Check-in Questions

Form Approved:

OMB No. 0920-0840

Expiration Date: 01/31/2013

Attach 2 Field Assessment Telephone Check-in Questions

Public reporting burden of this collection of information is estimated to average 15 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0840)

Introduction

Hello, my name is [state your name] and I work at the Battelle Centers for Public Health Research and Evaluation. We are working with the Centers for Disease Control and Prevention to obtain feedback about your impressions of the Comprehensive Hepatitis C Counseling and Testing manual that we have provided you with.

[During the first check in call ask the following:]

Have you received the manual and the accompanying informed consent document?

Do you have any questions about the informed consent document or your participation in the field assessment?

[Answer any questions that the participant may have]

Your participation is entirely voluntary. If at any time you do not want to answer one of my questions or don’t want to continue talking about something, please tell me and we will move on and not go back to it. We can also stop at any time if you wish. The information that you provide will be combined with the information that we receive from persons in other venues and you will not be identified by name or description in any reports.

Would you be willing to participate?

Check-in Questions

• Please tell me a little about your experience with reviewing (or using)the Hepatitis C counseling and testing manual in the past week:

  • Have you had a chance to look through it?

  • Have you had a chance to use it?

• What do you think about the testing and counseling process presented in the manual?

• What do you think about the organization and format of the modules?

• Please indicate how much of [The Hepatitis C manual] you read and used? [mark only one] • I have not read it or used it• I glanced at it and tried to use it• I have read all or most of it and have used it multiple times• I read it and have gone back to re-read a section or look something up

• Do you have any questions for me about the manual?