Letter to Dr. Schwab

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

January 10, 2012

Margo Schwab, Ph.D.

Office of Management and Budget

725 17th Street, N.W.

Washington, DC 20503

Dear Dr. Schwab:

The staff of the NCHS Questionnaire Design Research Laboratory (QDRL) (OMB No. 0920-0222, exp. 03/31/2013) plans to conduct a field test of 575 Audio Computer-Assisted Self-Interview (ACASI) interviews for the National Health Interview Survey (NHIS) beginning March 1. The 575 case test is a follow-up to the 50 case test explained to you in a letter dated October 6, 2011 and which was conducted November 15-28. The purpose of this field test is to test specific sexual identity questions and to test ACASI interviews in a household interview setting.

Based on the results of the 50 case test, training for the field staff will be in-person rather than by self-study and the transition to ACASI has been improved. No changes were recommended to the questions on sexual identity.

Proposed project: National Health Interview Survey (NHIS) ACASI 575 Field Test

Limited data are currently available on health disparities that involve the Lesbian, Gay, Bisexual, and Transgender (LGBT) populations.  Many Healthy People 2010 objectives went unmeasured because most general health studies do not include questions on sexual identity and those that do are usually targeted to a specific health-related issue or population subgroup. The introduction of questions on sexual identity to ongoing surveys requires methodological development and testing to assure that the data collected are valid across all population subgroups and can be used for policy and program development and evaluation.  The objective of asking a question on sexual identity in the NHIS is to fill the tremendous gap that exists regarding knowledge of general health behaviors, health status, and health care utilization of LGBT persons.

The 50 case test focused on the programming of the ACASI portion of the questionnaire and the transition from orally administered to self-administered questions. The 575 case test will employ field procedures consistent with the production NHIS, providing a more realistic reflection of the field effort required to obtain completed ACASI interviews and respondent acceptability of ACASI.

Respondent debriefing questions are included in the 575 case test to better measure respondents’ perceived sense of privacy using ACASI, difficulties in using the computer and associated equipment (e.g., headphones) to complete the ACASI module, and difficulties in comprehending the questions that comprise the ACASI module.

The sample from the 575 case test can be matched to a comparable NHIS sample where the production survey was administered. This will enable comparisons of responses to content currently included in the NHIS sample adult module but moved to the ACASI module for the field tests. Comparisons of prevalence estimates, item nonresponse rates, administration times, and others will be conducted.

While not available for the 50 case test, audit trails capturing item times and respondent movement through the ACASI module will be enabled for the 575 case test. Analyses of audit trail data will further aid detection of usability issues encountered by respondents.

As many as 575 field interviews will be completed by Census Bureau Field Representatives (interviewers) who have experience conducting the NHIS. An important component of this test is the emulation of usual NHIS procedures. Each interviewer will be assigned roughly 10-12 sample cases and asked to work those cases as they would a normal NHIS caseload. Each assigned case will be worked for up to one month and receive a final case disposition (e.g., interview, nonresponse, out-of-scope). While the goal for this test is 500 completed interviews, we anticipate that as many as 575 completed interviews could be achieved as if each case is worked thoroughly. It is imperative that interviewers continue to work outstanding cases once the 500 goal is achieved. Interviews completed toward the end of an interview period often include more difficult respondents and it is important to ensure their representation in this test.

Interviews will be conducted in English and Spanish. No predetermined number of completed Spanish interviews will be set. However, sample cases are being drawn from geographic areas with high concentrations of Hispanic persons (South Florida, Texas, Arizona, South California, and New York), ensuring that a greater number of interviews will be completed in Spanish than with a more disbursed sample. Census has pre-identified addresses from unused NHIS sample for inclusion in this field test.

The 2011 NHIS Core and the proposed ACASI questions (including sexual identity questions) will be asked as part of the 575 case test. The administration of the 2011 NHIS Core and the ACASI questions will take approximately 60 minutes.

The 2011 NHIS Core is conducted using computer-assisted personal interviewing (CAPI). CAPI allows interviewers to read questions from the computer screen and enter the respondents’ responses directly into the computer during the interview. Due to the length of the 2011 NHIS Core we have not included it in this package. However, it can be accessed online at http://www.cdc.gov/nchs/nhis.htm. The proposed ACASI questions will be administered directly after the 2011 NHIS Core. ACASI allows respondents to listen to prerecorded questions from the laptop computer through headphones and record their responses using the laptop computer. Respondents may or may not simultaneously read the questions from the computer screen. See Attachment 1 for the sexual identity question and other proposed ACASI questions.

Census interviewers will use the same procedures as used in the production NHIS to explain the survey and acquire informed consent (via the NHIS Advance Letter) using the HIS-100C, January 2011, Manual for NHIS Field Representatives. See Attachment 2 for excerpted pages A-10 through A-14 explaining the survey. The entire NHIS Field Representatives Manual can be accessed on NHIS’ webpage at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2011/frmanual.pdf. See Attachment 3 for the NHIS production advance letter to be used for the 575 case test.

Respondents will not be remunerated for participation. Interviews will not be taped.

In total, for this project, the maximum respondent burden will be 575 hours of interviewing. A burden table for this project is shown below:

Projects	Number of Participants	Number of Responses/ Participant	Average hours per response	Response burden
QDRL Interviews
3) Research on the effects of alternative questionnaire design	575	1	1	575

Attachment (3)

cc:

M. Moien

T. Richardson

DHHS RCO

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