1 Survey

Appendix A A.1.1.a–0

Visit Type: Enumeration

Target: Adult Household Member

Participant Evaluation Questionnaire

NATIONAL CHILDREN’S STUDY

Participant Evaluation Questionnaire

(08/21/2008)

Thank you for participating in the National Children’s Study. We would appreciate you taking a few minutes to answer questions about your experience in the study.

1. Before starting the interview part of the visit, the study representative explained all the different things included in the visit. How much did that explanation help prepare you for what actually happened during the visit?

• Not at all

• A little

• Some

• A lot

2. In your opinion, how well did the study representative or the materials we provided explain each of the activities listed below?

	Not at all well	Somewhat well	Very well	Did not complete
a. Measuring your weight	_____	_____	_____	_____
b. Measuring your arm, head and the skin on the back of your arm and upper back	_____	_____	_____	_____
c. Giving a blood sample.	_____	_____	_____	_____
d. Taking the urine sample that you did on your own.	_____	_____	_____	_____
e. Taking the vaginal swabs that you did on your own	_____	_____	_____	_____
f. Allowing the study representative to walk around the inside and outside of your home and fill out an observation form.	_____	_____	_____	_____
g. Vacuuming small areas of your home.	_____	_____	_____	_____

2. In general, would you say the amount of time you spent on all the activities you took part in was…

• Far too long

• A little too long

• About the right length

3. How important was each of the following in your decision to take part in the National Children’s Study?

	Not at all Important	Somewhat Important	Very Important
a. Receiving money or gifts for taking part in the study?	_____	_____	_____
b. Learning more about my health or the health of my child?	_____	_____	_____
c. Helping my child as he or she grows?	_____	_____	_____
d. Getting health information about myself or my child, including referrals to other doctors or specialists?	_____	_____	_____
e. Feeling as if I can help children now and in the future?	_____	_____	_____
f. Helping doctors and researchers learn more about children and their health?	_____	_____	_____
g. Helping the environment?	_____	_____	_____
h. Feeling part of my community?	_____	_____	_____
i. Knowing other women in the study?	_____	_____	_____
j. Having family members or friends support my choice to take part in the study?	_____	_____	_____
k. Having my doctor or health care provider support my choice to take part in the study?	_____	_____	_____
l. Feeling comfortable with the study staff who come to my home?	_____	_____	_____

4. How negative or positive do each of the following people feel about you taking part in the National Children’s Study?

	Very Negative	Somewhat Negative	Neither Positive or Negative	Somewhat Positive	Very Positive
a. Your family members	_____	_____	_____	_____	_____
b. Your friends	_____	_____	_____	_____	_____
c. Your doctor or health care provider	_____	_____	_____	_____	_____

5. In general, has your experience with the National Children’s Study been…

• Mostly negative

• Somewhat negative

• Neither negative or positive

• Somewhat positive

• Mostly positive

6. Of all the study activities you took part in so far, which one did you like the most and why?

7. Is there anything we can do to make the study more enjoyable for you and other people who join?

8. In your opinion, how much do you think the National Children’s Study will help improve the health of children now and in the future?

• Not at all

• A little

• Some

• A lot

Thank you for taking the time to complete this questionnaire. Please put your completed questionnaire in the envelope provided and return the questionnaire to the study representative before he or she leaves today. If the study representative leaves before you finish or if you prefer, you also can return your completed questionnaire by mail using the postage-paid envelope.

Completion of this form is voluntary. If you do not complete it, your participation in the National Children’s Study will not be affected. As with all other study activities, the information you provide will be kept confidential and used only for study purposes.

Revised 7/2/08