Intercept Interview of Pregnant Women in Puerto Rico

Form Approved

OMB No. 0920-1071

Expires 06/30/2018

Intercept Interview of Pregnant Women in Puerto Rico

1. General Introduction

Hello, [respondent name], my name is __________ and I am from the Centers for Disease Control and Prevention.

Would you be willing to talk with me for a few minutes (less than 10 minutes) to give me your opinions about a kit that may be given to pregnant women to protect you from Zika virus during their pregnancy? I need to speak with women who are over 18 years old. Are you over 18 years of age?

2. Introduction for Interview

Great! Thank you for your willingness to share your opinions with me. Your opinions will help us make decisions about what we can do to help pregnant women. I have just a few questions that will take less than 10 minutes.

Before I begin I want to go over a couple of items:

• This interview is voluntary. You do not have to answer any questions you don’t want to.

• There are no right or wrong answers. I am interested in your opinion. If you don’t understand the question, feel free to let me know and I can ask it another way. This is not a test, so feel free to say you don’t know or don’t have an opinion to offer and “I don’t know“ is a perfectly acceptable response to any question I ask you.

• It’s important to know that the questions I’m about to ask you will NOT be linked directly back to you personally and will only be reported at the group level.

• With your permission, I would like to record our conversation. I do this simply to make sure that I capture all of the information that you share and so I can listen to what you have to say and not worry about taking notes. The recording helps me in writing my report and is used for that purpose only. Is it okay for me to record our conversation?

• Do you have any questions before we begin?

3. Interview Questions

Show the pregnant women the Zika Prevention Kit. Ask her to take a few moments to look at the kit and all the items in it.

1. Who do you think this kit is made for? (Who should this kit be given to?) Do you think it is made for you? Why or why not?

2. If you were given a kit like this, how would it make you feel (how would you feel about being given a kit like this)?

3. If you were given a kit like this, how likely is it that you will use it for yourself (not for your children or other family members)?

1 Very Unlikely

2. Somewhat Unlikely

3. Likely

4. Very Likely

1. What about the kit makes you think you are (very unlikely/somewhat unlikely/likely/very likely) to use the kit?

4. The kit contains a variety of items, please tell me how likely you would be to use each of the items and why you would or would not use it?

How likely is it that you will use…	Very Unlikely	Somewhat Unlikely	Likely	Very Likely	Why or Why not?
The bag
Insect repellent for application to the skin
Educational materials about Zika prevention
Condoms
Thermometer
Mosquito dunks for treating standing water
Bed nets
Long sleeved shirt

1. Are there other items you think might be useful to add to the kit? Items to remove?

5. How easy or difficult will it be for you to use the items in the kit from now until you deliver your baby?

1 Very difficult

2 Difficult

3 Easy

4 Very easy

6. How confident are you that you could use a kit like this to protect you and your baby from Zika virus during your pregnancy?

1 Not confident at all

2 Somewhat unconfident

3 Confident

4 Very confident

7. How likely is it that pregnant women will use a kit like this to protect themselves and their baby from Zika virus during their pregnancy?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, 4 is very likely.

8. Do you think that giving a kit like this to all pregnant women will help them understand the importance of not getting Zika virus during their pregnancy? Why or why not?

9. Where should pregnant women get/receive a kit like this?

10. When is your baby due, and will this impact your willingness to use this kit?

Thank you so much for your participation.

Public reporting burden of this collection of information is estimated to average 10 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-1071).