EXAMPLE
Form Approved
OMB No. 0920-0621
Exp. Date xx/xx/XXXX
INTERVIEWER SCRIPT FOR A SEMI-STRUCTURED COGNITIVE INTERVIEW
Public reporting burden for this collection of information is estimated to average XX minutes per response, including 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: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0621).
INTERVIEWER READS:
Good morning, and thank you for your time. We’ve developed some questions for a survey that will be completed by students in middle school and high school. We need to know if the questions are clear. We’d also appreciate any other feedback that you’d like to provide. Your feedback will help us make the survey as understandable and useful as possible. During this discussion,
I will read each question and all the answer options out loud before you provide your answer.
We will move through the questions at a pace that you would use if you were taking the survey in a classroom.
There are no right or wrong answers.
Specific information about your tobacco use is not the main thing I’m interested in today. I will mainly be asking you what you think each questions means, or how you decided on the answer.
I will be taking notes and making an audio recording.
Thank you. Let’s begin:
Example Question #1:
During the past 30 days, on how many days did you smoke cigarettes?
0 days
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
Example Question #2:
During the past 30 days, on how many days did you use chewing tobacco, snuff, or dip?
0 days
1 or 2 days
3 to 5 days
6 to 9 days
10 to 19 days
20 to 29 days
All 30 days
[insert additional questions]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CDC User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |