Form 0920-0932 Attachment A_Final CARE Program_ECT_Intercept Interview

Form Approved

OMB No. 0920-0932

Expires xx/xx/xxxx

Intercept Interview of Traveler

1. General Introduction

Hello, [respondent name], my name is __________ and I am from the Centers for Disease Control and Prevention.

I know you must be tired from your trip but would you be willing to talk with me for a few minutes (less than 10 minutes) about the Ebola screening process to help us better understand your experience? [If yes, are you over 18 years of age]

2. Introduction for Interview

Great! Thank you for your willingness to share your opinions with me about your experience today. Your opinions will help us improve the process. I have just a few questions that will take less than 10 minutes so you so you can continue your journey.

Before I begin I want to go over a couple of items:

• This interview is voluntary. You can decline to answer any question.

• There are no right or wrong answers. I am interested in your opinion. If you don’t understand the question, feel free to let me know and I can ask it another way. This is not a test, so feel free to say you don’t know or don’t have an opinion to offer and “ I don’t know “ is a perfectly acceptable response to any question I ask you.

• The information you provide today will be kept secure. I will ask for your permission to call you in a few days which would require me to ask for a name and phone number. You do not need to decide on whether you want to participate in a follow-up interview right now. It’s important to know that the questions I’m about to ask you will NOT be linked directly back to you individually and will only be reported at the group level.

• With your permission, I would like to record our conversation. I do this simply to make sure that I capture all of the information that you share and so I can listen to what you have to say and not worry about taking notes. The recording helps me in writing my report and is used for that purpose only. Is it okay for me to record our conversation?

• Do you have any questions before we begin?

C. Interview Questions

1. Did you get a CARE Kit?

2. How clear was the purpose of Ebola screening?

For this question, 1 is very unclear, 2 is somewhat unclear, 3 is clear, 4 is very clear.

1. PROBE: What about Ebola screening was (very unclear/somewhat unclear/clear/very clear)?

3. Have you opened the CARE Kit yet?

4. How serious of a health concern is Ebola to you?

For this question, 1 is not serious at all, 2 is somewhat serious, 3 is serious, 4 is very serious.

5. How would you know whether you had Ebola or not?

6. In your opinion, how likely do you think it is that you will get sick with Ebola?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, 4 is very likely.

1. What about your experience makes you think you are (very unlikely/somewhat unlikely/likely/very likely) to get sick with Ebola?

7. Based on what you’ve heard so far, how long do you need to do health checks for Ebola?

1 month 21 days 1 wk unsure

8. Over the next few weeks, how often should you take your temperature?

once once a day twice a day unsure

9. How confident are you that you can check yourself for the next few weeks for symptoms of Ebola?

For this question, 1 is not confident at all, 2 is somewhat unconfident, 3 is confident, 4 is very confident.

1. What about your experience makes you (not confident at all/somewhat unconfident/confident/very confident) that you can check yourself for symptoms of Ebola?

10. How likely is it that you will report temperature and symptoms to the health department every day for the next few weeks?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, 4 is very likely.

11. If you have a temperature of 100.4 degrees Fahrenheit or 38 degrees Celsius, how likely would you be to seek medical care?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, 4 is very likely.

1. What (other) symptoms would prompt you to seek medical care?

2. What would you do to seek medical care?

12. How likely is it that you will use the resources given to you today?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, 4 is very likely.

13. Can I call you on the phone within the next week to ask you a few more questions about your experience coming to the U.S.?

1. Is there a phone number that I can reach you at? [Write down phone number]

2. Who should I ask for when I call this phone number? (you could use your name or another name, if you wish to be anonymous) [Write down name provided]

Thank you so much for your participation.

Visual Scales

Choose the wording that best describes your experience.

very unclear

somewhat unclear

Clear

very clear

Choose the wording that best describes your experience.

not serious at all

somewhat serious

serious

very serious

Choose the wording that best describes your experience.

very unlikely

somewhat unlikely

likely

very likely

Choose the wording that best describes your experience.

not confident at all

somewhat unconfident

confident

very confident

Public reporting burden of this collection of information is estimated to average 10 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-0932).