Form 3.1 Survey

OMB #: 0925-0593

OMB Expiration Date: 07/31/ 2013

Non-Interview Respondent Questionnaire, Phase 2e

Nonrespondent Questionnaire

Event:	All Events
Participant:	Pregnant Woman, Non-Pregnant Woman, Father, Parent/caregiver
Respondent:	Pregnant Woman, Non-Pregnant Woman, Father, Parent/Caregiver
Domain:	Questionnaire
Type of Document: Allowable Mode: Allowable Method:	Interview In Person, Telephone, Mail, Web CAPI/CATI
Recruitment Groups: Version: Release:	EH, PB, HI, LI, PBS 1.0 MDES 3.0

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Non-Interview Respondent Questionnaire

TABLE OF CONTENTS

Initial Script to Begin NIR Instrument 1

Non-Interview Respondent Questions 2

Non-Interview Respondent Questionnaire

Initial Script to Begin NIR Instrument

PROGRAMMER INSTRUCTION:

• INSERT TIME_STAMP_NIR_ST.

NIR001. I am sorry to hear that you are choosing {not to join/to no longer participate in} the National Children’s Study. I would like to briefly ask you a few questions about your decision not to {join/participate}. Your answers are very important to us. There are no right or wrong answers. You can skip over any question or stop the interview at any time. Participating in this interview is your choice. We will use this information to improve the quality of the National Children’s Study for future participants.

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

Non-Interview Respondent Questions

NIR005/(NIR_REFUSAL_REASON). Please tell me the main reason you don’t {want to join/continue to participate in} the National Children’s Study?

INTERVIEWER INSTRUCTIONS:

• CODE MOST APPROPRIATE RESPONSE; SELECT OTHER IF UNSURE.

• IF RESPONDENT/PARTICIPANT PROVIDES MORE THAN ONE RESPONSE, PROBE FOR THE MAIN REASON.

Too busy/No time 1 (NIR_LOW_BURDEN)

Confidentiality/Privacy Issues 2 (NIR020)

Not interested (in topic or in general) 3 (NIR020)

Nothing in it for me 4 (NIR020)

too intrusive 5 (NIR020)

Do not believe in studies 6 (NIR020)

Afraid to participate 7 (NIR020)

Legitimacy issues/Think study is a scam 8 (NIR020)

Waste of time or money 9 (NIR020)

concerns about providing specimens 10 (NIR020)

none of the government’s business 11 (NIR020)

NOT SURE OF PURPOSE 12 (NIR020)

Other -5 RefusED -1 (NIR020)

DON’T KNOW -2 (NIR020)

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

NIR010/(NIR_REFUSAL_REASON_OTH).

SPECIFY:__________________________ (NIR020)

INTERVIEWER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

NIR015/(NIR_LOW_BURDEN). We understand that {joining/continuing to participate in} the National Children’s Study requires you to give up valuable personal time. Would you change your mind if there was an option that required less of your time?

Yes 1

No 2 RefusED -1

Don’t know -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

NIR020. I am now going to read a list of statements. Please decide if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with each statement.

NIR025/(NIR_BUSY_SCHEDULE). My work/personal schedule was very busy and I did not have time to participate in the National Children’s Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR030/(NIR_NO_SUPPORT). My partner/husband/family did not support my participation in the National Children’s Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR035/(NIR_STAFF_ANSWERED). The Study staff answered all of my questions about the National Children’s Study to my satisfaction.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR040/(NIR_NEGATIVE_PRESS). I heard or read something negative or uncomplimentary about the National Children’s Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR045/(NIR_STAFF_INHOME). I was comfortable with Study staff coming to my home for Study appointments.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR050/(NIR_PROVIDE_SAMPLES). I was comfortable with the idea of providing biological samples, such as blood and urine.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR055/(NIR_CONFIDENTIALITY). I worried the information about me and my family might not be kept confidential.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR060/(NIR_COMPENSATION). If there had been more compensation for my time and effort, I might have stayed in the Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR065/(NIR_TIME_COMMITTMENT). Committing to participate in a study lasting 21 years seemed overwhelming to me.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR070/(NIR_FRIENDLY_STAFF). The National Children’s Study staff were friendly.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR075/(NIR_STUDY_UNCLEAR). I was unclear about what it meant to participant in the Study and what I would be asked to do.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR080/(NIR_CHILD_PARTICIPATION). I was uncomfortable with having my child participate in the Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

NIR085/(NIR_FEWER_QUESTIONS). If I was asked fewer questions, I may have {joined/stayed in} the Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

NIR090/(NIR_INTERNET_SURVEY). If I was able to complete a written or Internet-based survey, I may have {joined/stayed in} the Study.

Strongly agree 1

Somewhat agree 2

Somewhat disagree 3

Strongly disagree 4

Not applicable 5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

NIR095/(NIR_ENOUGH_INFO). Do you feel that you were provided enough information about the National Children’s Study before being asked to join?

YES 1

NO 2RefusED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• IF NIR_ENOUGH_INFO =1 AND IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE), GO TO NIR_COMMUNICATION_FREQ.

NIR100/(NIR_ENOUGH_INFO_OTH). What type or types of information do you feel would have been helpful to you?

SPECIFY:______________

RefusED -1

DON’T KNOW -2

INTERVIEWER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

PROGRAMMER INSTRUCTIONS:

• IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE), GO TO NIR_COMMUNICATION_FREQ, OTHERWISE, GO TO

• IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE), GO TO NIR_IMPORTANCE.

NIR105/(NIR_COMMUNICATION_FREQ). Thinking about the number of letters, phone calls, and other correspondence you received from us to review your information, remind you of upcoming appointments, and provide other Study updates, would you say we communicated with you…

Much too often 1

Too often 2

Just the right amount 3

Too little 4

Much too little 5

REFUSED -1

DON’T KNOW -2

NIR110/(NIR_IMPORTANCE). How important do you think the National Children’s Study is?

Would you say that the National Children’s Study is…

Very important, 1

Somewhat important, 2

Neither important nor unimportant, 3

Not very important, or 4

Not important at all? 5

RefusED -1

DON’T KNOW -2

NIR115/(NIR_INFLUENCE). Did any friends or family influence your decision {not to join/to choose to no longer participate in} the National Children’s Study?

YES 1 (NIR_WHO_INFLUENCE)

NO 2 (NIR_FRIENDS_FAMILY)

RefusED -1 (NIR_FRIENDS_FAMILY)

DON’T KNOW -2 (NIR_FRIENDS_FAMILY)

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

NIR120/(NIR_WHO_INFLUENCE). Who influenced your decision {not to join/to no longer participate in} the National Children’s Study?

MOTHER/FATHER 1

BROTHER/SISTER 2

AUNT/UNCLE 3

GRANDPARENT 4

NEIGHBOR 5

FRIEND 6

OTHER -5

REFUSED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

• IF NIR_WHO_INFLUNCE CODED WITH ANY COMBINATION OF VALUES 1-6, THEN GO TO PROGRAMMER INSTRUCTIONS FOLLOWING NIR_FRIENDS_FAMILY.

• IF NIR_WHO_INFLUENCE CODED -5, OR ANY COMBINATION OF VALUES 1-6 AND -5, GO TO NIR_WHO_INFLUENCE_OTH.

• IF NIR_WHO_INFLUENCE CODED -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSES AND GO TO PROGRAMMER INSTRUCTIONS FOLLOWING NIR_FRIENDS_FAMILY.

NIR125/(NIR_WHO_INFLUENCE_OTH).

SPECIFY:______________

RefusED -1

DON’T KNOW -2

INTERVIEWER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

PROGRAMMER INSTRUCTIONS:

• IF NIR_WHO_INFLUENCE_OTH CODED -1, -2, OR SPECIFY, GO TO PROGRAMMER INSTRUCTIONS FOLLOWING NIR_FRIENDS_FAMILY.

NIR130/(NIR_FRIENDS_FAMILY). Do you think that you would be more likely to {join/continue to participate in} the National Children’s Study if it was suggested by a friend or family member?

YES 1

NO 2

RefusED -1

DON’T KNOW -2

PROGRAMMER INSTRUCTIONS:

• DISPLAY FIRST BRACKETED PHRASE IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE).

• DISPLAY SECOND BRACKETED PHRASE IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE).

• IF PARTICIPANT DECLINED PARTICIPATION FOLLOWING ENROLLMENT (I.E., CONSENT SET TO COMPLETE), GO TO NIR_FINAL.

• IF RESPONDENT DECLINED PARTICIPATION PRIOR TO ENROLLMENT (I.E., CONSENT NOT SET TO COMPLETE):

  • FOR OVC AND EH STUDY CENTERS, GO TO NIR_OTH_RECRUITMENT_NONPBR, NIR_OTH_RECRUITMENT_NONHILO, AND NIR_OTH_RECRUITMENT_NONEOTH AND THEN GO TO NIR_FINAL.

  • FOR PB STUDY CENTERS, GO TO NIR_OTH_RECRUITMENT_NONHILO, NIR_OTH_RECRUITMENT_NONEHBR, AND NIR_OTH_RECRUITMENT_NONEOTH AND THEN GO TO NIR_FINAL.

  • FOR HILI STUDY CENTERS, GO TO NIR_OTH_RECRUITMENT_NONPBR, NIR_OTH_RECRUITMENT_NONEHBR, AND NIR_OTH_RECRUITMENT_NONEOTH AND THEN GO TO NIR_FINAL.

NIR135/(NIR_OTH_RECRUITMENT_NONPBR). Do you feel that you would have been more likely to join if you had been approached at your doctor’s office about the National Children’s Study?

Yes 1

No 2

RefusED -1

Don’t know -2

NIR140/(NIR_OTH_RECRUITMENT_NONHILO). Do you feel that you would have been more likely to join if you had first been contacted by phone about the National Children’s Study?

Yes 1

No 2RefusED -1

Don’t know -2

NIR145/(NIR_OTH_RECRUITMENT_NONEHBR). Do you feel that you would have been more likely to join if you had been approached at your home about the National Children’s Study?

Yes 1

No 2

RefusED -1

Don’t know -2

NIR150/(NIR_OTH_RECRUITMENT_NONEOTH). Is there anything we have not already discussed that you would like to share about why you decided not to join the National Children’s Study?

Yes 1

NO 2 (NIR_FINAL)

RefusED -1 (NIR_FINAL)

Don’t know -2 (NIR_FINAL)

NIR155/(NIR_OTH_RECRUITMENT_NONEOTH_OTH).

SPECIFY: ­­­­­­­­­­­_____________________________________________________________

RefusED -1

Don’t know -2

NIR160/(NIR_FINAL). Thank you for taking the time to answer these questions. Are there any additional comments, feedback, or suggestions you would like to give at this time related to the National Children’s Study?

Yes 1

No 2 (NIR_END)

RefusED -1 (NIR_END)

Don’t know -2 (NIR_END)

NIR165/(NIR_FINAL_OTH).

SPECIFY:______________

INTERVIEWER INSTRUCTION:

• LIMIT FREE TEXT TO 255 CHARACTERS.

NIR170/(NIR_END). Those are all of the questions I have for you. Thank you for your time.

PROGRAMMER INSTRUCTION:

• INSERT TIME_STAMP_NIR_ET.

Public reporting burden for this collection of information is estimated to average 5 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.