Interview Observation Form

NSFG OMB Attachment M OMB No. 0920-0314

Interview Observation Form

Interviewer Instructions:

Circle one response number only unless otherwise indicated

The following questions are about how you perceive the respondent and the housing unit. We are asking for your best, common-sense judgment. People could have different opinions about some of these things, but we would like to know your views, since you have spent some time with the respondent. Please do the best you can. Survey experience has shown that such observations are often useful, even if they are subjective.

Sample ID:

Iwer ID:

Date: (MM/DD/YY)

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/

Time: (HR:MIN)

:

AM

PM

1. Where was the interview conducted?

1. Inside R’s HU

2. I mmediately outside R’s HU (e.g., porch) (skip to 2)

3. In Iwer’s car (skip to 2)

4. At R’s worksite (skip to 2)

5. In a restaurant/fast food place (skip to 2)

6. At a library (skip to 2)

7. In a HU of a neighbor, friend, or relative (skip to 2)

8. At another location (Specify ___________) (skip to 2)

1a. In which room(s) was the interview conducted? (Circle ALL that apply)

1. Living room/family room/den

2. Kitchen/dining room

3. Bedroom

4. Office

5. Foyer/hallway

6. Basement

7. Other (Specify _____________)

2. Mark the appropriate answer about whether other persons were within hearing range at any time during the interview:

1. No other person was present at any time

(skip to 5)

2. One or more persons were present in the interview location but were not within hearing range (skip to 5)

3. One or more persons were present within hearing range at some portions of the interview

4. One or more persons were present within hearing range during the entire interview

3. Relationship to the R of other people present or within hearing range during the interview (Circle ALL that apply)

1. Parent(s)

2. Spouse / significant other

3. Other adult(s)

4. Child(ren) 4-17 years old

5. Child(ren) under 4 years old

6. Other

4. In what ways did the other people’s presence influence the interview? (Circle ALL that apply)

1. P erson(s) came into the room and you paused the interview until they left

(skip to 5)

2. Person(s) came into the room, you or R answered their question or explained that privacy was needed, and they left (skip to 5)

3. Person(s) stayed in the room but did not participate in interview

4. Person(s) stayed in the room and offered R help with answers

5. Person(s) stayed but was too young to understand the interview (skip to 5)

6. Other (Specify: ___________________)

4a. During which, if any, of the following sections or questions were the other person(s) within hearing range? (Circle ALL that apply)

1. Monthly contraceptive method history (Female interview only)

2. # of sexual partners

3. Detailed questions about previous partners

4. None of these sections

5. During the interview, was the atmosphere at the interview site:

1. Extremely chaotic and noisy; disruptive to interview

2. Some noise or interruptions but interview went reasonably smoothly

3. Very quiet and calm, ideal for interview

6. What types of distractions or interruptions were present during the interview? (Circle ALL that apply)

1. Television on during interview but R not watching

2. Television on during interview with R watching at least some of the time

3. R received 1 or 2 phone calls

4. R received 3 or more phone calls

5. Children present needed attention

6. Other (Specify: ___________________)

7. No distractions or interruptions present

7. In what language did you administer the CAPI (interviewer- administered) part of the interview?

1. English

2. Mix of English and Spanish

3. Spanish

8. In general, how did the R act toward you during the interview?

1. Hostile

2. Neither hostile nor friendly

3. Friendly

9. How attentive was the R to the questions during the interview?

1. Not at all attentive

2. Somewhat attentive

3. Very attentive

10. Was the R upset during the interview?

1. Yes, upset because of interview content

2. Yes, upset but NOT related to interview content

5. N o, not upset (skip to 12)

11. Was the R still upset at the end of the interview?

1. Yes

5. No

12. At the end of the interview, did the R seem to be tired?

1. Yes, tired because of interview

2. Yes, tired but NOT because of interview

5. No, not tired

13. To what extent did the R use the Life History Calendar (LHC) during the interview?

1. Male R, no LHC in interview

2. Used LHC as instructed throughout

3. Began using LHC but stopped because it wasn’t needed

4. Began using the LHC but stopped because of frustration

5. Did not use LHC at the beginning but began using it later in the interview

6. Did not use LHC at all

14. Overall, what is your opinion of the quality of the information provided by this R? Was it of:

1. E xcellent quality (skip to 16)

2. Good quality (skip to 16)

3. Fair quality

4. Poor quality

15. The interview was of fair or poor quality because the R was: (Circle ALL that apply)

1. Bored, disinterested

2. Embarrassed

3. Hostile or suspicious

4. Not serious

5. Not truthful

6. Distracted / could not concentrate

7. Not able to remember dates

8. R did not understand questions due to low literacy, language problems, etc.

9. Other (Specify: ___________________)

16. For most of the CAPI part of the interview, how would you describe your seating arrangement with the R?

1. Next to R (facing the same way)

2. Next to R (facing at a right angle)

3. Across from R

4. Some other arrangement

17. Was the R able to see the computer screen during the CAPI part of the interview?

1. R could see the screen during all of CAPI

2. R could see the screen on most, but not all CAPI questions

3. R could see the screen on a few CAPI questions

4. R could never see the screen during CAPI

18. What support did you have for the laptop during the CAPI part of the interview:

1. Table

2. Lap

3. Other (Specify: ______________)

19. Did you or the R encounter any difficulty during the interview because of the CAPI application? (Circle ALL that apply)

1. Hardware problem

2. Confusion about question referent: biological vs. adoptive parent

3. Confusion about question referent: first sex partner vs. first consensual sex partner

4. R got questions that s/he should not have gotten and you couldn’t skip past them

5. Other (Specify:___________________)

6. No difficulties encountered

The next set of questions asks about the ACASI (self-administered) part of the interview. Please base your answers on the real ACASI questions, not the practice questions.

20. Please choose the answer that best describes your seating arrangement during the ACASI (self-administered) part of the interview.

1. Next to R (facing the same way)

2. Next to R (facing at a right angle)

3. Seated across from R

4. Some other arrangement

21. Were you able to see the computer screen during the ACASI part of the interview?

1. I could see the screen during all of ACASI

2. I could see the screen on most, but not all ACASI questions

3. I could see the screen on a few ACASI questions

4. I could never see the screen during ACASI

22. What support did the R have for the laptop during the ACASI part of the interview?

1. Table

2. L ap

3. Other (Specify:_______________)

23. After you helped R with the practice questions, please indicate the level of assistance you provided to R during ACASI

1. R completed ACASI section with no assistance from me (skip to 25)

2. R completed ACASI section, but needed assistance on a few screens

3. R completed ACASI section, but needed assistance on many screens

4. I administered the ACASI section

(skip to 25)

24. What type of assistance did you provide to R? (Circle ALL that apply)

1. Read one or more questions to R

2. Helped with headphones

3. Helped R adjust volume

4. Helped R enter one or more answers

5. Helped R move to next screen

6. Helped R back up to previous screen

7. Helped R hide question text

8. Helped R replay audio

9. Answered questions about what a question meant

10. Other (Specify:_______________)

25. Please tell us about R’s use of headphones during ACASI.

1. R did not wear headphones for any ACASI questions

2. R wore headphones at start of ACASI, but removed them part way through

3. R did not wear headphones at start of ACASI, but put them on part way through

4. R wore headphones for all ACASI questions

5. Other (Specify:_______________)

26. Do you think that the R used the Audio in addition to the text during ACASI?

1. Unable to tell whether R was using audio

2. R turned audio off and used text only

3. R used both text and audio

4. R appeared to use audio only

27. Did the R make any comment(s) about the ACASI voice?

1. Yes, positive comment(s)

2. Yes, neutral comment(s)

3. Yes, negative comment(s)

4 . No (skip to 29)

28. What comment(s) did the R make? ___________________________________________________________________________________________________________________________________________________________________________________________________

29. How would you describe your mood at the beginning of this interview?

1. Happy

2. Neutral

3. Sad/Unhappy

30. Why do you think the R completed the interview? ___________________________________________________________________________________________________________________________________________________________________________________________________