Source/History for ZRHER Call-Back Survey Questions

Attachment 3: Source and history of questions on the ZRHER Call-Back Survey

Section name	Question	Comments on inclusion and prior use
Section 1: Zika-Related Knowledge and Healthcare Provider Communication	1.1. At any time, has a doctor, nurse, or other healthcare worker talked to you about Zika?	These questions were adapted from the Assessment of Contraceptive Use and Needs, Puerto Rico, 2016 (CAPRZ) survey (0920-1114); similar questions were asked on the Zika Postpartum Emergency Response Survey, Puerto Rico, 2016 (ZPER) (0920-1127). Including these questions on the ZRHER Call-Back Survey is important for determining if healthcare providers in the target states and territories are: screening non-pregnant women for potential exposure to Zika and other infectious diseases that can affect pregnancy outcomes; whether women have been counseled on appropriate waiting periods for trying to conceive; and whether their receipt of counseling and knowledge of preconception recommendations varies with the effectiveness of contraceptive method they are using and risk for unintended pregnancy. No other survey other than ZRHER provides this information for women of reproductive age who are not pregnant and representative of the women in the targeted states and territories, or aligns this information with contraceptive use data.
	1.2. Did you ask about Zika before that discussion?
	1.3. The last time you spoke to a doctor, nurse or other healthcare worker, did that person ask you whether you had recently traveled outside of the United States?
	1.4. The last time you spoke to a doctor, nurse or other healthcare worker, did that person ask you whether you had plans to travel outside of the United States?
	1.5. Do you think it is safe for a pregnant woman to travel to areas where there is Zika virus?
	1.6. Do you think a woman should wait to try to get pregnant after she has traveled to an area with Zika virus?
	1.7. How long should a woman wait to try to get pregnant after she returns from an area with Zika virus?
	1.8. Do you think a woman should wait to try to get pregnant after her male partner has traveled to an area with Zika virus?
	1.9. How long should a woman wait to try to get pregnant after her male partner returns?
Section 2: Having Children and Use of Birth Control	2.1. Did you or your partner do anything the last time you had vaginal sex in the past year to keep you from getting pregnant?	These question have been adapted from the optional BRFSS Preconception Care module, asked most recently in 2017 (0920-1061); similar questions were included on the Assessment of Contraceptive Use and Needs, Puerto Rico, 2016 (CAPRZ) survey (0920-1114). These questions help to identify women who may benefit from the use of contraception because they are at risk for becoming pregnant unintentionally, and the effectiveness of the contraceptive methods they are using. Additional questions have been added from the National Survey of Family Growth (0920-0314) to help states and territories identify the barriers for women in accessing contraception. No survey other than ZRHER provides state-based estimates of contraceptive use that can be matched with pregnancy intentions, barriers to contraception and receipt of preconception care.
	2.2. What was your main reason for not doing anything the last time you had sex in the past year to keep you from getting pregnant?
	2.3. If you did not have to worry about cost and could use any type of birth control method, would you want to use a method?
	2.4 What did you or your partner do the last time you had vaginal sex in the past year to keep you from getting pregnant?
	2.5 As best as you can remember, what month and year did you start using (that particular method)?
	2.6. What was your most important reason for starting that particular method?
	2.7. If you did not have to worry about cost and could use any type of contraceptive method available, would you want to use a different method?
	2.8. In addition to the method we just discussed, the last time you had sex in the past year, did you and your partner use a condom?	These questions have been adapted from the National Survey of Family Growth (0920-0314) and the Assessment of Contraceptive Use and Needs, Puerto Rico, 2016 (CAPRZ) survey (0920-1114). These questions are important for evaluating whether women are using condoms in addition to another contraceptive method, as an important strategy for preventing sexually transmitted infections, including Zika. No survey other than ZRHER provides state-based estimates for adults.
	2.9. Have you used a condom ever in the past year?
	2.10. Thinking back over the past year, would you say you used a condom when you had sex every time, most of the time, some of the time, or none of the time?
	2.11. Are you currently pregnant?	These questions have been adapted from the National Survey of Family Growth (0920-0314) and the Assessment of Contraceptive Use and Needs, Puerto Rico, 2016 (CAPRZ) survey (0920-1114). Knowledge of pregnancy status is important for differentiating between the primary target population for the ZRHER Call-Back Survey, as compared to the population of women included in the Zika Postpartum Emergency Response Survey, Puerto Rico, 2016 (ZPER) (0920-1127). Pregnancy intentions are also important to assess because they may influence women’s use of contraception, use of preconception care service, and adherence to preconception care recommendations.
	2.12 Have you ever been pregnant, including pregnancies that ended in miscarriage or abortion?
	2.13. In what month and year did your most recent pregnancy end?
	2.14. Thinking back to just before you got pregnant [“with your most recent pregnancy”, if not currently pregnant], how did you feel about becoming pregnant?
	2.15. How do you feel about having a [“another” for pregnant women] child now or sometime in the future?
Section 3: Other Healthcare Questions	3.1. Has a doctor, nurse, or other health care worker ever talked with you about ways to prepare for a healthy pregnancy and baby?	These questions have been adapted from the Pregnancy Risk Assessment Monitoring System, the National Health Interview Survey (0920-0214), and the Immunization and Healthcare Access modules of the BRFSS (0920-1061). Having questions on the ZRHER Call-Back Survey that are related healthcare utilization in general, and preconception services in particular, is important for assessing the degree to which use of these services is influenced by pregnancy intentions, and by the effectiveness of contraceptive methods being used to avoid unintended pregnancy. Having information on insurance is also important as a key determinant of access to healthcare.
	3.2. In the past year, have you seen a health care provider about your own health?
	3.3. In the past year, have you seen a doctor who specializes in women’s health (an Obstetrician Gynecologist)
	3.4. Have you received a tetanus shot in the past 10 years?
	3.5. Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, government plans such as Medicare, or Indian Health Service?
	3.6. Read: What is the primary source of your health care coverage?
Section 4. Emergency Preparedness	4.1. How many children under the age of 18 live in your home?	These questions have been adapted from the Community Preparedness and Participation Survey (1660-0105), and the optional BRFFS General Preparedness Module, last implemented in 2012. Having these questions on the ZRHER Call-Back Survey will be important for obtaining current state and territory-specific estimates that jurisdictions can use for women of reproductive age, given the Community Preparedness and Participation Survey provides only national or local estimates, and the BRFSS Preparedness module has not been implemented recently.
	4.2. Are you the primary caregiver for any of the children in your home?
	4.3. How well prepared do you feel your household is to handle a large-scale disaster or emergency? Would you say your household is…
	4.4. Do you have an emergency plan for where you and your child(ren) will go and what to do in the event of a disaster?
	4.5. Does the plan include a list of phone numbers and designated out-of-town contacts?
	4.6. Have you discussed this plan with all of the members in your household?
	4.7. Does at least one of the children in your household currently attend a school outside of your home, including day-care or part-time kindergarten?
	4.8. Are you aware of the details of the emergency or evacuation plan of the school or schools, including where the school plans to evacuate and how to get information about the child in the event of a disaster?
	4.9. Does your household keep copies of important paper or electronic documents like birth certificates and insurance policies in a waterproof container, fireproof safe, or other safe place?
	4.10. Does your household have a 3-day supply of water (besides tap) for everyone who lives there? A 3-day supply of water is 1 gallon of water per person per day.
	4.11. Does your household have a 3-day supply of nonperishable food for everyone who lives there? By nonperishable we mean food that does not require refrigeration or cooking.
	4.12. Does your household have a working battery operated radio and working batteries for your use if the electricity is out?
	4.13. In your household or vehicle are you able to charge your cellphone if the electricity is out? This may include a car charger or portable batteries?
	4.14. Does your household have a 7-day supply of prescription medication for each person who takes prescribed medicines?
	4.15. Earlier you mentioned you use [insert pill, patch, ring, condom based on Q2.2 response]. How long will your current supply of this birth control method last?	These questions were development in consultation with Emergency Planning and Response experts from the Division of Reproductive Health. These questions are unique and important for state and territory planning efforts, given evidence suggesting that women may have difficulty obtaining contraception during public health emergencies.
	4.16. Do you have a backup method such as condoms to prevent pregnancy if you run out of your supply of [insert pill, patch, ring based on Q2.2 response]?