0920-1264 Women's Health Need Study (revised)

Women’s Health Needs Study: The Health of US-Resident Women from Countries with Prevalent Female Genital Mutilation/Cutting (FGM/C)

Att H1 WHNS_Questionnaire (English)_Clean

Women's Health Needs STUDY_QUESTIONNAIRE

OMB: 0920-1264

Document [docx]
Download: docx | pdf






Attachment H1: WHNS Revised Questionnaire -- English

Shape2

Form Approved

OMB Number: 0920-XXXX

Expiration Date: XX/XX/XXXX





































Public reporting burden of this collection of information is estimated to average 45 minute 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-xxxx).

  1. Interview Start Time: ___ Hour ____ Minute


SECTION B. BACKGROUND CHARACTERISTICS

Now we can begin. I am going to start by asking you some basic questions about your background. Your answers will not be shared with anyone outside of the research team.

1. What language do you speak most often at home?

Shape5

2. What language(s) do you speak most often with your closest friends? [INTERVIEWER NOTE: Allow for two languages to be given]

Shape6

Shape7

3. In what country does your mother live now?

Shape8

Mother passed away [GO TO Q5]

Don’t Know [GO TO Q5]

Prefer not to answer [GO TO Q5]



4. How often do you speak with your mother?

Daily

2-3 times a week

Once a week

Once/twice a month

Less than once a month

Never

Don’t Know

Prefer not to answer


5. How many times have you traveled to each of the following countries? [ENTER 0 IF RESPONDENT HAS NEVER TRAVELED TO COUNTRY].


__Burkina Faso

__Egypt

__Eritrea

__Ethiopia

__Gambia

__Guinea

__Mali

__Mauritania

__Sierra Leone

__Somalia

__Sudan






6. How long ago did you move to the United States? [INTERVIEWER NOTE: Select best option based on answer for the most recent time]

Within the last year

1-5 years ago

6-10 years ago

Over 10 years ago

Born in the U.S. [GO TO SECTION C]

Don’t Know

Prefer not to answer



7. How old were you when you moved to the United States?


0-6 years old

7-12 years old

13-17 years old

18 years or older

Don't Know

Prefer not to answer

SECTION C. MARRIAGE AND HOUSEHOLD


Next, I am going to ask you questions about your marital status and living arrangements.

8. Including yourself, how many people live in your household now? Please count children and elders. Do NOT count people staying in the home for less than one month.

Shape9 Shape10

  • Don’t Know

  • Prefer not to answer

9. Which of the following describes your current marital status? Are you married, living with a partner, widowed, divorced, separated, or have you never been married?

Married

Widowed

Divorced

Separated

Not married, but living with a partner
Never married/lived with partner [GO TO Q14]

Prefer not to answer [GO TO Q14]













10. How old were you when you first got married or started living with a partner?

Under 18 years

18-24 years

25-29 years

30-39 years

40-49 years

Over 49 years

Don’t Know

Prefer not to answer

11. How old was your husband/partner when you first got married or started living together?

Under 18 years

18-24 years

25-29 years

30-39 years

40-49 years

Over 49 years

Don’t Know

Prefer not to answer

12. In what country did your first marriage/partnership take place?

Shape11

Don’t Know

Prefer not to answer


13. In what country was your husband/ partner born?

Shape12


Don't Know

Prefer not to answer

SECTION D. COMMUNITY ACTIVITIES


I am now going to ask you some questions about your participation in community activities such as neighborhood organizations or groups.

14. Are you a member of any club, association, or religious organization for people from your family’s home country or ethnic/cultural background?

Yes

No

Not sure

Prefer not to answer

15. When you invite people to your home,
are they. . .

Mostly people from my home country or ethnic/cultural background

Mostly people NOT from my home country or ethnic/cultural background

A mix of people from AND not from my home country or ethnic/cultural background

I never invite people to my home

Prefer not to answer

16. Have you done any work outside of the home for pay in the past 30 days?

Yes

No

Don’t Know

Prefer not to answer

SECTION E. HEALTH-SEEKING BEHAVIOR AND PROVIDER EXPERIENCE

Now I am going to ask you some questions about your overall health and experiences with health care, services, and providers.

17. In general, how would you describe your health? Is it excellent, very good, good, fair, or poor?

Excellent

Very good

Good

Fair

Poor

Not sure

Prefer not to answer

18. How many times have you gone to a clinic or hospital for health care for yourself in the past 12 months?

Not at all

Once

Twice

3-5 times

More than 5 times

Don’t Know

Prefer not to answer



















19. When visiting your healthcare provider, would you like to have someone present to interpret?

Yes

No [GO TO Q22]

Do not have a healthcare provider [GO TO Q22]

Don’t Know [GO TO Q22]

Prefer not to answer [GO TO Q22]


20. During your last visit, was an interpreter offered to you?

Yes

No

Don’t Know

Prefer not to answer

21. Who usually serves as an interpreter for you?

My health provider

Professional interpreter

A staff person

A female friend or relative

My husband or other male relative

Other, please specify:

Shape13

Prefer not to answer

22. Are you currently covered by any of the following types of health insurance?

A plan purchased through an employer or union (includes plans purchased through another person’s employer)

A plan that you or a family member buys on their own

Medicaid or other state or federal program

Some other source, please specify:

Shape14

I do not currently have health insurance

Don’t Know

Prefer not to answer

23. During the past 12 months, was there any time when you needed medical care but didn't get it because you couldn't afford it?

Yes

No

Don’t Know

Prefer not to answer

SECTION F. WOMEN’S HEALTH AND PREGNANCY OUTCOMES

I am now going to ask you questions about family planning and your sexual health.

24. Have you ever used any contraceptives or birth control methods to avoid or delay getting pregnant?

  • Yes

  • No [GO TO Q26]

  • Don’t Know [GO TO Q26]

  • Prefer not to answer [GO TO Q26]



25. Which method(s) have you ever used? Have you used this method in the past 30 days?


Ever Used?

Used in past 30 days?

Female sterilization (tubes tied)

1 Yes

2 No


Male sterilization

1 Yes

2 No


Contraceptive implant (Nexplanon, Jadelle, Sino, Implant, Implanon)

Shape15 1 Yes

2 No

1 Yes

2 No

IUD (for example, Paragard, Mirena, Skyla, Liletta)

Shape16 1 Yes

2 No

1 Yes

2 No

Shots/Injections (for example, Depo-Provera)

Shape17 1 Yes

2 No

1 Yes

2 No

Birth control pills (daily pills, any kind)

Shape18 1 Yes

2 No

1 Yes

2 No

Contraceptive patch (Ortho Evra, Xulane)

Shape19 1 Yes

2 No

1 Yes

2 No

Contraceptive ring (NuvaRing)

Shape20 1 Yes

2 No

1 Yes

2 No

Male condoms

Shape21 1 Yes

2 No

1 Yes

2 No

Diaphragm

Shape22 1 Yes

2 No

1 Yes

2 No

Female condoms

Shape23 1 Yes

2 No

1 Yes

2 No

Foam, jelly, or cream

Shape24 1 Yes

2 No

1 Yes

2 No

Emergency contraception (morning after pill)

Shape25 1 Yes

2 No

1 Yes

2 No

Not having sex at certain times (rhythm or natural family planning)

Shape26 1 Yes

2 No

1 Yes

2 No

Withdrawal (pulling out)

Shape27 1 Yes

2 No

1 Yes

2 No

Other, please specify:

Shape28

Shape29 1 Yes

2 No

1 Yes

2 No

26. In the past 12 months, have you had trouble getting the contraceptives or birth control methods you wanted?

Yes

No

I did not need a birth control method
Don’t Know

Prefer not to answer

27. When was your last pelvic exam and/or pap smear?

Within past year

2-3 years ago

3 to 5 years ago

More than 5 years ago

Never

Don’t Know

Prefer not to answer











































28. How old were you when you had sexual intercourse for the first time?
[READ IF NECESSARY: Do not count oral sex, anal sex, heavy petting, or other forms of sexual activity that do not involve vaginal penetration. Do not count sex with a female partner].

  • Under 18 years

  • 18-24

  • 25-29 years

  • 30-39 years

  • 40-49 years

  • Over 49 years

  • Never had sexual intercourse [GO TO Q37]

  • Prefer not to answer

SECTION G. WOMEN’S HEALTH AND PREGNANCY OUTCOMES

To finish up our questions about health and health care, we have a few questions for you about pregnancy and prenatal care. Prenatal care is when you get checkups from a doctor, nurse, or midwife while you are pregnant.


29. Are you pregnant now?

Yes

No [GO TO Q31]

Don’t Know [GO TO Q31]

Prefer not to answer [GO TO Q31]



30. Have you had prenatal care for this pregnancy?

Yes

No

Prefer not to answer


Now we have some questions about your children.

31. How many children have you given birth to that were born alive?

Shape30 Shape31 [IF 0, GO TO Q37]

Don’t Know [GO TO Q37]

Prefer not to answer [GO TO Q37]

Now I will ask a few questions about each child you had beginning with the oldest one.

Child

32.In what month and year was this child born?

33. Is this child still alive?

34. Was this child born in the U.S.?

35. How many weeks (or months) pregnant were you at the time of your first prenatal care visit?

36.Was this baby delivered by caesarean section (c-section)?

1

Month:
Shape32 Shape33

Year:
Shape34 Shape35 Shape36 Shape37

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape38 Shape39

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer



[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

2

Month:
Shape40 Shape41

Year:
Shape42 Shape43 Shape44 Shape45

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape46 Shape47

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

3

Month:
Shape48 Shape49

Year:
Shape50 Shape51 Shape52 Shape53

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape54 Shape55

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

4

Month:
Shape56 Shape57

Year:
Shape58 Shape59 Shape60 Shape61

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape62 Shape63

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

5

Month:
Shape64 Shape65

Year:
Shape66 Shape67 Shape68 Shape69

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape70 Shape71

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

6

Month:
Shape72 Shape73

Year:
Shape74 Shape75 Shape76 Shape77

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape78 Shape79

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

7

Month:
Shape80 Shape81

Year:
Shape82 Shape83 Shape84 Shape85

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape86 Shape87

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

8

Month:
Shape88 Shape89

Year:
Shape90 Shape91 Shape92 Shape93

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape94 Shape95

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

9

Month:
Shape96 Shape97

Year:
Shape98 Shape99 Shape100 Shape101

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape102 Shape103

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

10

Month:
Shape104 Shape105

Year:
Shape106 Shape107 Shape108 Shape109

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape110 Shape111

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

11

Month:
Shape112 Shape113

Year:
Shape114 Shape115 Shape116 Shape117

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape118 Shape119

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

12

Month:
Shape120 Shape121

Year:
Shape122 Shape123 Shape124 Shape125

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape126 Shape127

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

13

Month:
Shape128 Shape129

Year:
Shape130 Shape131 Shape132 Shape133

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape134 Shape135

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]]

14

Month:
Shape136 Shape137

Year:
Shape138 Shape139 Shape140 Shape141

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape142 Shape143

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]]

15

Month:
Shape144 Shape145

Year:
Shape146 Shape147 Shape148 Shape149

Prefer not to answer

Yes

No

Prefer not to answer

Yes

No

Prefer not to answer

Shape150 Shape151

Weeks

Months

No Prenatal Care

Don’t Know

Prefer not to answer

Yes

No

Prefer not to answer

[GO TO NEXT CHILD OR TO Q37 IF NO MORE CHILDREN]

SECTION H. FGM/C

In a number of countries, there is a practice called circumcision in which a girl or young woman may have part of her genitals cut. Now I would like to ask you some questions about your knowledge and experiences with female circumcision.

37.Do you come from a family that has practiced the tradition of female circumcision?

Yes

No

Don’t Know

Prefer not to answer

38. Does your husband/partner come from a family that has practiced the tradition of female circumcision?

Yes

No

Do not have husband/partner

Don’t Know

Prefer not to answer

39. Have you ever been circumcised?

Yes

No [GO TO Q50]

Don’t Know [GO TO Q50]

Prefer not to answer [GO TO Q50]

40. How old were you when first circumcised?

Less than 1 year old

1-4 years old

5-9 years old

10-14 years old

15-19 years old

More than 19 years old

Too young to remember

Don’t Know

Prefer not to answer



41. Now I would like to ask you some more questions about your circumcision. Was any flesh removed from the genital area?

Yes [GO TO Q43]

No

Don’t Know

Prefer not to answer

42. Was the genital area nicked without removing any flesh?

Yes

No

Don’t Know

Prefer not to answer

43. Was your genital area sewn closed?

Yes

No

Don’t Know

Prefer not to answer











44. What kind of circumcision do you have?

Type 1
Type 2
Type 3

Don’t Know

Prefer not to answer





45. Have you ever had any problems related to your circumcision?

Yes

No [GO TO Q47]

Don’t Know [GO TO Q47]

Prefer not to answer [GO TO Q47]


46. Please describe what problems occurred.

[INTERVIEWER NOTE: DO NOT READ RESPONSES OUT LOUD. SELECT ALL OPTIONS RESPONDENT MENTIONS OR SELECT OTHER AND WRITE IN OPEN ENDED BOX].

Difficulty passing menstrual blood

Difficulty passing urine

Pain with urination

Recurrent Urinary Tract Infections

Pain with sex

Bleeding with sex

Emergency C-section

Postpartum Hemorrhage

Extensive vaginal tears from childbirth

Other, please specify: _____________________________

Don’t Know

Prefer not to answer



47. Would you feel comfortable talking about your circumcision with a health care provider?

Yes

No

Don’t Know

Prefer not to answer





48. Have you ever talked with a health care provider about your circumcision?

Yes

No [GO TO Q50]

Don’t Know [GO TO Q50]

Prefer not to answer [GO TO Q50]



49. Who started the conversation about your circumcision, you or the health care provider?

You

The health care provider

Don’t Know

  • Prefer not to answer







Have you ever experienced any of these health issues or conditions?


50. Have you ever had. . .?






Is this an ongoing problem?

Did you seek professional health care for this?

Were you satisfied with how the problem was addressed?

a. Difficulty passing menstrual blood

Yes

No [GO TO Q50B]

Don't Know [GO TO Q50B]



Yes

No

Don't Know

Yes

No [GO TO Q50B]

Not treatable by a doctor [GO TO Q50B]
 Don't Know [GO TO Q50B]


Yes

No

Don't Know

b. Difficulty passing urine

Yes

No [GO TO Q50C]

  1. Don't Know [GO TO Q50C]




Yes

No

Don't Know

Yes

No [GO TO Q50C]

Not treatable by a doctor [GO TO Q50C]
 Don't Know [GO TO Q50C]


Yes

No

Don't Know

c. Pain with urination

Yes

No [GO TO Q50D]

  1. Don't Know [GO TO Q50D]




Yes

No

Don't Know

Yes

No [GO TO Q50D]

Not treatable by a doctor [GO TO Q50D]
 Don't Know [GO TO Q50D]


Yes

No

Don't Know

d. Recurrent Urinary Tract Infections

Yes

No [GO TO Q51A]

  1. Don't Know [GO TO Q51A]




Yes

No

Don't Know

Yes

No [GO TO Q51A]

Not treatable by a doctor [GO TO Q51A]
 Don't Know [GO TO Q51A]


Yes

No

Don't Know

51. Have you ever . . .?






Is this an ongoing problem?

Did you seek professional health care for this?

Were you satisfied with how the problem was addressed?



a. Felt sad for many weeks at a time

Yes

No [GO TO Q52A]

  1. Don't Know [GO TO Q52A]




Yes

No

Don't Know

Yes

No [GO TO Q52A]

Not treatable by a doctor [GO TO Q52A]
 Don't Know [GO TO Q52A]


Yes

No

Don't Know

52. Have you ever had. . .?






Is this an ongoing problem?

Did you seek professional health care for this?

Were you satisfied with how the problem was addressed?

a. Pain with sex

Yes

No [GO TO Q52B]

Never had sex [GO Q53]

  1. Don't Know [GO TO Q52B]




Yes

No

Don't Know

Yes

No [GO TO Q52B]

Not treatable by a doctor [GO TO Q52B]
 Don't Know [GO TO Q52B]


Yes

No

Don't Know

b. Bleeding with sex

Yes

No [GO TO Q53A]

  1. Don't Know [GO TO Q53A]




Yes

No

Don't Know

Yes

No [GO TO Q53A]

Not treatable by a doctor [GO TO Q53A]
 Don't Know [GO TO Q53A]



Yes

No

Don't Know

53. Have you ever had a/an...?







A. Emergency C-section

Yes



No


Don't Know


Never had live birth [GO TO Q54]

B. Postpartum hemorrhage

Yes

No

Don't Know



C. Extensive vaginal tears from childbirth

Yes

No

Don't Know



SECTION I. FGC BELIEFS

I am now going to ask you some questions about your beliefs and opinions about female circumcision.


54. Which of the following best describes your views about female circumcision? Would you say…

It should be stopped

It should continue as is

Depends on the family

I have mixed feelings about it

Other, please specify:

Shape152

Don’t Know

Prefer not to answer



55. Has your opinion about female circumcision changed in any way since you moved to the U.S.?

Yes

No [GO TO Q57]

Not applicable, born in the U.S. [GO TO 57]

Not applicable, did not have opinion before moving to U.S. [GO TO 57]

Don’t Know [GO TO 57]

Prefer not to answer [GO TO 57]


56. How has your opinion changed?

Would you say your opinion is . . .

More accepting of female circumcision

Less accepting of female circumcision

Don’t Know

Prefer not to answer


57. Do you believe that female circumcision is required by your religion?

Yes

No

No Religion

Don’t Know

Prefer not to answer


58. In your opinion, can female circumcision cause any health problems for women later on (for example during pregnancy and delivery)?

Yes

No

Don’t Know

Prefer not to answer

59. What are your husband/partner’s views about female circumcision? Do you think he would say. . .

It should be stopped

It should continue as is

Depends on the family

He has mixed feelings about it

Other, please specify:

Shape153

Do not have husband/partner

Don’t Know

Prefer not to answer



SECTION J. EDUCATION


60. What is the highest level of schooling you have completed?

No formal school [END OF SURVEY]

Less than a high school diploma

High school diploma or GED

Some college credit, no degree

Associate’s degree (for example: AA, AS)

Bachelor’s degree or higher (for example: BA, BS, MA, MS, MD, PhD, etc)

Don’t Know

Prefer not to answer

61. Have you ever attended school in the U.S.?

Yes

No [END OF SURVEY]

Prefer not to answer

62. Are you attending school now?

Yes

No

Prefer not to answer



Interview End Time: ___Hour ____Minute

1






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