Appendix C1 - Questionnaire Administration Guide - NYPANS Only

C1. Questionnaire Administration Guide – NYPANS only

Form Approved

OMB No.: 0920-xxxx

Expiration Date: xx-xx-xxxx

Survey

DATA COLLECTOR SURVEY ADMINISTRATION GUIDE

NATIONAL YOUTH PHYSICAL ACTIVITY AND NUTRITION SURVEY

STEP 1 - VERIFY THAT ALL ASSEMBLED STUDENTS HAVE COMPLETED APPROPRIATE PERMISSION FORM PROCESS REQUIRED FOR THIS SCHOOL AND THAT NONPARTICIPATING STUDENTS (IF ANY) HAVE AN ALTERNATE ACTIVITY.

STEP 2 - AFTER STUDENTS ARE SEATED, DISTRIBUTE (OR ASK TEACHERS TO DISTRIBUTE) PENCILS. DO NOT DISTRIBUTE QUESTIONNAIRE BOOKLETS OR STUDENT CONTACT FORMS.

STEP 3 - INTRODUCE YOURSELF AND THE SURVEY TO THE CLASS.

Good (morning/afternoon). I’d like to thank each of you for participating in the National Youth Physical Activity and Nutrition Survey on behalf of the Centers for Disease Control and Prevention (also known as CDC). Participating in this survey is voluntary and your grade in this class will not be affected whether or not you answer the questions. However, only a limited number of students like yourselves are participating in this survey in schools all over the country. The answers you give are very important so our results are accurate.

I would like to emphasize that this is not a test of you or this school. In order to develop better education programs, educators, and health officials must find out about the physical activity and dietary habits of students like yourselves.

You will be asked to complete the National Youth Physical Activity and Nutrition Survey today. On [DATE], I will return to your school to measure your height and weight. This will be done in a private location, not in your classroom.

Your participation in the survey is completely anonymous. Your name will never be linked to your answers. You should not write your name on the questionnaire. However, in order to make sure each student completes both parts of the data collection, you will be asked today to print your first and last names on a manila envelope that contains a form I will use to record your height and weight when I return. Before that form is filled out with your height and weight, you will be asked to destroy the envelope that has your name on it. Once the data collection is completed, there will be no way to link your information back to you.

Public reporting burden for this collection of information is estimated to average 45 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 Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:PRA (0920-XXXX)

STEP 4 - DISTRIBUTE QUESTIONNAIRES/STUDENT ENVELOPES. EMPHASIZE PRIVACY/ ANONYMITY.

I would like you to open your envelope. You will find 2 manila envelopes inside. Remove the envelope marked “Questionnaire” and place that to the side. Remove the remaining envelope marked “H/W.” Print your first and last names across the seal on the back of the envelope. When you have completed this, raise your hand and I will collect your envelope.

COLLECT H/W ENVELOPES AS STUDENTS SIGN THEM

STEP 5 - INSTRUCT THE CLASS IN FILLING OUT QUESTIONNAIRE.

Now I would like you to look inside the envelope labeled “Questionnaire” and remove the survey booklet. Please take a moment to read the instructions on the front cover of the questionnaire.

PAUSE TO ALLOW STUDENTS TO READ THE INSTRUCTIONS

Use the No. 2 pencil you have been given to fill out this survey. Do not use a pen or some other pencil. Do not write your name on the survey booklet. Notice that for each question on the survey, there is a corresponding set of ovals. For each question, choose the answer that best fits what you know, feel, or do, then fill in the corresponding oval. If you must change an answer, erase your old answer completely.

When you are finished with the survey, look over your booklet to make sure that you haven’t skipped any questions. We have allowed 35 minutes for completing the survey. If you finish before that time, place your survey booklet in the envelope, seal it, and stay seated until I ask you to turn it in. It is important that you answer the questions based on what you really know, believe, and do. Don’t pick a response just because you think that’s what someone wants you to say. Your teacher and I are not allowed to answer any questions. Simply do the best that you can. Please begin.

NOTE TO DATA COLLECTOR:

(DO NOT READ ALOUD TO STUDENTS)

While students are taking the survey, work with the teacher to complete the Data Collection Checklist, Make-up list, and confirm that you have a H/W envelope for each student taking the survey. Fill out the label on the front of the class envelope. Remember when calculating the enrollment, do not count students who are on the rolls but for all practical purposes have dropped out, are on suspension, or are on extended medical absence. Please write down the number of booklets enclosed.

STEP 6 - AT THE END OF CLASS PERIOD, COLLECT QUESTIONNAIRES.

STEP 7 - THANK PARTICIPANTS.

I would like to thank all of you for participating in this survey. The information you have provided will be used to develop better health education programs for students like yourselves all around the nation.

STEP 8 - THANK THE TEACHER.