Instructions: Module 16 - TheMeasurementGroup.com

SPNS Cooperative Agreement Evaluation

Module 16: Focus Group Characteristics form instructions

This form is intended to be filled out by the facilitator.

Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1995). Module 16: Focus Group Characteristics Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Use a black pen to complete this form. Answer questions by either filling in a circle, or writing a number or letter in a square box. If the answer goes in a square box, you must use a CAPITAL LETTER or number that does not touch the side of the box. Print only one letter or number in each box. If the letters or numbers that you print touch the sides of the boxes, or if you do not clearly print the information, the computer will "kick out" the form and we will need to return it to you to be completed correctly. If the question asks the answer to be filled in a circle, make sure that the circle is completely darkened. Only darken one circle for each question unless the instructions specifically tell you to darken as many as apply for that question.

Specific Parts of Module 16: Focus Group Characteristics Form

Site. This is a code to identify your project in the cross-cutting evaluation. It should be pre-printed on the form. If it has not been already entered on the form, check with your project to find out your site code and enter it in the boxes. Site codes are 3 letters.

Sub-Provider. This field may be used to designate specific sites or providers within your project. If appropriate, enter the code for the service provider agency doing the activity. Provider codes can be up to 3 letters.

Focus Group #. Enter the three-digit code for the focus group session. For example, if this is the third focus group that your project has held, you would enter "003" in these boxes.

Date. Enter the numbers representing the date of the focus group in these boxes. Enter the month as a number from 01 to 12 for January through December. Enter the day as a two-digit number (01 to 31). Enter the last two digits of the current year (for example, "95" for 1995). Make sure that if a month or day is less than 10, you place a "0" before the number.

Hour. Enter the starting time of the focus group as a two-digit number. Round to the nearest hour. For example, if the start time is between 10:31 am and 11:30 am you would enter "11" in the boxes and darken the circle labeled "am."

Length Minutes. Enter the length of time of the focus group as a three-digit number. For example, if the length of time of the focus group is 90 minutes, you would enter "090."

Staff Facilitators. Each staff member should be assigned a unique number code (up to 3 digits). Make sure that each new staff member has a unique code. Do not reassign any staff codes that have been previously assigned. Enter the staff member code or codes for each of the staff facilitating focus groups. Staff codes are 3 numbers. If the staff code is less than 3 digits, place "0"s before the number. For example, 3 is "003."

Language Used. Indicate the language used for the focus group by darkening the appropriate circle. For example, if both English and Spanish were spoken during the training, you would darken the circle labeled "Both E & S."

I. Participants. Indicate the types of participants by darkening one or more of the circles provided. There are three sections: "A. Service Recipients/Consumers/PWAs," "B. Primary Caregivers" and "C. Other Participant Groups." Use the boxes labeled "Other" to indicate a type of participant not listed on the form.

	Working Definitions
A. Service Recipients / Consumers / PWAs	Clients or recipients of HIV/AIDS services; persons with AIDS.

B. Primary Caregivers	Working Definitions
Mental Health Providers	Providers of mental health care, treatment, or services, such as psychiatrists, psychologists, counselors, and clinical social workers.
Primary Health Care Providers (Medical/Dental)	Providers of medical or dental services focusing on the prevention of illness and the ongoing management of chronic conditions and acute health problems.
Social Service Providers	Providers of social services, such as health educators, case managers, caseworkers, health education trainers, vocational training providers, and housing specialists.
Substance Abuse Treatment Providers	Providers of substance abuse treatment, care, or services.
Support Health Care Personnel	Providers of support health care, such as nurses, nurse practitioners, physician assistants, dental hygienists, and health technicians.
Other	Other primary caregivers not coded elsewhere.

c. Other Participant Groups	Working Definition
Advocates (including attorneys)	Providers that advocate on behalf of the client or give assistance to the client to gain medical or social services, benefits, entitlements, etc.
Case Managers / Case Coordinators	Providers of a range of client-centered services that link clients and other family members with health care, psychosocial services, and other services to ensure timely, coordinated access to appropriate services.
CJS Workers	Persons that work in the criminal justice system, such as probation and parole officers.
Community Services Providers	Providers of social services in the community, such as administrators of recreational and outreach programs.
Counselors	Providers of mental health or psychosocial care or services.
Employers	Persons who provide employment or jobs for client or client groups.
Family Members	Family members or relatives of client or client groups.
Grass Roots Organizations	Community organizations composed of persons interested in effecting social change, such as ACT-UP.
Peer Advocates	Non-professional activists that advocate on behalf of their peers.
Planning / Policy Makers	Persons who are involved with policy or planning, such as city planners, politicians or representatives of politicians, and other policy making groups.
Religious leaders	Persons who are in leadership positions in churches or other religious organizations, such as priests, pastors, and rabbis.
Teacher / Educational Leaders / Academics	Teachers of any level of students, or administrators of schools, school systems, or educational programs.
Young Adults: 19-25 years old	Persons who are 19 to 25 years old.
Youth: 12-18 years old	Persons who are 12 to 18 years old.
Other	Other participant groups not coded elsewhere.

II. PARTICIPANTS IN FOCUS GROUP

A. Number of Males. Write the number of males participating in this activity. If you do not have an actual count, provide an estimate. If the number is less than 100, place "0"s to the left of the number. For example, if 78 men attended the training, you would enter "078."

% aged 12 & under. Enter the percentage of males aged 12 years and younger. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 13-19. Enter the percentage of males aged 13-19 years. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 20+. Enter the percentage of males aged 20 years and older. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").
The total of the three age categories should add to 100%.

% African Am-Black. Enter the percentage of African American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Caucasian-White. Enter the percentage of Caucasian males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Native Am-Am Indian. Enter the percentage of Native American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Asian Am-Pac Island. Enter the percentage of Asian American males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Hispanic-Latino. Enter the percentage of Hispanic or Latino males. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Other-Multiracial. Enter the percentage of males with other ethnic/racial backgrounds. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").
The total of the six race/ethnicity categories should add to 100%.

B. Number of Females. Write the number of females participating in this activity. If you do not have an actual count, provide an estimate. If the number is less than 100, place "0"s to the left of the number. For example, if 78 women attended the training, you would enter "078."

% aged 12 & under. Enter the percentage of females aged 12 years or younger. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 13-19. Enter the percentage of females aged 13-19 years. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% aged 20+. Enter the percentage of females aged 20 years and older. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").
The total of the three age categories should add to 100%.

% African Am-Black. Enter the percentage of African American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Caucasian-White. Enter the percentage of Caucasian females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Native Am-Am Indian. Enter the percentage of Native American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Asian Am-Pac Island. Enter the percentage of Asian American females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Hispanic-Latino. Enter the percentage of Hispanic or Latino females. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").

% Other-Multiracial. Enter the percentage of females with other ethnic/racial backgrounds. If you do not have an actual count, provide an estimate. If the percentage is less than 100, place "0"s to the left of the percentage (e.g., "050").
The total of the six race/ethnicity categories should add to 100%.

Actual %s and Counts Used. Darken this circle if the numbers you provided were actual percentages and counts. If this is not marked, it will be assumed that they are estimates.

III. Purpose of Activity. Indicate the purpose of the focus group by darkening the appropriate circle(s). Please use the three areas of boxes labeled "Other #1," "Other #2," and "Other #3" to document other purposes not listed on the form.

Purpose of Activity	Working Definitions
Define Service Needs	The purpose of the focus group is to determine the service needs of the service recipients / consumers / PWAs.
Design Better Programs	The purpose of the focus group is to brainstorm ways to design better programs for service recipients / consumers / PWAs.
Education Update	The purpose of the focus group is to disseminate information among the participants.
Identify Barriers to Services	The purpose of the focus group is to identify barriers that exist for recipients / consumers / PWAs to access services.
Identify Services / Service Levels	The purpose of the focus group is to identify services that recipients / consumers / PWAs are currently utilizing.
Outreach Strategies	The purpose of the focus group is to determine effective outreach strategies to specific target populations.
Prioritize Policies	The purpose of the focus group is to rank the importance of various policies or issues regarding HIV services.
Other	Other purposes of activity not coded elsewhere.

IV. Major Question #1. Under "Major Question #1," print legibly or type inside the box the first question or topic raised in the focus group. Please do not write or type outside the box or on the lines of the box. An example of Major Question #1 is "What are the major barriers to services for HIV positive women?"

Major Conclusion #1 of Participants. Under "Major Conclusion #1," print legibly or type inside the box major conclusions or points derived from the first question. For example, "Major barriers consisted of lack of child care, transportation, and availability of translators."

Major Question #2. Under "Major Question #2," print legibly or type inside the box the second question or topic raised in the focus group. Please do not write or type outside the box or on the lines of the box. An example of Major Question #2 is "What are some ways that agencies can collaborate to provide comprehensive services for HIV positive women?"

Major Conclusion #2 of Participants. Under "Major Conclusion #2," print legibly or type inside the box major conclusions or points derived from the second question. For example, "Links could be established among agencies providing health care and support services."

Major Question #3. Under "Major Question #3," print legibly or type inside the box the third question or topic raised in the focus group. Please do not write or type outside the box or on the lines of the box. An example of Major Question #3 is "How can this agency help HIV positive women increase their access to services?"

Major Conclusion #3 of Participants. Under "Major Conclusion #3," print legibly or type inside the box major conclusions or points derived from the third question. For example, "The agency can allow the women to bring their children when receiving services. Vans can pick up clients or the agency can provide bus tokens. The agency can hire staff who can speak the same language as the population they serve."

Module 16

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