5.3 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Pregnancy Visit 2 SAQ, Phase 2g

OMB Specification

Pregnancy Visit 2 SAQ

Event Category:	Trigger-Based
Event:	PV2
Administration:	N/A
Instrument Target:	Pregnant Woman
Instrument Respondent:	Pregnant Woman
Domain:	Questionnaire
Document Category:	Questionnaire
Method:	Self-Administered
Mode (for this instrument*):	In-Person, PAPI
OMB Approved Modes:	In-Person, PAPI; Phone, PAPI; Web-Based, CAI
Estimated Administration Time:	3 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	2.4
MDES Release:	4.0

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

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Pregnancy Visit 2 SAQ

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

PREGNANCY VISIT 2 SAQ 3

FOR OFFICE USE ONLY: 9

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Pregnancy Visit 2 SAQ

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

PREGNANCY VISIT 2 SAQ

(TIME_STAMP_PV_ST).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

PV00100. Thank you for agreeing to participate in this study. This self-administered questionnaire will take about 3 minutes to complete. Your answers are important to us. There are no right or wrong answers. You can always refuse to answer any question or group of questions, and your answers will be kept confidential.  Please select only one answer for each question.

 

We would now like to take a few minutes to ask some questions about your experience in the study. 

 

How important was each of the following in your decision to take part in, or continue participation in the National Children’s Study?

PV01000/(LEARN). How important was … learning more about my health or the health of my child?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase (modified)

PV02000/(HELP). How important was … feeling as if I can help children now and in the future?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV03000/(INCENT). How important was … receiving money or gifts for taking part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV04000/(RESEARCH). How important was … helping doctors and researchers learn more about children and their health?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV05000/(ENVIR). How important was … helping researchers learn how the environment may affect children’s health?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV06000/(COMMUNITY). How important was … feeling part of my community?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV07000/(KNOW_OTHERS). How important was … knowing other women in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV08000/(FAMILY). How important was … having family members or friends support my choice to take part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV09000/(DOCTOR). How important was … having my doctor or health care provider support my choice to take part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV10000/(STAFF). How important was … feeling comfortable with the study staff who come to my home?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

PV10100. How negative or positive do each of the following people feel about you taking part in the National Children's Study?

PV11000/(OPIN_SPOUSE). Your spouse or partner?

Label	Code	Go To
Very negative	1
Somewhat negative	2
Neither positive or negative	3
Somewhat positive	4
Very positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

PV12000/(OPIN_FAMILY). Other family members?

Label	Code	Go To
Very negative	1
Somewhat negative	2
Neither positive or negative	3
Somewhat positive	4
Very positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

PV13000/(OPIN_FRIEND). Your friends?

Label	Code	Go To
Very negative	1
Somewhat negative	2
Neither positive or negative	3
Somewhat positive	4
Very positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

PV14000/(OPIN_DR). Your doctor or health care provider?

Label	Code	Go To
Very negative	1
Somewhat negative	2
Neither positive or negative	3
Somewhat positive	4
Very positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

PV15000/(EXPERIENCE). In general, has your experience with the National Children's Study been

Label	Code	Go To
Mostly negative	1
Somewhat negative	2
Neither positive or negative	3
Somewhat positive	4
Mostly positive	5

SOURCE

National Children’s Study, Vanguard Phase

PV16000/(IMPROVE). In your opinion, how much do you think the National Children's Study will help improve the health of children now and in the future?

Label	Code	Go To
Not at all	1
A little	2
Some	3
A lot	4

SOURCE

National Children’s Study, Vanguard Phase

PV17000/(INT_LENGTH). Did you think the interview was

Label	Code	Go To
Too short	1
Too long	2
Just about right	3

SOURCE

National Children’s Study, Vanguard Phase

PV18000/(INT_STRESS). Do you think the interview was

Label	Code	Go To
Not at all stressful	1
A little stressful	2
Somewhat stressful	3
Very stressful	4

SOURCE

National Children’s Study, Vanguard Phase

PV19000/(INT_REPEAT). If you were asked, would you participate in an interview like this again?

Label	Code	Go To
Yes	1
No	2

SOURCE

National Children’s Study, Vanguard Phase

PV20000. Thank you for participating in the National Children's Study and for taking the time to complete this survey.

FOR OFFICE USE ONLY:

FOU01000/(P_ID). PARTICIPANT ID:______________________________

Public reporting burden for this collection of information is estimated to average 3 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.