Cognitive interview screener

FDA Health and Diet Survey

Cognitive Interview Screener

SCREENER

Hello, my name is xxx and I work for (contractor), a research firm. We’re doing research for the Food and Drug Administration about foods. If you are eligible and you agree to participate in an one-hour in-person interview, we will offer you $xx as a thank you for your time with us. In order to find out if you are eligible to be interviewed, I’d like to get some background information.

Before I proceed, may I ask to which of the following age group do you belong?

18 years or younger :___: [THANK AND END]

19 to 35 years old :___: [THANK AND END]

36 to 50 years old :___: [THANK AND END]

51 to 65 years old :___:

66 years or older :___:

1. Do you work either full- or part-time in a healthcare company or a food or nutrition company?

YES :___: [THANK AND END]

NO :___:

2. [RECORD GENDER. IF NOT OBVIOUS, ASK; RECRUIT 4-5 OF EACH]

Are you male or female?

FEMALE :___:

MALE :___: [RECRUIT A MIX]

3. What is the highest level of education that you have completed?

LESS THAN A HIGH SCHOOL DIPLOMA :___:

HIGH SCHOOL GRADUATE OR GED :___:

SOME COLLEGE, ASSOCIATES DEGREE :___:

COLLEGE GRADUATE :___:

ADVANCED DEGREE :___: [RECRUIT A MIX]

4. Are you of Hispanic or Latino origin?

YES: :

NO:___ :

5. What is your race? You may choose one or more categories as they apply.

WHITE :___:

BLACK OR AFRICAN AMERICAN :___:

ASIAN:___:

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER:___:

AMERICAN INDIAN OR ALASKA NATIVE

[RECRUIT A MIX OF RACE/ETHNICITY, AT LEAST 2 HISPANICS, AT LEAST 4 NON-WHITE/NON-BLACK]

[THANK IF INELIGIBLE OR QUOTA FILLED.]

[CONTINUE OTHERWISE.]

INVITATION

Thank you for answering all my questions. I’d like to invite you to participate in an in-person interview that will take about an hour to complete. We’ll offer you $xx as a thank you for your time with us. Let me give you some available times and you tell me what would be best for you.

INTERVIEW DATE AND TIME:

The interview will be held at (location). Will you be able to come to the interview?

[THANK IF UNABLE OR UNAVAILABLE.]

[CONTINUE OTHERWISE.]

I would like to send you directions. Where can I send them? Also, may I please have your phone number in case we need to get hold of you for any reason?

COLLECT RESPONDENT NAME, ADDRESS (AND EMAIL ADDRESS, IF APPLICABLE) AND PHONE

Name: _____________________________________________________________

Address: _____________________________________________________________

City: _________________________________ State: ______ Zip Code: __________

Phone: ________________________________________

E-mail: ________________________________________

In case you need to contact me for any reason, you can reach me at 1-800-xxx-xxxx