Focus Group Incentive (Fgi) Evaluation Form Page 2

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1. Objective/purpose of focus group (as listed on FGI request form; include targeted
disease/behavior, if applicable):
2. What was the actual start date (date first focus group was conducted)?
3. What was the date of the last focus group?
4. How many focus groups did you have for this topic?
5. List number of focus groups by county:
6. List dates of focus group meetings and the number of participants at each one:
7. Describe any barriers encountered when you recruited members to participate in the
focus group(s):
8. Describe any barriers encountered when conducting the focus group(s):
DHCS / Managed Care Quality and Monitoring Division
Focus Group Incentive Evaluation Form 3/7/2016

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