CATI Option for Survey of Health Behaviors

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

CATI INTRODUCTORY SCRIPT

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including 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: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-XXXX).

[CALL INTRODUCTION]

Hello, my name is <name>, and I am calling on behalf of the Centers for Disease Control and Prevention (CDC). May I speak with <first and last name of potential participant>? Hi [Ms./Mr.] <last name>, researchers at CDC are conducting a study called the “survey of health behaviors” among men and women who have been previously diagnosed with colon or rectal cancer. Macro International is the agency responsible for collecting data for this study.

<If participant asks how you got their number:

We received your name and contact information from the State of California Cancer Registry. As you may know, doctors are required to inform the state cancer registry any time they diagnose a patient with cancer and the registry stores this information in their records. CDC worked with the California Cancer Registry to identify survivors of colon or rectal cancer. Your name was randomly selected from the California Cancer Registry database.

<If caller asks about who is conducting the interview:

I’m calling from Macro International Inc., a private health research and consulting firm, on behalf of the Centers for Disease Control and Prevention (CDC). CDC has contracted us to collect information for their study on health behaviors. >

Several weeks ago we mailed you an invitation packet that included the Survey of Health Behaviors. I am calling today because we have not received your completed survey and we are concerned that you either did not receive this important survey or that you had difficulty completing it.

1. Did you receive a copy of the CDC’s “Survey of Health Behaviors”?

___ Yes [go to 2A]

___ No [go to 2B]

2A. Have you had a chance to complete the survey?

___ Yes [go to 3A]

___ No [go to 3B]

2B. I’m sorry you did not receive that packet. Could we verify that your current mailing address is [READ ALOUD RESPONDENTS ADDRESS]?

___ Yes, address is correct (go to 3B)

___ No, address is incorrect (go to 3C)

___ Refuse to verify (go to 3C)

3A. Thank you. Your participation is very important to us and to our understanding of the experiences of people who have had colorectal cancer. If you haven’t already, can you please place the completed survey in the self-addressed envelope and place it in your outgoing mail today or tomorrow? If you cannot find your return envelope, I can send one to you. [If they need a return envelope, verify address then terminate call]

3B. Thank you. Your participation is very important to us and to our understanding of the experiences of people who have had colorectal cancer. Would you be willing to complete the survey now over the phone?

___ Yes (go to 4A)

___ No (go to 4B)

____Ref (go to 4C)

3C. Your participation in this study is very important to us. I can tell you about the study and conduct the survey with you now while you are on the phone or, if you prefer, we can mail you the survey packet and you can complete it and mail it back to us at our expense.

We will send you a $10 cash incentive; however, we will need your correct mailing address. We assure you that your address will be kept private and will only be used for the purposes of this study.

Would you be willing to tell me your correct mailing address?

___ Yes (RECORD ADDRESS, THEN go to 3D)

___ No, but I will participate on the phone (go to 4A)

___ No, not interested (go to 4C)

3D. Thank you. Would you be willing to complete the survey now over the phone?

___ Yes (go to 4A)

___ No (go to 4B)

____Ref (go to 4C)

4A. The survey should take about 40 minutes to complete. It asks about your previous and current health, medical care, health habits, and challenges to living a healthy lifestyle. Some of the questions are sensitive in nature but any information we gather will be treated in a confidential manner unless otherwise required by law.

Do you have any questions or concerns before we start? [RECORD & ANSWER ANY QUESTIONS.]

___Yes (Record, then go to 5A)

___No (go to 5A)

4B. We can schedule another time to complete the survey over the phone or you can complete and return the survey by mail. What would you like to do?

___ schedule another call (go to 5B)

___ complete the survey by mail (go to 5C)

___ Refuses (go to 4C)

4C. Thank you for your time. Can you please share with me any reasons why you are not interested so that we may better understand the reasons why some people choose not to participate in the survey?

___Yes (go to 4Ca)

___No (go to 4Cb)

___DK (go to 4Cb)

___REF (go to 4Cb)

4Ca. [CODE REASON]

1) NO TIME (TERM)

2) DOESN’T WANT TO DISCUSS (TERM)

1. TOO PERSONAL (TERM)

2. TOO PAINFUL TO TALK ABOUT (TERM)

3. OTHER ____(RECORD then go to TERM)

77 DK (TERM)

99 REF (TERM)

4Cb. Thank you again. If you change your mind and want to complete the survey, please call 1-800-XXX-XXXX.

5A. CONSENT

Before I begin the survey, I will need your verbal consent to participate in the study.

The purpose of this study is to learn about the health habits of men and women who are survivors of colon or rectal cancer.

If you participate, you will be asked a series of questions about your health behaviors, cancer-related medical history, and thoughts, attitudes, and beliefs about health habits and your future health.

The survey will take approximately 40 minutes to complete.

There is little risk in taking part; however, you might feel uncomfortable answering questions about your past experiences with illness, your current health-related habits, or your thoughts and beliefs about your health in the future. If I ask any questions you do not want to answer, tell me and I will skip them.

You may not directly benefit from answering our questions, but your answers will help researchers and medical providers understand more about the challenges faced by cancer survivors. The results may also help us find ways to achieve better long-term outcomes for cancer survivors.

This call may be monitored for quality assurance purposes, but what you say will be kept private to the extent allowed by law. Your answers will be kept separate from your name or any other personal information. We will never use your name in any report. We will always combine your answers with answers from other participants when we write reports or papers.

Participation is your choice. You may refuse to participate or drop out at any time. The decision to participate or not participate in the research project will not affect your access to present or future care.

If you have questions about this study, would like to be removed from this study, or think you may have been harmed by the study, you may contact Dr. Samantha Walker, study coordinator at Macro, at (404) 321-3211 or toll free at 1-800-###-####.

If you have a question about your rights as a research volunteer you may contact CDC’s Deputy Associate Director for Science at 1-800-584-8814. Leave a message with your name, phone number, and refer to CDC protocol #####, and someone will call you back.

Would you like me to repeat any of these numbers?

I will also read you the Participant’s Bill of Rights for Non-Medical Research.

You have been asked to participate in a research study. Any participant in a research study has the right to:

a) Be told the nature and purpose of the study.

b) Be given an explanation of what will happen during the study and of how the research participant is expected to participate.

c) Be given an explanation of any risks or discomforts that may be experienced as a result of participating in the study.

d) Be given an explanation of any benefits that may be expected from participation in the study.

e) Be told of other appropriate choices that may be better or worse than being in the study, and be told of the risks and benefits of those other choices.

f) Have the opportunity to ask questions about the study or about your participation in it, both before agreeing to participate in the study and during the course of the study.

g) Be told that you may withdraw your consent and participation in the study at any time, and that your withdrawal will not affect your services.

h) Be told that you may refuse to answer any question.

i) Be given a copy of the consent form.

j) Be free of pressure when considering whether to consent to, and participate in, the study.

k) Be informed, upon request, about the results of the study.

Do you give your verbal consent to participate in this study?

___Yes

___No/REFUSE

[IF YES]: Thank you.

Do you have any questions? Ok, Let’s begin the survey. [BEGIN SURVEY.]

[IF NO/REFUSE]: Thank you for your time. If you change your mind, please call 1-800-XXX-XXXX.

5B. SCHEDULE CALL BACK

Ok, when would be a good time for you to complete the survey? We could schedule a specific appointment if that would be helpful. [SCHEDULE CALL THEN TERMINATE]

5C. Do you have a copy of the survey and return envelope we mailed to you or do you need another copy?

___ I have a copy (go to 6A)

___ I need a copy (go to 6B)

___ DK/NS (go to 6B)

6A. Ok, please complete and return the survey in the mail as soon as possible. We appreciate your time and look forward to hearing from you. [TERMINATE]

6B. I will mail you another copy but let me first check that we have your correct mailing address. Is your current mailing address [READ ALOUD RESPONDENTS ADDRESS]?

___ Yes (continue)

___ No (get correct address, then continue)

Ok, I will mail another survey packet to you. When you receive it, please complete it and return it in the mail as soon as possible. We appreciate your time and look forward to hearing from you.

[TERMINATE]