Form 1 In Person Script

OMB#: 0925-XXXX

Exp. XX/XXXX

Public reporting burden for this collection of information is estimated to range an average 7 -12 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 currently 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-XXXX). Do not return the completed form to this address.

HCHS/SOL IN-PERSON SCRIPT

Section A. Introduction

Hello, my name is ________________ and I am an interviewer at _________________ (show name badge). I am here to talk about an important national study of Hispanic/Latino health in the United States and would like to speak to someone home about the study.

(IF NOT AN ADULT AT THE DOOR)

1. May I please speak with an adult who is age 18 or older?

Yes, speaking with adult

Yes, adult is coming

No, no adult available  1a. When would be the best time to come back to

talk to an adult age 18 or older?

Record time: _______________________

I Don't Know / Don't Understand

Thank you for your time. We will come back later.

The name of the study is the Hispanic Community Health Study/Study of Latinos or HCHS/SOL. We recently sent some information to your home about the study. (CONFIRM ADDRESS)

2. Did you get the information?

Text A: I am sorry you did not receive the information. Here, is a copy of the information sent to your home. Since I am here, let me tell you about the study.

No  Go to Question 3

Yes  Go to Section B

No  Read Text A

Text B: I am glad you received the information. Please let me explain more about the study.

No  Go to Question 3

Yes  Go to Section B

Yes  Read Text B

3. Would there be a better time to come back?

No, not interested  Read text: Thank you for your time. END VISIT

Yes  3a. What time?

Time:_______________________.

Thank you, we will come back later.

Section B. Explanation of Study

The study is called the Hispanic Community Health Study/Study of Latinos or HCHS/SOL. The purpose of this study is to learn about the health issues that affect the Hispanic/Latino community. It is the largest national study on Hispanic/Latino health in the United States. Please feel free to interrupt me if you have any questions or comments.

If you are eligible to participate in the study you will be asked to make a one-time visit to our clinic at ___________________. At that time, you will be asked questions about your health, including medical history, family and work history, occupation, and lifestyle, among other topics. You will also receive physical/medical examinations, including a hearing exam and a dental exam, electrocardiogram, physical activity assessment, lung function tests, among other tests. All of this is being done free of charge. In addition, all participants who complete the full examination at our clinic will be compensated for their transportation, childcare, and other costs.

We are visiting households in the area to see which households might be eligible and would like to participate.

4. May I ask you some questions about the people living at this address?

No, not interested  Read text: Thank you for your time. END VISIT

Yes  GO TO HOUSEHOLD SCREENING

Section C. Closing Scripts

Script A – NOT ELIGIBLE

I am sorry but unfortunately your household is not eligible to participate. We are interested in households whose residents are of Hispanic/Latino origin and between the ages of 18 – 74 and randomly selected to participate. Thank you for your time.

END VISIT

Script B – ELIGIBLE, NOT SELECTED

I appreciate you taking the time to talk to me. However, your household was not selected to participate in the study. Thank you for your time.

END VISIT

Script C – ELIGIBLE AND SELECTED

You and the others in your household are eligible and have been selected to participate in HCHS/SOL. Let me explain more about participating in the study.

GO TO SITE SPECIFIC INFORMATION, INCLUDING SCHEDULING CLINIC VISIT, CONFIRM PHONE NUMBER, ETC…