Parent Survey

Evaluation of the Summer Food Service Program Enhancement Demonstrations

H1. eSFSP 2011 R1 MEAL DELIVERY QUEST 6-10-2011

Parent Survey

OMB: 0584-0560

Document [doc]
Download: doc | pdf


OMB Control # 0584-NEW

Expiration Date: xx/xx/20xx


Public reporting burden for this collection of information is estimated to average 30 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: U.S. Department of Agriculture, Food and Nutrition Services, Office of Research and Analysis, 3101 Park Center Drive, Room 1014, Alexandria, VA 22302 ATTN: PRA (0584-xxxx*). Do not return the completed form to this address.


MEAL DELIVERY PROGRAM

PARENT QUESTIONNAIRE SUMMER 2011 (Round 1)



INTRODUCTION


NOTE: Interviews will be conducted with primary care giver or other adult who can answer questions about children in the household.


INTRO1: Hello, may I speak to [NAMED ADULT FROM SAMPLE FILE]?


Yes/speaking or available Continue

No INTRO4



INTRO2: My name is ______________ and I’m calling on behalf of the [PROGRAM]. Our records show that one or more children from your household is taking part in this program and we’d like to ask you some questions about this. Are you familiar with your child(ren)’s participation in this program?


Yes START

No Continue



INTRO3: May I speak to an adult in this household who is familiar with this program?


Knowledgeable adult available INTRO2 [TO NEW ADULT]

Adult not available Collect first name and schedule call-back



INTRO4: My name is ______________ and I’m calling on behalf of the [PROGRAM]. Our records show that one or more children from your household is taking part in this program and we’d like to ask you some questions about this. May I speak to an adult in this household who is familiar with this program?


Knowledgeable adult speaking or available START

Adult not available schedule call-back



START: The interview takes about 30 minutes to complete. Your participation in this survey is voluntary. You have the right to stop at any time or skip questions with no penalty. All your answers are private and the information you provide will not be identified by your name, except as otherwise required by law. You will receive (INCENTIVE) as a thank you for completing the survey. Your answers to our survey questions will provide important [PROGRAM] with important information to help improve its services. Any information you provide will remain private.



ASK FIRST SURVEY QUESTION.




PARTICIPATION IN SUMMER FOOD SERVICE PROGRAM AND DEMONSTRATION PROJECTS


For this survey, when I say household I mean your family and other people who live in your household and with whom you share food and food expenses.


1. Thinking about your household please tell me the first name and age of all people in your household who received a meal delivery from (NAME OF MEAL DELIVERY PROGRAM).


Name

Age (years)













2. Was the meal delivery:


At Home 1

Drop-off Site 2

REFUSED 77

DON’T KNOW 99



FOR MEAL DELIVERY AT HOME


3. How often do you receive meal delivery for (NAME OF PERSON)?


Everyday 1

Once every week 2

Other, specify:________________ 3

REFUSED 77

DON’T KNOW 99



4. How many (days/weeks) did the (NAME OF PROGRAM) deliver meals for (NAME OF PERSON) at your home?


June: |___|___| weeks

July: |___|___| weeks

August: |___|___| weeks



5. Did you or someone else have to be home at the time of meal delivery?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99


6. Did you have to sign a (FORM OR SLIP) each time you received the meal delivery?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



7. Were you satisfied with the schedule of meal delivery?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



FOR MEAL DELIVERY AT A DROP-OFF SITE


8. How far do you have to travel to pick up the meals from (name of program)?


One mile or less 1

More than one mile 2

REFUSED 77

DON’T KNOW 99



9. Who usually picks up the meals? (CHECK ALL THAT APPLY)


Parent 1

Sibling 2

Relative 3

Child himself/herself 4

Other, specify: ________________ 5

REFUSED 77

DON’T KNOW 99



10. Did you have to sign a (FORM OR SLIP) each time you picked up the meal?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



11. Was there ever an occasion when the meal wasn’t picked up?


Yes 1 GO TO #12

No 2 GO TO #13

REFUSED 77 GO TO #13

DON’T KNOW 99 GO TO #13


12. Please tell me if the meals were not picked up on one or more occasion because …


INTERVIEWER: Check all that apply


It takes too long to get to the drop-off site 1

You did not have transportation to get to the drop-off site 2

The timing of meal pick up is not convenient for you 3

There is a long wait to pick up a meal 4

Other, specify:_________________________________ 5

REFUSED 77

DON’T KNOW 99

MEALS ALWAYS PICKED UP, DOES NOT APPLY 88



FOR MEAL DELIVERY AT HOME AND DROP-OFF SITE


13. How did you find out about the meal delivery program?


Flyer 1

Brochure 2

Newsletter 3

Word of mouth 4

Other, specify:_______________ 5

REFUSED 77

DON’T KNOW 99




14. Why did you enroll your children (or others) to receive a meal delivery from (NAME OF PROGRAM)?







SFSP Meal Description, Consumption, Sharing and Wastage


Now I am going to ask you some questions about the meals that your children (or others) received through (NAME OF THE PROGRAM)


15. Now please think about the most recent meal delivery you received. What foods were provided?


INTERVIEWER: Do not read. Check all that apply


Name of Person

Milk

Fruit

Juice

Vegetable

Bread/

Grains

Meat

Meat Alternate




















































16. Thinking about all the food that was provided in the meal delivery package, can you tell me where (NAME OF FOOD) was stored or kept at home?


INTERVIEWER: Do not read. Check all that apply


Food

Fridge

Pantry

Counter or Table

Child’s Room

Other, specify

Refused

DK

Milk








Fruit








Fruit Juice








Vegetable








Bread/Grains








Meat








Meat Alternate













17. For this question, please tell me how often your children (or others who received the meal delivery) drank or ate (NAME OF FOOD)?


How many…

Always

Most of the Time

Sometimes

Rarely

Never

Refused

DK

Drank Milk








Ate Fruit








Drank Fruit Juice








Vegetable








Bread/Grains








Meat








Meat Alternate










18. Did any of the PEOPLE in your household share (NAME OF FOOD) from the meal delivery with each other, other children in the household who did not receive a meal delivery, adults in the household, friends, or others?



Share (NAME OF FOOD)

Food

Yes

No

Refused

DK

Milk





Fruit





Fruit Juice





Vegetable





Bread/Grains





Meat





Meat Alternate









19. If yes to #18 (for each food), who did they share (NAME OF FOOD) it with?



Who was (NAME OF FOOD) shared with?

Food

Children in the HH who also get a meal delivery

Children in the HH who don’t get a meal delivery

Adults
in the household

Friend

Pet

Other, Specify

Refused

DK

Milk









Fruit









Fruit Juice









Vegetable









Bread/Grains









Meat









Meat Alternate











20. Were there any foods in the meal delivery package that were not eaten by anyone?


Yes 1 GO TO #21

No 2 GO TO #22

REFUSED 77 GO TO #22

DON’T KNOW 99 GO TO #22



21. I am going to ask you about the foods that were left over. Which foods were left over? What was the reason for not eating these foods? What was done with the food?


Food

Why was (food not eaten)

What was
done with food?*

Milk



Fruit



Fruit Juice



Vegetable



Bread/Grains



Meat



Meat Alternate




*Codes for what was done with food:

Thrown away 1

Returned to Drop-off site 2

Given away to friend/neighbor 3

Saved for later 4

Other, specify 5

REFUSED 77

DON’T KNOW 99


Parent Satisfaction with SFSP Demonstration and Foods


Now I am going to ask you a few questions about your impression of the meals included in the meal delivery.


22. How would you describe the meals that are provided? Would you say the foods are healthy, somewhat healthy, or not at all healthy?


Very healthy 1

Somewhat healthy 2

Not at all healthy 3

REFUSED 77

DON'T KNOW 99



For the next few questions, please tell me if you agree strongly, agree, neither agree nor disagree, disagree, or disagree strongly with these statements.


23. The delivery packages generally include a variety of foods. Would you say you …


Agree strongly 1

Agree 2

Neither agree nor disagree 3

Disagree 4

Disagree strongly 5

REFUSED 77

DON'T KNOW 99



24. The delivery package foods are convenient to eat. Would you say you …


Agree strongly 1

Agree 2

Neither agree nor disagree 3

Disagree 4

Disagree strongly 5

REFUSED 77

DON'T KNOW 99



25. People who get the meal delivery in my household like the foods provided in the package. Would you say you …


Agree strongly 1

Agree 2

Neither agree nor disagree 3

Disagree 4

Disagree strongly 5

REFUSED 77

DON'T KNOW 99


HH Food Security


The next questions are about the food eaten in your household in the last 30 days, which is (REFER TO START AND END DATE).

26. Which of these statements best describes the food eaten in your household in the last 30 days: —enough of the kinds of food (I/we) want to eat; —enough, but not always the kinds of food (I/we) want; —sometimes not enough to eat; or, —often not enough to eat?


Enough of the kinds of food we want to eat 1

Enough but not always the kinds of food we want 2

Sometimes not enough to eat 3

Often not enough to eat 4

REFUSED 77

DON'T KNOW 99



Now I’m going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for (you/your household) in the last 30 days—that is, since last (name of current month).


27. The first statement is “(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more.” Was that often true, sometimes true, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON'T KNOW 99



28. “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.” Was that often, sometimes, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON'T KNOW 99




29. “(I/we) couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON'T KNOW 99



Screener for Stage 2 Adult-Referenced Questions: If affirmative response (i.e., "often true" or "sometimes true") to one or more of Questions 27-29, OR, response [3] or [4] to question 26, then continue to Adult Stage 2; otherwise, skip to Child Stage 1.



Adult Stage 2


30. In the last 30 days, since last (name of current month), did (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn't enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



31. [IF YES ABOVE, ASK] In the last 30 days, how many days did this happen?


INTERVIEWER: If needed, did that happen on 3 or more days? Y/N


|___|___| days

Enter Number


REFUSED 77

DON’T KNOW 99



32. In the last 30 days, did you ever eat less than you felt you should because there wasn't enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99





33. In the last 30 days, were you every hungry but didn't eat because there wasn't enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



34. In the last 30 days, did you lose weight because there wasn’t enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



Screener for Stage 3 Adult-Referenced Questions: If affirmative response to one or more of questions 25 through 29, then continue to Adult Stage 3; otherwise skip to Child Stage 1.



Adult Stage 3


35. In the last 30 days, did (you/you or other adults in your household) ever not eat for a whole day because there wasn’t enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



36. [IF YES ABOVE, ASK] In the last 30 days, how many days did this happen?


INTERVIEWER: If needed, did that happen on 3 or more days? Y/N


|___|___| days

Enter Number


REFUSED 77

DON’T KNOW 99




Child Stage 1:
ADMINISTER TO ALL HOUSEHOLDS WITH CHILDREN UNDER 18


Now I'm going to read you several statements that people have made about the food situation of their children. For these statements, please tell me whether the statement was OFTEN true, SOMETIMES true, or NEVER true in the last 30 days for (your child/children living in the household who are under 18 years old).


37. “(I/we) relied on only a few kinds of low-cost food to feed (my/our) child/the children) because (I was/we were) running out of money to buy food.” Was that often, sometimes, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON'T KNOW 99



38. “(I/We) couldn’t feed (my/our) child/the children) a balanced meal, because (I/we) couldn’t afford that.” Was that often, sometimes, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON’T KNOW 99



39. "(My/Our child was/The children were) not eating enough because (I/we) just couldn't afford enough food." Was that often, sometimes, or never true for (you/your household) in the last 30 days?


Often true 1

Sometimes true 2

Never true 3

REFUSED 77

DON’T KNOW 99



Screener for Stage 2 Child Referenced Questions: If affirmative response (i.e., "often true" or "sometimes true") to one or more of questions 37-39, then continue to Child Stage 2; otherwise skip to #45.




Child Stage 2


40. In the last 30 days, since (current day) of last month, did you ever cut the size of (your child’s/any of the children’s) meals because there wasn’t enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



41. In the last 30 days, did (CHILD’S NAME/any of the children) ever skip meals because there wasn’t enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



42. [IF YES ABOVE ASK] In the last 30 days, how many days did this happen?


INTERVIEWER: If needed, did that happen on 3 or more days? Y/N


|___|___| days

Enter Number


REFUSED 77

DON’T KNOW 99



43. In the last 30 days, (was your child/were the children) ever hungry but you just couldn’t afford more food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



44. In the last 30 days, did (your child/any of the children) ever not eat for a whole day because there wasn’t enough money for food?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



45. Would you say that children in your household eat more balanced meals and healthy foods during the regular school year, during the summer, or about the same in the summer and the school year?


Regular school year 1

Summer 2

Eats about the same 77

REFUSED 77

DON’T KNOW 99



46. Thinking about the food available to (NAME OF CHILD) during summer and comparing it to the school year … (CHECK ONE BOX FOR EACH ROW)



More in the summer

About the same in summer and school year

Less in the summer

DK

Refused

Was the quantity of food available …






Was the variety of food available…






Was the amount of fruits and vegetables available …






Was the amount of meat available…






Was the amount of milk and milk products available …






Children ate regular meals …






Children ate fast food …








Participation in Other Nutrition Assistance Programs


The next few questions are about your household’s participation in other nutrition assistance programs.


47. Did your household receive SNAP or food stamp benefits in the past 30 days?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



48. Did anyone in your household receive assistance from the Women, Infant, and Children program – also known as the WIC program in the past 30 days?


Yes 1 GO TO #49

No 2 GO TO #51

REFUSED 77 GO TO #51

DON’T KNOW 99 GO TO #51


49. How many women participated in WIC in the past 30 days?


|___|___| women

Enter Number


REFUSED 77

DON’T KNOW 99



50. How many Infants and Children participated in WIC in the past 30 days?


|___|___| infants and children

Enter Number


REFUSED 77

DON’T KNOW 99



51. Did any children in your household attend the Head Start program or a preschool child care program where they get free meals in the past 30 days?


Yes 1 GO TO #52

No 2 GO TO #53

REFUSED 77 GO TO #53

DON’T KNOW 55 GO TO #53



52. How many children participated in Head Start or other preschool child care program in the past 30 days?


|___|___| children

Enter Number


REFUSED 77

DON’T KNOW 99



53. Did any children in your household receive free or reduced price school lunches in the past school year (i.e., in the winter or spring 2011)?


Yes 1 GO TO #54

No 2 GO TO #55

REFUSED 77 GO TO #55

DON’T KNOW 55 GO TO #55



54. How many children received free or reduced price lunch in the winter or spring 2011?


|___|___| children

Enter Number


REFUSED 77

DON’T KNOW 99

55. Did anyone in your household receive assistance from Meals on Wheels or the Senior Nutrition Progam in the past 30 days?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



Perception of Change in Food Expenditure


Now I am going to ask you a couple of questions about the money you spend on food during the school year and summer.


56. Compared with the amount of money you spend on food each month during the school year, would you say you spend:


The same amount on food in the summer months 1

More on food in the summer months 2

Less on food in the summer months 3

REFUSED 77

DON’T KNOW 99



I’m going to read a statement to you. Please tell me how strongly you agree or disagree with the statement.


57. Because the people in my household participated in the summer food program, I spent less money on food during the summer months than if s/he had not particpated in the program. Do you …


Agree strongly 1

Agree 2

Neither agree nor disagree 3

Disagree 4

Disagree strongly 5

REFUSED 77

DON’T KNOW 99



Household and Respondent Characteristics


We are almost done. The last few questions are about you and the people who live in your household.


58. Thinking about your entire household, meaning family or other people living in your home, including family and other people who share food and food expenses, how many people currently live in your household, including yourself?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



59. Of these, how many are adults age 65 or older?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



60. How many are adults age 18 to 64?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



61. How many are children age 5 to 17?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



62. And, how many are children under five years of age?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99


63. Does anyone in your family have any difficulty in doing day to day activities because of a physical, mental or emotional (or other health) condition?


Yes 1

No 2

REFUSED 77

DON’T KNOW 99



The next set of questions ask about some basic information about you.


64. Are you male or female?


INTERVIEWER: If gender is obvious, enter item without asking; otherwise ask this question.


Male 1

Female 2

REFUSED 77

DON’T KNOW 99



65. Are you Hispanic or Latino?


Yes 1

No 2

Not Hispanic or Latino........................ 3

REFUSED 77

DON’T KNOW 99



66. Which one or more of the following would you say is your race?


INTERVIEWER: Please read. Select all that apply.


American Indian or Alaskan Native 1

Asian 2

Black 3

Native Hawaiian or other Pacific Islander 4

White 5

REFUSED 77





67. What language or languages do you usually speak at home? (DO NOT READ)


INTERVIEWER: Select all that apply.


English 1

Spanish 2

Other, specify:________________ 3

REFUSED 77

DON’T KNOW 99



68. Are you …?


Married 1

Divorced 3

Widowed 2

Separated 4

Never Married 5

Living With Partner 6

REFUSED 77

DON’T KNOW 99



69. What is the highest grade or year of school you completed?


INTERVIEWER: Do not read


Never Attended/Kindergarten Only 0

Grades 1 through 8 (elementary/middle school) 1

Grades 8 through 11 (some high school) 2

Grade 12 or GED (high school graduate) 3

College 1 to 3 years (some college or technical school) 4

College 4 years or more (college graduate) 5

REFUSED 77

DON’T KNOW 99




70. What is your date of birth?


|___|___| / |___|___| / |___|___|___|___|

mm dd yyyy


REFUSED 77

DON’T KNOW 99



71. Are you currently …?


Employed for wages 1

Self-employed 2

Out of work for more than 1 year 3

Out of work for less than 1 year 4

A homemaker 5

A student 6

Retired 7

Unable to work 8

REFUSED 77

DON’T KNOW 99



72. Not including yourself, how many adults in the household were employed full-time last week?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



73. Not including yourself, how many adults in the household were employed part-time last week?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99



74. Not including yourself, how many adults in the household were not employed last week?


|___|___|

Enter Number


REFUSED 77

DON’T KNOW 99




75. Is your annual household income from all sources …?


Less than $25,000 1

If yes, ask…

Less than $20,000 2

If yes, ask…

Less than $15,000 3

If yes, ask…

Less than $10,000 4


If NO to LESS THAN $25,000, ask…

Less than 35,000 5

Less than 50,000 6

Less than 75,000 7

75,000 or more 8


REFUSED 77

DON’T KNOW 99



END1: Thank you so much for completing this interview. The information you provided will help administrators better understand and improve the [PROGRAM]. Because it is important to learn about people’s experiences after they have been in this program for a longer period of time, we’d like to call you again in about 4 to 6 weeks to conduct a follow-up interview. Will this number [READ CURRENT PHONE NUMBER] be the best number to call?


Yes END3

No Continue to END2



END2: What is the best number to call next time?


(_____)_____-________



END3: In case we can’t reach you at this number, please tell me one or two other numbers where we might be able to contact you:


(_____)_____-________


(_____)_____-________




END4: Thank you again for your time. Goodbye.



24

File Typeapplication/msword
AuthorBeth Riley
Last Modified Bycchanhatasilpa
File Modified2011-05-12
File Created2011-05-12

© 2024 OMB.report | Privacy Policy