42.2 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Physical Activity Monitor Pick-Up Instrument, Phase 2g

OMB Specification

Physical Activity Monitor Pick-Up Instrument

Event Category:	Time-Based
Event:	36M, 48M, 60M
Administration:	N/A
Instrument Target:	Child
Instrument Respondent:	Primary Caregiver
Domain:	Environmental
Document Category:	Sample Collection
Method:	Data Collector Administered
Mode (for this instrument*):	In-Person, CAI
OMB Approved Modes:	In-Person, CAI
Estimated Administration Time:	6 minutes
Multiple Child/Sibling Consideration:	Per Child
Special Considerations:	N/A
Version:	1.0
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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Physical Activity Monitor Pick-Up Instrument

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

PHYSICAL ACTIVITY MONITOR PICK-UP 3

GPS MONITOR PICK-UP 6

PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG PICK-UP 9

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Physical Activity Monitor Pick-Up Instrument

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.

PHYSICAL ACTIVITY MONITOR PICK-UP

(TIME_STAMP_PAM_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP.

• PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR CAREGIVER.

• PRELOAD SAMPLE_ID, EQUIP_ID, MMS_SETUP, GPS_SETUP, AND MLG_LOG_OKAY FROM THE PHYSICAL ACTIVITY MONITOR SET UP INSTRUMENT.

• INSTRUMENT SHOULD ONLY BE LAUNCHED WHEN MMS_SETUP OR GPS_SETUP = 1.

PAM01000/(STAFF_ID). ENTER STAFF ID

___________________________________________

STAFFID

PROGRAMMER INSTRUCTIONS

• IF MMS_SETUP = 1 IN THE PHYSICAL ACTIVITY MONITOR SET UP INSTRUMENT, GO TO PAM02000.

• IFMMS_SETUP = 2 IN THE PHYSICAL ACTIVITY MONITOR SET UP INSTRUMENT, GO TO TIME_STAMP_GMP_ST.

PAM02000. PHYSICAL ACTIVITY MONITOR PICK-UP INSTRUCTIONS

DATA COLLECTOR INSTRUCTIONS

• PICK UP THE PHYSICAL ACTIVITY MONITOR IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.

PAM03000/(MMP_PICKUP_WRIST). WAS THE CHILD WEARING THE PHYSICAL ACTIVITY MONITOR ON HIS/HER WRIST AT PICK-UP?

Label	Code	Go To
YES	1
NO	2

PAM04000/(MMP_PICKUP_PROBLEM). DID YOU OBSERVE ANY PROBLEMS WITH THE PHYSICAL ACTIVITY MONITOR?

Label	Code	Go To
YES	1
NO	2	SAMPLE_ID

PAM05000/(MMP_PICKUP_PROBLEM_REASONS). RECORD THE PROBLEMS YOU OBSERVED WITH THE PHYSICAL ACTIVITY MONITOR.

Label	Code	Go To
MONITOR MISSING	1	PAM07000
MONITOR DAMAGED	2	PAM07000
OTHER	-5

PAM06000/(MMP_PICKUP_PROBLEM_REASONS_OTH). SPECIFY: __________________________________________

PAM07000. EQUIPMENT PROBLEM

DATA COLLECTOR INSTRUCTIONS

• COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.

PAM08000/(SAMPLE_ID). PHYSICAL ACTIVITY MEASUREMENT SAMPLE ID.

|E|__|__|__|__|__|__|__|__|-MT01

PHYSICAL ACTIVITY MEASUREMENT SAMPLE ID

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED PHYSICAL ACTIVITY MEASUREMENT SAMPLE ID.

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH MT01.

PAM09000/(SAMPLE_ID_SAME). {SAMPLE_ID} IS THE DISPLAYED SAMPLE ID THE SAME AS THE SAMPLE ID SHOWN ON THE LABEL PLACED ON THE PHYSICAL ACTIVITY MONITOR?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• DISPLAY PRELOADED PHYSICAL ACTIVITY MEASUREMENT SAMPLE_ID IN {SAMPLE_ID}.

PAM10000/(EQUIP_ID). PHYSICAL ACTIVITY MONITOR ID

_______________________________________________________

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED EQUIPMENT ID OF THE PHYSICAL ACTIVITY MONITOR.

PAM11000/(EQUIP_ID_SAME). {EQUIP_ID}  IS THE DISPLAYED EQUIPMENT ID THE SAME AS THE EQUIPMENT ID ON THE PHYSICAL ACTIVITY MONITOR?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED EQUIP_ID IN {EQUIP_ID}.

PAM12000. PHYSICAL ACTIVITY MONITOR PICK-UP DATE

(MMP_COLL_MM) MONTH: |___|___|

               M     M       

(MMP_COLL_DD) DAY:       |___|___|

                 D     D       

(MMP_COLL_YYYY) YEAR:     |___|___|___|___|                               

                    Y     Y     Y     Y

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF MM, DD OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.

PAM13000. PHYSICAL ACTIVITY MONITOR PICK-UP TIME

(MMP_PICK_TIME)      |___|___| : |___|___|

      H      H        M    M

(MMP_PICK_TIME_UNIT)

Label	Code	Go To
AM	1
PM	2

PAM15000/(MMP_PICKUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE PHYSICAL ACTIVITY MONITOR PICK-UP ACTIVITY.

COMMENTS: ____________________________

(TIME_STAMP_PAM_ET).

PROGRAMMER INSTRUCTIONS

INSERT DATE/TIME STAMP

GPS MONITOR PICK-UP

(TIME_STAMP_GMP_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

GMP01000. GPS MONITOR PICK-UP INSTRUCTIONS

DATA COLLECTOR INSTRUCTIONS

• PICK UP THE GPS MONITOR IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.

GMP02000/(GPP_PICKUP_WAIST). WASTHE CHILD WEARING THE GPS ON HIS/HER WAIST AT PICK-UP?

Label	Code	Go To
YES	1
NO	2

GMP03000/(GPP_PICKUP_PROBLEM). DID YOU OBSERVE ANY PROBLEMS WITH THE GPS?

Label	Code	Go To
YES	1
NO	2	SAMPLE_1_ID

GMP04000/(GPP_PICKUP_PROBLEM_REASONS). RECORD THE PROBLEMS YOU OBSERVED WITH THE GPS.

Label	Code	Go To
MONITOR MISSING	1	GMP06000
MONITOR DAMAGED	2	GMP06000
OTHER	-5

GMP05000/(GPP_PICKUP_PROBLEM_REASONS_OTH). SPECIFY: __________________________________________

GMP06000. EQUIPMENT PROBLEM

DATA COLLECTOR INSTRUCTIONS

• COMPLETE THE ENVIRONMENTAL EQUIPMENT PROBLEM LOG.

GMP07000/(SAMPLE_1_ID). GPS MEASUREMENT SAMPLE ID.

|E|__|__|__|__|__|__|__|__|-GP01

GPS MEASUREMENTSAMPLE ID

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED GPS MEASUREMENT SAMPLE ID

• ID MUST BE FORMATTED WITH TWO ALPHA 7 NUMERIC DASH GP01

GMP08000/(SAMPLE_1_ID_SAME). {SAMPLE_ID} IS THE DISPLAYED SAMPLE ID THE SAME AS THE SAMPLE ID SHOWN ON THE LABEL PLACED ON THE GPS MONITOR?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED GPS MEASUREMENT SAMPLE_IDIN {SAMPLE_ID}

GMP09000/(EQUIP_1_ID). GPS MONITOR ID

_______________________________________________________

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED EQUIPMENT ID OF THE GPS MONITOR.

GMP10000/(EQUIP_1_ID_SAME). {EQUIP_ID}  IS THE DISPLAYED EQUIPMENT ID THE SAME AS THE EQUIPMENT ID ON THE GPS MONITOR?

Label	Code	Go To
YES	1
NO	2
DON'T KNOW	-2

PROGRAMMER INSTRUCTIONS

• DISPLAY THE PRELOADED EQUIP_ID IN {EQUIP_ID}.

GMP11000. GPS MONITOR PICK-UP DATE

(GPP_PICK_DATE_MM) MONTH:|___|___|

                 M    M       

(GMP_PICK_DATE_DD) DAY:       |___|___|

                 D     D       

(GPP_PICK_DATE_YYYY) YEAR:     |___|___|___|___|

                  Y    Y      Y     Y       

PROGRAMMER INSTRUCTIONS

• DISPLAY HARD EDIT IF MM, DD OR YYYY ARE OUTSIDE CRITERIA DEFINED IN GENERAL PROGRAMMER INSTRUCTIONS.

GMP12000. GPS MONITOR PICK-UP TIME

(GPP_PICK_TIME)    |___|___| : |___|___|

     H      H       M    M

(GPP_PICK_TIME_UNIT)

Label	Code	Go To
AM	1
PM	2

GMP14000/(GPP_PICKUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE GPS MONITOR PICK-UP ACTIVITY.

COMMENTS: ____________________________

(TIME_STAMP_GMP_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP.

• IF MLG_LOG_OKAY = 1 IN THE PHYSICAL ACTIVITY MONITOR SET UP INSTRUMENT, GO TO TIME_STAMP_PAA_ST.

• IF MLG_LOG_OKAY = 2 IN THE PHYSICAL ACTIVITY MONITOR SET UP INSTRUMENT, GO TO TIME_STAMP_PAA_ET.

PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG PICK-UP

(TIME_STAMP_PAA_ST).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP.

PAA01000. PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG PICK-UP INSTRUCTIONS

DATA COLLECTOR INSTRUCTIONS

• PICK UP THE COMPLETED PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG IN ACCORDANCE WITH THE PHYSICAL ACTIVITY MEASUREMENT SOP.

PAA02000/(MLP_LOG_PICKUP). WERE YOU ABLE TO PICK UP THE PHYSICAL ACTIVITY AND GPS MONITOR WEAR LOG?

Label	Code	Go To
YES	1
NO	2

PAA03000/(MLP_LOG_PICKUP_PROBLEM). WERE THERE ANY PROBLEMS WITH THE LOG?

Label	Code	Go To
YES	1
NO	2	MLP_PICKUP_COMMENTS

PAA04000/(MLP_PICKUP_PROBLEM_REASONS). RECORD THE PROBLEMS YOU OBSERVED WITH THE LOG.

Label	Code	Go To
LOG MISSING	1	MLP_PICKUP_COMMENTS
LOG INCOMPLETE	2	MLP_PICKUP_COMMENTS
LOG ILLEGIBLE	3	MLP_PICKUP_COMMENTS
LOG NOT FILLED	4	MLP_PICKUP_COMMENTS
OTHER	-5

PAA05000/(MLP_PICKUP_PROBLEM_REASONS_OTH). SPECIFY: __________________________________________

PAA06000/(MLP_PICKUP_COMMENTS). RECORD ANY COMMENTS ABOUT THE PHYSICAL ACTIVITY AND GPS MONITORS WEAR LOG PICK-UP ACTIVITY.

COMMENTS: ____________________________

(TIME_STAMP_PAA_ET).

PROGRAMMER INSTRUCTIONS

• INSERT DATE/TIME STAMP

Public reporting burden for this collection of information is estimated to average 6 minutes per response, including the time for 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.