Project One Screener

Communication Research on Folic Acid

Attachment C1_Screener (English)PROJ1Dec9REVISEDFINALcleancopy

Screener

OMB: 0920-0926

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ScreenerProject 1: Exploratory Research of Hispanic Women’s Health: Awareness, Knowledge, and Behavior related to Foods Fortified with Folic Acid.

Introductory Statement:


Hello, my name is _________ and I am calling on behalf of the Battelle Centers for Public Health Research and Evaluation. This project is being sponsored by the Centers for Disease Control and Prevention, also called CDC. We are going to be conducting discussion groups to better understand women’s beliefs about women’s health and vitamins. We would like to speak with you about your thoughts and opinions on this topic. We are looking for women to participate in these discussions. The discussions will be with other women from your community. They will last one hour and a half. If you are eligible to participate, you will receive $75 at the end of the discussion as a thank-you for sharing your thoughts about women’s health and vitamins. Would you be interested in participating?


If she is NOT interested:

Thank you very much for taking the time to speak with me.


If she is interested:

May I ask you a few questions to see whether you are eligible to participate in the discussion group?


Eligibility Questions:


1. What is your age? _________ If under 18 years old or 45 or older [SKIP TO CLOSE]


2. Would you describe yourself as: Hispanic or Latina?

 Yes [CONTINUE]

 No [SKIP TO CLOSE]


3. Were you born in the United States?

 Yes [SKIP TO #4]

 No [CONTINUE]


4. In which country were you born? Do not read list

Specify: __________________________________________________

5. What language do you speak at home?

Spanish only [CONTINUE]

Mostly Spanish, some English [CONTINUE]

Spanish and English about equally [CONTINUE]

Mostly English, some Spanish [CONTINUE]

English only [CONTINUE]


6. Are you currently pregnant?

Yes [SKIP TO CLOSE]

No [CONTINUE]


7. Do you have any children?

Yes [CONTINUE ]

No [CONTINUE]


8. Have you ever had a child with a spina bifida or anencephaly?

Yes [READ STATEMENT BELOW]

No  [CONTINUE]


If “Yes” to Q8, read this statement: Thank you for taking the time to answer my questions. I am sorry that I am not able to include you in a discussion group. You already have knowledge and experience about ______(spina bifida or anencephaly). The discussion group is more for women who do not have that experience.


9. Do you take a multivitamin?

Yes [CONTINUE]

No. [CONTINUE]


10. What is the highest level of education you have completed? Read options below; only mark one response

Less than High School [CONTINUE]

High School Graduate/ GED [CONTINUE]

Some college. [CONTINUE]

College Graduate [CONTINUE]

Graduate School or beyond [CONTINUE]


(ELIGIBLE)

Thank you for answering my questions. Based on your answers, you are eligible to participate in the study. I would like to invite you to participate in the discussion. This is not a sales meeting. No one will try to sell you anything. We are only interested in your opinions. Your opinions will help us better understand what women think about vitamins and health. This discussion will last one hour and a half and we will give you $75 for taking the time to participate. Would you be interested in participating?

  • No [THANK YOU AND END CALL]

  • Yes [CONTINUE TO Q12]


Great!

11. Would you prefer to be in a discussion group about pregnancy and health in English or Spanish? Do not read

Spanish [Go to scheduling]

English [Go to scheduling]

Either language is fine [Go to scheduling]


In the next few days, we will send you a packet of information with the details about where the discussion group will be held, as well as a reminder of the date and time of the group. I want to thank you again for your participation. We will call you the night before the group to remind you. It is very important that you arrive on time. Thank you for accepting our invitation. We look forward to hearing your opinions and comments. Have a nice day.


CLOSE (INELIGIBLE ONLY)

Thank you for answering my questions. I am sorry that I am not able to include you in a discussion group because you are not eligible. I appreciate your interest and taking the time to answer my questions.




File Typeapplication/msword
AuthorDorthina G Grant
Last Modified ByFlores, Alina (CDC/ONDIEH/NCBDDD)
File Modified2011-12-09
File Created2011-12-09

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