Questionnaire for English/Chinese Cognitive Interviewing Project:
First, how many people are now living or staying in your house, apartment, or mobile home?
_________________________________
2. What is your ancestry or ethnic origin?
__________________________________
3. In general, would you say your health is…
[ ] Excellent
[ ] Very good
[ ] Good
[ ] Fair, or
[ ] Poor?
4. How many servings of fruits and vegetables do you think the average adult should eat each day for good health? (HINTS 2007-F3)
____________________________________
5. Not including psychiatrists and other mental health professionals, is there a particular doctor, nurse, or other health professional that you see most often?
[ ] Yes
[ ] No
6. Some people avoid visiting their doctor even when they suspect they should. Would you say this is true for you, or not true for you?
[ ] True
[ ] Not true
7. This question is about your communication with all doctors, nurses, or other health professionals you saw during the past 12 months. How often did they help you deal with feelings of uncertainty about your health or health care?
[ ] Always
[ ] Often
[ ] Sometimes
[ ] Never
8. The next questions are about cancer.
How much do you agree or disagree with the following statement - There’s not much you can do to lower your chances of getting cancer. Do you strongly agree, agree somewhat, disagree somewhat, or strongly disagree?
[ ] Strongly agree
[ ] Somewhat agree
[ ] Somewhat disagree
[ ] Strongly disagree
9. If you were given a genetic testing for your risk of cancer today, would you get it?
[ ] Yes
[ ] No
10. Finally -- Do you ever go on-line to access the Internet or World Wide Web, or to send and receive e-mail?
[ ] Yes
[ ] No
File Type | application/msword |
Author | Bureau Of The Census |
Last Modified By | Bureau Of The Census |
File Modified | 2009-03-03 |
File Created | 2009-03-03 |