Interviewer Form (for staff use only)

Att 7- Interviewer Form.docx

Formative Research and Tool Development

Interviewer Form (for staff use only)

OMB: 0920-0840

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Form Approved

OMB No: 0920-0840

Exp. Date: 01/31/2019

Attachment 7: Interviewer Form

[Completed by study staff]

Public reporting burden of this collection of information is estimated to average 15 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0840)

RESILIENCE & TRANSGENDER YOUTH

PARTICIPANT ID:

INTERVIEWER ID:

DATE OF INTERVIEW

Month

Day

Year

PARTICIPANT WAS CONSENTED?

_________YES

_________NO

_________DECLINED AFTER CONSENT

TIME AT START OF INTERVIEW: __________________MINS

TIME AT END OF INTERVIEW: __________________MINS

LENGTH OF INTERVIEW __________________MINS

INTERVIEWER OBSERVATIONS

Please write a detailed memo of the interview experience. This memo should include any information that would help you remember the interview, details of participant affect or body language that might not be apparent in the audio recording, interesting themes/comments that were brought up by the participant, or any emotional reactions/ reflections you experienced during the interview.

_________________________________________________________________________________

Were there any unforeseen interruptions during the course of the interview? [Not expected or part of the protocol, but possible there are unexpected interruptions.]

YES	NO	DON’T KNOW
GO TO #3	GO TO #4

To what extent do you believe these interruptions affected the answers given by the participant?

NOT AT ALL	VERY LITTLE	SOME	A GREAT DEAL
GO TO #4	PLEASE ANSWER BELOW

Please identify particular questions where you feel this may have occurred and explain the nature of the influence:

_________________________________________________________________________________

How much did the respondent seem to enjoy the interview?

NOT AT ALL

VERY LITTLE

SOME

A GREAT DEAL

Did the respondent seem to find the interview too long?

NO INDICATION

SOME INDICATION

DEFINITE INDICATION

How well did the respondent appear to understand the questions?

NOT AT ALL

VERY LITTLE

SOME

A GREAT DEAL

Please identify any questions that the participant seemed to have trouble understanding:

_________________________________________________________________________________

As far as you could tell, how interested in providing useful answers was the respondent?

NOT AT ALL

VERY LITTLE

SOME

A GREAT DEAL

Were there any questions that seemed to make the respondent uncomfortable?

NONE	VERY LITTLE	SOME	MANY
GO TO #9	PLEASE ANSWER BELOW

Which questions? (Explain effect)

_________________________________________________________________________________

How comfortable were you with the participant during the interview?

NOT AT ALL

VERY LITTLE

SOME

A GREAT DEAL

What happened?

_________________________________________________________________________________

Were there any other circumstances that may have affected the quality of the interview?

YES	NO
PLEASE ANSWER BELOW

What happened?

_________________________________________________________________________________

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Michelle M Johns
File Modified	0000-00-00
File Created	2021-01-24