Sample Interview Guide

U.S. Department of Health and Human Services (HHS)                        OMB Control # 0920-0932

Centers for Disease Control and Prevention (CDC)                               Expiration Date XX/XX/XXXX

TravAlert Evaluation Interview Guide

ID: <airport code. interviewer initials, number of person approached (e.g., 12^th person approached)>

Date:

DEMOGRAPHIC INFORMATION
1.	[MARK THE SEX OF THE PERSON APPROACHED]		Female Male
2.	Do you live in the United States?		Yes [Go to 4] No [Go to 3]
3.
	a. In what country do you live?
	b. Did you visit any countries before arriving in the U.S.? Where?
	c. Are you visiting any other countries after the U.S.? Where?
	d. How long do you plan on staying in the U.S.?
4.	What country (countries) did you visit on your trip?
5.	What is (if non U.S. resident)/was (if U.S. resident) the main reason for your trip?		Visiting family and or friends Business Vacation/tourism School Mission or volunteering Other _______
ENVIRONMENT
6.	In this airport, did you see any electronic monitors or screens with health or disease information?		Yes [Go to 7] No [Go to 6a]
	a. If no, where in the airport could we put monitors or screens with health information or disease information to get your attention?		[GO TO ITEM 13]
7.	Where did you see them?
8.	What would be the best place(s) in the airport to put monitors or screens showing health or disease information?
MESSAGE TESTING
9.	Do you remember the main topic of the message?		Yes [Go to 9a] No [Go to 10]
	a. List:		[If answer = measles, go to 11] [If answer ≠ measles, go to 12].
10.	I’m going to read four (other) health topics to you. Please tell me if you saw any of these messages on the monitors or screens (select all that apply).	Healthy Eating [GO TO 13 if “Measles” IS NOT ALSO SELECTED] Flu [GO TO 12 if “Measles” IS NOT ALSO SELECTED] Exercise [GO TO 12 if “Measles” IS NOT ALSO SELECTED] Measles [GO TO 11] None of these [GO TO 12 if “Measles” IS NOT ALSO SELECTED]
11.	What did the message say?
12.	What is a better way we could have provided health or disease information?
BEHAVIOR
13.	If you thought you had measles after this trip, what would you do? Would you do anything else?
14.	Have you been vaccinated for measles?		Yes [Go to 15] No [Go to 14a and 14b] Don’t know [Go to 15]
	a. If no, why not?
	b. How likely are you to get a measles vaccine in the future? Would you say you are:		Very likely Somewhat likely Not sure Somewhat unlikely Very unlikely
15.	One last question. What is your age?

[Interviewer Script: “Thank you for your time, your answers will be very helpful.”]

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor a project, 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 0920-0932.