17.2 Survey

Provider-Based Sampling Feasibility Study for the Vanguard (Pilot) Study and Data Collection Updates for the National Children's Study (NICHD)

Attach B7. LOI2-QUEX-14 Infant Acceptability Questionnaire #1

Formative - Developmental

OMB: 0925-0593

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The ASA24 Acceptability Questionnaire #1

(Infant Version)


The purpose of this questionnaire is to obtain information about your experience with the ASA24 (the computer tool that you used to tell us what your infant ate and drank in a 24 hour time frame). Please fill out this questionnaire after you have completed the first ASA24 recall. Your responses would be greatly appreciated as they will help researchers learn more about the foods people eat.


1. – Was it easy to find the ASA-24 on the website?

01 Yes, it was easy to find

02 No, it was not


2. – Did you have or are you having any of the following technical difficulties in using the ASA24?

(Check ALL boxes that apply)

2A Wrong computer—website did not work on my computer

2B Website crashed on me

2C Got the following message: “Your computer screen’s resolution is not set to

recommended settings of 1024 X 768”

2D I could not get to the dietary part on my own

2E I could not navigate the software and make my way through it

2F Other (2H. Please describe) _________________________________________________

________________________________________________________________________

2G No problems


3A. - Was it easy for you to get access to the website with the ASA24?

01 Yes

02 No

3B. Why not?

01 No computer available at that time

02 Too busy with the household to get on computer

03 Computer connection too slow

04 I really have no quiet time to do this

05 I had to go away from home to get computer access

06 Other (3C. Please describe) ___________________________________

________________________________________________________________






4. – Did you ever quit the ASA24 because it took too long to finish or you could not figure out how to record your infant’s food intake? (Check ONE box)

01 No, I never quit ASA24 before recording all the foods I ate

02 One time I quit ASA24 before recording all the foods I ate

03 More than one time I quit ASA24 before recording all the foods I ate


5A. – How many times did you go to the ASA24 to enter a single day of food intake?

(Check ONE box)

01 One Time only- I always completed the ASA24 in the same session as when I started reporting my infant’s diet

02 More than one time- I entered some foods, had to do other things and continued

Later

5B. If “More than one time”-- how many times did you stop and start again

last day of recall? ______


6A. – Did the ASA24 include all foods that you wanted to report eating by your infant at your most recent recall?

01 Yes

02 No

6B – 6K. If No, please name as many missing foods as you can think of from your last recall _____________________________________________________________________

_____________________________________________________________________


7. – How difficult was it for you to find your infant’s foods? (Check ONE box)

01 Very easy

02 Easy

03 Moderate

04 Somewhat difficult

05 Difficult

06 Very difficult


8A. – Do you feel you were able to report the foods your infant ate in enough detail? (Check ONE box)

01 Yes, there was enough detail on all the foods my infant ate

02 Occasionally there was not enough detail on the ASA24 for the foods my Infant ate

03 Frequently I could not report the foods my infant ate to the exact detail


8B. Please provide as many food examples or details you have liked to find (this is really helpful to researchers and to other mothers) _____________________________________

__________________________________________________________________________

__________________________________________________________________________


9A. – Were you able to report the amount of the foods your infant ate? (Check ONE box)

01 Yes, I was always able to report the right amount for foods my infant ate

02 Occasionally I could not report the amount of the foods my infant ate

03 Frequently I could not report the right amount of the foods my infant ate

04 No, I could not report the right amount of the foods my infant ate


9B. How could this be made easier? _______________________________________

_____________________________________________________________

__________________________________________________________________


10. – Were the foods listed or named the way you know them?

01 Yes

02 No


11A. – Are there specific foods or foods names you think should be added to the ASA24?

01 Yes

11B. If Yes, please list as many foods as you can think of: ________________________________________________________________________

________________________________________________________________________________________________________________________________________________

02 No


12. - About how long did it take to complete the ASA24?

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Minutes


13. - How do you feel about the length of time it took to complete the ASA24? (Check ONE box)

01 It took a short amount of time

02 It took just the right amount of time

03 It took too long


14A. - Would you choose an internet-based tool to answer questions about your child’s dietary habits if you were asked again?

01 Yes

02 No

14B. If No, What would you prefer? Please select from the following options (Check ONE box)

01 Paper and pencil

02 In person interview

03 Phone interview


Thank you for your time and participation!

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File Typeapplication/msword
File TitleThe ASA24 Acceptability Questionnaire
Authorlporras
Last Modified Byhashemip
File Modified2012-10-17
File Created2012-10-11

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