCRIPT

[AGE]

  1. What is your current age in years?

____ years [NUMERIC, WHOLE NUMBERS ONLY. ALLOW 1-99]


[If <18, TERMINATE AND GO TO END SCRIPT]

[If >18, CONTINUE to Q3]

[PASTRES]

  1. In the past 3 months, how many times have you participated in an interview or a focus group for a research study?

  • Never – CONTINUE to Q4

  • One time – CONTINUE to Q4

  • Two or more times – HOLD, but continue script

[RECORDING]

  1. If selected for the interview, would you consent to having the interview audio- and video-recorded?

  • Yes – CONTINUE to Q5

  • No – TERMINATE AND GO TO END SCRIPT

[LIVESTREAM]

  1. If selected, would you consent to having the interview livestreamed so that our study team can watch and listen in?

  • Yes – CONTINUE to Q6

  • No – TERMINATE AND GO TO END SCRIPT

[DRIVE]

  1. If selected, are you able to drive or otherwise get to the study site located in the Raleigh-Durham metropolitan area?

  • Yes – CONTINUE to Q7

  • No – TERMINATE AND GO TO END SCRIPT

[WORK]

  1. Have you ever worked for any of the following agencies? Please check all that apply.

  • The Department of Health and Human Services – TERMINATE AND GO TO END SCRIPT

  • A market research firm – TERMINATE AND GO TO END SCRIPT

  • An advertising agency – TERMINATE AND GO TO END SCRIPT

  • A pharmaceutical company – TERMINATE AND GO TO END SCRIPT

  • None of the above – CONTINUE to Q8


Social Media Use

[PLATFORM]

  1. Which social media platforms do you have an account for and have used in the past month? Please check all that apply.

  • SnapChat

  • Facebook

  • Twitter

  • Instagram

  • TikTok

  • Pinterest

  • None of the above – TERMINATE AND GO TO END SCRIPT

Note: Must select “Facebook” and/or “Instagram” to qualify. Otherwise, terminate.


[FREQ_FB]

  1. [If PLATFORM = Facebook] In an average 7-day week, about how many days do you use Facebook? Enter a number between 0 and 7.

____ days [NUMERIC, WHOLE NUMBERS ONLY. ALLOW 0-7]

[Must be 4 or more days; otherwise not eligible as a Facebook user.]


[FREQ_IG]

  1. [If PLATFORM =Instagram] In an average 7-day week, about how many days do you use Instagram? Enter a number between 0 and 7.

____ days [NUMERIC, WHOLE NUMBERS ONLY. ALLOW 0-7]

[Must be 4 or more days; otherwise not eligible as an Instagram user.]


[MEDIA_USE]

  1. What devices do you use for social media? Please check all that apply.

  • Computer (laptop or desktop)

  • Tablet (iPad or Android tablet)

  • Smartphone (iPhone or Android)


At least one option must be checked. If “computer” is selected, eligible for Computer group. If “Smartphone” is selected, eligible for Mobile group. If only “Tablet” is selected, HOLD.



Medical Condition

[MED_COND]

  1. Have you ever been diagnosed by a medical professional with any of the following conditions? Please check all that apply.

  • Psoriasis

  • Type 1 diabetes

  • Type 2 diabetes

  • High cholesterol

  • Heart disease

  • None of the above

Note: Must select “Type II Diabetes” to quality. Otherwise, terminate.

Terminate individuals who select all medical conditions.



Demographics

[GEN]

  1. Are you:

Mark all that apply.

  • Male

  • Female

  • Transgender, non-binary, or another gender identity


[ETH]

  1. Are you Hispanic, Latino, or Spanish origin?

  • Yes

  • No

[RACE]

  1. Which of these best describes your racial background? Mark one or more.

  • American Indian or Alaska Native 

  • Asian

  • Black or African American 

  • Native Hawaiian or Other Pacific Islander

  • White 

  • Prefer not to answer [EXCLUSIVE]


[EDUCATION]

  1. What is the highest level of school you have completed or the highest degree you have received?

  • Less than high school diploma

  • High school graduate—high school diploma or the equivalent (for example: GED) 

  • Some college, but no degree

  • Technical or associate degree (for example: AA, AS)

  • Bachelor’s degree (for example: BA, AB, BS)

  • Advanced or post-graduate degree (for example: Master’s degree, MD, DDS, JD, PhD, EdD)


Closing Scripts

You have completed the online screener. One of our recruiters will be in touch if you qualify for this study. Thank you for your time.

[If a participant is eligible, L&E will follow up with a phone call using the script below.]

Part 2: Telephone Eligibility and Scheduling Script


Note: This script will be used only for individuals who complete the web screener.


Hello, this is {NAME} calling from L&E Research. I’m calling regarding the in-person interview study about prescription drug information on social media you recently expressed interest in.

I’m calling to confirm a few pieces of information you shared with us to ensure you are eligible. If you are, I would like to schedule you to participate in one of the in-person interviews. As a reminder, each interview will last about one hour, and we will audio and video record the discussion. You will receive a $75 e-gift card if you complete the study.

Can I ask you a few questions now to confirm your eligibility and schedule your participation?

  • Yes è [CONTINUE]

  • No è Would another time be better? [Schedule a time to call back or thank them for their time]


  1. Is it correct that you consent to having your interview audio and video recorded and livestreamed?

  • Yes [CONTINUE]

  • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]

  1. Is it correct that you are able to drive or otherwise get to the study site located in the Raleigh-Durham metropolitan area in the {NEIGHBORHOOD} area?

  • Yes [CONTINUE]

  • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


  1. Is it correct that you have been diagnosed with type 2 diabetes?


  • Yes [CONTINUE]

  • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


[FOR FACEBOOK DESKTOP GROUP]

  1. Is it correct that you use Facebook 4 or more days per week?

    • Yes [CONTINUE]

    • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]



  1. Is it correct that you use a laptop or desktop computer when using Facebook?

    • Yes [CONTINUE]

    • No [CONTINUE; GO TO Q7]


[FOR FACEBOOK MOBILE GROUP]

  1. Is it correct that you use Facebook 4 or more days per week?

    • Yes [CONTINUE]

    • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


  1. Is it correct that you use a mobile device when using Facebook?

    • Yes [CONTINUE]

    • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


[FOR INSTAGRAM MOBILE GROUP]

  1. Is it correct that you use Instagram 4 or more days per week?

    • Yes [CONTINUE]

    • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


  1. Is it correct that you use a mobile device when using Instagram?

    • Yes [CONTINUE]

    • No [TERMINATE; GO TO INELIGIBLE CLOSING SCRIPT]


Thanks for answering all our questions. Based on your responses, we would like to invite you to take part in the study. The interviews will take place on {DATES AND TIMES}. Which date and time would work best for you?

Great, we have you scheduled for an interview on {DATE/TIME}. Please arrive 5 to 10 minutes before the starting time. Here is the location: {LOCATION}

The research term will provide a device logged into a test {Facebook/Instagram} account, so you don’t need to bring your own device if you don’t want to. You also will not be asked to log into your personal account.

I will be sending you a confirmation email with this date and time that will include directions to the facility and additional information about the study.

{Ask for participants email address and phone number if not already on file.}

I will also email you a day or two before your scheduled appointment to remind you. If you have any questions or if you need to reschedule or cancel, please contact me at {PHONE/EMAIL}.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorRichardson, Courtney
File Modified0000-00-00
File Created2023-12-12

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