Zika Family Survey: In-Depth Interviews with Women Affected by Zika Virus

Form Approved

OMB No. 0920-1154

Exp. Date: 01/31/2020

Family Zika Survey – Follow-up Telephone Script for Health Department

Hello, I’m [insert name] calling from [health department]. You may have received a letter in the mail in the last week telling you about the opportunity to participate in a telephone interview about your experience with Zika. The purpose of these interviews is to better know what types of medical and other services your baby is receiving. We will use information from these interviews to improve services for babies affected by Zika.

I have called to answer any questions you may have.

We are working with RTI International, a non-profit research organization, to conduct the interviews. If you are interested in participating in an interview, the next step is for you to contact RTI. The letter included a postcard you can send to RTI. The letter also has information to contact RTI by phone, email, or on a website. Do you still have the letter with this information? If not, I can give you the phone, email, and website information again.

I can also pass your telephone number or email to one of the RTI interviewers and they will schedule a time that is convenient for you. Please let me know if you would like me to pass your information on to the interviewers at RTI.

Note to interviewer: Verify primary and secondary phone numbers and email address.

Frequently Asked Questions

1. Who is sponsoring this study?

This study is supported by the Centers for Disease Control and Prevention, or CDC, a federal government health agency, and the March of Dimes, a nonprofit organization dedicated to preventing birth defects.

2. What is the purpose of this study?

The purpose of these interviews is to learn about the experiences mothers have had with Zika, and the types of medical and other services your baby is receiving. We will use information from these interviews to help other mothers who are affected by Zika and improve services for babies affected by Zika.

3. What kinds of questions are you going to ask?

We will ask you questions about the medical care and other services you and your baby received, as well as your experiences finding answers to the questions you had about Zika.

4. How do I know this information will remain confidential?

I can assure you that all information that we obtain from you will be kept confidential to the extent allowed by law. Your answers will never be connected with your name or contact information. The answers provided will be combined with those from other participants when we look at all of the information we collect.

5. How do I know this study is legitimate? Where do I get more information?

You can call Caitlin Green at CDC at [telephone #] to verify information about the study. You can call Molly Lynch at RTI International (RTI is a trade name of Research Triangle Institute) at 919-541-6000 ext. 25709 weekdays during normal working hours (9am to 5 pm Eastern) for more information about this study (or toll-free option: 800-334-8571 x25709).

6. Who else is participating in this survey?

About 00 women from Virginia or Pennsylvania who have been impacted by Zika are being asked to participate in this survey.

7. What will my participation involve?

It will involve a one hour telephone interview where we ask you questions about your experiences and ideas.

8. Is it mandatory for me to do the survey?

No. Participation in this study is completely voluntary.

9. How was I selected?

We have your name as part of the U.S Zika Pregnancy Registry. This information is given to state health departments.

10. Why should I participate?

The study will help the CDC and March of Dimes to develop information and services mothers and families need when they learn their baby has been exposed to the Zika virus during the mother’s pregnancy. By “exposed” to the Zika virus, I mean the mother had Zika infection during pregnancy and the baby may have been infected too. By sharing your experiences and ideas, you can help other mothers who had the Zika virus infection during pregnancy.

11. What do I get for participating in this survey?

This is your opportunity to tell us your views and experiences related to Zika. As a token of appreciation for your time, we will send you a $75 VISA gift card. In the mail, you should have received a $5 bill along with the letter and consent form. You can use this money to cover the cost of the minutes you may be charged for the phone call.

12. What do I need to do to participate?

The letter included several ways to contact RTI International, the organization that will conduct the interviews. You can: (1) send the postcard that was included with the letter to RTI; (2) call RTI at [telephone]I; (3) email RTI at [email]; or (4) go to a website at [url]. An RTI interviewer will then contact you to schedule the interview.

13. What is RTI?

RTI International is a not-for-profit research organization based in North Carolina. (RTI International is a trade name of the Research Triangle Institute.) For more information, you can visit: www.rti.org

Voicemail Script

To be used after 3 attempts to contact the potential respondent have been made.

Hi. This is {insert name} from the {Virginia / Pennsylvania} state health department. Please contact me at {insert phone number} at your earliest convenience.

Public reporting burden of this collection of information is estimated to average 10 minutes, 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:  PRA (0920-1154).