OMB Memo

Generic Information Collection Request

Cognitive Testing of National Survey of Children’s Health Screener Card

Request: The U.S. Census Bureau plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725). We propose to conduct cognitive interviews to pretest and vet possible treatments for the 2019 National Survey of Children’s Health (NSCH) Screener Card Test. We are seeking approval for this project.

Background: The NSCH is conducted by the Census Bureau and sponsored by the Health Resources and Services Administration in the Department of Health and Human Services. The NSCH is conducted using self-administered paper and web modes. The survey first employs a screener instrument, which asks whether children 17 or younger live or stay at the household, along with some questions about those children (NSCH-S1). Then, if there are children in the household, a child is randomly selected to be the focus of a main topical questionnaire (Child and Adolescent Health Measurement Initiative, 2017). The three topical questionnaires collect detailed information about children who are aged 0-5 (NSCH-T1), 6-11 (NSCH-T2), and 12-17 (NSCH-T3).

In an effort to reduce costs and respondent burden, a new data collection strategy is being considered for future NSCH survey cycles. In this new design, data collection would start with a simple screener card asking about the presence of children 17 or younger in the household. If children are present, the respondent would be eligible to complete the full screener and subsequent survey questions, which would be sent together in one mailing or completed online using the current instrument. The goals of this design are to:

• Reduce respondent burden by providing households without children a simple way to complete the screener without requiring them to log into the web instrument (although web still remains an option).

• Reduce costs by only sending a screener card and associated letter instead of a full screener questionnaire package to all sampled households. With this approach, cost savings are realized in both the outgoing and return mail packages.

• Lessen the risk of losing sample cases between the screener and topical survey stages. When households with children respond to the screener by web, they can move directly into the topical questionnaire, which eliminates the need for further follow-up mailings.

The 2019 NSCH Screener Card Test, which will be implemented concurrently with the production operation, is intended to be a proof of concept for the simplified screener component of the redesigned data collection strategy. Cognitive interviews will help evaluate the perception and feasibility of various design options for the experimental materials and to identify ways they may be improved.

Purpose: The purpose of this research is to assess mail materials under consideration for the NSCH Screener Card Test. Since the primary goals of the proposed data collection strategy are to save mailing costs for all sample cases and to provide an easier response option for households without children, we will interview adults from the general U.S. population who have and do not have children. In cognitive interviews, we will assess the clarity and perception of possible options for the screener card and associated mailings, with the goal of producing valid materials that minimize the potential for measurement error and maximize the likelihood that sample cases would respond. The results of the cognitive interviews will influence decisions about the final content and format of the mailings, including the screener card and associated letters and reminders.

Population of Interest: Participants will be screened during the study effort to ensure that all participants are adults that typically open their mail in their home. An attempt will be made to recruit a mix of individuals with and without children 17 years old or younger that usually live or stay with them. This will allow us to gauge the perception and clarity of the materials among those households eligible and ineligible for the full NSCH survey.

Language: While all materials will contain both English and Spanish messaging, cognitive interviews will be conducted in English only.

Timeline: Cognitive interviews will be conducted from November 14, 2018 to January 9th, 2019.

Project scope: The cognitive testing of the proposed revisions to the NSCH screener and topical questionnaires will be carried out according to the schedule described in Table 1.

Table 1. Estimated Project Schedule

Project Activity	Dates
Recruiting for Round 1 (Ongoing)	Wednesday 11/14/18 – Thursday 11/29/18
Conduct Round 1 Interviews	Tuesday, 11/15/18 - Friday 11/30/18
Data Analysis – Round 1 Preliminary Results	Wednesday 12/5/18
Prepare Materials for Round 2	Thursday 12/6/18 - Friday 12/14/18
Recruiting for Round 2 (Ongoing)	Friday 12/14/18 – Tuesday 1/8/18
Conduct Round 2 Interviews	Monday 12/17/18 – Wednesday 1/9/18
Data Analysis – Round 2 Preliminary Results	Friday 01/25/19
Develop Final Content Recommendations	Monday 01/25/18 – Friday 02/08/19
Deliver Report	Wednesday 02/08/19

General Protocol: Participants will be asked to review mail materials eligible to be sent to the experimental sample in the 2019 NSCH Screener Card Test. Participants will be asked to use the “think aloud” method to explain their feedback on the materials. We will use concurrent and retrospective probing to get a full understanding of the participant’s thought processes and interpretations of different variations of the screener card and associated mailings. After completing the task, each participant will be asked debriefing questions. All interviews will be audio-recorded to facilitate a summary of the results. Participants will be asked to sign consent forms for permission to be recorded.

Sample: A total of 30 participants will be interviewed over two rounds (15 per round) in the Washington, D.C. and Flagstaff, Arizona metropolitan areas. Participants will be screened during the study recruitment phase to ensure that around half of participants in each round have a child 0-17 years old that usually lives or stays in their household. This will help us understand how those who are ineligible and eligible for the NSCH would respond to the screener card mailings.

Recruitment: We will use a multi-pronged strategy to recruit participants, such as posting ads on Craigslist, distributing flyers, and using personal networks. While not nationally representative, an attempt will be made to recruit participants with varying demographic characteristics (e.g., sex, education, age, race and ethnicity).

Use of Incentive: Due to the length and complexity of the task as well as the necessity to travel to test locations, we plan to offer a $40 honorarium to offset the costs of participation, such as travel and parking.

Below is a list of materials to be used in this research.

1. Screener Card Content – 2 Options

2. NSCH11wa – Experimental Treatment B_Non-perforated Mockup 1

3. NSCH11wa – Experimental Treatment B_Non-perforated Mockup 2

4. NSCH11wa – Experimental Treatment B_Perforated Mockup 1

5. NSCH11wa – Experimental Treatment B_Perforated Mockup 2

6. NSCH11wa – Experimental Treatment C

7. NSCH11wa – Standard Version (Treatments A and D)

8. NSCH12wa – Non-perforated Mockup 1

9. NSCH12wa – Non-perforated Mockup 2

10. NSCH12wa – Perforated Mockup 1

11. NSCH12wa – Perforated Mockup 2

Length of interview: Based on past experience with similar pretesting efforts, it requires four screener conversations to recruit one participant. Each screener conversation lasts approximately three minutes. We estimate it will take 6 hours to screen and recruit 30 participants. We estimate it will take 60 minutes per participant to complete the cognitive interview. For 30 participants, the estimated burden for the interviews is therefore 30 hours, bringing the total burden to no more than 36 hours.

The contact person for questions regarding data collection and statistical aspects of the design of this research is listed below:

M. Christopher Stringer

Demographic Statistical Methods Division

U.S. Census Bureau

Washington, D.C. 20233

[email protected]

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