Surveys and other audiences research for Radio and TV Marti

Qualitative Research Among Recently-Arrived Cuban Immigrants
Recruitment Screener
S1.

QUESTIONNAIRE NUMBER: __________________________

S2.

INTERVIEW DATE (MMDDYYYY): _____________________________________

S3.

INTERVIEW LOCATION/ADDRESS: _____________________________________

INTERVIEWER READ INTRO: Hi, my name is ________________ with Spanish Radio Productions. We
are a private company studying the experiences of people recently arrived from Cuba. I’d like to ask you a
few questions and your answers will be kept completely confidential.

Q1A.

First, what is your age?

INTERVIEWER: Record actual age ____________

Q1B.

INTERVIEWER: RECORD AGE BASED ON RESPONSE IN Q1A.
CIRCLE ONE
RESPONSE
Under 18

1

18-25
26-35
36-49
50+
Don’t know
Refused

2
3
4
5
8
9

ROUTE
THANK AND
TERMINATE
CONTINUE
THANK AND
TERMINATE

Q2. Did you leave Cuba within the last two years?

Yes
No
Don’t know
Refused

Q3.

CIRCLE ONE
RESPONSE
1
2
8
9

ROUTE
CONTINUE
THANK AND
TERMINATE

In what month and year did you leave Cuba?

INTERVIEWER: RECORD MONTH AND YEAR BELOW.
Q3A.

Month

January
February

CIRCLE ONE
RESPONSE
1
2

Q3B.

March
April
May
June
July
August
September
October
November
December

3
4
5
6
7
8
9
10
11
12

Don’t know
Refused

98
99

Year

2009 or earlier
2010
2011
2012

CIRCLE ONE
RESPONSE
1
2
3
4

Don’t know
Refused

8
9

(INTERVIEWER: FILL IN CURRENT MONTH MARKERS BEFORE CONTINUING)
Q4. (DO NOT ASK- CODE BASED ON RESPONSES TO Q3A AND Q3B)

Within the past 3 months
(February 2012 or later)
3 months ago to less than 6 months ago
(November 2011 to January 2012)
6 months ago to less than 1 year ago
(May 2011 to October 2011)

Q5.

CIRCLE ONE
RESPONSE
1

CONTINUE

2
3

1 year ago to less than 18 months ago
(November 2010 to April 2011)
More than 18 months ago
(October 2010 or earlier)

4

Don’t know
Refused

8
9

ROUTE

TERMINATE
CONTINUE

5
TERMINATE

Have you done any of the following in the last six months?

INTERVIEWER: READ Q5A-Q5F. CIRCLE ONE RESPONSE FOR EACH ROW.

Q5A.

Enrolled in a course to learn English

Q5B.

Purchased a car

Yes

No

Don’t
know

Refused

1

2

8

9

1

2

8

9

Q5C.

Travelled to other states inside the U.S

1

2

8

9

Q5D.

Travelled back to Cuba

1

2

8

9

Q5E.

Opened a checking account

1

2

8

9

Q5F.

Sent money or other assistance to family/friends in
Cuba

1

2

8

9

Q6.

While you were in Cuba, did you have any of the following?

INTERVIEWER: READ Q6A-Q6E. CIRCLE ONE RESPONSE FOR EACH ROW.
Yes

No

Don’t
know

Refused

Q6A.

An automobile

1

2

8

9

Q6B.

A mobile phone that you regularly used

1

2

8

9

Q6C.

A landline telephone at home

1

2

8

9

Q6D.

A bank account
Shared access to satellite TV via cable at home

1

2

8

9

1

2

8

9

Q6E.
Q7.

While you were in Cuba, did you use any of the following?

INTERVIEWER: READ Q7A-Q7C. CIRCLE ONE RESPONSE FOR EACH ROW.
Yes

No

Don’t
know

Refused

Q7A.

Websites located outside Cuba excluding sites
used only for email)

1

2

8

9

Q7B.

Your own-home satellite antenna and receiver

1

2

8

9

Q8.

During your last 3 months in Cuba, how often did you watch television?

INTERVIEWER: READ 1-3.

At least once a week
Less than once a week
Never
Don’t know
Refused
Q9.

CIRCLE ONE
RESPONSE
1
2
3
8
9

During your last 3 months in Cuba, how often did you listen to the radio?

INTERVIEWER: READ 1-3.

At least once a week
Less than once a week
Never
Don’t know
Refused

CIRCLE ONE
RESPONSE
1
2
3
8
9

Q10. How comfortable are you sharing your opinion in a group discussion with other recent Cuban
immigrants that you may not know? Use a 5-point scale, where 5 means extremely comfortable and 1
means not comfortable at all.
CIRCLE ONE
RESPONSE
5
4
3
2
1

Extremely comfortable

Not comfortable at all
Don’t know
Refused

Q11.

ROUTE
CONTINUE

TERMINATE

8
9

What is the highest level of education you completed?

INTERVIEWER: READ CATEGORIES IF NECESSARY. CLARIFY WHETHER LEVEL OF EDUCATION
IS COMPLTE OR INCOMPLETE. IF COMPLETE, ASK IF RESPONDENT HAS SOME STUDIES AT
THE NEXT HIGHEST LEVEL.

Less than Primary
th
Primary (6 grade)
Some Secondary (did not complete
th
9 )
th
Completed Secondary (9 grade)
Some or all pre-university
Intermediate or advanced
technical
Some or all University
Some or all Post graduate
Don’t know
Refused
Q12.

CIRCLE ONE
RESPONSE
1
2
3
4
5
6
7
8
98
99

ROUTE

TERMINATE

CONTINUE

TERMINATE

INTERVIEWER: Record Gender (DO NOT ASK)

Male
Female

CIRCLE ONE
RESPONSE
1
2

Thank you for your time. I would now like to get some contact information for you in case we’d like to
contact you in the future.

RESPONDENTS NAME: ____________________________________________________________

ADDRESS: ________________________________________________________________________

__________________________________________________________________________________

LANDLINE TELEPHONE: ____________________________________________________________

MOBILE TELEPHONE: ______________________________________________________________

EMAIL: ___________________________________________________________________________

RECRUITER’S NAME: _______________________________________________________________

DATE RECRUITED: _________________________________________________________________

UNIQUE RESPONDENT INDENTIFIER (4-DIGIT # BETWEEN 0001-9999): ______________________
[FIELDS IN RED FOR INTERNAL USE DURING RECRUITMENT]