24 Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture

Attachment 26-2. AHS Phase IV Health Follow-Up CATI Proxy Survey Script

Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen

OMB: 0925-0406

Document [pdf]

Download: pdf | pdf

26-2. AHS Phase IV Health Follow-Up CATI Participant Survey Script

OMB No.: 0925-0406
Expiration Date: 09/30/2016
Collection of this information is authorized by The Public Health Service Act (42 USC 285l). Rights of study
participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for
not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in
any way. The information collected in this study will be kept private to the extent provided by law. Names and
other identifiers will not appear in any report of the study. Information provided will be combined for all study
participants and reported as summaries. You are being contacted by mail or telephone to complete the health
follow-up survey for members of the Agricultural Health Study because continued involvement in this study can
help us learn more about how agricultural and environmental factors may affect the health of farmers and their
families.
Public reporting burden for this collection of information is estimated to average 25 minutes per response for
members of the Agricultural Health Study cohort and about 10 - 15 minutes per response for those answering
on behalf of the cohort member, 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 (0925-0406). Do not return the completed form to this address.

AHS_PhIV_AU_ScrnShots_20120829.docx

Attachment 26-2:
AHS PHASE IV - CATI CALL SCRIPT

MAIN INTRODUCTION
MN1.

Hello, this is [INTERVIEWER NAME] calling on behalf of the Agricultural Health Study. May I please
speak with [Mr/Ms] [FIRST/LAST NAME/SUFFIX]?
YES .......................................... [STS1] ............................... 1
NOT AVAIL/TEMP ILL
BY R OR PROXY ......... [APPT/CB]............................ 2
WRONG NUMBER [WN]............. ..................................... 3
DECEASED.............................[DEC1]............................... 4
TOO ILL/INCAPABLE
PERM BY PROXY............. [MN2]................................ 5

[IF PERSON WITH WHOM YOU ARE SPEAKING EXPLICITLY VOLUNTEERS THAT R IS
PERMANENTLY INCAPABLE OF PARTICIPATING, ENTER “5” AND PROCEED TO “TOO
ILL/INCAPABLE PERMANENTLY” BLOCK; IF NOT SURE IF R IS PERMANENTLY UNABLE TO
PARTICIPATE, ASK MN2:]
MN2.

Will [Mr/Ms] [FIRST/LASTNAME], be available sometime over the next month or so to talk with us
about possibly participating in a follow up interview for the Agricultural Health Study?
YES ................................ [APPT/CB]............................ 1
NO ....................................... [ILL1]................................ 2

SET THE STAGE
STS1.

Occasionally, we contact everyone in the Agricultural Health Study to update information about their
health. Now is the time for our next follow up. It is important for us to get this information so we can
continue to learn about how agricultural and environmental factors may affect the health of farmers and
their families. Would you be willing to answer some questions about his/her health? This call should take
approximately 15 minutes.
Did you receive the follow up questionnaire in the mail?
YES ......................................... [STS3] ............................... 1
NO........................................... [STS2] ............................... 2

08/30/2012

STS2.

I have your mailing address as [MAILADD1]. Is this correct?
YES ..................................................................................... 1
NO............................. [UPDATEMAILADD1].................. 2

STS3.

We can complete the interview by phone now, or we can schedule a time that is more convenient for you.
The call should take approximately 10 - 15 minutes.
YES, COMPLETE CATI NOW [STS4]..............................
YES, COMPLETE CATI LATER [APPT/CB] ...................

1
2

NO, PLEASE RE-MAIL HARD COPY....................... [STS3a]

STS3a.

We will mail the study letter and another copy of the questionnaire. Please return it in the envelope
provided to you. The letter will also include your username and password to complete this survey online
if that is your preference. If you have any questions, or decide you would prefer to complete the follow
up by phone, please call our toll-free number 1-XXX-XXX-XXXX. Thank you for your time. [END
CALL]

STS4.

Do you have any questions before we begin?
YES ............................................................................ 1
NO ...............................................................................2

[IF STS4 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]

08/30/2012

TOO ILL/INCAPABLE PERMANENTLY
ILL1.

I am very sorry to hear that. Occasionally, we contact everyone in the Agricultural Health Study to
update information about their health. Now is the time for our next follow up. It is important for us to
get this information so we can continue to learn about how agricultural and environmental factors may
affect the health of farmers and their families. Would you be willing to answer some questions about
his/her health? This call should take approximately 15 minutes.
YES, COMPLETE NOW [ILL2] ....................... 1
YES, SCHEDULE CB [APPT/CB].................... 2
NO........................... [ILL3]................................ 2

ILL2.

[IF ILL2 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
ILL3.

Is there someone else we might call you could answer our questions?
YES ............................................................................ 1
NO [REF2] ..................................................................2

[IF ILL3 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION FOR PROXY/END CALL]

08/30/2012

DECEASED
DEC1.

I am very sorry to hear that. We try to contact everyone in the Agricultural Health Study to update
information about their health, and now is the time for our next follow up. It is important for us to get
this information, especially regarding those who have passed away, so we can continue to learn about
how agricultural and environmental factors may affect the health of farmers and their families. Would you
be willing to answer some questions about his/her health up to the time he/she died? This call should take
approximately 15 minutes.
YES, COMPLETE NOW [DEC2]...................... 1
YES, SCHEDULE CB [APPT/CB].................... 2
NO...........................[DEC3]............................... 2

DEC2.

[IF DEC2 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
DEC3.

[IF DEC3 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION FOR PROXY/END
CALL]

08/30/2012

REFUSAL
REF2. [IF PARTICIPANT/PROXY HAS NOT OFFERED A REASON OF REFUSAL ASK: Would you be willing

to tell me why you do not want to participate at this time?]
I DON’T HAVE ENOUGH TIME ............................................................. 1
I AM TOO ILL TO PARTICIPATE........................................................... 2
I’M JUST NOT INTERESTED .................................................................. 3
I DON’T WANT TO BE IN THE AG HEALTH STUDY AT ALL ............. 4
OTHER ......................................................... [REF2sp] ............................. 5
REF2sp.

[SPECIFY OTHER REASON FOR REFUSAL]

[REFER TO QUESTIONS AND CONCERNS DOCUMENT FOR REFUSAL CONVERSION]

REF3. (We will try to call you at some point in the future in case things change.) Thank you for your time. Have a good

(day/afternoon/evening). [END CALL]

[IF R EXPLICITLY STATES THAT WE SHOULD NOT CALL BACK, RECORD THE REQUEST IN
THE COMMENTS FOR THIS CALL]

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
MAILADD1 = ADDRESS SENT IN SMS
PRE-LOAD MAILADD1 DATA FROM WESTAT

UA1. What part of the address is incorrect?
[MAILADDRESS1]
[MAILADDRESS2]
[CITY], [ST] [ZIP]
CHECK ALL THAT APPLY
STREET ADDRESS
CITY
STATE
ZIP
*IF UA1 INCLUDES STREET ADDRESS*
UA1a. What is your correct street address?
ENTER FIRST LINE OF STREET ADDRESS
*IF UA1 INCLUDES STREET ADDRESS*
UA1b. (What is your correct street address?)
ENTER SECOND LINE OF STREET ADDRESS, IF NECESSARY, OR PRESS
[ENTER] TO SKIP
 IF CITY/STATE/ZIP ALL CORRECT, GO TO UA1f
*IF UA1 INCLUDES CITY*
UA1c. What is the correct city for this address?
ENTER CITY
 IF STATE AND ZIP CORRECT, GO TO UA1f
*IF UA1 INCLUDES STATE*
UA1d. What is the correct state for this address?
ENTER STATE
 IF ZIP CORRECT, GO TO UA1f
*IF UA1 INCLUDES ZIP*
UA1e. What is the correct ZIP code for this address?
ENTER ZIP CODE

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
“PHONE1” IS THE NUMBER RECEIVED FROM WESTAT AND CAN ONLY BE UPDATED THROUGH THE WRONG
NUMBER MODULE
“ALTPHONE1” IS ADDED WHEN A PARTICIPANT REPORTS THERE IS A BETTER NUMBER TO REACH HIM OR
HER – ADDING AN ALTPHONE1 DOES NOT OVERRIDE PHONE1
UALTP1a.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER AREA CODE AS ###
UALTP1b.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER PREFIX AS ###
UALTP1c.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER LINE AS ####

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
**NOTE: MN1 is the starting point of all interviews as it is defined as the initial question in the standard scheduler for all
CATI instruments. To accommodate this, the program will rely on a flag to recognize whether a case is a new contact or a
resumption of a previous contact. The script below assumes that this flag indicates the case is being re-entered.
MN1.

Hello, this is [INTERVIEWER NAME] calling on behalf of the Agricultural Health Study. May I please
speak with [Mr/Ms] [FIRST/LAST NAME/SUFFIX]?
YES [IF STS3, ILL1 OR DEC1 = 2, GO TO CB2, IF STS3, ILL1 OR DEC1 = 3, GO TO CB3]
1
NOT AVAIL/TEMP ILL
BY R OR PROXY ........ [APPT/CB1]........................... 2
WRONG NUMBER [WN]............. ..................................... 3
DECEASED.............................[DEC1]............................... 4
TOO ILL/INCAPABLE
PERM BY PROXY............. [MN2]................................ 5

CB1.

When would be a good time to reach him/her?
CONTINUE

CB2.

Good [morning/afternoon/evening]. (This is [INTERVIEWER NAME] calling on behalf of the Agricultural
Health Study.) We spoke to you earlier about participating in this study.
CONTINUE

CB3.

 [APPT/CB]

 [LAUNCH CATI]

Good [morning/afternoon/evening]. Recently, we mailed you a copy of the AHS follow up questionnaire. We
have not yet received this from you. I am calling to complete the interview by phone. This call will take
approximately (15) minutes.
YES, COMPLETE NOW [CB4] ........................ 1
YES, SCHEDULE CB [APPT/CB].................... 2
NO............................ [CB5] ................................ 2

CB4.

Do you have any questions before we begin?
YES ............................................................................ 1
NO................................................................................2

[IF CB4 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
CB5.

Is there someone else we might call you could answer our questions?
YES ............................................................................ 1
NO............................ [REF2].......................................2

[IF CB5 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION FOR PROXY/END CALL]

08/30/2012

WRONG NUMBER SCRIPT
WN1. Is this [PHONE NUMBER]?
YES
NO



GO TO WN3

WN2. Our records show that [PS NAME] lives at this number. Is this correct?
YES
NO, BUT KNOWS HOW TO CONTACT R
NO, DON’T KNOW R
WN3.

 GO TO MN1
 GO TO WN4
 GO TO WN4

Phone number: [PHONE NUMBER]
I apologize for the inconvenience. I do need to redial this number in order to determine the source of the problem. If your
phone should ring, please answer it. Thank you.
HANG UP AND RE-DIAL NUMBER.
SAME PERSON
DIFFERENT PERSON

WN4.

 GO TO WN5

I’m sorry to have disturbed you. Thanks (again) for your help. Goodbye.
*IF WN2 = KNOWS HOW TO CONTACT R*
RECORD NEW CONTACT INFORMATION AND GIVE TO SUPERVISOR
WHAT IS WRONG WITH THIS NUMBER?
DOUBLE WRONG NUMBER
R NOT KNOWN AT THIS NUMBER
NEW CONTACT INFO FOR R OBTAINED

WN5.

Have I reached [PHONE NUMBER]?
CORRECT
INCORRECT

WN6.

 Record Comments. END.
 Record Comments. END.
 Record Comments. END.

 GO TO MN1

I’m sorry to have disturbed you. Thanks (again) for your help. Goodbye.
CONTINUE

WN7. WHAT IS WRONG WITH THIS NUMBER?
DOUBLE WRONG NUMBER
R NOT KNOWN AT THIS NUMBER
NEW CONTACT INFO FOR R OBTAINED

08/30/2012

 Record Comments. END.
 Record Comments. END.
 Record Comments. END.

AHS_PhIV_HFUP_CAWI_Pxy_Survey_20130206.docx

File Type	application/pdf
File Title	Microsoft Word - AHSPhaseIV_OMB_TitlePage_ProxyCATI_21Mar2016
Author	erevak
File Modified	2016-03-21
File Created	2016-03-21