Rev Attach 9b Clinic Survey Interviewer Script

Attachment 9b

Clinic Survey Interviewer Script

SciMetrika Health Survey Script

In Coordination with CDC and your local Health Department

Clinic Survey Interviewer Script

Setting: Clinic staff will identify potential respondents from participating HIV clinics. The Interviewer will have available additional survey information and project identification. Interviewer will have the available survey equipment, name badge identifying the project, and will present the role of a professional person with the objective of talking to patients in an HIV clinic.

INTRODUCTION TO SURVEY

Interviewer Script: 

“Hello. My name is ____________ and I am working with CDC and the local Health Department to conduct a health survey in your community. We’re doing surveys of people to help understand better about you, your health, your health behaviors, alcohol and drug use, and how HIV (the virus that causes AIDS) may affect you.

We estimate that it will take about 40 minutes to complete the survey. If you are eligible to participate and complete the survey, you will be provided with $­­­­_____ as a token of our appreciation ^a.

Please know we are not trying to sell you anything, we just want to know more about you and your community. The information you share in the survey will not affect your medical care at this clinic. Also, the information you give will be kept completely secure to the extent permitted by law, and we will destroy any information that identifies you personally after the survey has been completed (for example, name and any contact information you gave us to schedule the interview). Additionally, you can stop the survey at any time; your participation is totally voluntary.

Are you interested in participating?”

• If no: “Thank you very much for your time! If you change your mind in the future, please feel free to contact us.”

• If yes:

“Thank you for your interest. The survey is conducted in two parts. The first is a short series of questions to see if you are eligible to participate and will take only 3 or 4 minutes. I will enter your responses here [interviewer shows electronic data capture device] and the computer will let us know if you are eligible to participate. Are you ready to begin?”

• Interviewer conducts screener

• If individual is eligible to participate: “It looks like you are eligible to participate. If you are ready, let’s proceed with the survey.”

• If individual is not eligible to participate: “Unfortunately, the computer says that you are not eligible to participate. Thank you very much for your interest, though.”

FOR INTERVIEWER: ASSURANCES / ENCOURAGEMENTS

• We are you are not trying to sell anything.

• We do not share any of this information with anyone.

• Your information will be kept secure to the extent permitted by law.

• Your information is protected because it is combined with many other answers and reported as a total.

• The survey is voluntary; You can choose to refuse to answer any particular question.

^a Tokens will be $40 per participant.

Clinic Survey Interviewer Script Page