Appendix I_IPV_Workplace_OMB_Package_10_21_07

Appendix I:     Pilot Test Feedback Form

Evaluation of Workplace Interventions Designed to Prevent

Intimate Partner Violence (IPV)

DEBRIEFING QUESTIONS

1. Did you have any difficulty understanding the recruitment e-maileither the language or what you were agreeing to? If so, what was confusing?

2. Please tell me in your own words what you understood the purpose of the study to be after reading the recruitment e-mail and introductory page on the survey website.

3. Were there any questions in the interview you didn’t understand? SPECIFY

4. Were there any questions that were hard to answer because you couldn't remember the needed information? SPECIFY

5. When we asked you about your productivity during work hours in the past 4 weeks, was it difficult to answer those questions? If so, in what way was it difficult?

6. We asked a lot of questions that required you to say how often you had different relationship experiences, including domestic violence, over the past year. How did you come up with your answers? Did you think back to each individual time and count them all up, or did you try to guess or estimate?

7. When we asked you hypothetical questions about actions you would take if you were a victim of domestic violence or knew someone who was, was it difficult to answer those questions? How did you come up with your answers?

8. Were there any questions that upset you? SPECIFY

9. Were there any questions that you felt did not apply to you or your situation? SPECIFY

10. Do you think we asked all the important questions, or are there other things that you think should be covered?

11. Are there any questions that you think people will not answer honestly?

12. How did you feel about the length of the interview? Did you stay interested the whole time, or was there a point at which you just wanted it to be over? [SPECIFY THE POINT AT WHICH IT BECAME TOO LONG.]

13. Imagine that you were offered a chance to win one of 150 gift certificates for $100 as a thank you for completing this survey again in six months. Would you be willing to participate? Why or why not?