Verification for Interview

ATTACHMENT Q

Verification Questionnaire for Interview

Form Approved:

OMB No. 0920-xxxx

Exp. Date __xx/xx/2012

VERIFICATION QUESTIONNAIRE FOR INTERVIEW

General Information:

Gender = Male/Female

All fills are designated by italics text in parents (address) (FI/Nurse Pronoun): he/she based on FI’s or Nurse gender (FI/Nurse Description): age, gender, height, race

(Roster Data): age, gender, race for each HH member (Screening Date) fill: Date of final Screening Code(child demo): demographic data for child respondent - age, gender. If no gender, use “youth”(parent/guardian demo): demographic data for adult respondent - age, gender. If no gender, use “person”(child pronoun): his/her fill for child respondent(relationship to R): Relationship to Respondent from Verification Form for age 3-15 (Adult who gave permission for youth to complete the interview. If “relationship to R” is missing, the word choice after the / will appear.

Preload information Provided for Completed Interviews

CaseID

Phone number (designates home or work phone) from CAPI

Address from CAPI

Notes to Verification Caller [Additional data from handheld or laptop]

First Name of Adult Parent/Guardian Respondent from CAPI

Demographic data for adult Parent/Guardian respondent from CAPI

Relationship to Child Respondent (from Verification Form) for child age 3-15

First Name of Child Respondent from CAPI

Demographic data for Child respondent from CAPI

Date of Session 1 interview

Date of Session 2 Interview

Child’s Assigned Environmental Group Type:

Environmental Group A - Age 7 or older assigned to monitor Personal Exposure Only

Environmental Group B - Age 7 or older assigned to monitor Personal, Indoor and Outdoor Exposure

Environmental Group C - Age 6 or under and assigned to monitor indoor Exposure Only

Environmental Group D - Age 6 or under and assigned to monitor indoor and Outdoor Exposure

Consent response to Medical Records Abstraction

Consent response to Environmental Exposure Collection

Consent response to Health Assessment and Biological Specimen Collection

Public reporting burden of this collection of information is estimated to average 5 minutes per participant, 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).

Language of interview (from QLAUNCH response in Laptop)

English assign to normal queue in CATI

Spanish assign to Spanish Interviewing queue in CATI

Vietnamese assign to mail verification

VINTRO

May I please speak to {fill parent guardian name}?

(My name is _______________. I am calling from RTI International regarding the Children’s Health after the Storms (CHATS) sponsored by the Centers for Disease Control and Prevention (CDC).

We just need to speak to {fill parent/guardian name} for about 5 minutes to verify the quality of our interviewer's performance.)

targetr “SPEAKING TO TARGET R”

ravail “R IS AVAILABLE”

runavail “R IS UNAVAILABLE”

unknown “R UNKNOWN”

rf “REFUSED”

{if VINTRO = rf ask CONVERT1, if VINTRO = targetr skip VINTRO2, if VINTRO = ravail skip to VINTRO2, if VINTRO = unknown skip to UNKNOWNR, if VINTRO = runavail go to CATI SET CALLBACK}

CONVERT1

CHATS is a scientific research study and the quality of data is essential. Please help us ensure this quality by verifying that our interviewer and nurse did their job correctly and behaved professionally. May I speak to {fill parent/guardian name}?

targetr “SPEAKING TO TARGET R”

ravail “R IS AVAILABLE”

runavail “R IS UNAVAILABLE”

unknown “R UNKNOWN”

rf “REFUSED”

{if CONVERT1 = unknown ask UNKNOWNR, if CONVERT1 = targetr skip to blaise SCRN1, if CONVERT1 = ravail skip to VINTRO2, if CONVERT1 = rf send to refusal queue, if CONVERT1 = runavail go to CATI SET CALLBACK,}

UNKNOWNR

(My name is _______________. I am calling from RTI International regarding the Children’s Health after the Storms Study (CHATS).)

It is important that we verify that our researches made contact with the correct respondent, {fill parent/guardian name}. Is this the correct phone number for {fill Pld_RNAME}?

yes “YES”

nomoved “NO, HAS MOVED OR HAS NEW NUMBER”

nowrong “NO, THIS IS THE WRONG NUMBER”

{if UNKNOWNR = nomoved ask New, if UNKNOWNR = yes skip to SPEAKW, if UNKNOWNR = nowrong skip to DIALED}

NEW

Could you please give me with the correct phone number for {fill parent/guardian name}?

YESNO

{if NEW = no, Finalize UTC; else ask PHONE}

PHONE

ENTER 10 DIGIT PHONE NUMBER

TI: REPEAT PHONE NUMBER BACK TO R TO COMFIRM CORRECT ENTRY.

PRESS ENTER TO CONTINUE

{allow 3+3+4 numeric}

{hard check for 10-digit phone number}

{reset case with updated phone number}

DIALED

Have I reached {fill Pld_phone number variables}?

YESNO

SORRY

I am sorry that we reached your home in error. Thank you for your time.

ENTER 1 TO CONTINUE.

{if DIALED = yes or refuse it is potentially wrong number – send to project for review}

{if DIALED = no, go to CATI SET CALLBACK}

SPEAKW

May I please speak to {fill parent/guardian name}?

Yesavail “YES, R IS AVAILABLE”

nounavail “NO, R IS UNAVAILABLE”

{if SPEAKW = yesavail ask VINTRO2, else go to CATI SET CALLBACK}

VINTRO2

(Hello {fill parent/guardian first name}, my name is _______________. I am calling from RTI International regarding The Children’s Health after the Storm (CHATS) Study. This call is to verify the performance quality of our interviewer and nurse. It will take less than five minutes of your time.)

Our records indicate that you were interviewed and agreed to verify your participation.

PRESS 1 TO CONTINUE WITH INTERVIEW

IF R VERBALLY REFUSES TO CONTINUE ENTER F4

{if VINTRO2 = 1 begin blaise scripts at SCRN1, if VINTRO2 = refuse finalize as refusal}

CATI VERIFICATION BLAISE SCRIPT:

SCRN1

Were you and your child recently interviewed for the CHATS study?

yes “YES”

no “NO”

donotrem “DOES NOT REMEMBER”

{if SCRN1 = no or donotrem or DK or RF ask SCRN2, if SCRN1 = yes skip to C2 }

SCRN2

Checking our records, the {fill interviewer’s name would have been {pld_FI NAME or NAMES) and the interviews took place on {fill Pld_Session 1 DOI} and {fill Pld_Session 2 DOI}. The interviewer would have been wearing an RTI identification badge with {his/her/their} picture on it, and would have asked you questions pertaining to your child’s daily activities, health care and housing following the hurricanes. {He/She/They} would have also left some devices to monitor air quality. During the second visit {He/She/They} would have been joined by a nurse. {They} may have had a laptop computer and, box and/or a rolling backpack with them. Does any of this sound familiar?

{use ‘interviewer’s name would have been’ if same FI for both sessions and use ‘interviewers names were’ if interview sessions were conducted by two different FIs; use ‘he’ or ‘him’ if the Pld_FI GENDER IS MALE and only 1 FI; use ‘she’ or ‘her’ if PLD_FIGENDER is FEMALE; and use ‘their’ or “them” if interviews were conducted by two different FIs.}

yes “YES”

no “NO”

maybe “MAYBE”

{if SCRN2 = yes or maybe skip to SCRN3, if SCRN2 = no or DK or RF skip to SCRN4}

SCRN3

Do you remember being interviewed for the CHATS study?

yes “YES”

no “NO”

maybe “MAYBE”

{if SCRN3 = maybe, no or DK or RF ask SCRN4, if SCRN3 = yes skip to C2}

SCRN4

Were you ever contacted by one of the CHATS interviewers either in person or by phone?

yesinperson “YES, IN PERSON”

yesbyphone “YES, BY PHONE”

no “NO”

{if SCRN4 = yesinperson or yesbyphone ask SCRN5, else skip to THANKR}

SCRN5

What was the nature of the contact? What did the interviewer talk to you about?

setupappt “SET UP AN APPOINTMENT TO MEET IN PERSON”

phointerview “CONDUCTED AN INTERVIEW OVER THE PHONE”

inperstudy “IN PERSON TO INTRODUCE STUDY/IDENTIFY R/ASKED R TO PARTICIPATE”

other “OTHER”

{if SCRN5 = other ask SCRNE5, if SCRN5 = inperstudy skip to SCRN7, else skip to SCRN6}

SCRNE5

Would you tell me more about that?

ENTER R ANSWER VERBATIM UPTO 300 CHARACTERS. PRESS ENTER TO CONTINUE

{allow 300 characters}

{skip to SCRN7}

SCRN6

Not including initial contacts to set up the interview, did the interviewer conduct the interview with you in person or over the phone?

inperson “IN PERSON”

byphone “BY PHONE”

neither “NEITHER”

{if SCRN6 = if neither or byphone or DK ask SCRN7, if SCRN6 = RF skip to SCRN20, if SCRN6 = inperson and VFLAG = 1 skip to C2}

SCRN7

Did the interviewer ever conduct a face-to-face interview with you by reading some questions from a laptop computer and typing your answers into the computer?

YESNO

{if SCRN7 = no or DK or RF skip to SCRN 20, if SCRN7 = yes C2}

C2

Did our interviewer recently complete two interview visits with you for the CHATS study?

yestwo “YES (TWO)”

noonlyone “NO, ONLY ONE”

{if IIVC2 = noonlyone or RF ask R2, else skip to R2LEAD}

R2

Were you recently asked to participate in a second in person interview visit for the CHATS study?

YESNO

R2LEAD

These next questions are about the first interview visit recently completed with you and your child. That is the one completed on {fill Pld_Session 1 DOI}. Please think about that interview visit while answering these next questions…

FI ENTER TO CONTINUE.

S8

About how long did the first interview visit take from start to finish?

underone “UNDER 1 HOUR”

betwonetwo “BETWEEN 1 & 2 HOURS”

betwtwothree “BETWEEN 2 & 3 HOURS”

morethree “MORE THAN 3 HOURS”

{if S8 = DK or RF ask S8A, else skip to S10}

S8A

Was it…

Ltone “less than1 hour,”

betwonetwo “BETWEEN 1 & 2 HOURS”

betwtwothree “BETWEEN 2 & 3 HOURS”

morethree “MORE THAN 3 HOURS”

S10

During the first interview visit did the interviewer ask you questions and record your answers into a laptop computer?

YESNO

S12

During the first interview visit, did the interviewer ask your permission to review your child’s medical records?

YESNO

{If Environmental Group A or B ask S12A; If Environmental Group C or D ask S12B}

S12A

During the first interview visit, did the interviewer provide your child with a personal air quality measuring device (called a PEM) to wear and a Time and Activity Log?

Both YES BOTH PEM AND LOG

PEMonly ONLY GAVE PEM

Logonly ONLY GAVE LOG

Neither DID NOT GIVE EITHER LOG OR PEM

{if Environmental Group A skip to 12D; If Environmental Group B Ask S12B}

S12B

During the first interview visit, did the interviewer set up a wire box containing equipment to measure air quality inside your home?

YESNO

{If yes ask S12B_1; IF NO/DK/RF ask S12C}

S12B_1

Where inside your home did the interviewer set up the wire box to measure air quality?

Kitchen KITCHEN

Commonarea LIVING ROOM, DEN, COMMON AREA

Hallway HALLWAY

ChildBed CHILD’S BEDROOM

ParentBed PARENT/GUARDIAN BEDROOM

Bath BATHROOM

Base BASEMENT

Other OTHER

{If Environmental Group C ask 12D; If Environmental Group B or D ask S12C}

S12C

During the first interview visit, did the interviewer set up a wire box containing equipment to measure air quality outside of your home?

YESNO

{If yes ask S12C_1; IF NO/DK/RF ask S12D}

S12C_1

Where outside your home did the interviewer set up the wire box to measure air quality?

Backyard BACKYARD

Courtyard COURTYARD

Parkinglot PARKING LOT

Driveway DRIVEWAY

Other OTHER

S12D

During the first interview visit, did the interviewer collect floor dust samples from your home using a hand held vacuum cleaner?

YESNO

APAY1

Again, thinking back to the first interview visit completed on {fill Pld_Session 1 DOI}, please tell me what if anything the interviewer gave you for your participation.

Yescash “GIVEN CASH”

yesservsal “NOT GIVEN CASH BUT OFFERED SERVICE OR GIFT”

nothing “NOT GIVEN ANYTHING”

{if APAY1 = nothing or DK or RF ask APAY1F, if APAY1= yescash skip to A1AMT, if APAY1 = yesservsal skip to APAY1E}

APAY1F

It is important to know if our interviewer followed the correct procedures. It would be very helpful if you could take another moment to think back to the time of the first interview visit on {fill Pld_DOI}, and then answer this question. Were you given anything for your participation?

Yescash “YES - GIVEN CASH”

yesserv “YES - NOT CASH BUT OFFERED SERVICE OR GIFT”

nothing “NOTHING”

{if APAY1F = yeserv ask APAY1E, if APAY1F = yescash skip to A1AMT, if APAY1F = no or DK or RF skip to CPAY1}

APAY1E

Please describe what you were given for your participation during the first visit?

FI ENTER ANSWER VERBATIM UP TO 150 CHARACTERS.

PRESS ENTER TO CONTINUE

INTERVIEWER NOTE: IF IT BECOMES APPARENT THAT THE RESPONDENT WAS GIVEN CASH BACK UP AND CHANGE ANSWER AT PREVIOUS QUESTION TO CASH.

{allow 150 characters}

{skip to CPAY1}

A1AMT

How much did the interviewer give you, in cash, for your participation in first interview visit?

forty “$40.00 ”

thirtyfive “$35.00”

other “OTHER”

{if A1AMT = other ask A1AMTE, else skip to SSLEAD}

A1AMTE

FI ENTER THE DOLLAR AMOUNT GIVEN VERBATIM UP TO 7 CHARACTERS.

PRESS ENTER TO CONTINUE

{allow 7 characters}

{IF R2=no/dk/rf skip to SN1; else continue}

SSLEAD

These next questions are about your experiences during the second interview visit. That is the interview visit completed on {fill Pld_Session 2 DOI}. Please think about this second visit while answering these next questions.

FI ENTER TO CONTINUE.

SS1

When the interviewer returned for the second visit on {fill Pld_Session 2 DOI} did {he/she} collect all the air quality measuring devices that were left during the first visit?

YESNO

SSPAY

Now thinking only about your second interview visit, that is the interview you completed on {fill Session 2 DOI}…

During your second interview visit, what if anything did the interviewer give you for your participation at the time of the second interview visit?

Yescash “GIVEN MONEY/CASH”

yesserv “OFFERED OR GIVEN A SERVICE OR GIFT”

nothing “NOTHING”

{if SSPAY =no or DK or RF ask SSPAY2, if SSPAY=yescash skip to SSAMT, if SSPAY=yeserv skip to SSTYPE}

SSPAY2         

It is important to know if our interviewer followed the correct procedures. It would be very helpful if you could take another moment to think back to the time of the second interview visit, and then answer this question. Were you given anything for your participation during your second interview visit? That is the interview you completed on {fill Pld_Session 2 DOI}.

yescash “YES - GIVEN CASH”

yesserv “YES - NOT CASH BUT OFFERED SERVICE OR GIFT”

no “NOTHING”

{if SSPAY2 = yesserv ask SSTYPE, if SSPAY2 = yescash skip to SSAMT, if SSPAY2 = no or DK or RF skip to SN1}

SSTYPE

Please describe what you were given for your participation in your second interview visit?

ENTER ANSWER VERBATIM UP TO 150 CHARACTERS. PRESS ENTER TO CONTINUE

IF IT BECOMES APPARENT THAT THE RESPONDENT WAS GIVEN CASH, BACK UP AND CHANGE ANSWER TO PREVIOUS QUESTION TO 1.

{skip to SN1}

SSAMT

How much did the interviewer give you, in cash, for your participation in the second interview visit?

threefive “$35.00”

fortyy “$40.00”

Other “OTHER AMOUNT”

{if SSAMT = other ask SSINT, If SSAMT ne other and Environmental group A or B ask SSCPAY; else skip to SN1}

SSINT

ENTER THE DOLLAR AMOUNT GIVEN VERBATIM UP TO 7 CHARACTERS.

PRESS ENTER TO CONTINUE

SSCPAY

Now thinking only about your second interview visit, that is the interview you completed on {fill Session 2 DOI}…

During the second interview visit, what if anything did the interviewer give your child for {his/her} participation in wearing the personal air quality measuring device?

yescash “GIVEN MONEY/CASH”

yesserv “OFFERED OR GIVEN A SERVICE OR GIFT”

nothing “NOTHING”

{if SSCPAY =no or DK or RF ask SSCPAY2, if SSCPAY=yescash skip to SSCAMT, if SSCPAY=yeserv skip to SSCTYPE}

SSCPAY2         

It is important to know if our interviewer followed the correct procedures. It would be very helpful if you could take another moment to think back to the time of the second interview visit, and then answer this question. Was your child given anything for {his/her} participation in wearing the personal air quality measuring device during the second interview visit? That is the interview visit completed on {fill Pld_Session 2 DOI}.

yescash “YES - GIVEN CASH”

yesserv “YES - NOT CASH BUT OFFERED SERVICE OR GIFT”

no “NOTHING”

{if SSCPAY2 = yesserv ask SSCTYPE, if SSCPAY2 = yescash skip to SSCAMT, if SSCPAY2 = no or DK or RF skip to SN1}

SSCTYPE

Please describe what your child was given for {his/her} participation in wearing the personal air quality measuring device (PEM) during the second interview visit?

ENTER ANSWER VERBATIM UP TO 150 CHARACTERS. PRESS ENTER TO CONTINUE

IF IT BECOMES APPARENT THAT THE RESPONDENT WAS GIVEN CASH,BACK UP AND CHANGE ANSWER TO PREVIOUS QUESTION TO 1.

{skip to SN1}

SSCAMT

How much did the interviewer give your child, in cash, for {his/her} participation in wearing the personal air quality measuring device during the second interview visit?

Thirty “$30.00”

Other “OTHER AMOUNT”

{if SSCAMT = other ask SSCINT, else skip to SN1}

SSCINT

ENTER THE DOLLAR AMOUNT GIVEN VERBATIM UP TO 7 CHARACTERS.

PRESS ENTER TO CONTINUE

SN1

Our records show that [REGISTERED NURSE NAME] completed a health assessment with your child on [DATE OF EXAM] for the Children’s Health after the Storms study. Do you remember your child completing the health assessment?

YESNO

SN1_R

The nurse would have performed some height and weight measurements along with lung function tests and collection of blood and/or urine from your child. Does any of this sound familiar?

YESNO

{If Yes continue; If No/DK/RF and child is 12 or older ask SPEAKC; If NO/DK/RF and child is under 12 ask SNAA}

SPEAKC

Our records indicate that your child, {Fill Child Name}, completed a health assessment with Nurse, {Fill Nurse Name}, on {FILL HEALTH ASSESSMENT DATE}. Would it be possible for us to speak with {Fill Child Name} to verify with {him/her} that the nurse did {his/her} job correctly? These questions will only take a few minutes of the child’s time.

YESNO

{IF YES ask SNInto; If NO/DK/RF skip to SNAA}

SNAA

(Our records indicate that your child, {Fill Child Name}, completed a health assessment with Nurse, {Fill Nurse Name}, on {FILL HEALTH ASSESSMENT DATE}.) Is there another adult who was present during the child’s health assessment who would be able to verify the quality of the nurse’s performance?

YESNO

{If YES ask SPEAKAA; IF R2= YES and SNAA= NO/DK/RF skip to BLEAD; IF R2=NO/DK/RF go to BI4}

SPEAKAA

Would it be possible for us to speak with the adult who was present to verify that the nurse did {his/her} job correctly? These questions will only take a few minutes their time.

YESNO

{IF YES ask SNIntro; IF R2= YES and SPEAKAA= NO/DK/RF skip to BLEAD; IF R2=NO go to BI4}

SNIntro

(Hello my name is _______________. I am calling from RTI International regarding The Children’s Health after the Storm (CHATS) Study. This call is to verify the performance quality of our interviewer and nurse. It will take less than five minutes of your time.)

PRESS ENTER TO CONTINUE

SN2

Did the nurse who completed the health assessment call you to remind you of your appointment?

YESNO

SN3

Did the nurse…

PRESS 1 to CONTINUE

SN3_H

Measure your child’s height?

YESNO

SN3_W

Measure your child’s weight?

YESNO

SN3_B

Collect a blood sample from your child?

YESNO

SN3_U

Collect a urine sample from your child?

YESNO

SN3_L

Perform lung function and asthma evaluations by having the child breath into a device?

YESNO

SN3_T

About how long did the health assessment take?

Betenfif “BETWEEN 10-15 MIN”

betfifthirty “BETWEEN 15-30 MIN”

thirtyto45 “BETWEEN 30-45 MIN”

onehour “1 HOUR”

morethan “MORE THAN 1 HOUR”

SNPAY

When the nurse was done with the health assessment, what if anything did the nurse give you/child for {his/her} participation in the health assessment and specimen collections?

yescash “GAVE MONEY/CASH”

yescb “GAVE COLORING BOOK”

bothcacb “GAVE CASH AND COLORING BOOK”

yesserv “OFFERED OR GAVE A SERVICE OR GIFT”

nothing “NOTHING”

{if SNPAY =no or DK or RF ask SNPAY2, if SNPAY=yescash skip to SNAMT, if SNPAY=yeserv skip to SSTYPE; if SNPAY=yescb or bothcacb skip to SWITCH}

SNPAY2

It is important to know if our nurse followed the correct procedures. It would be very helpful if you could take another moment to think back to the time of the health assessment, and then answer this question. Were you or the child given anything for {his/her} participation in the health assessment and specimen collection that was completed on {fill Pld_Session 2 DOI}?

yescash “YES - GAVE CASH”

yescb “YES- GAVE COLORING BOOK”

bothcacb “YES-GAVE CASH AND COLORING BOOK”

yesserv “YES NOT CASH OR COLORING BOOK BUT OFFERED SERVICE OR GIFT”

nothing “NO-GIVEN NOTHING”

{if SNPAY2 = yesserv ask SNTYPE, if SNPAY2 = yescash skip to SNAMT, if SNPAY2 = no or DK or RF skip to SWITCH; if SNPAY2=yescb or bothcacb skip to SWITCH}

SNTYPE

Please describe what you or the child was given for {his/her} participation in the health assessment and specimen collections?

ENTER ANSWER VERBATIM UP TO 150 CHARACTERS. PRESS ENTER TO CONTINUE

IF IT BECOMES APPARENT THAT THE RESPONDENT WAS GIVEN CASH, BACK UP AND CHANGE ANSWER TO PREVIOUS QUESTION TO 1.

{skip to SN1}

SNAMT

How much did the nurse give you or the child, in cash, for {his/her} participation in the health assessment and specimen collections?

fifteen “$15.00”

twenty “$20.00”

thirty5 “$35.00”

sixty5 “$65.00”

Other “OTHER AMOUNT”

{if SNAMT = other ask SNINT, else skip to SNP}

SNINT

ENTER THE DOLLAR AMOUNT GIVEN VERBATIM UP TO 7 CHARACTERS.

PRESS ENTER TO CONTINUE

SNP

Was the nurse polite and did {he/she} treat you (and the child) professionally during the health assessment?

YESNO

{If YES/DK/RF ask SWITCH; IF NO ask SNP_E}

SNP_E

Please tell me more about how the nurse treated you (and/or the child).

ENTER RESPONDENT’S ANSWER VERBATIM UP TO ALLOW 250 CHARACTERS. ENTER 1 TO CONTINUE.

{allow 250 characters}

SWITCH

TI NOTE: IF YOU ARE SPEAKING TO A CHILD OR ANOTHER ADULT REGARDING THE HEALTH ASSESSMENT ASK THAT PERSON TO PUT THE PARENT {FILL PARENT/GUARDIAN NAME} BACK ON THE PHONE FOR REMAINDER OF VERIFICATION CALL.

PRESS ENTER WHEN YOU ARE READY TO CONTINUE.

BISLEAD

These next questions are about your experiences during both interview visits. That is the first interview visit completed on {fill Pld_Session 1 DOI} and the second interview visit completed on {fill Pld_Session 2 DOI}. Please think about both of these visits while answering these next questions.

BI1

Were both interview visits conducted in your home?

both “BOTH”

neither “NEITHER”

firston “FIRST ONLY”

secondon “SECOND ONLY”

{if BI2 = neither or firtson or secondon ask BIE, else skip to BI2}

BIE

Please describe the place or places where the interviews were conducted?

ENTER ANSWER VERBATIM UP TO 300 CHARACTERS.

IF IT BECOMES APPARENT THAT BOTH INTERVIEWS AND SPECIMEN COLLECTIONS WERE DONE AT OR ON THE PREMISE OF THE R’S HOME BACK UP AND RE-CODE SCRNIIVB1 TO 1. PRESS ENTER TO CONTINUE

{allow 300 characters}

BI2

During both interview visits, did the interviewer read you some questions from a laptop computer and type your answers into the computer?

both “BOTH”

neither “NEITHER”

firston “FIRST ONLY”

secondon “SECOND ONLY”

BI3

{Was/Were} the {interviewer/interviewers} polite and did {he/she/they} treat you professionally during each interview visit?

{fill ‘Was’ if only one interviewer; Fill ‘Were’ if two interviewers; fill ‘he’ if only one interviewer and FI gender is male; fill ‘she’ if only one interviewer and FI gender is female; fill they if there was two different interviewers.}

both “BOTH”

neither “NEITHER”

firston “FIRST ONLY”

secondon “SECOND ONLY”

{if BI3 = neither or firston or secondon ask B13_A, else skip to BI4}

BI3_A

Please tell me more about how the {fill interviewer/interviewers} treated you.

ENTER RESPONDENT’S ANSWER VERBATIM UP TO ALLOW 250 CHARACTERS. ENTER 1 TO CONTINUE.

{use fill ‘interviewer’ if BI3 = firston or secondon, use fill ‘interviewers’ if BI3 = both or neither}

{allow 250 characters}

BI4

Do you have any additional feedback that you would like to give regarding {the/either of our} interviewer’s or nurse’s performance?

YESNO

{fill “the” if only one interviewer; fill ”either of our” if two interviewers}

{if BI4=YES ask BI4_E; else skip to THANKR}

BI4_E

ENTER RESPONDENT’S ANSWER VERBATIM UP TO ALLOW 250 CHARACTERS. ENTER TO CONTINUE.

THANKR

Those are all the questions I have. Thank you very much for your time. Have a good {fill evening/day}.

ENTER 1 TO CONTINUE AND FINALIZE THE INTERVEIW.

{use “day” for cases called before 5PM and “evening” for those called after 5PM}

{if NEW = 1 and PHONE has phone number entry, load new phone info into pre-load and re-release the case for production}

ENTER 1 TO CONTINUE AND FINALIZE THE INTERVIEW

Verification Questionnaire for Interview Q-26