OMB #: 0925-0593
Expiration Date: xx/xxxx
JULY LAUNCH VERSION
VERSION 6/7/2010
ASSUME PRE-PREGNANCY VISIT WAS
ADMINISTERED UNLESS NOTED
Recruitment Strategy Substudy
Pregnancy Probability Group Follow Up
CATI Instrument
TABLE OF CONTENTS
CATI
1. PREGNANCY SCREENER
2. TRACING QUESTIONS
DOCUMENT HISTORY
DATE |
VERSION |
SUMMARY OF CHANGE/MILESTONE |
5/20/2010 |
CATI_v1 |
Schoendorf draft with Graber’s programming and operational content |
5/20/2010 |
20100520 |
Formatted for IRB; modification of (STATUS) PPG_GROUP=5 language; yet to apply to all relevant instruments; add in tracing questions. |
5/21/2010 |
20100520_jg_edits |
Modified tracing items. |
5/21/2010 |
20100521 |
Accepted Graber’s comments; tweak of phone number item. |
5/24/2010 |
20100521 |
INFORMAL SUBMISSION TO OMB |
5/26/2010 |
20100526 |
Additional comments from Jessica |
5/26/2010 |
20100526 |
INCORPORATE COMMENTS FROM OMB (no changes) |
5/27/2010 |
20100527 |
Revised closing scripts |
5/28/2010 |
20100527 |
Comments from SDSU |
6/3/2010 |
20100603 |
Incorporated changes from Program Office Staff and checked for eligibility-related language |
6/7/2010 |
20100607 |
Accepted changes from previous version |
6/7/2010 |
20100607a |
Incorporate changes from J. Slutsman |
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COMMENTS FROM HIRSCHFELD |
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RECONCILE WITH DATA ELEMENTS TABLES |
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FORMAL SUBMISSION TO OMB |
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INCORPORATE COMMENTS FROM OMB |
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SUBMIT TO NICHD IRB |
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RECONCILE WITH DATA ELEMENTS TABLES |
NOTE: Italics denote anticipated development stages
CATI
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PG001 |
/ |
(TIME_STAMP_1) |
PROGRAMMER INSTRUCTIONS: ENTER DATE/TIME STAMP
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PG002 |
Hello. My name is [INTERVIEWER FIRST AND LAST NAME] from the National Children’s Study. It’s been a few months since we have spoken with you.
We’re following up with women of childbearing age and our first questions are always about pregnancy. We first want to know…
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PG003 |
/ |
(PREGNANT) |
Are you pregnant now?
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YES |
………………………. |
1 |
PG005 |
/ |
(PPG_DUE_DATE_1) |
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NO |
………………………. |
2 |
PG004 |
/ |
(TRYING) |
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RECENTLY LOST PREGNANCY (MISCARRIAGE OR ABORTION |
………………………. |
3 |
PG010 |
/ |
(MED_UNABLE) |
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RECENTLY GAVE BIRTH |
………………………. |
4 |
PG011 |
/ |
(STATUS) |
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UNABLE TO HAVE CHILDREN (E.G., HYSTERECTOMY, TUBAL LIGATION) |
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5 |
PG010 |
/ |
(MED_UNABLE) |
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REFUSED |
………………………. |
-1 |
PG004 |
/ |
(TRYING) |
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DON’T KNOW |
………………………. |
-2 |
PG004 |
/ |
(TRYING) |
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INTERVIEWER INSTRUCTIONS: ENTER “YES” EVEN IF R IS UNSURE THAT SHE IS PREGNANT |
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PROGRAMMER INSTRUCTIONS:
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PG004 |
/ |
(TRYING) |
Are you currently trying to become pregnant?
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YES |
………………………. |
1 |
PG010 |
/ |
(MED_UNABLE) |
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NO |
………………………. |
2 |
PG010 |
/ |
(MED_UNABLE) |
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RECENTLY LOST PREGNANCY (MISCARRIAGE OR ABORTION |
………………………. |
3 |
PG011 |
/ |
(STATUS) |
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RECENTLY GAVE BIRTH |
………………………. |
4 |
PG011 |
/ |
(STATUS) |
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UNABLE TO HAVE CHILDREN (E.G., HYSTERECTOMY, TUBAL LIGATION) |
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5 |
PG010 |
/ |
(MED_UNABLE) |
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REFUSED |
………………………. |
-1 |
PG010 |
/ |
(MED_UNABLE) |
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DON’T KNOW |
………………………. |
-2 |
PG010 |
/ |
(MED_UNABLE) |
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INTERVIEWER INSTRUCTIONS: DO NOT DEFINE “TRYING TO BECOME PREGNANT” |
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PROGRAMMER INSTRUCTIONS:
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PG005 |
/ |
(PPG_DUE_DATE_1) |
[Congratulations.] When is your baby due?
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__ __ / __ __/ __ __ __ __
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………………………. |
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PG011 |
/ |
(STATUS) |
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M M D D Y Y Y Y |
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REFUSED |
………………………. |
-1 |
PG006 |
/ |
(DATE_PERIOD) |
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DON’T KNOW |
………………………. |
-2 |
PG006 |
/ |
(DATE_PERIOD) |
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INTERVIEWER INSTRUCTIONS: ENTER A TWO DIGIT MONTH, TWO DIGIT DAY, AND A FOUR DIGIT YEAR. |
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PROGRAMMER INSTRUCTIONS: SO SOFT EDIT:
HARD EDIT:
IF DATE IS COMPLETE, SET (PPG_DUE_DATE_2) TO DATE PROVIDED; ELSE GO TO (DATE_PERIOD) |
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PG006 |
/ |
(DATE_PERIOD) |
What was the first day of your last menstrual period?
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__ __ / __ __/ __ __ __ __
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………………………. |
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PG011 |
/ |
(STATUS) |
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M M D D Y Y Y Y |
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REFUSED |
………………………. |
-1 |
PG007 |
/ |
(WEEKS_PREG) |
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DON’T KNOW |
………………………. |
-2 |
PG007 |
/ |
(WEEKS_PREG) |
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INTERVIEWER INSTRUCTIONS: ENTER A TWO DIGIT MONTH, TWO DIGIT DAY, AND A FOUR DIGIT YEAR. |
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PROGRAMMER INSTRUCTIONS: SO HARD EDIT:
IF DATE IS COMPLETE, CALCULATE DUE DATE FROM FIRST DATE OF LAST MENSTRUAL PERIOD, WHERE (PPG_DUE_DATE_2) = (DATE_PERIOD) + 280 DAYS)) ; ELSE GO TO (WEEKS_PREG) |
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PG007 |
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(WEEKS_PREG) |
How many weeks pregnant are you now? If you’re not sure, please make your best guess.
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__ __
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………………………. |
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PG011 |
/ |
(STATUS) |
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NUMBER OF WEEKS |
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REFUSED |
………………………. |
-1 |
PG008 |
/ |
(MONTHS_PREG) |
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DON’T KNOW |
………………………. |
-2 |
PG008 |
/ |
(MONTHS_PREG) |
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PROGRAMMER INSTRUCTIONS: SO
IF DATE IS COMPLETE, CALCULATE DUE DATE FROM NUMBER OF WEEKS PREGNANT, WHERE (PPG_DUE_DATE_2) = TODAY’S DATE + (280 DAYS – (WEEKS_PREG)*7); ELSE GO TO (MONTHS_PREG) |
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PG008 |
/ |
(MONTHS_PREG) |
About how many months pregnant are you? If you’re not sure, please make your best guess.
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__ __
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………………………. |
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PG011 |
/ |
(STATUS) |
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NUMBER OF MONTHS |
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REFUSED |
………………………. |
-1 |
PG009 |
/ |
(TRIMESTER) |
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DON’T KNOW |
………………………. |
-2 |
PG009 |
/ |
(TRIMESTER) |
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PROGRAMMER INSTRUCTIONS: SO
IF DATE IS COMPLETE, CALCULATE DUE DATE FROM NUMBER OF MONTHS PREGNANT, WHERE (PPG_DUE_DATE_2) = TODAY’S DATE + (280 DAYS – (MONTHS_PREG)*30 - 15) ; ELSE GO TO (TRIMESTER) |
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PG009 |
/ |
(TRIMESTER) |
Are you currently in your First, Second, or Third trimester?
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1ST (1 to 3 months pregnant) |
………………………. |
1 |
PG011 |
/ |
(STATUS) |
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2ND (4 to 6 months pregnant) |
………………………. |
2 |
PG011 |
/ |
(STATUS) |
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3RD (7 to 9 months pregnant) |
………………………. |
3 |
PG011 |
/ |
(STATUS) |
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REFUSED |
………………………. |
-1 |
PG011 |
/ |
(STATUS) |
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DON’T KNOW |
………………………. |
-2 |
PG011 |
/ |
(STATUS) |
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PROGRAMMER INSTRUCTIONS:
REFERENCE CODE LIST: TRIMESTER_CL1 SO CALCULATE DUE DATE FROM (TRIMESTER),
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PG010 |
/ |
(MED_UNABLE) |
Do any of the following apply to you? Have you had:
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YES |
………………………. |
1 |
PG011 |
/ |
(STATUS) |
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NO |
………………………. |
2 |
PG011 |
/ |
(STATUS) |
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REFUSED |
………………………. |
-1 |
PG011 |
/ |
(STATUS) |
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DON’T KNOW |
………………………. |
-2 |
PG011 |
/ |
(STATUS) |
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PROGRAMMER INSTRUCTIONS:
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PG011 |
/ |
(STATUS) |
Are yo
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IF PPG_GROUP =1 |
[Congratulations again on your pregnancy.] We would like to set up a time to talk about the National Children’s Study. If you have any other questions before that time, please call xxx-xxx-xxxx, which is XXX’s local toll free National Children’s Study office. Thank you for taking time to answer these questions.
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PG012 |
/ |
(TIME_STAMP_2) |
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IF PPG_GROUP =2 |
We will call you again in a couple of months to ask a few quick questions. If you find out that you’re pregnant before our next call, please call xxx-xxx-xxxx, which is XXX’s local toll free National Children’s Study office. Thank you for taking time to answer these questions. .
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PG012 |
/ |
(TIME_STAMP_2) |
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IF PPG_GROUP =3 |
[I’m so sorry to hear that you’ve lost your baby. I know this can be a hard time.] Because your address is in the study area, we may be back in touch at a later time to update your household information. If you have any other questions before that time, please call xxx-xxx-xxxx, which is XXX’s local toll free National Children’s Study office. Thank you for taking time to answer these questions.
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PG012 |
/ |
(TIME_STAMP_2) |
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IF PPG_GROUP =4 |
We will call you again in a couple of months to ask a few quick questions. If you have any other questions before that time, please call xxx-xxx-xxxx, which is XXX’s local toll free National Children’s Study office. Thank you for taking time to answer these questions. |
PG012 |
/ |
(TIME_STAMP_2) |
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IF PPG_GROUP =5 |
Based on what you’ve told me, we will not ask you to take part in the study at this time. We may be back in touch at a later time to update your household information. If you have any other questions before that time, please call xxx-xxx-xxxx, which is XXX’s local toll free National Children’s Study office. Thank you for taking time to answer these questions. |
PG012 |
/ |
(TIME_STAMP_2) |
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INTERVIEWER INSTRUCTIONS: READ APPROPRIATE PPG SCRIPT |
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PROGRAMMER INSTRUCTIONS:
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PG012 |
/ |
(TIME_STAMP_2) |
PROGRAMMER INSTRUCTIONS: ENTER DATE/TIME STAMP |
TR001 |
/ |
(BST_NMBR) |
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TR001. |
/ |
(BST_NMBR) |
Just to confirm, is this the best phone number to reach you?
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YES |
………………………. |
1 |
TR004. |
/ |
(TIME_STAMP_3) |
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NO |
………………………. |
2 |
TR002 |
/ |
(PHONE_NBR) |
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REFUSED |
………………………. |
-1 |
TR004. |
/ |
(TIME_STAMP_3) |
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DON’T KNOW |
………………………. |
-2 |
TR004. |
/ |
(TIME_STAMP_3) |
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TR002. |
/ |
(PHONE_NBR) |
What is the best phone number to reach you?
ENTER PHONE NUMBER AND CONFIRM. |___|___|___| - |___|___|___| - |___|___|___|___| |
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RESPONDENT PROVIDED TELEPHONE NUMBER |
………………………. |
1 |
TR003 |
|
(PHONE_TYPE) |
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|
RESPONDENT HAS NO TELEPHONE |
………………………. |
-8 |
TR004 |
/ |
(TIME_STAMP_3) |
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REFUSED |
………………………. |
-1 |
TR004. |
/ |
(TIME_STAMP_3) |
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DON’T KNOW |
………………………. |
-2 |
TR004. |
/ |
(TIME_STAMP_3) |
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TR003. |
/ |
(PHONE_TYPE) |
Is that your home, work, cell, or another phone number?
CONFIRM IF KNOWN. |
|
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|
HOME |
………………………. |
1 |
TR004. |
/ |
(TIME_STAMP_3) |
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WORK |
………………………. |
2 |
TR004. |
/ |
(TIME_STAMP_3) |
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CELL |
………………………. |
3 |
TR004. |
/ |
(TIME_STAMP_3) |
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FRIEND/RELATIVE |
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4 |
TR004. |
/ |
(TIME_STAMP_3) |
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OTHER |
|
5 |
TR004. |
/ |
(TIME_STAMP_3) |
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REFUSED |
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-1 |
TR004. |
/ |
(TIME_STAMP_3) |
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DON’T KNOW |
|
-2 |
TR004. |
/ |
(TIME_STAMP_3) |
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TR004. |
/ |
(TIME_STAMP_3) |
PROGRAMMER INSTRUCTIONS: ENTER DATE/TIME STAMP |
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|
TR005. Thank you for participating in the National Children’s Study and for taking the time to answer our questions.
Public reporting burden for this collection of information is estimated to average 5 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593). Do not return the completed form to this address.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | graberje |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |