2.3 Survey

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Pre-Pregnancy SAQ, Phase 2g

OMB Specification

Pre-Pregnancy SAQ

Event Category:	Trigger-Based
Event:	Pre-Pregnancy
Administration:	N/A
Instrument Target:	Pre-Pregnant Woman
Instrument Respondent:	Pre-Pregnant Woman
Domain:	Questionnaire
Document Category:	Questionnaire
Method:	Self-Administered
Mode (for this instrument*):	In-Person, PAPI
OMB Approved Modes:	In-Person, PAPI; Phone, PAPI; Web-Based, CAI
Estimated Administration Time:	3 minutes
Multiple Child/Sibling Consideration:	Per Event
Special Considerations:	N/A
Version:	1.2
MDES Release:	4.0

*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.

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Pre-Pregnancy SAQ

TABLE OF CONTENTS

GENERAL PROGRAMMER INSTRUCTIONS: 1

INTERVIEW EVALUATION 3

FOR OFFICE USE ONLY: 9

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Pre-Pregnancy SAQ

GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:

DATA ELEMENT FIELDS	MAXIMUM CHARACTERS PERMITTED	DATA TYPE	PROGRAMMER INSTRUCTIONS
ADDRESS AND EMAIL FIELDS	100	CHARACTER
UNIT AND PHONE FIELDS	10	CHARACTER
_OTH AND COMMENT FIELDS	255	CHARACTER	Limit text to 255 characters
FIRST NAME AND LAST NAME	30	CHARACTER	Limit text to 30 characters
ALL ID FIELDS	36	CHARACTER
ZIP CODE	5	NUMERIC
ZIP CODE LAST FOUR	4	NUMERIC
CITY	50	CHARACTER
DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)	10	NUMERIC CHARACTER	DISPLAY AS MM/DD/YYYY STORE AS YYYY-MM-DD HARD EDITS: MM MUST EQUAL 01 TO 12 DD MUST EQUAL 01 TO 31 YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.
TIME VARIABLES	TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION	NUMERIC	HARD EDITS: HOURS MUST BE BETWEEN 00 AND 12; MINUTES MUST BE BETWEEN 00 AND 59

Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).

POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.

A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.

INTERVIEW EVALUATION

IE01000. We would now like to take a few minutes to ask some questions about your experience in the study.  There are no right or wrong answers.  You can always refuse to answer any question or group of questions, and your answers will be kept confidential.

 

How important was each of the following in your decision to take part in the National Children’s Study?

PARTICIPANT INSTRUCTIONS

• Please mark only one answer per question.

SOURCE

National Children’s Study, Vanguard Phase

IE02000/(LEARN). How important was… learning more about my health or the health of my child?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE03000/(HELP). How important was…  feeling as if I can help children now and in the future?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE04000/(INCENT). How important was… receiving money or gifts for taking part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE05000/(RESEARCH). How important was… helping doctors and researchers learn more about children and their health?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	5

SOURCE

National Children’s Study, Vanguard Phase

IE06000/(ENVIR). How important was… helping researchers learn how the environment may affect children’s health?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE07000/(COMMUNITY). How important was… feeling part of my community?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE08000/(KNOW_OTHERS). How important was… knowing other women in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE09000/(FAMILY). How important was… having family members or friends support my choice to take part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE10000/(DOCTOR). How important was… having my doctor or health care provider support my choice to take part in the study?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE11000/(STAFF). How important was… feeling comfortable with the study staff who come to my home?

Label	Code	Go To
Not at all important	1
Somewhat important	2
Very important	3

SOURCE

National Children’s Study, Vanguard Phase

IE12000. How negative or positive do each of the following people feel about you taking part in the National Children’s Study?

SOURCE

National Children’s Study, Vanguard Phase

IE13000/(OPIN_SPOUSE). Your spouse or partner

Label	Code	Go To
Very Negative	1
Somewhat Negative	2
Neither Positive nor Negative	3
Somewhat Positive	4
Very Positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

IE14000/(OPIN_FAMILY). Other family members

Label	Code	Go To
Very Negative	1
Somewhat Negative	2
Neither Positive nor Negative	3
Somewhat Positive	4
Very Positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

IE15000/(OPIN_FRIEND). Your friends

Label	Code	Go To
Very Negative	1
Somewhat Negative	2
Neither Positive nor Negative	3
Somewhat Positive	4
Very Positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

IE16000/(OPIN_DR). Your doctor or health care provider

Label	Code	Go To
Very Negative	1
Somewhat Negative	2
Neither Positive nor Negative	3
Somewhat Positive	4
Very Positive	5
Not Applicable	-7

SOURCE

National Children’s Study, Vanguard Phase

IE17000/(EXPERIENCE). In general, has your experience with the National Children's Study been

Label	Code	Go To
Mostly negative	1
Somewhat negative	2
Neither negative nor positive	3
Somewhat positive	4
Mostly positive	5

SOURCE

National Children’s Study, Vanguard Phase

IE18000/(IMPROVE). In your opinion, how much do you think the National Children's Study will help improve the health of children now and in the future?

Label	Code	Go To
Not at all	1
A little	2
Some	3
A lot	4

SOURCE

National Children’s Study, Vanguard Phase

IE19000/(INT_LENGTH). Did you think the interview was

Label	Code	Go To
Too short	1
Too long	2
Just about right	3

SOURCE

National Children’s Study, Vanguard Phase

IE20000/(INT_STRESS). Do you think the interview was

Label	Code	Go To
Not at all stressful	1
A little stressful	2
Somewhat stressful	3
Very stressful	4

SOURCE

National Children’s Study, Vanguard Phase

IE21000/(INT_REPEAT). If you were asked, would you participate in an interview like this again?

Label	Code	Go To
Yes	1
No	2

SOURCE

National Children’s Study, Vanguard Phase

IE22000. Thank you for participating in the National Children’s Study and for taking the time to complete this survey.

FOR OFFICE USE ONLY:

FOU01000/(P_ID). PARTICIPANT ID: ______________________________________

Public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*). Do not return the completed form to this address.