Cognitive Protocol

COGNITIVE INTERVIEWING PROTOCOL

National Survey of Children’s Health

Development of Mail and Internet Questionnaires with Measurement Equivalence

Respondent ID
Appointment Date	_____/_____/_____ MM DD YY
Appointment Time	_____:_____ AM/PM
Interviewer name
Observations or comments

Step 1

Interviewer: make sure you have the following materials.

Checklist

Interviewer protocol booklet (THIS BOOKLET)

Respondent questionnaire

Consent form (Two copies)

$50 cash in envelope

Payment receipt

Pens, pencils and extra white paper

Recorder

Step 2

Interviewer: Provide respondent with a copy of the informed consent form. Ask the respondent to read the form (or read it to him/her, depending on respondent preference), answer any questions, and have the respondent sign their initials giving consent. Leave a separate copy of the form with the respondent.

[INTERVIEWER]: IF CONDUCTING OVER THE PHONE, HAVE RESPONDENT GIVE VERBAL CONSENT AND SIGN YOUR INITIALS ON THE FORM].

Signed consent form collected

Copy of consent form given to respondent

Step 3

Interviewer: Confirm participant has consented to recording.

Pens, pencils and extra white paper

If not, DO NOT audiotape but continue with the interview stating that the conversation is not being

audiotaped

Step 4

Interviewer [ASK]: Do you have any questions before I begin?

Answer any questions R may have

R did not have questions

Interviewer: Although we will use your notes and recordings to obtain detailed feedback for the write-up, please use the coding scheme provided throughout this protocol to facilitate the summary of main findings. Do not read the coding scheme to the respondent.

Step 4

Interviewer [READ]: We discussed briefly during the initial phone screening whether you would be able to provide documentation of insurance coverage. Do you have this documentation available?

Did respondent provide documentation to confirm insurance coverage?

Yes

No

Physician Letter

Letter from the child’s school

Prescription bottle

Medical Records

Other (please specify)___________________________

____________________________________________

Step 5

Interviewer [READ]: We discussed briefly during the initial phone screening whether you would be able to provide documentation on your child’s condition(s). If you have this documentation available, we can collect it at this time. If you do not have the documentation available, we can discuss alternative options for verifying your child(s) conditions following the interview.

Did respondent provide documentation to confirm the child’s diagnosed condition(s)?

Yes

No

Physician Letter

Letter from the child’s school

Prescription bottle

Medical Records

Other (please specify)___________________________

____________________________________________

Cognitive Interview: SCREENER

Interviewer: Hand respondent a copy of a screener and a pen.

[READ] Now I would like you to complete this screening questionnaire. Once you’ve completed the screening questionnaire, I’ll also have some questions to ask you about it.

Section: “Survey Instructions”, “Start Here” and “Household”
Interviewer: Record START time	___:___AM/PM
Interviewer: Record END time	___:___AM/PM

Section: Survey Instructions
Is there anything unclear or confusing that you’ve noticed in section “Survey Instructions”? If yes, which parts?
1	No
2	Yes, which parts? What you’d change:

Section: Start Here
Is there anything unclear or confusing that you’ve noticed in section “Start Here”? If yes, which parts?
1 2	No Yes, which parts? What you’d change:

Section: Household
In general, is there anything unclear or confusing that you’ve noticed in section “Household”?
1	No
2	Yes, which parts? What you’d change:

Section: Child 1
In general, is there anything unclear or confusing that you’ve noticed in section “CHILD 1”?
1	No
2	Yes, which parts? What you’d change:

Section: Child 1/Q7 “Does this child currently need or use medicine prescribed by a doctor, other than vitamins?”
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

Section: Child 1/Q8 “Does this child need or use more medical care, mental health, or educational services than is usual for most children of the same age?”
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

Section: Child 1/Q9 “Is this child limited or prevented in any way in his/her ability to do the things most children of the same age can do?”
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

Section: Child 1/Q10 “Does this child need or get special therapy, such as physical, occupational, or speech therapy?”
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

Section: Child 1/Q11 “Does this child have any kind of emotional, developmental, or behavioral problems problem for which he/she needs treatment or counseling?”
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

Section: Mailing Instructions
Is there anything unclear or confusing that you’ve noticed in this section?
1	No
2	Yes, which parts? What you’d change:

Cognitive Interview: Topical Questionnaire (0-5)

Interviewer: Hand respondent a copy of a questionnaire and a pen.

[READ] Now I would like you to complete this screening questionnaire. As you go through the questionnaire, I’ll also have some questions to ask you about some of the survey items.

Section: Your Child’s General Health

Interviewer: Record START time	___:___AM/PM
Interviewer: Record END time	___:___AM/PM
Once R has completed Section A, please administer these probes.

Section: General Health/Q1 [QUESTION TEXT] *[INTERVIEWER: ONLY ASK QUESTIONS ASSIGNED FOR PROBING]
1.-Are there any terms or phrases that are not clear to you in this survey question? Which ones and why?	2.-Did you have troubles remembering information to answer this question? How?
R experienced difficulties understanding meaning of the survey question R did not experience difficulties	1 R experienced difficulties remembering relevant information 2 R did not experience difficulties
3.-Did you have trouble deciding on which information to use? Why?	4.-Did you have troubles selecting a response category to provide your answer? Why?
R experienced difficulties deciding on which info to use R did not experience difficulties	1 R experienced difficulties selecting a response category 2 R did not experience difficulties
5.-Interviewer: Record by observation alone or probe to see if R experienced difficulties with the following aspects
FOR PAPER & WEB	FOR WEB ONLY
R experienced issues locating instructions to answer survey item Issues locating navigating the question (following numbering) Issues following skip patterns Issues using arrows Issues locating response options Issues filling out boxes with blank space Issues seen boldface text 8 R experienced issues with font size 9 R experienced issues using colors Issues using segmented square spaces	R experienced issues locating navigational arrows (forward /backward) R experienced issues using vertical scroll bar 13 R experienced issues using drop down menu

End of interview

Interviewer: Thank the respondent for his/her time and his/her help. Ask if there is anything else R would like to add. To stop the recording.

These are all the questions I had for you. We sincerely appreciate your time and help. Your answers are very helpful to improve our questionnaire. Is there anything else you would like to add?

Thank you again, and have a good day.