A.2.1.h Survey

Appendix A A.2.1.h–12

QUESTIONNAIRE ADDRESSING:

PARTICIPANT EVALUATION OF DATA COLLECTION ACTIVITIES

NATIONAL CHILDREN’S STUDY

Participant Evaluation Questionnaire

Thank you for participating in the National Children’s Study (NCS). We would appreciate you taking a few minutes to answer some questions about your experience in the study so far. Your feedback will help us improve the National Children’s Study for future phases of the study in which you or your child may choose to participate. Additionally, your feedback can help us improve this phase of the study for other women who haven’t yet participated. Please answer these questions to the best of your ability.

Completion of this form is voluntary and you can choose to complete it or not. If you do not complete it, your participation in the National Children’s Study (NCS) will not be affected. As with all other NCS activities, the information you provide will be kept confidential and used only for purposes of the study.

1. Did a study representative conduct an interview with you?

• Yes

• N o (GO TO 2)

1a. How much time did you spend on the interview?

• Far too much time

• A little too much time

• An acceptable amount of time

1b. How uncomfortable or comfortable did you feel completing an interview with the study representative?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

1c. How clearly did a study representative explain the interview process to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

2. Did a study representative collect environmental samples from your home, such as water, air, dust, or soil?

• Yes

• N o (GO TO 3)

2a. How much time did a study representative spend collecting environmental samples from your home?

• Far too much time

• A little too much time

• An acceptable amount of time

2b. How uncomfortable or comfortable did you feel with the study representative collecting environmental samples from your home?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

2c. How clearly did a study representative explain the process of collecting environmental samples to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

3. Did you collect any environmental samples for the study, such as water, air, dust, or soil samples?

• Yes

• N o (GO TO 4)

3a. How much time did you spend collecting your own environmental samples for the study?

• Far too much time

• A little too much time

• An acceptable amount of time

3b. How uncomfortable or comfortable did you feel collecting your own environmental samples?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

3c. How clearly did a study representative explain the process of collecting your own environmental samples?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

4. Did a study representative collect any biospecimens from you, such as blood, saliva, hair or nail clippings?

• Yes

• N o (GO TO 5)

4a. How much time did a study representative spend collecting biospecimens?

• Far too much time

• A little too much time

• An acceptable amount of time

4b. How uncomfortable or comfortable did you feel allowing a study representative collect biospecimens?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

4c. How clearly did a study representative explain the process of collecting biospecimens to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

5. Did you collect any of your own biospecimens for the study such as vaginal swabs or urine?

• Yes

• N o (GO TO 4)

5a. How much time did you spend collecting your own biospecimens for the study?

• Far too much time

• A little too much time

• An acceptable amount of time

5b. How uncomfortable or comfortable did you feel collecting your own biospecimens for the study?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

5c. How clearly did a study representative explain the process of collecting your own biospecimens to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

6. Did a study representative collect any physical measures form you, such as blood pressure, weight, or height?

• Yes

• N o (GO TO 7)

6a. How much time did a study representative spend collecting physical measures from you?

• Far too much time

• A little too much time

• An acceptable amount of time

6b. How uncomfortable or comfortable did you feel having a study representative collect physical measures?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

6c. How clearly did a study representative explain the process of collecting physical measures to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

7. Did you complete any paper questionnaires given to you by a study representative?

• Yes

• N o (GO TO 8)

7a. How much time did you spend on the paper questionnaires?

• Far too much time

• A little too much time

• An acceptable amount of time

7b. How uncomfortable or comfortable did you feel completing the paper questionnaires?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Comfortable

7c. How clearly did a study representative explain the paper questionnaires to you?

• Did not explain clearly at all

• Explained somewhat clearly

• Explain pretty clearly

• Explained very clearly

T3X. (T3 VERSION ONLY) At a previous visit, the study representative may have left a diary with you to help keep track of things between visits such as any illnesses you experienced, injuries, or medicines that you may have used.

If you received a diary, how difficult or easy was it to use the diary?

• Very difficult

• Somewhat difficult

• Somewhat easy

• Very easy

• I did not receive a diary

8. How important were each of the following in your decision to participate in this phase of the National Children’s Study?

	Not at all important	Not too important	Somewhat important	Very important
a. Receiving payments or gifts for your participation?	_____	_____	_____	_____
b. Learning more about your health or the health of your child?	_____	_____	_____	_____
c. Helping your child as he/she develops?	_____	_____	_____	_____
d. Getting medical information about myself or my child that I wouldn’t otherwise receive, including referrals to other doctors or specialists	_____	_____	_____	_____
e. Feeling as if you can help children now and in the future?	_____	_____	_____	_____
f. Contributing to science?	_____	_____	_____	_____
g. To help the environment	_____	_____	_____	_____
h. Feeling part of my community?	_____	_____	_____	_____
i. Knowing other people in the study?	_____	_____	_____	_____
j. Having family members or friends support your decision to participate in the study?	_____	_____	_____	_____
k. Having your doctor support your decision to participate?	_____	_____	_____	_____
l. Having a good relationship with the NCS researchers?	_____	_____	_____	_____

9. How much do each of the following people discourage or encourage your participation in the National Children’s Study?

	Very discouraging	Somewhat discouraging	Neither encouraging or discouraging	Somewhat encouraging	Very encouraging
a. Family members	_____	_____	_____	_____	_____
b. Friends	_____	_____	_____	_____	_____
c. Your doctor or healthcare provider	_____	_____	_____	_____	_____

T3Y. (T3 VERSION ONLY) How difficult or easy is it to schedule appointments for home or clinic visits?

• Very difficult

• Somewhat difficult

• Somewhat easy

• Very easy

T3Z. (T3 VERSION ONLY) How uncomfortable or comfortable are you at the NCS study center?

• Very uncomfortable

• Somewhat uncomfortable

• Somewhat comfortable

• Very comfortable

10. In general, how would you describe your experiences as a participant in the National Children’s Study?

• Very negative

• Somewhat negative

• Neither negative or positive

• Somewhat positive

• Very positive

11. Of all the study activities you participated in so far, which one did you like the most?

12. Is there anything we can do to make your participation in NCS more enjoyable?

13. In your opinion, how valuable do you think the National Children’s Study will be to the health and well being of children?

• Not at all valuable

• A little valuable

• Pretty valuable

• Very valuable

Thank you for taking the time to complete this questionnaire.

Please put your completed questionnaire in the envelope provided and return the questionnaire to the study representative before he or she leaves today. If the study representative leaves before you finish, or if you prefer, you can also return your completed questionnaire by mail using the postage-paid envelope.