Non-Substantive Change Request Justification

Change Request

October 3, 2016

Information Collection Request: “Knowledge, Attitudes, and Practices related to a Domestic Readiness Initiative on Zika Virus”

(OMB no. 0920-1136, exp. date 3/31/2017)

Background and Justification

CDC is currently approved to conduct random-digit dial telephone surveys via computer-assisted interviewing, in order to collect data on knowledge, attitudes and practices related to the Domestic Readiness Initiative on Zika Virus Disease, which is being launched in select regions of the United States mainland and Puerto Rico. This data will be used to improve planning, implementation, refinements, and demonstrate outcomes of this communication and education effort.

Due to the public health emergency of fielding Zika prevention interventions based on need and strategy, the implementation of the campaign has evolved and become more geographically targeted.

The initial evaluation design was structured around three survey waves as follows: 1) a baseline survey at the start of the campaign, 2) a mid-point assessment survey, and 3) a final measurement survey at a concluding point in time. Each survey wave was designed to capture a total of 2,400 interviews equally split between a domestic sample (n=1,200 covering 20 states plus the District of Columbia) and Puerto Rico sample (n= 1,200). The use of the approved 2400 completed interviews at each of the three points in time is now reconsidered.

The revised evaluation design focuses on four locations, each with differing levels of campaign activity. This design utilizes the same number of survey waves (3 waves), same number of interviews per wave (2400 interviews per wave) and same number of total completed interviews (7200 completed interviews) as the previous design; however, the number of interviews will be distributed differently to better align with updated campaign activities.

The four targeted geographic locations can be described as follows:

1. an area that has had an intense, long-running active campaign, of which the Island of Puerto Rico is the only such location

2. a current intense active campaign that is taking place in the Miami DMA (designated market area)

3. a new campaign area (southeastern states) with mass media plus digital of which the Houston DMA is typified as representing, and,

4. a control area that currently only has a digital campaign in progress and of which the state of Mississippi would represent.

The 2,400 interviews per wave would be distributed equally across these four areas giving each area 600 completed interviews. This balanced, rectangular evaluation design is intended to capture differences among the differing campaign levels, and moving forward in time, differences across time.

Supporting Statements A and B have been updated to reflect this change.

Adjustments have been made to the survey to address these campaign changes which include 1) expanded communication channels and venues and 2) expansion of campaign messaging around normative expectations of condom use during pregnant to prevent Zika transmission. As such, CDC is requesting changes to the survey as listed in this document and the attached survey in track changes.

There are no changes to the overall burden estimates previously approved as part of this request. Table 12.A and 12.B below show how the burden is shifting by removing some of the participants in Puerto Rico and adding them to the U.S. Domestic Adults group.

Currently Approved:

Table 12.A: Estimated Annualized Burden to Respondents

Type of Respondents	Form Name	Number of Respondents	Number of Responses per Respondent	Average Burden per Response (in hours)	Total Burden Hours
U.S. Domestic Adults	Zika Readiness Initiative Survey	3600	1	12/60	720
Puerto Rico Adults	Zika Readiness Initiative Survey	3600	1	12/60	720
TOTAL		7200			1,440

Table 12.B: Estimated Annualized Burden Hours

Type of Respondent	Form Name	Total Burden Hours	Hourly Wage Rate	Total Respondents’ Costs
U.S. Domestic Adults	Zika Readiness Initiative Survey	720	$23.23	$16,726
Puerto Rico Adults	Zika Readiness Initiative Survey	720	$23.23	$16,726
TOTAL	--	1440	$23.23	$33,452

Proposed Changes:

Table 12.A: Estimated Annualized Burden to Respondents

Type of Respondents	Form Name	Number of Respondents	Number of Responses per Respondent	Average Burden per Response (in hours)	Total Burden Hours
U.S. Domestic Adults	Zika Readiness Initiative Survey	5400	1	12/60	1080
Puerto Rico Adults	Zika Readiness Initiative Survey	1800	1	12/60	360
TOTAL		7200			1,440

Table 12.B: Estimated Annualized Burden Hours

Type of Respondent	Form Name	Total Burden Hours	Hourly Wage Rate	Total Respondents’ Costs
U.S. Domestic Adults	Zika Readiness Initiative Survey	1080	$23.23	$25,088
Puerto Rico Adults	Zika Readiness Initiative Survey	360	$23.23	$8,363
TOTAL	--	1440	$23.23	$33,451

Proposed changes in Zika Readiness Initiative Survey:

To accommodate the new target locations for survey administration, additional screener questions are needed to ensure participants are residing in the selected cities or states.

Currently Approved:

S.14c. What state do you currently reside in? [TERMINATE IF STATE IS NOT ONE OF THE TARGETED STATES]

1. ___________ Gave Answer

8. [VOL] Don’t Know

9. [VOL] Refuse

Proposed Changes:

S.14c. What state do you currently reside in? [TERMINATE IF STATE IS NOT FL, TX OR MS, OR IF DK OR REF]

2. ___________ Gave Answer

8. [VOL] Don’t Know

9. [VOL] Refuse

S.14c2. Do you currently reside in Puerto Rico?

1. Yes

2. No

1. [VOL] Don’t Know

2. [VOL] Refuse

[TERMINATE IF ‘NO’, ‘Don’t Know’, OR ‘Refuse’]

[ASK IF IN MIAMI OR HOUSTON MARKETS, ELSE SKIP TO S.15]

S.14d. What county do you currently reside in? [TERMINATE IF COUNTY IS NOT ONE OF THE TARGETED COUNTIES IN FLORIDA OR TEXAS]

1. ___________ Gave Answer

1. [VOL] Don’t Know

2. [VOL] Refuse

[ASK IF S.14d = “Don’t Know” OR “Refuse”, ELSE SKIP TO S.15]

S.14e. In which zip code do you currently live? ENTER FIVE DIGIT ZIP CODE.

[TERMINATE IF ZIP CODE DOES NOT MATCH THE MIAMI OR HOUSTON DMA’S FRAME OF ZIP CODES]

1_________Gave Answer

8 [VOL] Don’t know

9 [VOL] Refuse

As the Zika virus campaign developed, there were some small modifications to the tagline as well as the locations where the materials will be placed. We’ve updated both B.1 and B.2 to reflect these campaign changes. The revised tagline and the ‘fake/comparison’ tagline were changed accordingly in B.1, as well as removing one response to maintain the overall burden of the survey. Adjustments were made to B.2 regarding locations while keeping the overall burden neutral.

Currently Approved:

B.1 Now I’m going to read a list of a few Zika public health campaign names you may or may not have heard about. Which of the following campaigns have you heard about? Please answer yes or no for each campaign. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Stop Zika	1	2	8	9
Together Against Zika	1	2	8	9
Zap Zika	1	2	8	9
This is how we stop Zika	1	2	8	9

Proposed:

B.1 Now I’m going to read a list of a few Zika public health campaign names you may or may not have heard about. Which of the following campaigns have you heard about? Please answer yes or no for each campaign. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Zika No More!	1	2	8	9
Zap Zika	1	2	8	9
This is how we prevent Zika. This is why.	1	2	8	9

Currently Approved:

B.2 Where have you heard information about a Zika prevention campaign? Please answer yes or no for each choice. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Somewhere else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Healthcare workers or private doctor	1	2	8	9
Pharmacy	1	2	8	9
Radio	1	2	8	9
Television	1	2	8	9
Posters	1	2	8	9
Newspapers	1	2	8	9
Internet	1	2	8	9
Social media (Facebook, Twitter, etc)	1	2	8	9
SMS, or text messages	1	2	8	9
Movies	1	2	8	9
Billboards	1	2	8	9
Somewhere else [SPECIFY]	1	2	8	9

Proposed:

[ASK B.2 IF YES TO ANY ITEMS IN B.1 OR B.1b, OTHERWISE SKIP TO C.1]

B.2 Where have you heard information about a Zika prevention campaign? Please answer yes or no for each choice. [READ CHOICES]

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Somewhere else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Healthcare workers or private doctor	1	2	8	9
Community event	1	2	8	9
Radio	1	2	8	9
Television	1	2	8	9
Posters or Billboards	1	2	8	9
Newspapers	1	2	8	9
Internet	1	2	8	9
Social media (Facebook, Twitter, etc)	1	2	8	9
SMS, or text messages	1	2	8	9
Movies	1	2	8	9
Workplace	1	2	8	9
Shopping mall or other public venue	1	2	8	9

In order to further streamline the survey and improve efficiency, we updated C.4. The proposed question provides the most efficient data for capturing information regarding sexual transmission of the Zika virus.

Currently Approved:

C.4 Are you currently married or in a committed relationship?

1. Yes [ASK C.4b ]

2 No [SKIP TO C.8]

8 [VOL] Don’t Know [SKIP TO C.8]

9 [VOL] Refuse [SKIP TO C.8]

Proposed:

C.4 Are you currently sexually active?

1. Yes [ASK C.4b ]

2 No [SKIP TO C.8]

8 [VOL] Don’t Know [SKIP TO C.8]

9 [VOL] Refuse [SKIP TO C.8]

While pregnant women continue to be a key target audience, partners of pregnant women also need to be reached. While this subgroup has always been a targeted group for the campaign, additional efforts will be made on the ground to reach this specific population. We have revised questions D3. and E.5 through E.8 to gather specific data on normative expectations for using condoms during pregnancy to prevent Zika transmission. We implemented a skip pattern for E.5 and E.6 or E.7 and E.8 depending on pregnancy status of the woman or a partner in order to gather efficient information without adjusting the overall burden.

Currently Approved:

D.3 Please answer yes or no for each of the following statements [READ CHOICES]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
I believe that I am at risk of being infected with Zika.	1	2	8	9
I believe that Zika is a serious disease.	1	2	8	9
I believe I can protect myself from Zika.	1	2	8	9

Proposed:

D.3 Please answer yes or no for each of the following statements [READ CHOICES]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
I believe that I am at risk of being infected with Zika.	1	2	8	9
I believe that Zika is a serious disease.	1	2	8	9
I believe I can protect myself from Zika.	1	2	8	9
I believe I can protect my partner from Zika.	1	2	8	9

**E.7 and E.8 are only asked of those who say yes to either a current pregnancy or a pregnancy within the last year

[ASK E.7 and E.8 IF C.1 = YES OR C.2 = YES OR C.5=YES OR C.6=YES]

E.7 During pregnancy, how often do (or did) you use condoms to protect the unborn baby from Zika?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

E.8 During pregnancy, how often do (or did) you avoid sex to protect the unborn baby from Zika?

Always Usually Sometimes, Rarely Never

1 2 3 4 5 8 (DK) 9 (REF)

A.5. In your opinion, which of the following activities are expected of individuals who’ve been in areas with Zika, in order to protect their loved ones or communities against Zika? Please check all that apply.

[PROGRAMMER NOTE: RANDOMIZE AND ROTATE LIST. “Something else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Wear insect repellant while in areas with Zika	1	2	8	9
Wear insect repellant for 3 weeks after returning from an area with Zika	1	2	8	9
Wear long sleeves and long pants when going outdoors in an area with Zika	1	2	8	9
Consistently use condoms during sex if partner is pregnant	1	2	8	9
Consistently use condoms during sex if partner is concerned about Zika	1	2	8	9
Get vaccinated	1	2	8	9

In order to balance this addition and keep overall burden neutral, we will remove the following questions:

A.2b Where have you heard information about how to protect yourself from Zika? Please answer yes or no for each choice. [READ CHOICES]

[PROGRAMMER’S NOTE: RANDOMIZE AND ROTATE LIST; “Somewhere else [SPECIFY]” SHOULD ALWAYS BE ASKED LAST]

	Yes	No	[VOL] Don’t Know	[VOL] Refused
Healthcare workers or private doctor	1	2	8	9
Pharmacy	1	2	8	9
Radio	1	2	8	9
Television	1	2	8	9
Posters	1	2	8	9
Newspapers	1	2	8	9
Internet	1	2	8	9
Social media (Facebook, Twitter, etc)	1	2	8	9
SMS, or text messages	1	2	8	9
Movies	1	2	8	9
Billboards	1	2	8	9
Somewhere else [SPECIFY]	1	2	8	9

9