Methodology and Selection Specs

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Health Center Patient Survey

Methodology and Selection Specs

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Attachment 11
Survey Methodology and Selection Specifications

September 2013

2014 Health Center Patient Survey
Deliverable 6: Survey Methodology and
Selection Specifications

Prepared for
Charles Daly
Health Resources and Services Administration
Bureau of Primary Health Care
Parklawn Building, 5600 Fishers Lane
Rockville, MD 20857
Draft: July 26, 2013
Revision #1: September 13, 2013
Revision #2:
Revision #3:
Final:
Prepared by
Tim Flanigan
Kathleen Considine
Patrick Chen
Shampa Saha
Azucena Derecho
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709

RTI Project Number 0213547.001.006

RTI Project Number
0213547.001.006

2014 Health Center Patient Survey
Deliverable 6: Survey Methodology and
Selection Specifications

_________________________________
RTI International is a trade name of Research Triangle Institute.

TABLE OF CONTENTS
Section 1. Introduction ........................................................................................................... 1-1
Section 2. Target Population .................................................................................................. 2-1
Section 3. Grantee Sample Selection ..................................................................................... 3-1
3.1

Sampling Frame Construction ............................................................................. 3-1

3.2

Stratification Variables ........................................................................................ 3-2

3.3

Grantee Sample Allocation .................................................................................. 3-3

3.4

Select Stratified PPS Sample of Grantees ............................................................ 3-5

Section 4. Site Sample Selection ........................................................................................... 4-1
4.1

Determination of Eligible Sites within Participating Grantees ............................ 4-1

4.2

Complete a Grantee Roster of All Eligible Sites ................................................. 4-2

4.3

Evaluate Distances between Eligible Sites .......................................................... 4-2

4.4

Select Sites ........................................................................................................... 4-4

Section 5. Patient Sample Selection....................................................................................... 5-1
5.1

Patient Sample Allocation to Grantee .................................................................. 5-1

5.2

Patient Interview Allocation to Sites within Grantee .......................................... 5-2

5.3

Patient Sample Selection Procedure .................................................................... 5-2

5.4

Special Considerations ......................................................................................... 5-5

iii

EXHIBITS
1.
2.
3.
4.
5.
6.
7.
8.
9.

Target Sample Sizes for the 2014 Health Center Patient Survey .................................... 1-2
Three-Stage Sample Design ............................................................................................. 1-2
Definition of Final Stratification...................................................................................... 3-4
Grantee Sample Allocation to Final Strata ...................................................................... 3-4
Grantee Sampling Rates for First-Level Strata ................................................................ 3-5
Grantee Information Sheet ............................................................................................... 4-3
Expected Yield of the Grantee Funding Type and Patients of a Stratified
Disproportionate Sampling .............................................................................................. 5-1
Patient Arrival and Selection Tracking Form .................................................................. 5-4
Patient Screening Form .................................................................................................... 5-6

SECTION 1.
INTRODUCTION
The 2014 Health Center Patient Survey, sponsored by the Health Resources and Services
Administration (HRSA), aims to collect data on patients who use health centers funded under
Section 330 of the Public Health Service Act. The Bureau of Primary Health Care (BPHC) will
build on prior Patient Survey research not only to collect updated information on patient
behaviors and perceptions, but also to identify ways to improve on survey methodologies and
analyses in the context of existing and emerging dynamics within the safety-net health care
landscape, the growth of the 330 Health Center Program, and the program enhancements across
HRSA that have occurred since the last survey.
Results from this survey will guide and support the BPHC in its mission to improve the
health of the nation’s underserved communities and vulnerable populations by assuring access to
comprehensive, culturally competent, quality primary health care services. The 2014 Health
Center Patient Survey will collect data from the clients of health centers funded through four
BPHC grant programs: the Community Health Center program (CHC), the Migrant Health
Center program (MHC), the Health Care for the Homeless program (HCH), and the Public
Housing Primary Care program (PHPC).
The sample design goals (presented in Exhibit 1) for the Health Center Patient Survey
are to
■

recruit 165 grantees;

■

select a sufficient number of patients to complete 3,630 patient interviews for the
CHC Patient Survey;

■

select a sufficient number of patients to complete 2,970 patient interviews for Special
Populations: 1,210 for MHC, 1,210 for HCH, and 550 for PHPC.

■

oversample patients of American Indian/Alaska Native (AIAN), Native
Hawaiian/Pacific Islanders (NHPI), and Asian race groups. Patients aged 65 or older
will also be oversampled.

In Deliverable 5–Statistical Design Plan, we presented a three-stage sample design for
the Patient Surveys (as shown in Exhibit 2) and discussed the plan of sample selection at each
stage in order to select a representative patient sample for four funding programs and meet
BPHC’s research interests in race/ethnicity and older age groups (AIAN, NHPI, Asian race
groups, and patients aged 65 or older).

1-1

Exhibit 1.
Funding
Program

Target Sample Sizes for the 2014 Health Center Patient Survey
Target Sample
Size

Race / Ethnicity

Target Sample Size Age Group

Target Sample
Size

CHC

3,630

Hispanic

2,044

0–17

2,200

MHC

1,210

Non-Hispanic White

1,558

18–64

3,200

HCH

1,210

Non-Hispanic Black

1,618

65+

1,200

550

Non-Hispanic AIAN

409

Non-Hispanic Asian

647

Non-Hispanic NHPI

251

Non-Hispanic Others

PHPC

Exhibit 2.

Three-Stage Sample Design

Sampling Stage

Sample Selection

Stage 1

Grantee sample selection

Stage 2

Site sample selection from participating grantee

Stage 3

Patient sample selection from site

In the first stage, grantees will be selected using the stratified probability proportional to
size (PPS) sampling method. Grantees participating in PHPC, MHC, and HCH funding programs
and grantees with concentrated AIAN, Asian, or NHPI patients will be oversampled. The
oversampling is achieved by stratification and application of different selection probability
among strata. The explicit stratification is based on the type of funding received by a grantee.
The stratum of grantees receiving CHC funding only is further stratified according to the
proportions of patients in one of the three oversampling race/ethnicity categories. In addition,
sorting the grantee frame by region, urbanicity, and grantee size (large, medium, or small 1)
before selecting the grantee sample serves as the implicit stratification, and it ensures that the
grantee sample has the good coverage of regions, urban and rural areas, and grantee sizes.
Because of the high costs involved in recruiting a grantee and hiring a field interviewer (FI) to
perform the data collection, we will select an independent site and patient sample from each
funding program for grantees receiving multiple funding programs.

Eligible grantees are sorted by the patient volume in each grantee, and then the top one third of grantees are
classified large, the middle third of grantees as medium, and the bottom third of grantees as small.

1-2

The second stage selects sites within participating grantees. If a grantee has three or
fewer sites in a funding program, they will all be selected, assuming they are in reasonable
proximity for an FI. A grantee with more than three sites in a funding program will have three
sites selected using PPS sampling, based on the number of patients served. A maximum of three
sites per funding program is allowed in each grantee. Again, to ensure a success of oversampling
AIAN, Asian, and NHPI patients, sites with concentrated patients in those three race/ethnicity
categories will be oversampled.
At the third stage, patients will be selected as they enter the site and register with the
receptionist. Patients in three oversampling race/ethnicity categories and patients aged 65 or
older will be identified and oversampled; that is, they will have higher probability of selection
than patients who are not in the oversampling groups. The receptionist will refer the first eligible
patients who are not in the oversampling groups to the FI when the FI indicates he/she is ready
for the next interview. The receptionist will refer patients in oversampling groups to the FI more
frequently. For each funding program, the same number of patient interviews will be completed
from each grantee to reduce unequal weighting effects (UWE) and maintain a balanced
workload. The total number of patient interviews within a grantee will be divided among
multiple sites if more than one site is selected for a funding program in the following two ways:
1. For grantees with more than three sites selected through PPS, the patient interviews
will be evenly divided among the three sites.
2. For the grantees with more than three sites not selected through PPS or grantees with
three or fewer sites that are all included in the study, the patient interviews will be
allocated proportionally to the patient size of sites.
In this report, RTI International 2 will further clarify our design plan by providing more
details on methodology and selection specification at each stage.

RTI International is a trade name of Research Triangle Institute.

1-3

SECTION 2.
TARGET POPULATION
The target population for the 2014 Health Center Patient Survey is defined as persons
who meet the definition of a health center patient used in the BPHC’s Uniform Data System
(UDS); that is, persons receiving face-to-face services from a CHC, MHC, HCH, or PHPC
grantee clinical staff member who exercises independent judgment in the provision of services. 3
Patients from grantees located within the 50 United States and the District of Columbia are
included; while patients from grantees within U.S. territories and possessions are excluded.
Only persons who received services through one of these grantees at least once in the
year prior to the current visit are considered eligible for the survey. This eligibility criterion will
be used because many of the questions in the survey ask about services received in the past year;
individuals without previous visits will not be able to answer these questions and, therefore, are
not considered eligible. This eligibility criterion was also implemented in the BPHC’s 2009
Primary Health Care Patient Surveys (PHCPS), the 2002 Community Health Center Survey, and
the 2003 Healthcare for Homeless Survey.

To meet the criterion for “independent judgment,” the provider must be acting on his/her own when serving the
patient and not assisting another provider.

2-1

SECTION 3.
GRANTEE SAMPLE SELECTION
This section discusses the methodology for selecting grantees. This process includes
sampling frame construction, stratification, sample allocation, and PPS selection of grantee
samples.
3.1

Sampling Frame Construction
Grantee sample selection will begin with the construction of a sampling frame using the

most recent available BPHC UDS. In this report, we use the 2012 UDS for illustrative purposes.
The information and variables necessary to construct the sample frame are as follows:
■

grantee identification number,

■

grantee address including street, city, and state,

■

grantee contact person information including name, telephone number, and e-mail
address,

■

number of patients served in the previous year,

■

number of health sites,

■

funding program indicators that provide information about what funding programs a
grantee received in the previous year (grantee type),

■

urban/rural indicator,

■

proportion of non–English-speaking patients,

■

proportion of patients with Hispanic origin, and

■

racial distribution (White, Black, AIAN, Asian, NHPI, more than one race).

In addition to the variables provided in UDS, five variables are derived and defined.
These variables are:
■

grantee size (large, medium, or small, in terms of patients served),

■

categorized number of sites (1, 2, 3, 4–9, 10–14, 15–19, 20+),

■

census region,

■

proportion of AIAN patients in a grantee,

3-1

■

proportion of Asian patients in a grantee,

■

proportion of NHPI patients in a grantee,

■

stratification variable, and

■

potential language barrier flag indicator.

The grantee type, proportion of AIAN patients, proportion of Asian patients, and
proportion of NHPI patients are used for stratification (see details in Section 3.2). The potential
language barrier variable warns whether conducting patient interviews in English or Spanish may
be problematic in a grantee. The variable flags a grantee if it has more than 30% non–Englishspeaking patients, fewer than 50% Hispanic patients, and more than 50% Asian patients.
The following grantees are ineligible for the Patient Surveys, and they will be excluded
from the grantee sample frame:
■

grantees located in U.S. territories or possessions (i.e., those in Puerto Rico, the
Virgin Islands, and the Pacific Basin);

■

grantees funded through the CHC program that only operated school-based sites;

■

grantees that have fewer than 300 patients;

■

grantees that received MHC funding only and that served clients only through a
voucher program; and

■

any grantee that has exited or will soon be exiting the Section 330 Program.

The 2011 UDS grantee-level data has 1,128 grantees. A total of 1,094 grantees were
considered eligible for the Patient Surveys by excluding 5 grantees that received CHC funding
but only operated school-based health centers; also excluded were 28 grantees that are located in
Puerto Rico, the Virgin Islands, and the Pacific Basin U.S. territories/possessions/affiliated states
and one grantee with fewer than 300 patients. A sampling frame file with all eligible grantees in
SAS will be created, and the SAS data file will include all of these variables.
3.2

Stratification Variables

As discussed in Deliverable 5–Statistical Design Plan, a random unstratified sample
would yield a very small patient sample size for the PHPC, MHC, and HCH funding programs,
which would result in very limited statistical power to compare survey outcomes among funding
programs. Our design goal is to recruit 165 grantees and complete 3,630 interviews for the CHC
Patient Survey contract and 2,970 for the Special Populations contract (1,210 for MHC, 1,210 for

3-2

HCH, and 550 for PHPC). To achieve the design goals, we will apply stratification in grantee
selection. As shown in Exhibit 3, 7 final strata will be used. These strata are defined as follows:
1. First-Level Strata: Four mutually exclusive strata that group grantees according to
the types of funding they receive (Stratum 1, Stratum 2, Stratum 3, and Stratum 4).
These first-level strata are used to ensure that the selected grantees are representative
of the four funding programs and are defined as follows:
– Stratum 1: Grantees received PHPC funding solely or in combination with other
funding programs.
– Stratum 2: Grantees received MHC funding solely or in combination with other
funding programs.
– Stratum 3: Grantees received HCH funding solely or in combination with other
funding programs.
– Stratum 4: Grantees received CHC funding solely.
2. Second-Level Strata: To achieve target sample sizes in three race/ethnicity
categories, grantees with concentrated patients in three race/ethnicity categories must
be obtained and selected at the first-stage selection. Grantees with more than 20% of
patients in one of the three race/ethnicity categories are considered as patientconcentrated grantees. Stratum 4 (CHC funding solely) has over 90% of such
grantees, and very few such grantees are from Strata 1, 2, and 3. Therefore, to select
grantees with concentrated patients in three race/ethnicity categories, Stratum 4 is
further divided into four second-level strata according to whether a grantee has
concentrated patients (over 20%) in one of the three race/ethnicity categories.
3.3

Grantee Sample Allocation

We plan to recruit 165 unique grantees to participate in the Patient Surveys to achieve our
targeted 6,600 completed patient interviews. As stated in Deliverable 5–Statistical Design Plan,
the grantees with PHPC, MHC, or HCH-funded programs and grantees with concentrated
patients in three oversampling race/ethnicity categories (AIAN, NHPI, and Asians) will be
oversampled. We allocate the grantee sample so that a minimum unequal weighting effect
(UWE) is achieved. We employed a nonlinear optimization procedure OPTMODEL in SAS,
which minimizes the UWE with the following constraints:
■

select 165 grantees;
■ complete 6,600 interviews;
■ complete following interviews per grantee: 22 for CHC, 25 for MHC, 25 for HCH, 15
for PHPC; and
■ select at least one grantee in each grantee type. 4
4

Grantee type is defined according to what funding program(s) a grantee participated or received funding from.

3-3

Exhibit 3.

Definition of Final Stratification
Number of
Grantees in
Sampling Frame

First-Stage and Second-Stage Strata

Grantee Funding
Type

Final
Stratum

Stratum 1: Grantees received PHPC funding solely or in
combination with other programs.

P; CP; PH; CMP;
CPH; CMPH

Stratum 2: Grantees received MHC funding solely or in
combination with other programs.

M; CM; MH;
CMH

138

Stratum 3: Grantees received HCH funding solely or in
combination with other programs.

H; CH

179

Stratum 4: Grantees received CHC funding solely.

Stratum 4.1: Grantees with more than 20% of AIAN
patients

Stratum 4.2. Grantees with more than 20% of Asian
patients

Stratum 4.3. Grantees with more than 20% of NHPI
patients

Stratum 4.4: All remaining grantees in Stratum 4

704

Total

1,149

NOTE: C = Community Health Center program; H = Healthcare for Homeless program; M = Migrant Health Center
program; P = Public Housing Primary Care program.

Exhibit 4 displays the grantee sample allocation to the final seven strata.
Exhibit 4.

Grantee Sample Allocation to Final Strata

First-Stage and Second-Stage Strata

Grantee Funding
Type

Final
Stratum

Stratum 1: Grantees received PHPC funding solely or in
combination with other programs.

P; CP; PH; CMP;
CPH; CMPH

Stratum 2: Grantees received MHC funding solely or in
combination with other programs.

M; CM; MH;
CMH

Stratum 3: Grantees received HCH funding solely or in
combination with other programs.

H; CH

Stratum 4: Grantees received CHC funding solely.

Grantee Sample
Allocation

Stratum 4.1: Grantees with more than 20% of AIAN
patients

Stratum 4.2. Grantees with more than 20% of Asian
patients

Stratum 4.3. Grantees with more than 20% of NHPI
patients

Stratum 4.4: All remaining grantees in Stratum 4

Total

166*

Note: The optimum grantee sample allocation results in 166 grantees instead of 165 due to rounding.

3-4

Exhibit 5 shows the overall grantee sample allocation for the first-level strata.
Exhibit 5.

Grantee Sampling Rates for First-Level Strata
Total Number
of Grantees

Selected
Grantees

Sampling
Rate

Stratum 1: Grantees received PHPC funding solely or in
combination with other programs.

50.7%

Stratum 2: Grantees received MHC funding solely or in
combination with other programs.

138

26.8%

Stratum 3: Grantees received HCH funding solely or in
combination with other programs.

179

9.5%

Stratum 4: Grantees received CHC funding solely.

761

10.0%

1,149

166

14.5%

Strata

Total

NOTE: CHC = Community Health Center program; H = Healthcare for Homeless program; PHPC = Public Housing
Primary Care program; MHC = Migrant Health Center program.

3.4

Select Stratified PPS Sample of Grantees

In this section we discuss the details of grantee selection based on the grantee sample
allocation summarized in Exhibit 4. To account for selected grantees’ refusal to participate, we
will select extra grantees within each stratum. The additional grantees will be held in reserve to
replace grantees that refuse to participate in the study. When we select the grantee sample, we
will assume an 85% response rate and select 195 grantees.
With the specified grantee sample allocation for each stratum shown in Exhibit 4, we
will then select grantees by PPS sample selection using PROC SURVEYSELECT in SAS. We
will use the sequential random selection option and sort the frame by region, urban/rural
location, and grantee size (large, medium, small) to serve as implicit stratification within each
stratum, as discussed in Deliverable 5–Statistical Design Plan. The number of patients served
by a grantee is used as the size measure in the PPS sequential sample selection. A random
number seed will be used and retained to ensure that the sample is repeatable and verifiable. The
selected grantee samples will be output to a SAS dataset, and analyses will be conducted to
ensure the selected grantees are a representative sample for key grantee characteristics such as
funding type, region, urban/rural location, and size of the grantee in terms of patient volume. All
RTI International standard operating procedures and technical operating procedures regarding
sample selection will be followed.
The steps of the grantee sample selection process are as follows:
1. Calculate the number of grantees selected from each final stratum (the grantee sample
allocation plus extra grantees selected to account for refusals).
3-5

2. Select grantee sample using PROC SURVEY SELECT in SAS.
a. Specify Method=SEQ.
b. Specify number of grantees selected from each final stratum.
c. Specify the number of patients that each grantee served in previous year as size
measure.
d. Sort sample frame by region, urban/rural location, and grantee size (large,
medium, small).
e. Specify a random seed.
f. Output selected grantees to a SAS data file.
3. Conduct RTI standard operating procedures and technical operating procedures of
sample selection.
a. Check all design parameters for completeness, namely final stratification variable,
number of patients that each grantee served, region, urban/rural location, and
number of sites within each grantee. Ensure that no values are missing for
numerical variables. For categorical variables, frequencies can be run to check
range and nonmissingness.
b. Check the sample frame to ensure that each element has a known, nonzero
probability of selection.
c. Check the distribution of implicit stratification variables.
d. Verify sample sizes for each final stratum.
e. Verify that the weighted size measures sum to the total number of grantees in the
sample frame.
After 195 grantees are selected and finalized, we will release 165 grantees to the field for
grantee recruitment. With each stratum, we will release the 85% of grantees with the largest
patient volume first. For example, we select 42 grantees for final Stratum 1; 36 grantees with
largest number of patients will be released to the field, and the remaining 6 grantees serve as
candidate grantees if any of 36 grantees released to the field refuse to participate in the study.
We offer questionnaires in six languages: English, Spanish, Chinese (Mandarin and
Cantonese), Korean, and Vietnamese. We will check each grantee in the first released list (165
grantees) to make sure that no potential language barrier problem exists. If a grantee with a
potential language barrier is selected, we will consult with the BPHC Contracting Officer

3-6

Representative (COR). The BPHC COR may need to verify the patient race/ethnicity distribution
with the grantee and determine a plausible solution. There are two options for dealing with such
a grantee:
1. Replace the grantee with a candidate grantee in the same final stratum, if languages
other than English, Spanish, Chinese, Korean, or Vietnamese are predominant.
2. Recruit patients from the grantee who speak one of the five languages if it can be
assured that a reasonably large proportion of patients in the grantee speak one of the
five languages.

3-7

SECTION 4.
SITE SAMPLE SELECTION
As discussed in Deliverable 5–Statistical Design Plan, more than two thirds of grantees
have three or more sites. In general, grantees with more sites tend to have more patients. At the
first-stage selection, grantees are selected with the PPS method, which means that grantees with
large numbers of patients have a higher probability of being selected in the sample. As a result,
we expect a fair number of the grantees recruited to have more than three sites. We will spread
the sample of patients across multiple sites to reduce the within-grantee clustering effect and
increase the precision of the analysis. We allow at most three sites for each funding program
within a grantee to be in the 2014 Health Center Patient Survey. This section discusses the
methodology and specifications for selecting sites from participating grantees.
4.1

Determination of Eligible Sites within Participating Grantees

Once a grantee is recruited and agrees to participate in the survey, our recruiters will
work with the grantee administration to collect and verify the number of sites and the funding
support that each site receives. The sites that do not receive support from at least one of the four
specific funding programs will be excluded from the study.
As discussed in Deliverable 5–Statistical Design Plan, some grantees have school-based
sites, which are funded under the CHC program. Because of the complexity of recruiting schoolbased sites and the extra effort required to get permission from schools and parents/guardians to
interview the patients, recruiting stand-alone, school-based sites is not feasible within the current
survey schedule and budget. Therefore, such sites will be excluded from the 2014 Health Center
Patient Survey. Although we will exclude these sites and any grantees with only school-based
sites, we will not necessarily exclude all patients who receive school-based health services; some
children who receive medical care at school-based health center sites may receive some of their
care at nonschool-based CHC sites near their residences.
Sites operated by the grantee and subcontractor sites are considered eligible if they meet
the following criteria:
■

The site should participate in at least one of the four specific funding programs and
must have been operating under the grantee for at least 1 year.

■

The site is not a temporary clinic.

■

The site is not a school-based health center.

4-1

4.2

■

The site is not a specialized clinic, except clinics providing ob-gyn services.

■

The site does not provide services only through the migrant and seasonal farmworker
voucher screening program.

■

A site serves at least 100 patients.

Complete a Grantee Roster of All Eligible Sites

After determining which sites are eligible, the recruiter will complete a grantee roster of
all eligible sites, and complete the Grantee Information Sheet (Exhibit 6) to gather the following
information from each participating grantee. The recruiter must ensure that the collected
information is accurate and up to date because the information is critical to the Patient Surveys.
The sampling staff will use that information to select the sites from participating grantees. For
each program from which the grantee receives funding, staff will collect the following
information:

4.3

■

number of eligible sites serving each client type (i.e., migrants, homeless, publichousing, and general patients);

■

address and contact information for each eligible site;

■

number of patients served in each eligible site, overall and by type of client (CHC,
MHC, HCH, and PHPC); and

■

sites with concentrated patients (more than 20%) in one of the three race/ethnicity
categories (AIAN, Asian, or NHPI).

Evaluate Distances between Eligible Sites

In most cases, one FI will be hired to collect data for each participating grantee.
Therefore, selected sites must be located within manageable distances for the FI(s). The grantees
tend to operate sites in relatively localized areas. Our sampling staff will evaluate distances
between the administrative office/central site and the associated sites. For a specific funding
program, the site with largest patient volume could be used as the central site. Typically sites will
be excluded if they are located more than 100 miles from the central site. However, we will pay
special attention to those sites located more than 100 miles from the administrative office/central
site, consult with BPHC COR, and determine if any modifications are needed or if special data
collection arrangements should be made.

4-2

Exhibit 6.

Grantee Information Sheet

Grantee Name:
Grantee Address:
Funding Type Received:
Number of Eligible Heath Center Sites Receiving Support at Least One of the Four Funding Programs:
Number of Patients Served under Each
Funding Program
Total # of
Eligible Health
Street
General
Patients
Migrant
Public Housing
Homeless
Center Site
Address City State ZIP
Served
Patient

4-3

1–name1
2–name2
3–name3
4–name4
5–name5
6–name6
7–name7
8–name8
9–name9
10–name10
11–name11
12–name12
13–name13
14–name14
15–name15
16–name16
17–name17
18–name18
.
.
99–name99
100–name100
Note: AIAN=American Indian/Alaskan Natives; NHPI=Native Hawaiians/Pacific Islanders.

Site has concentrated (over
20%) patients?
AIAN

NHPI

Asians

4.4

Select Sites

To achieve our target sample sizes of AIAN, Asian, and NHPI patients, we will not only
oversample grantees with concentrated patients in these three race groups at the first stage of
selection, we will also identify sites with concentrated patients in at least one of the three
targeted race/ethnicity categories. These sites will be selected with higher probabilities than sites
without concentrated patients.
If there are three or fewer sites for a population type (i.e., migrant and seasonal
farmworkers, homeless, public housing, and general community patients) and all of the sites are
within a manageable distance for one FI, all of the sites will be included in the study. If one site
is far from the other sites and the other sites are close to one another, we will select the two sites
that are close to each other. However, if all three sites are far from one another, we will select the
site with the largest patient volume. Similarly, when two sites for a specific funded program are
far from each other, we will select the one with the largest number of patients. Again, we will
review these special cases with the COR.
For grantees with more than three sites for a specific funding program, we will evaluate
the distances between all sites and the grantee’s central site, as discussed in Section 4.3. We will
sample only from the sites that are within a manageable distance for one FI to cover, and we will
use a PPS sampling method similar to the one described in Section 3.4 to select three sites. The
number of patients for the sites of a specific funding program will serve as the size measure in
the PPS sampling. For the grantees that participate in multiple funding programs, an independent
PPS selection of sites will be conducted for each funding program, if needed.
We will select three sites with the PPS selection method using PROC SURVEYSELECT
in SAS for each funding program. Some grantees may have sites in both urban and rural areas.
For those grantees, we will balance the selected site sample in terms of urban/rural locations. We
will sort the sites by urban/rural location before PPS selection. A random number seed will be
used and retained to ensure that the sample is repeatable and verifiable. The selected site sample
will be output to a SAS dataset, and we will conduct analyses to ensure that the selected health
center sites are representative. As discussed in grantee selection (Section 3.4), we will follow all
RTI standard operating procedures and technical operating procedures regarding sample
selection.

4-4

SECTION 5.
PATIENT SAMPLE SELECTION
In Sections 3 and 4 of this report, we discussed the selection of grantees and the selection
of sites from selected grantees. In this section, we present the methodology and specifications for
selecting patients from participating sites.
5.1

Patient Sample Allocation to Grantee
To achieve the near self-weighting within each grantee stratum and, thus, reduce the

UWE, the same number of patients will be interviewed from the grantees in each of the funding
programs. Following the grantee sample selection example presented in Exhibit 7, 163 CHC
grantees, 47 MHC grantees, 46 HCH grantees, and 36 PHPC grantees will be recruited. To
achieve 3,630 completed interviews for CHC, we will need to complete 22–23 patient interviews
per CHC grantee. We will need 25–26 completed interviews per MHC grantee to achieve 1,210
interviews for MHC; 26–27 completed patient interviews per HCH grantee to yield a total of
1,210 interviews for HCH; and 15–16 completed interviews per PHPC grantee to yield a total of
550 completed interviews for PHPC.
Exhibit 7.

Expected Yield of the Grantee Funding Type and Patients of a
Stratified Disproportionate Sampling

Funding Program

Expected Number of
Grantees

Number of Patients per
Grantee

Expected Number of
Completed Interviews for
Each Funding Program

CHC

163

22.4

3,630

HCH

26.3

1,210

MHC

25.7

1,210

PHPC

15.3

550

Total

290

6,600

NOTE: CHC = Community Health Center program; HCH = Healthcare for Homeless program; MHC = Migrant
Health Center program; PHPC = Public Housing Primary Care program.

This sampling example achieves the design objective of recruiting 165 grantees (in this
case, 166 grantees) and selecting enough patients to complete 6,600 total patient interviews:
3,630 for the CHC Patient Survey and 2,970 for Special Populations (1,210 for MHC, 1,210 for
HCH, and 550 for PHPC).
To meet the target of 6,600 complete interviews, when we select the real sample, we will
adjust the sampling rates at grantee selection for each stratum described previously and the
number of interviews per grantee for a specific funding program.
5-1

If more than one site is selected for a funding program within a grantee, the number of
completed interviews will be divided among those sites. Section 5.2 discusses patient interview
allocation to sites in detail.
5.2

Patient Interview Allocation to Sites within Grantee

As discussed in Deliverable 5–Statistical Design Plan, we will apply two different
methods to allocate patient interviews to multiple sites to reduce the UWE.
1. In grantees with more than three sites selected through PPS, the patient interviews
will be divided equally among three sites.
2. In grantees with more than three sites not selected through PPS or grantees with three
or fewer sites for which all sites are selected, the number of patient interviews within
that grantee will be allocated proportionally to the patient size of the sites. That is,

n fij = n fi

s fij

∑s

,
fij

where nfi is the number of interviews from a grantee for funding program f.
5.3

Patient Sample Selection Procedure

Because some of the target populations of this study are mobile, a random sample of
patients will be chosen for interviews as they enter the site and register with the receptionist for
services. The patients will be selected for the study using on-site recruitment procedures
designed to address Health Insurance Portability and Accountability Act (HIPAA) privacy
concerns. No FI will be allowed to approach any of the health center’s patients or to obtain any
identifying information about a patient unless the selected patient initiates such contact with an
FI.
FIs will work with the site to determine a specific schedule for patient sampling and data
collection that is feasible for all involved. It is not necessary to randomly select data collection
times, because type of illness and demographic characteristics are unlikely to be associated with
the day and time that a patient arrives for services. When the site has been recruited and agrees to
participate, RTI will arrange a training of the site receptionist by telephone to discuss the on-site
patient recruitment procedures. Upon arrival at the facility, the FI will again review the
procedures with the receptionist to ensure that she/he understands how to track the patients and
systematically sends patients to the FI for screening.

5-2

When an FI is onsite, the receptionist will be instructed to administer the following four
questions to every patient who arrives at the facility:
1. Have you received services from a health care professional such as a doctor, nurse,
drug counselor, mental health counselor, or dentist at __ FILL GRANTEE/SITES___
in the last 12 months?
1=YES  [CONTINUE]
2=NO  [PATIENT NOT ELIGIBLE]
2. Are you 65 years of age or older?
1=YES
2=NO
3. What race or races {do you/does name} consider {yourself/himself/herself} to be?
You may select one or more.
1=WHITE
2=BLACK OR AFRICAN AMERICAN
3=AMERICAN INDIAN OR ALASKA NATIVE
4=NATIVE HAWAIIAN / PACIFIC ISLANDER
5=ASIAN
6=OTHER
4. Do you consider {yourself/name} to be Hispanic or Latino(a)?
1=YES
2=NO
If the FI is available, the receptionist will send the NEXT patient that approaches the
counter to check in, regardless of age and race, as long as they received services in the past 12
months.
If the FI is unavailable or in the process of conducting an interview, the receptionist will
select the NEXT patient who meets the following criteria:
1. Is 65 years of age or older (regardless of race/ethnicity)
2. Is AI/AN, NH/PI, ASIAN, or Hispanic/Latino
The patient will be given a yellow laminated card that reads:
You have been selected for an interview. The interviewer is currently
unavailable but would like to ask you a few questions to determine if you are
eligible. Please keep this card with you and be sure it is visible to the
interviewer upon his/her return.
Only one card will be handed out (per FI) to ensure that we maintain control of the
sampling flow. This process also ensures that we oversample target populations while on-site.

5-3

The receptionist will be asked to keep track of the number of patients who enter the site
and the number of patients selected while the FI is at the site to conduct data collection. The
receptionist will either use tally marks to count patients as they enter or complete a table based
on the sign-in sheet or appointment list before the FI leaves the site. The patient count sheets for
each FI data collection visit will be sent to RTI for data entry, and counts will be used to
calculate the analysis weights for survey (see Exhibit 8).
Exhibit 8.

Patient Arrival and Selection Tracking Form

Grantee:
Health Center Site:
Funding Program:
Start Time:
End Time:
Today’s Date:
RECORD A TALLY MARK FOR EACH PATIENT WHO PRESENTS FOR SERVICES AND ANOTHER
FOR EACH PATIENT WHO IS SELECTED AND REFERRED TO THE INTERVIEWER.
Age

65+

Under
65

Race

Visited

Eligible

Referred

Approached FI

Selected

Completed

All Race/
Ethnicity

Completed by
FI

AI/AN
NH/PI
ASIAN

Completed by
FI

Other

Completed by
FI

If a grantee participates in more than one funding program, we will select an independent
patient sample for each funding program. If a site is chosen for multiple funding programs, the
receptionist at the site will be asked to select and count patients on the FI visiting dates. The FI
will screen participating patients to determine patient population types (i.e., homeless, migrant
and seasonal farmworkers, public housing, or general patients). If the quota for a specific
population type has not been met, the FI will conduct patient interviews for that population.
Patient/Interviewer Contact: If the selected patient is interested in participating in the
survey or has questions, he/she will approach the FI, who will be waiting in a designated area in
the site. The FI will take the participant to a designated, private location at the site to begin the
screening, informed consent, and interview processes. Migrant workers and homeless individuals
will be encouraged to begin the interview process immediately because we anticipate that it will
be more difficult for them to arrange to meet at a later time or date. In general, all patients will be
encouraged to begin the interview process immediately, but we anticipate that some may find it
more convenient to schedule an appointment with the FI for a later time or date. The FI will ask
5-4

the participant some initial screening questions to confirm the patient’s eligibility for the study.
Several screening questions ask whether the patient received services in the last 12 months;
whether the patient meets the criteria for services under the CHC, MHC, HCH, or PHPC
programs; what the patient’s age is; whether a young patient has a parent or guardian present;
etc. (see Exhibit 9 at the end of this section). If the patient is eligible, the FI will continue the
data collection interview. When the interview is complete, the patient will receive a $25
incentive.
At the end of each day, the FI will collect the Patient Arrival and Selection Tracking
Form from the receptionist. Collected forms will be shipped to RTI’s sampling department on a
weekly basis. The number of completed patient interviews for each funding program will be
monitored to ensure that the sample size targets are being met for each site.
5.4

Special Considerations

Several situations may require special attention during patient sample selection. In this
section, we discuss these situations and propose a solution for each.
Recruiting Patients from Mobile Van Grantee/Site: Grantees that operate mobile vans
to serve patients are included in the grantee sample frame. If such a grantee is selected, some
sampled sites could include mobile vans or outreach teams. These grantees provide services in
shelter-based clinics and mobile clinics that transport health service providers to sites where
homeless people congregate, including soup kitchens, streets, parks, under bridges, and other
public places. Most mobile vans operate on scheduled routes (i.e., one or two locations on a
designated day/night). Having scheduled routes allows clients to know in advance when and
where they will be able to obtain services. The FI needs to call ahead to determine the route or
meeting place for each day. The FI might select a specific route or place on certain days to
conduct patient interviews. If the van will be moving to multiple sites within an FI’s shift, the FI
should follow the van in his/her own automobile. We may apply systematic sampling procedures
from sign-in sheets. If systematic sampling procedures are not feasible, we will select time
periods to interview everyone who presents himself/herself for services within that time period.
We will consult with the BPHC COR to determine the best strategy for recruiting such patients
into the survey.

5-5

Exhibit 9.

Patient Screening Form

FRONT END:
PROGRAMMER: WE WILL NEED TO DEVELOP THE FOLLOWING VARIABLES FROM INORMATION
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.
S1a.

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

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
S1_child What is your child’s first name? I just need a way of referring to your child.
[Allow 20]
S3. Please tell me the age category that applies to {you/name}?
PROBE FOR BEST ESTIMATE, IF NECESSARY
IF UNABLE TO COMPLETE SCREENING, ENTER YOUR BEST GUESS BASED ON OBSERVATION
1=12 and under
2=13 to 17
3=18 to 34
4=35 to 49
5=50 and over
[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.
Do you consider {yourself/name} to be Hispanic or Latino(a)?
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}...
EXPLAIN, IF NECESSARY: “We ask this for statistical purposes only, to help us analyze the results of the
study.”

(continued)

5-6

Exhibit 9.

Patient Screening Form (continued)

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
S_INT3.
IF SELF-RESPONDENT: RECORD; IF NOT OBVIOUS, ASK: What is your gender?
IF PROXY-RESPONDENT, ASK: What is {name’s} gender?
[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.”
1=MALE
2=FEMALE
[IF S3 = 2-5: 3=TRANSGENDER MALE/ TRANS MAN/ FEMALE TO MALE]
[IF S3 = 2-5: 4=TRANSGENDER FEMALE /TRANS WOMAN/ MALE TO FEMALE]
[IF S3 = 2-5: 5=GENDERQUEER]
[IF S3 = 2-5: 6=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.
{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}?
1=YES
2=NO  [GOTO END1 AND SET EVENT CODE TO 452.]
S2_Intro Do any of the following apply to you?
S2a. 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?
1=YES
2=NO

(continued)

5-7

Exhibit 9.

Patient Screening Form (continued)

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.
1=YES
2=NO
S2c. Are you currently living in a public housing unit? Do not count Section 8 housing as public housing.
IF NEEDED, YOU MAY EXPLAIN: “Public housing is housing that is built, operated, and owned by a
government and that is typically provided at nominal rent to the needy.”
1=YES
2=NO
S4_Intro. INTERVIEWER: PLEASE ANSWER THE FOLLOWING QUESTIONS
S4a. HAS YOUR QUOTA BEEN MET FOR FARMWORKERS
1=YES
2=NO
S4b. HAS YOUR QUOTA BEEN MET FOR HOMELESS
1=YES
2=NO
S4c. HAS YOUR QUOTA BEEN MET FOR PUBLIC HOUSING
1=YES
2=NO
S4d. HAS YOUR QUOTA BEEN MET FOR CHC
1=YES
2=NO
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 453.
IF FARM1=2 and HOME1 = 2 and PUB1 = 2 and CHC1=2 THE CREATE NEW VARIABLE
CALLED PTYPE AND SET PTYPE TO EQUAL 5. SKIP TO END1.
S4e.
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? 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”

(continued)

5-8

Exhibit 9.

Patient Screening Form (continued)

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? 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? 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? 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? 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? 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? 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? 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”
IF S3 = 13, 14, 15, 16, OR 17 CONTINUE
IF S3 = LE 12 = GOTO INTRO1, ELSE GO TO INTRO2

(continued)

5-9

Exhibit 9.
S5.

Patient Screening Form (continued)

Is a parent or guardian with you?
1=YES
2=NO

[IF S5=1 GOTO INTRO3, ELSE SET EVENT CODE=451 UNACCOMPANIED MINOR AND GO TO END2]
END1 Thank you very much, but unfortunately you were not selected for interview.
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.
INTRO1: [PROXY CONSENT PROCEDURES]
GIVE @BPARENT PROXY CONSENT FORM@B, WHICH IS @B@UPINK@U@B.
“Please look over this form as I read aloud”
READ CONSENT. “Do you have any questions?” ANSWER QUESTIONS AND HAVE RESPONDENT SIGN
FORM. PROVIDE THE RESPONDENT WITH A BLANK COPY OF THE CONSENT FORM.
CONSENT1: DID RESPONDENT SIGN CONSENT FORM?
1=YES
2=NO
IF CONSENT1=1 GOTO RECORD1, ELSE GO TO END5
RECORD1
FI MAY READ THIS CARI CONSENT SCRIPT EITHER ON SCREEN OR ON THE HARD COPY
CONSENT FORM.
We are using a special quality control system on this project. The system runs on the computer and will record
what we say to each other during several different parts of the interview. Neither of us will know when the
computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and
will be kept private. You may still participate in the interview even if you do not consent to the recordings. May
we use this quality control system during your interview?
RECORD1:

DID RESPONDENT ALLOW CARI RECORDING?
1=YES
2=NO
IF RECORD1=1 GOTO INTERVIEW, ELSE: We will turn off the recording function so that none of the
interview is recorder. TURN CARI OFF AND GO TO INTERVIEW.
INTRO2: [ADULT CONSENT PROCEDURES]
GIVE RESPONDENT @BADULT CONSENT FORM@B, WHICH IS @B@UORANGE@U@B.
“Please look over this form as I read aloud”
READ CONSENT. “Do you have any questions?” ANSWER QUESTIONS AND HAVE RESPONDENT SIGN
FORM. PROVIDE THE RESPONDENT WITH A BLANK COPY OF THE CONSENT FORM.
CONSENT2: DID RESPONDENT SIGN CONSENT FORM?
1=YES
2=NO
IF CONSENT1=2 GOTO RECORD2, ELSE GO TO END5
RECORD2
FI MAY READ THIS CARI CONSENT SCRIPT EITHER ON SCREEN OR ON THE HARD COPY
CONSENT FORM.

(continued)

5-10

Exhibit 9.

Patient Screening Form (continued)

We are using a special quality control system on this project. The system runs on the computer and will record
what we say to each other during several different parts of the interview. Neither of us will know when the
computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and
will be kept private. You may still participate in the interview even if you do not consent to the recordings. May
we use this quality control system during your interview?
RECORD2:

DID RESPONDENT ALLOW CARI RECORDING?
1=YES
2=NO
IF RECORD2=1 GOTO INTERVIEW, ELSE: We will turn off the recording function so that none of the
interview is recorder. TURN CARI OFF AND GO TO INTERVIEW.
INTRO3: [ACCOMPANIED ADOLESCENT CONSENT PROCEDURES]
GIVE PARENT THE @BPARENT CONSENT FORM FOR ADOLESCENT INTERVIEW@B, WHICH IS
@B@UBLUE@U@B.
GIVE ADOLESCENT THE @BADOLESCENT ASSENT FORM@B, WHICH IS @B@UPURPLE@U@B.
“Please look over this form as I read aloud”
READ CONSENT. “Do you have any questions?” ANSWER QUESTIONS AND HAVE RESPONDENT
SIGN FORM. PROVIDE THE RESPONDENT WITH A BLANK COPY OF THE CONSENT FORM.
CONSENT3:

DID PARENT AND ADOLESCENT SIGN CONSENT FORM?
1=YES
2=NO
IF CONSENT3=1 GOTO CONSENT3_1, ELSE GO TO END3.
CONSENT3_1: TELL PARENT THAT WE NEED TO INTERVIEW ADOLESCENT RESPONDENT
PRIVATELY. DID PARENT AGREE?
1=YES
2=NO
IF CONSENT3_1=1 GOTO RECORD3, ELSE GO TO END4.
RECORD3
FI MAY READ THIS CARI CONSENT SCRIPT EITHER ON SCREEN OR ON THE HARD COPY
CONSENT FORM.
We are using a special quality control system on this project. The system runs on the computer and will record
what we say to each other during several different parts of the interview. Neither of us will know when the
computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and
will be kept private. You may still participate in the interview even if you do not consent to the recordings. May
we use this quality control system during your interview?
RECORD3:

DID RESPONDENT ALLOW CARI RECORDING?
1=YES
2=NO
IF RECORD3=1 GOTO INTERVIEW, ELSE: We will turn off the recording function so that none of the
interview is recorder. TURN CARI OFF AND GO TO.
END3: Thank you very much, but unfortunately we cannot proceed with the interview without a signature from
both of you.
END4: Thank you very much, but unfortunately we cannot proceed with the interview without your agreement.
END5: Thank you very much, but unfortunately we cannot proceed with the interview without your signed
consent.

5-11

Selecting Parent/Guardian-Child Patients: The parent/guardian and child/children can
enter a site together as patients to receive service. If the parent/guardian is eligible, the
receptionist will always select the parent/guardian and send him/her to the FI on site. If the
parent/guardian is not eligible but the children are eligible, the oldest child will be selected for
the survey.
Sites with More than One Receptionist Desk: Some sites with large numbers of patient
may have more than one receptionist desk. In these cases, receptionists must coordinate
extensively with each other for patient recruitment to go smoothly. When the FI is on site, one
receptionist desk will be designated for patient recruitment. All of the receptionists, however,
will need to track the patients entering the site regardless of whether they are chosen for patient
recruitment.
Sites that Serve More than One Population Type: Our patient screening procedure will
ensure that the site-specific interviewing quotas for each patient type are efficiently met. Three
hypothetical examples illustrate how patient selection operates at sites that serve more than one
population type:
1. If a site is selected for the MHC funding program, only patients who identify
themselves as migrants/farmworkers will be interviewed. Patients can be classified as
multiple population types, but they must be classified as migrants/farmworkers to be
eligible to participate in the survey. Patients who are not migrants/farmworkers will
not be interviewed.
2. If a site is selected for multiple funding programs—for example, MHC, PHPC, and
HCH—general community patients who are not served by these programs will not be
interviewed. If a patient is classified as being in an eligible population, he/she will be
interviewed if the quota for his/her specific funding program has not been met. If a
patient has multiple classifications, we will use the following priority ordering:
PHPC, MHC, and HCH. If the quota for a funding program with a higher priority
(e.g., PHPC) has been met and the quota for a lower priority funding program (e.g.,
MHC) has not been met, the patient will be interviewed for the lower priority funding
program.
3. If a patient identifies himself/herself as a member of one of the special populations
(i.e., either migrants/farmworkers, homeless, or living in public housing), the patient
will be not selected as general community patient to meet the quota for general
community patients.
Multiple Interviewers at a Site: Usually, one FI will be assigned to a grantee to conduct
patient interviews. There might be cases in which a site receives funding from multiple programs
and selected sites are far from one another; in such cases, one FI would have difficulty handling

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all the patient interviews. Two FIs might be assigned to such a site. It is possible that two FIs
will interview in the same site on the same day. In that case, if more than one receptionist is on
site, a receptionist can be designated to each FI to coordinate the patient interviewing. If only one
receptionist is on site, the receptionist can send patients to both FIs, alternating between the two.
In this case, the two FIs will need to communicate frequently during the day to track the status of
the quotas for each funding program.

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File Type	application/pdf
Author	derecho
File Modified	2014-02-12
File Created	2014-02-11