17.4 Survey

BAR CODE LABEL OR SUBJECT ID HERE |___|___|___|___|___|___|___|___|

The ASA24 Acceptability Questionnaire #1

(Child 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 child 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 child’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 child’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 child 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 child’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 child ate in enough detail? (Check ONE box)

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

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

□₀₃ Frequently I could not report the foods my child 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 child ate? (Check ONE box)

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

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

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

□₀₄ No, I could not report the right amount of the foods my child 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?

|___|___|___|

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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