Intro & Recruitment Materials Chinese

Attachment 4
Introductory and Recruitment Materials for Grantees, Sites, and Patients

HCPS Brochure

INFORMATION TO BE INCLUDED AS PART OF A TRIFOLD BROCHURE
(DESIGN IS IN PROGRESS)
關於健康中心患者問卷調查的常見問題
問卷調查的內容是什麼？目的是什麼？
RTI 研究所 (Research Triangle Institute) 正在進行健康中心患者問卷調查。此調查由健康資
源及服務管理署 (HRSA) 的基層保健局主辦。 這是針對在此類健康中心接受醫療護理的
人們的問卷調查。該調查將設法了解在此健康中心就診的病人面對何種健康問題，以及他
們的需求得到滿足的情況。調查不涉及任何移民法，研究主辦機構與移民機構沒有關聯。
問卷調查涉及範圍多大以及費時多長時間？
如果您同意參加，您就可以參加與我們訪員對您進行的現場訪談。我們將在健康中心或者
其他方便的地點進行私人面談。所有回答都會保密處理。您可以拒絕回答任何問題或者隨
時結束面談。
將會問到哪種類型的問題？
提的問題和您獲得的衛生保健，醫療條件，酒精和藥物使用，以及醫療保險有關。
面談時間是多久？
每個人的面談時間不同，但是一般需要 75 分鐘完成。
我有酬勞嗎？
您將獲得 25 美元現金或者等值的禮品作為您參加訪談的酬勞。支付形式由這家健康中心
所選。
我的隱私怎麼辦？
您提供的資訊將會保密。我們會創建並使用一個數字代替您的姓名存入電腦，並以此來確
定與您的面談。這就防止了任何人找出您的回答。您完成面談之後，訪談人員將不能再看
您的回答內容。我們將會把您的資訊與所有其他參加者的資訊合併，創建統計表。
為什麼選擇我來做這個調查？
RTI 研究所邀請了 495 所健康中心來進行此項研究。此健康中心已經同意參加。您是從這
家健康中心隨機抽取來參加的患者。

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我為什麼要參加？
您的意見及經歷非常寶貴。您代表了數以千計的接受相似醫療護理及服務的其他人。我們
通過這項調查收集的資訊將提供給決策者及健康中心，令其更好地理解病人受到怎樣的待
遇以及如何更好地服務這些健康中心的病人。
我是不是一定要參加？
您 不是 一定得參加這項調查或者您可以不回答任何您不想回答的問題。如果您選擇不參
加並不會對您或您的家人在這個健康中心獲取的任何服務有所影響。
RTI 研究所是什麼地方？
RTI 研究所是一個非盈利公司，位於北卡州的三角研究園區。RTI 進行各種研究，為當地，
州及聯邦機構提供服務。
我還有其他問題。誰來幫我解答？
如果您對研究有任何問題，您可以撥打袁瑜的電話：919-316-3576。如果您對您作為研究
參與者的權力方面有任何疑問，您可以撥打 RTI 研究保護部的免費電話(1-866-214-2043)。

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Respondent Recruitment Script at Clinic

Health Center Patient Survey
Respondent Recruitment Script
健康中心患者問卷調查
用於招募受訪者的腳本

您被邀請來參加基層保健局主辦，RTI 研究所進行的一項重要研究訪談。訪談將涉及您
的醫療保健經歷及其他話題。

如果您符合能參與此問卷調查的條件，您將會獲得 25 美元的現金或者等值的禮品作為
對您的感謝。

這本小冊子提供了提供有關此研究的信息。

如果您有興趣參與，或者有任何疑問，請閱讀這本小冊子並咨詢這裡的 RTI 研究所的
工作人員，_______________________________.

如果 RTI 研究所的人員不在這裡，但是您想了解更多關於此研究的信息，我們可以為
您預約與工作人員的咨詢。

我們希望您能夠參加這項研究。

謝謝！

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Interviewer Recruitment Script

Health Center Patient Survey
Interviewer Recruitment Script
INTRODUCTION
健康中心患者問卷調查
訪員招募腳本
介紹
您好，我的名字叫：YOUR NAME ，我在 RTI 研究所工作，這是位於北卡州羅利市的一
個非盈利調查研究公司。
我現在在：NAME OF CLINIC。我來進行一項由健康資源及服務管理署 (HRSA) 的基層保
健局主辦的患者調查。
此調查將設法了解人們面臨的各類健康問題，並看看健康中心如何滿足患者的需要。
此項面對面訪談調查需要近 75 分鐘完成，我們將提供 25 美元表示對參與人員的感謝。調
查為自願參加，所有您告訴我的信息都將完全保密。
我想先問您一些問題來看看您是否符合條件參加。
IF NOT IN PRIVATE LOCATION: 請您跟我來，我們可以去有隱私性場所來問關於您參與
資格的問題。

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Participant Screening Form

Patient Screening Form
Primary Health Care Patient Survey

FRONT END:
PROGRAMMER: WE WILL NEED TO DEVELOP THE FOLLOWING VARIABLES FROM
INFORMATION GATHERED AT GRANTEE RECRUITMENT:
DEVELOP VARIABLE “FAC1”=NAME OF FACILITY [ALLOW 40]
DEVELOP VARIABLE “STATE” [ALLOW 2 CHARACTER STATE ABBREVIATION]
PROGRAMMER: DO NOT ALLOW DK OR REF RESPONSE FOR ANY OF THE SCREENER
QUESTIONS.

S_LANG.
SELECT 1 FOR ENGLISH
SELECT 2 FOR SPANISH
SELECT 3 FOR CHINESE - MANDARIN
SELECT 4 FOR CHINESE - CANTONESE
SELECT 5 FOR KOREAN
SELECT 6FOR VIETNAMESE
[NOTE TO PROGRAMMER: WE WILL BE USING THE SAME CHINESE INSTRUMENT
FOR BOTH MANDARIN AND CHINESE. WE JUST NEED A MECHANISM IN THE
SCREENER TO KEEP TRACK OF THE DIFFERENT TYPES OF INTERVIEWS.]
S1a.

IS THIS A PROXY INTERVIEW?
1=YES [USE TO DEVELOP PROPER FILLS] -- CONTINUE
2=NO – GOTO S3

S1_child
What is your child’s first name? I just need a way of referring to your child.您的
孩子叫什麽名字？我只需要一個名字，在接下來的訪談中指代您的孩子。
[Allow 20]
S3. Please tell me the age category that applies to {you/name} 請告訴我{you/name}在哪個年
齡段。
PROBE FOR BEST ESTIMATE, IF NECESSARY
IF UNABLE TO COMPLETE SCREENING, ENTER YOUR BEST GUESS BASED ON
OBSERVATION

1=12 歲或以下
2=13 to 1713 到 17 歲
3=18 to 34 歲
4=35 to 49 歲
5=50 to 64 歲
6=65 歲或以上
[IF NOT A PROXY INTERVIEW AND IF S3=1, PRESENT ERROR MESSAGE:
“Children 12 years old and younger should only be interviewed through a proxy.”]
RETURN TO S1a.
S_INT1.
The first few questions are for statistical purposes only, to help us analyze the results of the
study. 前面幾個問題僅作統計用途，以幫助我們分析研究結果。
Do you consider {yourself/name} to be Hispanic or Latino(a)? 您覺得 {yourself/name}是否為西
班牙裔或拉丁美洲裔？

1=YES
2=NO
S_INT2.
What race or races do you consider {yourself/name} to be? You may select all that apply.
{FILL: Are you/Is he/Is she}...
您認為{yourself/name} 是什麼種族？您可選擇一項或多項。

{FILL: Are you/Is he/Is she}...是……?
EXPLAIN, IF NECESSARY: “We ask this for statistical purposes only, to help us analyze the
results of the study.” 前面幾個問題僅作統計用途，以幫助我們分析研究結果。
NOTE: CODE “NATIVE AMERICAN” AS “AMERICAN INDIAN”
IF UNABLE TO COMPLETE SCREENING, ENTER YOUR BEST GUESS BASED ON
OBSERVATION
1=White
2=Black or African American
3=American Indian or Alaska Native (American Indian includes North American, Central
American, and South American Indians)

4=Native Hawaiian
5=Guamanian or Chamorro
6=Samoan
7=Tongan
8=Marshallese
9=Asian Indian
10=Chinese
11=Filipino
12=Japanese
13=Korean
14=Vietnamese
15=Other
1=白人
2=黑人或非裔美國人
3=美洲印第安人或阿拉斯加原住民（美洲印第安人包括北美洲、中美洲及南美洲印第安
人）
4=夏威夷原住民
5=關島人或查莫洛人
6=薩摩亞人
7=東加人
8=馬紹爾人
9=亞洲印度人
10=華裔
11=菲律賓裔
12=日裔
13=韓裔
14=越南裔
15=其他

S_INT3.
IF SELF-RESPONDENT: RECORD; IF NOT OBVIOUS, ASK: What is your gender?
IF PROXY-RESPONDENT, ASK: What is {name’s} gender? {name’s}的性別？
[SHOW ONLY FOR RESPONDENTS GE 13 YEARS OLD, NON PROXY
INTERVIEWS:] IF R ANSWERS THAT THEYARE TRANSGENDER AND WHICH
KIND IS NOT OBVIOUS – PROBE IF THEY ALTERED GENDER FROM MALE TO
FEMALE OR FROM FEMALE TO MALE
IF UNABLE TO COMPLETE SCREENING, ENTER YOUR BEST GUESS BASED ON
OBSERVATION

EXPLAIN, IF NECESSARY: “We ask this for statistical purposes only, to help us analyze the
results of the study.” 前面幾個問題僅作統計用途，以幫助我們分析研究結果。
1=MALE
2=FEMALE
3=OTHER
S1b.

Thank you for your interest in participating in this patient survey. I have a few questions
to determine whether or not {you are /name is} eligible. 謝謝您對參加這個患者問卷調
查有興趣。我有幾個問題要問您，看看您是否符合條件。

{Have you}{Has your child} received services from a health care professional such as a doctor,
nurse, drug counselor, mental health counselor, or dentist at {reference health center} in the last
12 months, that is since {12 MONTH REFERENCE DATE}?過去 12 個月內，也就是從{12
MONTH REFERENCE DATE}開始，{Have you}{Has your child}是否從專業人士處獲得醫
療保健服務，比如醫生，護士，藥劑諮詢師，精神健康諮詢師，或牙醫？
1=YES
2=NO --- [GOTO END1 AND SET EVENT CODE TO 1320.]

S2_Intro
S2a.

Do any of the following apply to you?下面幾道題是否符合您的情況？

Have you worked as a farmworker in the past 24 months or have you or has anyone in
your family been supported by someone who worked as a farmworker in the past 24
months? 過去 24 個月內，您是否從事過農場工人的工作，或者您或您家裡的其他
人過去 24 個月內是否受過農場工人的支持？
1=YES
2=NO

S2b.

In the past 12 months, has there been a period in which you have been without regular
housing or homeless? To clarify, that is not living in your own house, apartment, or
room on a regular basis and not in a hospital or jail/prison. For example, living in a
shelter, on the street/campsite/car/etc. or in temporary or transitional housing where
services are provided.過去 12 個月內，有沒有哪個時期內您沒有固定住處或無家可
歸？也就是說，經常沒有住在自己的房子，公寓或房間里，也沒有住在醫院或監獄
里。比如說，住在避難所，露宿街頭，住在帳篷里或車裡，或在暫時性或過渡性的
為您提供服務的住處。
1=YES
2=NO

S2c. Are you currently living in a public housing unit? Do not count Section 8 housing as
public housing. 您目前是否住公屋？請不要包括《1937 年美國住房法》第 8 款規定的住房
補貼 （Section 8 housing）。

IF NEEDED, YOU MAY EXPLAIN: “Public housing is housing that is built, operated, and
owned by a government agency and that is typically provided at nominal rent to the needy.” 公屋
歸政府所有，由政府機構建造和管理，提供給有需要的人，只象徵性地收取租金。

1=YES
2=NO
S4_Intro.

INTERVIEWER: PLEASE ANSWER THE FOLLOWING QUESTIONS

S4a.

HAS YOUR QUOTA BEEN MET FOR FARMWORKERS
1=YES
2=NO
3=NO QUOTA FOR THIS FUNDING TYPE

S4b.

HAS YOUR QUOTA BEEN MET FOR HOMELESS
1=YES
2=NO
3=NO QUOTA FOR THIS FUNDING TYPE

S4c.

HAS YOUR QUOTA BEEN MET FOR PUBLIC HOUSING
1=YES
2=NO
3=NO QUOTA FOR THIS FUNDING TYPE

S4d.

HAS YOUR QUOTA BEEN MET FOR CHC
1=YES
2=NO
3=NO QUOTA FOR THIS FUNDING TYPE

NOTE TO PROGRAMMERS: THE FOLLOWING PRELOAD WILL COME FROM
SAMPLING AS THEY DETERMINE WHAT FUNDING TYPE THIS SITE FALLS
UNDER.
IF SITE = SINGLE FUNDING TYPE [FARMWORKER] THEN DEVELOP NEW
VARIABLE “FARM0” AND GO TO S5, ELSE CONTINUE

IF SITE = SINGLE FUNDING TYPE [HOMELESS] THEN DEVELOP NEW VARIABLE
“HOME0” AND GO TO S5, ELSE CONTINUE
IF SITE = SINGLE FUNDING TYPE [PUBLIC HOUSING] THEN DEVELOP NEW
VARIABLE “PUB0” AND GO TO S5, ELSE CONTINUE
IF SITE = SINGLE FUNDING TYPE [CHC] THEN DEVELOP NEW VARIABLE “CHC0”
AND GO TO S5, ELSE CONTINUE TO S4e.
S4e. SELECTION:
IF S2a=1 AND S4a=2 THEN CREATE NEW VARIABLE FARM1=1, ELSE FARM1=2
IF S2b=1 AND S4b=2 THEN CREATE NEW VARIABLE HOME1=1, ELSE HOME1=2
IF S2c=1 AND S4c=2 THEN CREATE NEW VARIABLE PUB1=1, ELSE PUB1=2
IF S4d=2 AND S2a = 2 AND S2b = 2 AND S2c = 2 THEN CREATE NEW VARIABLE
CHC1=1, ELSE CHC1=2
IF S4A-S4D ALL EQUAL 1, THEN FILL: “ALL OF YOUR QUOTAS ARE FILLED.
PLEASE DO NOT CONTINUE TO INTERVIEW AT THIS SITE.” SET EVENT
CODE TO 1390
IF FARM1=2 and HOME1 = 2 and PUB1 = 2 and CHC1=2 THEN CREATE NEW VARIABLE
CALLED PTYPE AND SET PTYPE TO EQUAL 5. SKIP TO END1.
IF FARM1=1 AND HOME1=2 AND PUB1=2 AND CHC=2, THEN SET PTYPE = 2 AND
FILL: “You have been selected for an interview. Would you be able to complete the
interview at this time?您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS
@UFARMWORKER@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE WITH INTERVIEW.
IF HOME1=1 AND FARM1=2 AND PUB1=2 AND CHC=2 THEN SET PTYPE = 3 AND
FILL: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS
@UHOMELESS@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE WITH INTERVIEW”
IF PUB1=1 AND HOME1=2 AND FARM1=2 AND CHC=2 THEN SET PTYPE = 1 AND
FILL: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS @U PUBLIC

HOUSING@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE WITH INTERVIEW”
IF CHC1=1 AND S2b=2 AND S2c=2 AND S2a=2 THEN SET PTYPE = 4 AND FILL: “You
have been selected for an interview. Would you be able to complete the interview at this
time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES – PROCEED
WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS @UCHC@U –
PLEASE UPDATE QUOTA AND CSR IF R AGREES TO PARTICIPATE AND
CONTINUE WITH INTERVIEW”
MULTIPLE SELECTION:
IF 2 OR MORE OF THE FOLLOWING: FARM1=1 AND/OR HOME1=1 AND/OR PUB1=1
AND/OR CHC1=1 THEN CONTINUE ELSE GOTO END1
SELECTION OF VARIABLES WHEN 2 OR MORE OF THE FOLLOWING (FARM1,
HOME1, PUB1) = 1.
IF PUB1=1 THEN SET PTYPE = 1 AND FILL “You have been selected for an interview.
Would you be able to complete the interview at this time? 您被選中參與研究訪談。您
現在能做這個訪談嗎？ IF YES –PROCEED WITH INTERVIEW. IF NO –
BREAKOFF AND SCHEDULE A TIME TO INTERVIEW IN CMS.
RESPONDENT INTERVIEW HAS BEEN SELECTED AS [FILL: @UPUBLIC
HOUSING@U]”,
ELSE IF FARM1=1 THEN SET PTYPE = 2 AND FILL “You have been selected for an
interview. Would you be able to complete the interview at this time? 您被選中參與研究
訪談。您現在能做這個訪談嗎？ IF YES –PROCEED WITH INTERVIEW. IF NO –
BREAKOFF AND SCHEDULE A TIME TO INTERVIEW IN CMS.
RESPONDENT INTERVIEW HAS BEEN SELECTED AS [FILL:
@UMIGRANT@U]”,
ELSE IF HOME1=1 THEN SET PTYPE = 3 AND FILL “You have been selected for an
interview. Would you be able to complete the interview at this time? 您被選中參與研究
訪談。您現在能做這個訪談嗎？ IF YES –PROCEED WITH INTERVIEW. IF NO –
BREAKOFF AND SCHEDULE A TIME TO INTERVIEW IN CMS.
RESPONDENT INTERVIEW HAS BEEN SELECTED AS [FILL:
@UHOMELESS@U]”,
ELSE IF CHC1=1 THEN SET PTYPE = 4 AND FILL “You have been selected for an
interview. Would you be able to complete the interview at this time? 您被選中參與研究

訪談。您現在能做這個訪談嗎？ IF YES –PROCEED WITH INTERVIEW. IF NO –
BREAKOFF AND SCHEDULE A TIME TO INTERVIEW IN CMS.
RESPONDENT INTERVIEW HAS BEEN SELECTED AS [FILL: @UCHC@U]”,
“PLEASE UPDATE QUOTA AND CSR IF R AGREES TO PARTICIPATE AND
CONTINUE WITH INTERVIEW”
S4f.
IF FARM0: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS
@UFARMWORKER@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE TO S5.”;
IF HOME0: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS
@UHOMELESS@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE TO S5”;
IF PUB0: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS @UPUBLIC
HOUSING@U – PLEASE UPDATE QUOTA AND CSR IF R AGREES TO
PARTICIPATE AND CONTINUE TO S5”;
IF CHC0: “You have been selected for an interview. Would you be able to complete the
interview at this time? 您被選中參與研究訪談。您現在能做這個訪談嗎？ IF YES –
PROCEED WITH INTERVIEW. IF NO – BREAKOFF AND SCHEDULE A TIME TO
INTERVIEW IN CMS. RESPONDENT INTERVIEW SELECTED AS @UCHC@U –
PLEASE UPDATE QUOTA AND CSR IF R AGREES TO PARTICIPATE AND
CONTINUE TO S5”;

S5. IF S3 = 13, 14, 15, 16, OR 17 CONTINUE
IF S3 = LE 12 = GOTO INTRO1, ELSE GO TO INTRO2
Is a parent or guardian with you?你的父母或監護人在嗎？
1=YES
2=NO

[IF S5=1 GOTO INTRO3, ELSE SET EVENT CODE=2231 UNACCOMPANIED MINOR
AND GO TO END2]
END1 Thank you very much, but unfortunately you were not selected for interview. 謝謝您！
但很遺憾，您沒有被選中參加此訪談。
END2

Thank you very much, but unfortunately we need to speak with your parent or
guardian to gain their permission for you to continue with the interview. 謝謝你！但
很遺憾，我需要先和你父母或監護人談談，獲得許可讓你繼續此訪談。