3 HINTS Cycle 2 Screener

ATTACHMENT E

HINTS 4 – Cycle 2: Cognitive Interviewer Screener Script 12-19-11

OMB #: 0925-0589-03

Expiry Date: 4/30/2014

Public reporting burden for this collection of information is estimated to average 15 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 (0925-0589-03). Do not return the completed form to this address.

INTRO

Screener for the Health Information National Trends Survey (English)

NAME: ______________________________________ R PHONE: ( ) ________ - ___________

DC NAME: _____________________________________ DATE: _____/_____/20 ____

|__| C= Eligible,Can Attend |__| E= Eligible, Can’t Attend Current Date(s)/Time(s)

|__| I= Ineligible |__| QF= Eligible, Cell Quota Filled

NAME____________________________ PHONE__________________________

RESPONDENT Number ____________________

Hello, my name is (NAME) and I’m calling from Westat, a research company in Rockville. May I speak with (NAME)?

[IF NEEDED, RE-INTRODUCE YOURSELF.]

Thank you for your interest in the Health Information National Trends Survey (HINTS). I would like to tell you a little bit about the study and then I’ll ask you a few questions to see if you are eligible to take part.

We’re looking for people to participate in a session that can last about an hour and a half. In that session you would meet with a Westat researcher who would ask you to complete a questionnaire from a survey that we’re developing about how people look for and use health-related information. We need men and women over the age of 18 to take part in the interviews. All the interviews are being conducted at Westat, in Rockville MD, and everyone who participates will receive $50 in appreciation for their time.

May I ask you a few questions to see if you’re eligible to participate.

IF NEEDED: Westat, a research company in Rockville, Maryland is conducting survey research for the U.S. Department of Health and Human Services to test questions for an upcoming national survey – we’d like to get your opinion on whether the questions are easy to understand and answer.

Q1. As I said, these interviews will take place at Westat’s headquarters, located on Research Boulevard in Rockville, Maryland. Are you within driving or commuting distance of our location?

[IF NEEDED: If driving, take I270, and get off at the Route 28exit towards Darnestown; turn right onto Research Boulevard and go to 1600 Research Blvd.

OR

We’re at 1600 Research Boulevard near the corner of Research and Gude Drive.

OR

If taking Metro, get off at the Rockville Metro station [NEAR SHADY GROVE END OF RED LINE]; THE 63 OR 54 BUS STOPS IN FRONT OF 1600 Research Boulevard.]

1. YES

2. NO – TERMINATE AND THANK: Based on the study design, our interviews are going to be conducted at Westat, so it looks like we can’t include you at this time.

Q2. ASK ONLY IF NOT OBVIOUS: Are you male or female?

• MALE

• FEMALE

Q3. Which of the following age categories are you in?

1. Under 18 – TERMINATE AND THANK: Based on the requirements of this study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.

2. 18 – 29,

3. 30 – 44,

4. 45 – 54,

5. 55 – 64, OR

6. 65 and older?

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q4. How many adults age 18 or older live in your household?

Q5. Are you of Hispanic or Latino Origin?

1. YES

2. NO

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q6. What race do you consider yourself? MARK ALL THAT APPLY.

1. White,

2. Black or African American,

3. Asian or Pacific Islander, or

4. American Indian or Alaska Native?

5. Other? ______________________

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q7. What is the highest level of education you have completed?

1. 11^th grade or less ,

2. 12 years of school, no diploma,

3. GED or high school graduate (diploma),

4. Some college or technical school,

5. College or technical school graduate, or

6. Post-graduate

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q8. Have you ever been told by a doctor that you have any of the following health conditions?

1. Asthma?

2. Diabetes?

3. Any type of cancer?

4. Heart disease?

5. High cholesterol?

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q8b. ASK IF NOT KNOWN: What type of cancer were you diagnosed with?

1. Skin cancer

2. Any other type

[INTERVIEWER: IF SKIN CANCER ONLY, THIS PERSON DOES NOT COUNT TOWARDS OUR QUOTA OF PEOPLE WITH A CANCER DIAGNOSIS.]

Q9. Have you smoked at least 100 cigarettes in your entire life?

a. Yes

b. No

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q10. In a typical week, about how often do you do any type of exercise?

a. Never

b. once or twice a week

c. three or four times a week

d. 5 or more times a week

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q11. When was the last time you participated in this type of interview session or a focus group?

a. 6 months ago or less – THANK AND TERMINATE: Based on the requirements of this study, it looks like we can’t include you at this time. Thanks you for your interest.

b. More than 6 months but less than a year –GO TO CLOSING 2.

c. More than a year ago

d. Never

Q12. Do you now or have you ever worked for Westat?

1. YES – THANK AND TERMINATE: Based on the requirements of this study, it looks like we can’t include you at this time. Thanks you for your interest.

2. NO

Q13. Have you ever worked in a job related to health or medicine, for example in nursing, as a lab technician, in medical or public health research, in an HMO office or a health related government agency?

1. YES

2. NO

[INTERVIEWER: RECRUIT ACCORDING TO OPENINGS POSTED.]

Q14. Have you ever heard of the Health Information National Trends Survey?

a. YES – ASK: Where have you heard of it? Are you a researcher who uses or have used HINTS data [IF YES TO USE OF HINTS DATA: “Based on the requirements of this study, it looks like we can’t include you at this time. It is possible we will be calling you in the future for other studies.]

b. NO

Q15. In the interview, we would need for you to read a questionnaire. Would that be a

problem for you?

1. YES– THANK AND TERMINATE: Based on the requirements of this study, it looks like we can’t include you at this time. Thank you for your interest.

2. NO

Q16. In what type of place do you live – a house, apartment or condo, or something else?

1. HOUSE

2. APARTMENT OR CONDO

3. SOMETHING ELSE (SPECIFY)_______________________________________________

[IF GROUP QUARTERS (DORMS, SHELTERS, ETC. Based on the requirements of this study, it looks like we can’t include you at this time. Thank you for your interest.

Q17. What time of day during the week would you be available to participate in an interview?

[NOTE ALL TIMES PERIODS CORRESPONDING TO THEIR GENERAL AVAILABILITY]

a. 7am to Noon

b. Noon to 4pm

b. 4pm to 7pm

c. After 7pm

d. Weekends only

Closing #1

You are eligible to help with this research project. Just to give you a little more information, we’ll be asking people about how they get information about health and their thoughts about health-related topics. Please note, we will not share your personal information with anyone outside of the study staff. Are you interested in participating?

YES — Thank you so much for your willingness to help us. If you are selected as a participant you will receive $50 cash upon completion of the interview. If you are chosen as a participant, I will call you back within a week to set up a time for you to meet with someone from the study team.

NO — Thank you for taking the time to talk with me today. Are you interested in being added to our database as someone who might be interested in participating in future studies like this one?

• YES ADD TO DATABASE.

• NO  Okay. Thank you again for your time today.

Closing #2

Thank you for answering those questions. We will contact you within the next week to indicate if you are eligible to help with this research project.

In the mean time, are you interested in being added to our database as someone who might be interested in participating in future studies like this one?

• YES  ADD TO DATABASE.

• NO  Okay. Thank you again for your time today.

RECRUITING TARGETS:

Characteristic	English Targeted number (22)	Spanish Targeted number (11)
Education
High school or lower	5	5
Some college	5	4
College or more	12	2
Race
African American or other minority	8	--
White	14	--
Male	10	4
Ever diagnosed with cancer	10	4
Ever smoked more than 100 cigarettes	6	4
Exercises at least once during typical week	6	4

INTRO

Screener for the Health Information National Trends Survey (Spanish)

NAME: ______________________________________ R PHONE: ( ) ________ - ___________

DC NAME: _____________________________________ DATE: _____/_____/20 ____

|__| C= Eligible,Can Attend |__| E= Eligible, Can’t Attend Current Date(s)/Time(s)

|__| I= Ineligible |__| QF= Eligible, Cell Quota Filled [CAN BE 1 BOX FOR THE CODE]

NAME____________________________ PHONE__________________________

RESPONDENT Number ____________________

Hola, mi nombre es (NAME) y estoy llamando de EurekaFacts de parte de Westat. ¿Puedo Hablar con (NAME)?

(reintroduce yourself if needed)

Gracias por su interés en la Encuesta Nacional de Tendencias Sobre Salud (HINTS por sus siglas en Ingles). Permítame contarle un poco sobre el estudio y luego le voy hacer algunas preguntas pare ver si usted es elegible para participar.

Estamos buscando personas para participar en una sesión que durara aproximadamente 90 minutos. En esa sesión, usted va a reunirse con un encuestador de EurekaFacts que le pedirá que complete un cuestionario de una encuesta que estamos elaborando para un estudio acerca de cómo la gente busca y utiliza información sobre salud. Necesitamos hombres y mujeres mayores de 18 años para participar en las entrevistas. Las sesiones se realizaran en EurekaFacts en Rockville MD, y todos los participantes recibirán $50 en efectivo como agradecimiento por su tiempo.

Si le parece bien, me gustaría hacerle unas pocas preguntas para saber si es elegible para participar.

IF NEEDED: Westat, una compañía de estudios de investigación en Rockville, MD está llevando a cabo estudios de investigación para el Departamento de Salud y Servicios Sociales de los Estados Unidos para poner a prueba preguntas para una encuesta nacional que se próxima y nosotros estamos trabajando con ellos– nos gustaría saber su opinión sobre si las preguntas son fáciles de entender y responder.

Q1. Como dije, la sesión se llevara a cabo en EurekaFacts, ubicado en Hungerford Drive en Rockville, Maryland. ¿Vive usted a una distancia donde se puede conducir o viajar por transporte público a nuestra localidad?

PROVIDE MORE INFO IF NEEDED: 495 HACIA LA 270 (ROCVILLE/FREDERICK); TOME LA SALIDA/EXIT DE FALLS ROAD; TOME MARYLAND AVENUE (MD-189) Y HAGA DERECHA EN BEALL AVENUE; DESPUES HAGA IZQUIERDA EN HUNGERFORD DRIVE (MD-355); EL EDIFICIO ESTARA EN EL LADO IZQUIERDO.

3. Si

4. No – TERMINATE AND THANK (“Basado en el diseño del estudio, nuestra sesión será realizada en EurekaFacts, por lo tanto parece que no podemos incluirle a usted en este momento.”)

Q2. ¿Habla usted español?

1. Si

2. No – THANK AND TERMINATE

Q3. ¿Diría usted que habla español…?

1. Muy bien

2. Bien, o

3. No muy bien– THANK AND TERMINATE

Q4. ¿Es el español su primer idioma o su lengua materna?

1. Si

2. No – THANK AND TERMINATE

Q5. ¿Diría usted que lee el español…?

1. Muy bien

2. Bien

3. No muy bien– THANK AND TERMINATE

4. No leo el español – THANK AND TERMINATE

Q6. ¿Habla usted Ingles…?

1. Si, muy bien – THANK AND TERMINATE

2. Si, bien– THANK AND TERMINATE

3. No muy bien– CONTINUE

4. No hablo Ingles– CONTINUE

RECRUITMENT CHECK: RECRUITED PARTICIPANTS SHOULD BE NATIVE SPANISH SPEAKERS ONLY.

Q7. ASK ONLY IF NOT OBVIOUS: ¿Es usted de sexo femenino o masculino?

• Male

• Female

Q8. ¿En cuál de las siguientes categorías de edad se encuentra usted?

7. Menor de 18 años – TERMINATE AND THANK (“Basado en los requerimientos de este estudio parece que o podemos incluirle a usted en este momento. Es posible que se le llame en el futuro para otros estudios.”)

8. 18 – 29

9. 30 – 44

10. 45 – 54

11. 55 – 64

12. Mayor de 65 años

INTERVIEWER: RECRUIT A MIX OF AGES.

Q9. ¿Cuántos adultos de 18 años de edad o mayor viven en su hogar?

Q10. ¿Es usted de origen hispano/latino?

3. Si

4. No – TERMINATE AND THANK

Q11. ¿Cuál es su país de origen/En donde nació?

____________________

INTERVIEWER – RECRUIT A MIX OF COUNTRIES

Q12. ¿De qué raza se considera usted? (MARK ALL THAT APPLY)

6. Blanco

7. Negro o Afro-Americano

8. Asiatico

9. Nativo de Hawái u otra isla del Pacifico

10. Indio Americano/ Indio Nativo Americano o Nativo de Alaska

Q13. ¿Cual es el nivel más alto de estudios que usted ha completado?

7. Primaria pero menos de Secundaria

8. Secundaria pero menos de estudios universitarios

9. Algunos estudios universitarios

10. Graduado de Universidad

NOTE: (Many Latin American Countries split secondary school into two parts- “basico” and “diversificado”)

INTERVIEWER: RECRUIT A MIX OF RESPONDENTS FROM EACH EDUCATION GROUP.

Q14. ¿Le ha dicho alguna vez un médico que usted tiene alguna de las siguientes condiciones de salud/médicas?

6. ¿Asma?

7. ¿Diabetes?

8. ¿Cualquier tipo de cancer?

9. ¿Enfermedad del corazón?

10. ¿Colesterol alto?

INTERVIEWER: RECRUIT UP TO 5 SPANISH SPEAKING RESPONDENTS FROM GROUP C.

Q14b. (If not already known) ¿Que tipo de cancer tuvo usted?

3. Cancer de la piel

4. Cualquier otro tipo

INTERVIEWER: IF SKIN CANCER ONLY, THIS PERSON DOES NOT COUNT TOWARDS OUR QUOTA OF PEOPLE WITH A CANCER DIAGNOSIS

Q15. ¿Cuándo fue la última vez que usted participo en este tipo de entrevista o grupo de discusión?

a. Hace 6 meses o menos –THANK AND TERMINATE (“Basado en los requerimientos de este estudio parece que o podemos incluirle a usted en este momento. Es posible que se le llame en el futuro para otros estudios.”)

b. Más de 6 meses pero menos de un año

c. Hace más de un año

d. Nunca

Q16. ¿Trabaja o ha trabajado alguna vez para Westat?

3. Si – THANK AND TERMINATE

4. No

Q17. ¿Alguna vez ha trabajado usted en un trabajo relacionado a la salud o medicina? (Ej. ENFERMERA/O, ESTUDIOS DE MEDICINA O SALUD PUBLICA, OFFICINA DE HMO, O ALGUNA AGENCIA GUVERNAMENTAL RELACIONADA CON LA SALUD)

3. Si

4. No

Q18. ¿Alguna vez ha escuchado hablar sobre la Encuesta Nacional de Tendencias Sobre Salud [Health Information National Trends Survey (HINTS por sus siglas en Ingles)]?

a. Si – Ask ¿Cómo supo de ésta encuesta? (where they have heard of it?) [Find out if they are a researcher that uses/used HINTS data. If they are, TERMINATE AND THANK (“Basado en los requerimientos de este estudio parece que o podemos incluirle a usted en este momento. Es posible que se le llame en el futuro para otros estudios”)]

b. No

Q19. En la entrevista, vamos a necesitar que usted lea el cuestionario. ¿Seria eso un problema para usted?

3. Si – THANK AND TERMINATE

4. No

Q20. ¿En qué tipo de vivienda vive usted, una casa, apartamento o condominio, o algún otro tipo de vivienda?

4. Casa

5. Apartmento or condominio

6. Algún otro tipo de vivienda(especifique)_______________________________________________

NO GROUP QUARTERS (DORMS, SHELTERS, ETC.) – TERMINATE AND THANK

Q21. ¿A Qué horas durante la semana está usted disponible para participar en la entrevista? [NOTE ALL TIMES PERIODS CORRESPONDING TO THEIR GENERAL AVAILABILITY]

a. Antes de 4pm

b. 4pm a 7pm

c. Después de 7pm

d. Fin de semana solamente

If response to Q9 = B (i.e., usted participo en este tipo de entrevista hace 6 meses o menos), then read Closing #2

Otherwise read Closing #1

Closing #1

Usted es elegible para participar y ayudarnos con este proyecto. Estaremos preguntado a la gente sobre como obtienen información acerca de la salud y sus opiniones sobre tópicos relacionados a la salud. Por favor tenga en cuenta que no compartiremos su información personal con nadie que no sea parte del estudio. ¿Esta usted interesado(a) en participar?

SI — Muchas gracias por su voluntad en ayudarnos. Si usted es seleccionado como participante usted recibirá $50 en efectivo por su participación. Si usted es elegido como participante, yo le llamare a usted dentro de unos días con la fecha y hora que usted se reunirá con alguien de nuestra oficina para la entrevista.

NO — Gracias por tomarse el tiempo para hablar conmigo hoy. ¿Le gustaría que le agreguemos a nuestra lista para ver si califica para participar en futuros estudios como este?

• Si  Add to database

• No  Bien. Gracias por darnos su tiempo hoy.

Closing #2

Gracias por contestar las preguntas. Nos comunicaremos con usted dentro de la próxima semana para dejarle saber si usted es elegible para ayudar con este proyecto.

Mientras tanto, ¿Le gustaría que le agreguemos a nuestra lista por si califica a participar en futuros estudios como este?

• Si  Add to database

• No  Bien. Gracias por darnos su tiempo hoy.