Justification for Non-Substantive Change

Non-Substantive Change Request to OMB Control Number 0920-1118:

Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections

Program Contact

Lee Samuel

National Center for Emerging and Zoonotic Infectious Diseases

Office of Policy

1600 Clifton Rd, C-12

Atlanta GA 30333

Submission Date: January 23, 2021

CDC requests approval for a non-substantive change to OMB Control No. 0920-1118: Zika Emergency Package V: Assessment of Interventions Intended to Protect Pregnant Women in Puerto Rico from Zika virus Infections. Changes are necessary to ensure questions are clear and culturally-competent as well as to optimize participation in the information collection.

Changes are requested to the supporting statement A and to Attachment C, the Initial telephone interview.

Supporting Statement A

Description of changes:

As an incentive to participate in the monthly interviews, the program will offer monthly raffles with three possible prizes—1st prize: $100 gift card; 2nd prize: $75 gift card; 3rd prize: $50 gift card. CDC Foundation funds have been made available for participant incentives.

Justification for changes:

Evaluation efforts conducted in Puerto Rico (also with CDC Foundation financial support) as part of the Zika response have included incentives for participation in in-depth interviews and focus group discussions. Offering incentives has been extremely helpful in recruiting participants for information collections with very short turn-around times and has conveyed value to participants, who are most vulnerable to the adverse effects of Zika and who feel most threatened by it (e.g., pregnant women). To date, pregnant women have been very willing to participate so there is no need for giving all participants an incentive. However, giving participants a chance to receive an incentive is seen as an appropriate way to improve response rates, improve data quality, and show appreciation for their time.

Using incentives may improve the survey response rate and will demonstrate respect and appreciation for participants’ time and effort. A monthly raffle is feasible to implement and affordable. CDC’s evaluation briefs acknowledge the use of incentives in boosting response rates (http://www.cdc.gov/HealthyYouth/evaluation/pdf/brief22.pdf ) as does the National Business Research Institute (https://www.nbrii.com/customer-survey-white-papers/survey-incentives-response-rates-and-data-quality/).

Attachment C: Initial Telephone Interview

Description of changes: A team of Puerto Rico Spanish speakers reviewed and tested the instruments to assess the language, structure, flow, and time that the interview would take. Interviews were taking approximately 30-35 minutes, which is longer than the 20 minutes we have been approved for. The team has revised the instrument. The instrument has gone from 56 questions down to 49 questions.

The changes to the form are as follows:

1. Introductory text is more clear and concise

2. Section numbers were added

3. Some questions were edited to make them more clear and/or concise

4. Some questions were deleted

5. Some instructions were added for the people who will be conducting the interviews

6. Closing statement edited

Justification for changes:

Proposed changes make the interview more clear, culturally-competent, conversational, and concise. The changes ensure that the interview can be completed within the 20 minute timeframe for each call.

Form	Question Number	Requested Change
Initial Telephone Interview	Q4	Follow-up question was changed FROM “What make you think you { } to get infected with Zika virus during your pregnancy (or while you are pregnant)? TO “And Why?”
	Q2	In the Spanish version, several response options were changed: FROM “Solo una o dos veces” TO “Casi nunca” FROM “A menudo” TO “Casi siempre” FROM “A diario” TO “Siempre”
	Q3	In the Spanish version, the question changed FROM “Cuanto le preocupa el virus del Zika para usted y su bebé?” TO “Cuán preocupada se encuentra por su salud y la de su bebé a causa del virus del Zika?”
	Q4	In the Spanish version, several response options were changed FROM “Muy poco probable” TO “Improbable” FROM “Improbable” to “Muy poco probable” Added: “Ya tuvo Zika”
	Q5	Follow-up question was change FROM “What makes you [insert response] in your ability to protect yourself against Zika?” TO “And Why?”
	Q9	Question edited FROM “Have you attended an educational session at WIC that provided information about Zika? TO “Have you been oriented at WIC about Zika?” Which in the Spanish-version went FROM “Usted ha asistido a sesiones de educación en el WIC donde ofrecen información sobre el Zika?” TO “Usted ha sido orientada en el WIC sobre el Zika?”
	Q11	Added fake campaign name, “Musicians against Zika” [Música Contral el Zika]
	Q14	Created table to list out communication products that will be asked about each month. In Spanish version putt he question, without all the [spaceholders] in front of the table so it can be easily read as follows: “Ahora , le voy a leer una lista de varios tipos de comunicación que puede que usted haya escuchado como puede que no. ¿Cuál de los siguientes medios usted ha visto o escuchado?”
	Q17	Edited the question to remove the text in parentheses after the question. Deleted “[or has anyone called you/contacted you to offer you a Zika Prevention Kit for free?)”
	Q20	Edited the question to remove the text, “Have you opened your Zika Prevention kit? What did the information in the kit say you need to do?” The question now starts with what was a follow-up question, “What items were included in the kit?”
	Q21	Table edited so “Importance” is the heading. Removed last column of table labeled “Participant did not list this item in their kit” [La participant no mencionó este artículo”]
	Q22	Deleted
	Q23	Added response option, “There were no instructions in the kit” [“Había no hay instrucciones en el kit”]
	Q24	Deleted
	Q25	Deleted
	Q27	In Spanish version one response option was changed FROM “Seguido” TO “Con frecuencia”
	Q28	In Spanish version, question was changed FROM “Mientras estuvo embarazada pero DESPUés de haber recibido el kit, ¿cuán seguido usted utiliza los artículos incluidos en si Kit de Prevención del Zika?” TO “DESPUÉS de haber recibido el kit, durante su embarazo ¿con que frecuencia utiliza usted los siguientes artículos (incluidos en si Kit de Prevención del Zika)?” In Spanish version one response option was changed FROM “Seguido” TO “Con frecuencia” Fixed lettering in table from e through h to a through d
	Q29	In Spanish version, question changed FROM “¿Ha utilizado algunos de los artículos incluidos en el Kit de Prevención del Zika? (¿o ha tenido que reemplazar algunos de los artículos que vinieron en el Kit de Prevención del Zika?) ¿Cuáles artículos?” TO “¿Se le han acabado algunos de los artículos incluidos en el Kit de Prevención del Zika? (¿o ha tenido que reemplazar algunos de los artículos que vinieron en el Kit de Prevención del Zika?) ¿Cuáles artículos?”
	Q31	Deleted
	Q32	Edited the question FROM “If you got to say what items should go into a Zika Prevention Kit to help pregnant women in Puerto Rico to protect themselves from getting infected with Zika, what items would you put in the kit?” TO “What other items do you recommend to be included in the Zika Prevention Kit to help pregnant women in Puerto Rico to protect themselves from getting infected with Zika?” For items not currently in the kit, ask them “Why?” In Spanish version, question changed FROM “Si usted fuera a decir que artículos deben estar en el Kit de Prevención del Zika para ayudar a las mujeres embarazadas en puerto Rico a protegerse del zika, ¿Qué artículos usted pondría en el Kit?” TO “¿Qué otros artículos recomendaría incluir en el Kit de Prevención del Zika para ayudar a las mujeres embarazadas en Puerto Rico a protegerse del Zika? y ¿por qué?”
	Q33	Deleted
	Q34	In Spanish version, question changed FROM “¿Ha escuchado sobre regar insecticida dentro y fuera del hogar?” TO “¿Ha escuchado sobre la fumigación (insecticida en aerosol o spray) dentro y fuera del hogar para proteger contra los mosquitos del zika?”
	Q39	Edited the question FROM “In your opinion, how important is it to offer insecticide spraying services to pregnant women in Puerto Rico?” TO “How important was it for you to receive insecticide spraying services to prevent Zika while pregnant?” In Spanish version, question changed FROM “¿En su opinión, cuán importante es ofrecer servicios de fumigación a mujeres embarazadas en Puerto Rico?” TO “¿Cuán importante fue para usted recibir los servicios de fumigación para prevenir la infección con el Zika durante su embarazo?”
	Q40	Edited the question FROM “During the day, how often are you bothered by mosquitoes biting you?” TO “In a typical day, how often are you bothered by mosquitoes biting you?” In Spanish version, question was changed FROM “Durante el día, cuan a menudo usted es molestada por picadas de mosquitos?” TO “¿En un día típico ¿cuán a menudo usted es molestada por picadas de mosquitos?” Several response options changed FROM “Raremente” TO “Casi nunca” FROM “A menudo” TO “Casi siempre”
	Q41	Deleted
	Q42	Deleted
	Q47	Edited the question FROM “How about screens on the doors that open?” TO “How about screens on the doors that open to the outside (exterior)? In Spanish version, question changed FROM ¿Y tiene escrines en las puertas que abren a la calle?” TO “¿Y tiene escrines en las puertas que abren a al exterior?”
	Q48	Edited the question FROM “Do you currently rent or own your home?” TO “Do you have the authority to decide about structural changes (like installing screens) and to fumigate your home inside and outside? New response option are, Yes, No, Other, please specify, and Refused In Spanish version, question was changed FROM “¿Usted actualmente alquila o tiene una casa propia?” TO “¿Tiene usted autoridad para tomar en su casa para tomar decisiones como puede ser poner o no escrines en su casa o fumigarla por dentro y por fuera? actualmente alquila o tiene una casa propia?” Response options are No, Otros, favor especifique, Rehúso
	Q50	Edited the question FROM “Do you personally know anyone who has been diagnosed or told that they have Zika infection?” TO “Do you personally know anyone who has been told by a health professional that they have Zika infection?” In Spanish version, question changed FROM “¿Usted personalmente conoce a alguien que ha sido diagnosticado o le han dicho que tiene la infección de zika? (Lea las opciones)” TO “Usted personalmente ¿conoce a alguna persona a quien algún profesional de salud le ha dicho que tiene Zika?”
	Q51	Edited the question FROM “Do you personally know anyone who has been diagnosed or told she has a Zika infection while pregnant?” TO “Do you personally know anyone who has been told by a health professional she has Zika infection while pregnant?” In Spanish version, question changed FROM “Usted personalmente conoce a alguien que ha sido diagnosticado o le han dicho que ha tenido zika mientras está embarazada? (Lea las opciones)” TO “Usted personalmente ¿conoce a alguna mujer embarazada a quien algún profesional de salud le ha dicho que tiene Zika?”
	Q53	Deleted
	Q55	In Spanish version question changed FROM “?Que usted cree que se necesite o qué es necesario que pase para poder proteger a la mujer embarazada de que se infecte con el virus del Zika?” TO “¿Qué acciones usted recomienda se deben tomar para proteger a la mujer embarazada de que se infecte con el virus del Zika?”
	Q56	Deleted
	Question added for DHHS indicators dashboard	In the past week, how often have you used insect repellant? Never, Seldom or rarely, Sometimes, Often, Usually or most of the time, Always, Refused ¿Cuántas veces ha usado repelente de mosquito en la semana pasada? Nunca, Casi nunca, A veces, Casi siempre, Siempre, No se/ No estoy seguro, Rehúso
	Question added for DHHS indicators dashboard	Which of the following are actions that someone can take to protect themselves from getting infected with Zika? Use mosquito repellant Drink only clean water Use condoms or not having sex Put screens on windows and doors Wear clothes to cover arms and legs. Response options are yes, no, don’t know/not sure, and refused Cuales de los siguientes son acciones que alguien puede tomar para protegerse de ser infectado con el virus de Zika? Marque todas las acciones que se puede aplicar. (Lea las opciones). Usa repelente de mosquito Toma solamente agua potable Usa condones o abstenerse del sexo Pone pantallas en las ventanas y puertas Lleva ropa que cubre los brazos y las piernas Response options are si, no, No se/ No estoy seguro, Rehúso

Burden:

Estimates of annualized burden hours for this change request will remain the same.

Type of Respondent	Form Name	No. of Respondents	No. of Responses per Respondent	Average Burden per Response	Total Burden Hours
Project 1
Pregnant WIC participant	Initial Telephone Interview	1,800	1	20/60	600
	Follow-up Telephone Interview	900	1	15/60	225
Project 2
Pregnant WIC participant	Telephone interview of cases and controls	200	1	20/60	67
Total					892