B2 Pretest

Form Approved

OMB Control No.: 0920-0932

Expiration date: 05/31/2021

Attachment 6: Data Collection Instrument B2 Pre-Test

A. Demographic Characteristics: B2 Applicant

1. How old is your child?

2. What is their gender?

3. What state is your child from?

B. Demographic Characteristics: Parent or Guardian

1. What is your age?

2. What is your gender?

• Male

• Female

3. Which state were you born in?

4. What languages do you speak?

5. How often do you speak English? (very often, somewhat often, rarely, never)

6. How often do you speak English at home? (very often, somewhat often, rarely, never)

7. Do you know how to read in Spanish? (¿Sabe leer y escribir un recado en español?) Yes/No

8. How often do you read in English? (very often, somewhat often, rarely, never)

9. What is your marital status?

• Single (Está soltero)

• Married (Esta casada)

  • Only legally (Solo por el civil)

  • Only religiously (Solo religiosamente)

  • Legally and religiously (civil y religiosamente)

• Divorced (Está divorciado)

• Separated (Está separado)

• Domestic partnership (Vive con su pareja en unión libre)

• Widowed (Es viudo)

10. Do you plan on immigrating with your spouse?

11. What is the last year or grade that you completed in school? (¿Cuál fue el último año o grado que terminó en la escuela?)

• Ninguno

• Preescolar

• Primaria

• Secundaria

• Preparatoria o bachillerato

• Normal básica

• Estudios técnicos o comerciales con primaria terminada

• Estudios técnicos o comerciales con secundaria terminada

• Estudios técnicos o comerciales con preparatoria terminada

• Normal de licenciatura

• Licenciatura o profesional

• Maestría

• Doctorado

12. Have you ever lived in the United States? If yes, in total: less than a year? 1-3 years, longer than 3 years?

13. When you arrive to the United States, will there be someone to provide you with transportation?

14. When you arrive to the United States, will there be someone to help share household chores or yard work?

15. When you arrive to the United States, will there be someone to help you go shopping?

For most of the next questions, I will ask you to answer using a scale with 4 options. I will give you the options each time. The scale with the options will be shown to you as well.*

C. General health perception

1. How would you rate your child’s overall health on a scale of 1 to 4, in the past month, with 1 being very good, 2 being good, 3 being bad, and 4 very bad ?

Now I will ask you some questions related to tuberculosis or TB. You can answer that you do not know for any question, but I would like you to take your best guess. For most of these questions, there is no right or wrong answer.

D. General TB knowledge

1. Share with me what you know about TB. You may know TB as (insert colloquial term for TB in Mexico).

Only read the following if absolutely nothing is known: Tuberculosis (also called TB) is caused by germs that usually attack the lungs. Not everyone infected with TB germs becomes sick. As a result, there are two TB conditions, TB infection and TB disease. Try and answer as best as you can on the following questions.

_____Read script to participant (check if applicable)

2. Please let me know how much you agree with this statement: A child can have TB infection in their body, but not have symptoms or feel sick. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

3. TB infection can become TB disease if it is not treated. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

4. When TB infection becomes active it can make a child sick. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

E. Severity of TB

1. Having TB infection could have negative effects on a child’s health. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

2. Having TB disease could have negative effects on a child’s health. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

3. Developing TB disease could keep a child from doing their regular activities. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

4. Developing TB disease could keep a child from going to school. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

5. A child who developed TB disease could spread it to their family, friends and schoolmates. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

F. Benefit of TB follow-up care

1. Through treatment, TB infection can be prevented from developing into TB disease. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

2. Taking medication for TB infection can keep a child healthy. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

3. If a child who moves to the US has TB infection, going the doctor at the health department in the US could keep them healthy. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

4. If a child who recently moved to the US has TB infection, going the doctor at the health department in the US could keep their family and friends healthy. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

G. Control

1. I believe it is in my control whether I take my child to a health department after we arrive to the US, if my child needs it. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

For the next few questions, please let me know your opinion using the scale of 1 for not at all likely and 4 for very likely.

2. If a child has TB infection how likely is it that they will develop TB disease if they do not get treatment for TB infection? 1= Very likely/ 2= Likely/ 3= Unlikely/ 4= Not at all likely

Next, I will ask a few questions about your feelings about your own risk for TB.

H. Susceptibility to TB

How likely is it that your child …

1. How likely is it that your child has TB infection right now? 1= Very likely/ 2= Likely/ 3= Unlikely/ 4= Not at all likely

2. How likely is it that your child will ever develop TB disease? 1= Very likely/ 2= Likely/ 3= Unlikely/ 4= Not at all likely

We are almost done with the interview. Before we finish, I would like to hear about your expectations about what it could be like to get TB health services in the United States you immigrate there, if you needed them. Remember, there are no right or wrong answers.

H. Attitudes

1. How beneficial do you think it might be to go to the doctor at the health department for your child’s TB care, where 1 is very beneficial and 4 is harmful? 1= Very beneficial/ 2= Beneficial/ 3= Not beneficial/ 4= Harmful

2. How easy or difficult do you think it might be to go the doctor at the health department for your child’s TB care, where 1 is very easy and 4 is very difficult? 1=Very easy/ 2= Easy/ 3=Difficult/ 4= Very difficult

3. How easy or difficult would it be to call or email the health department to see a doctor in the US for your child’s TB services? 1=Very easy/ 2= Easy/ 3=Difficult/ 4= Very difficult

4. What might make it difficult for a person to call or email a health department after they arrive to the US? (Open Ended)

5. What might make it difficult for a person go to a health department after they arrive to the US? (Open Ended)

6. (Only ask if barriers are mentioned in 4 and 5: Overall, how difficult would these barriers be for a person like yourself to overcome? 1=Very easy/ 2= Easy/ 3=Difficult/ 4= Very difficult

7. Finding the right health department in the US for your child’s TB services would be difficult. 1= if Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

8. Going to the health department to see a doctor in the US could cause your child problems. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

10. Providing an updated US address and phone number to immigration officials in Mexico or at the border is important for an immigrant’s health if they have TB infection. 1=Strongly agree / 2= Agree/ 3= Disagree/ 4=Strongly disagree

Thank you for your time!

Public reporting burden of this collection of information is estimated to average 7-15 minutes per response, 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 0920-0932