A. 2.2 HCPS Round 1 Cognitive Interview Results_080819

August 2019

2019 Health Center Patient Survey

Cognitive Interview Findings – Round 1

Draft: August 8, 2019

Prepared for

Alissa Harvey

Health Resources and Services Administration

Bureau of Primary Health Care

Parklawn Building, 5600 Fishers Lane

Rockville, MD 20857

Prepared by

RTI International

3040 E. Cornwallis Road

Research Triangle Park, NC 27709

RTI Project Number 0214097.001.100.001.007

I. Methods

Cognitive interviews are one-on-one interviews used to assess a survey questionnaire in terms of general understanding, question and response wording, skip logic, and visual aids. The goal is to gain an understanding of how well the questions work when administered to a sample of the survey’s target population. The interview follows a cognitive protocol with pre-scripted probes. Cognitive interviewers also use spontaneous probes to gain a better understanding of questions.

Recruiting Patients at Participating Health Centers

RTI recruited patients at two participating Section 330-funded health centers for English and Spanish patients. The other languages (Chinese, Vietnamese, and Tagalog) used traditional methods of cognitive recruiting due to the relatively small numbers of these patients that may be at health centers on the day of recruiting. In recruiting at the health centers, the interviewers instructed the receptionist at the recruited health center to read a brief recruitment script to each selected patient (or his or her parent or guardian, for selected children 12 and under and adolescents) and give him/her a flyer describing the study. If the selected patient was interested in participating, she/he approached one of the RTI interviewers assigned to that health center. The interviewer took him/her to a designated private location at the site to administer the screening instrument and conduct the interview.

Traditional Recruiting of Health Center Patients

For the Chinese, Vietnamese, and Tagalog patients, it was decided that the most efficient process was to use traditional recruitment methods. Patients were recruited through posted online ads using Craigslist. Flyers were also posted near local health centers that would qualify for the HCPS (Section 330-funded health centers). Each bilingual interviewer handed out study flyers to people at bus stops, grocery stores, and other businesses close to the health centers. The goal was to identify adults that have visited an eligible health center in the past 12 months. Vietnamese patients were recruited in San Francisco. Chinese patients were recruited in Chicago, IL and Tagalog patients in Raleigh/Durham, NC.

Recruited and Screened Participants

A total of 25 cognitive interviews were conducted during the first round of interviews. All attempts were made to diversify the sample in terms of age, gender, and race (see table 1a-1e). Completed interviews included 9 in English, 8 in Spanish, 3 in Tagalog, 2 in Chinese, and 3 in Vietnamese. Due to the timing of the first-round interviews and the challenges in recruiting Asian participants, we were short of 10 participants (4 Chinese, 3 Vietnamese and 3 Tagalog). However, these interviews will be made up during the second round of cognitive interviews.

Table 1a: Distribution of Interview Participants - English

R	R Age	Proxy Interview?	IF PROXY- Gender and age of child	R Gender	R Race
1*	71			Female	White
2*	35	No		Male	AA
3*	47	No	10	Male	AA
4*	29	Yes	6	Female	AA
5*	33	Yes	11	Female	AA
6*	28	No		Female	White
7	53	No		Female	White
8	58	No		Male	White
9	66	No		Male	White

*Conducted prior to OMB approval (9 are allowed per OMB directive)

Table 1b: Distribution of Interview Participants - Spanish

R	R Age	Proxy Interview?	IF PROXY- Gender and age of child	R Gender	R Race
1*	45	No		Male	Mexican
2*	35	Yes	9	Male	Mexican
3*	64	No		Female	Mexican
4	52	No		Female	Mexican
5	35	Yes	9	Female	El Salvadoran
6	39	Yes	10	Female	Puerto Rican
7	50	No		Male	Mexican
8	50	No		Male	El Salvadoran

*Conducted prior to OMB approval (9 are allowed per OMB directive)

Table 1c: Distribution of Interview Participants - Chinese

R	R Age	Proxy Interview?	IF PROXY- Gender and age of child	R Gender	R Race
1	30	Yes	1	Female	Chinese
2	29	No		Male	Chinese
3	57	No		Female	Chinese

Table 1d: Distribution of Interview Participants - Vietnamese

R	R Age	Proxy Interview?	IF PROXY- Gender and age of child	R Gender	R Race
1	28	No		Male	Vietnamese
2	86	No		Female	Vietnamese
3	49	Yes	12	Female	Vietnamese
4	67	No		Female	Vietnamese

Table 1e: Distribution of Interview Participants - Tagalog

R	R Age	Proxy Interview?	IF PROXY- Gender and age of child	R Gender	R Race
1	68	No		Female	Filipino
2	48	No		Female	Filipino
3	43	No		Female	Filipino

RTI conducted 6 English interviews and 3 Spanish interviews in August 2018. The remaining first round interviews in all languages were conducted in July 2019. Seven cognitive interviewers each conducted several interviews. This ensured that we had good variance in reporting. The interviews ranged from 75 to 90 minutes in length. However, each of the languages takes longer to administer than English, with Spanish and Tagalog, being as much as 30% longer. Since the instrument is quite long, we could not administer the entire questionnaire to each participant and have time to administer scripted and spontaneous probes. To ensure proper coverage of questionnaire modules, we pre-selected a subset of modules to be administered to each type of participant. Following each interview, participants were provided $25 as a token of appreciation for completing the interview.

II. Global Findings

Following the administration of the cognitive interviews, some global issues/themes became apparent. The following are some global findings that we found:

• Overall, there were few issues found with the questions. These are all validated items from other national surveys so we would not expect to find many problems.

• Participants were asked at the end of the interview if they felt there were questions that were uncomfortable to answer. In general, everyone felt the questionnaire was not sensitive and they were not uncomfortable answering questions. Some of them explained that the purpose of the study is to understand patient’s health so they would expect these questions.

• Participants were asked at the end of the interview if there was anything, they were hesitant to provide. One participant felt we asked too many questions about income and they did not see the relevance of asking where their parents were born. Another person was concerned about the suicide questions as they were concerned that the interviewer would judge her if she answered honestly. She also felt this way about the other mental health questions.

• The interviews were long. We only selected a subset of modules to allow interviewers time to administer probes, but the interviewers felt the questionnaire was very long even without administering the entire instrument. In Round 2, we will obtain full timing estimates as the interviewers will administer the entire instrument without interruption.

III. Question by Question Findings

The following are specific questions that the cognitive interview participants had trouble with or provided feedback to us. If we did not encounter a problem with a question during testing, it was not included here.

MODULE A: INTRODUCTION

INT4. {Do you/Does NAME} speak a language other than English at home?

1=YES

2=NO

Findings:

Several respondents answered “Spanish” when asked this question. One participant said she was confused why we were was asking about speaking English at home.

Another respondent thought the question was asking if he spoke English at home.

Another respondent does not speak English at all.

Recommendation:

Consider underlining “Other than English” for emphasis.

INT5. Please look at this showcard.

Which of the following best describes {your/NAME’s} Hispanic, Latino or Spanish origin? You may select one or more.

1=Mexican, Mexican American, Mexicano or Chicano

2=Puerto Rican

3=Central American

4=South American

5=Cuban or Cuban American

6=Dominican (From Dominican Republic)

7=Spanish (From Spain)

8=Other Latin American, Hispanic, Latino or Spanish Origin

Findings:

One patient did not select Central American for Honduras, but selected other, and specified Honduran.

Another participant asked, "what is Chicano?", he took time looking at answer options because he was looking for El Salvador

Recommendation:

No changes.

INT2. Please look at this showcard. What race or races do you consider {yourself/NAME} to be? You may select one or more.

NOTE: CODE “NATIVE AMERICAN” AS “AMERICAN INDIAN”

1=WHITE

2=BLACK OR AFRICAN AMERICAN

3=AMERICAN INDIAN OR ALASKA NATIVE (AMERICAN INDIAN INCLUDES NORTH AMERICAN, CENTRAL AMERICAN, AND SOUTH AMERICAN INDIANS)

4=NATIVE HAWAIIAN

5=GUAMANIAN OR CHAMORRO

6=SAMOAN

7=TONGAN

8=MARSHALLESE

9=ASIAN INDIAN

10=CHINESE

11=FILIPINO

12=JAPANESE

13=KOREAN

14=VIETNAMESE

15=OTHER ASIAN

16=OTHER NATIVE AMERICAN/AMERICAN INDIAN

Findings:

Several of the participants had trouble with this question as they could not select a race from the showcard. Several participants could not select a race from the card and repeated Hispanic. Another participant provided a nationality as a response.

Recommendation:

RTI will be reviewing this question to provide interviewer assistance in how to handle respondents that do not provide a response that fits within the listed categories. It is likely that the interviewer will need to probe and provide guidance to the respondent.

MODULE B: ACCESS TO CARE

MODULE C: ROUTINE CARE

ROU9f2. [IF INTAGE=11-64 CONTINUE ELSE GO TO ROU9a]

{Have you/Has NAME} ever received an HPV shot or vaccine? Would you say, Yes at {REFERENCE HEALTH CENTER}, Yes at some other place, or No?

[ALLOW MULTIPLE RESPONSES FOR RESPONSE 1 AND 2]

IF NEEDED: HPV is Human papillomavirus. The HPV vaccines are called Cervarix or Gardisil. Genital human papillomavirus is the most common sexually transmitted disease

1= YES - {REFERENCE HEALTH CENTER}

2= YES - SOME OTHER PLACE

3= NO

Findings:

Several participants asked about the definition of HPV. The interviewers read the instruction. They commented that the definition was somewhat complicated, but it ultimately helped them understand what we were asking about.

Recommendation:

No changes.

ROU9e. Has {NAME} received all of the shots recommended for {his/her} age according to the immunization schedule?

1=YES

2=NO

Findings:

This means "shot records are up-to-date". Instead of saying schedule, R suggested saying are immunization records up to date or up to the doctor's standards.

Recommendation:

We could include an interviewer note for clarification: “For example, your child has received all of the recommended shots for his/her age.”

ROU12. [IF INTAGE LESS THAN 18 CONTINUE, ELSE GO TO ROU14]

These next questions are about well-child check-ups, that is a general check-up, performed when {you were/NAME was} not sick or injured. About how long has it been since {you/he/she} received a well-child or general check-up?

1=NEVER

2=LESS THAN 1 YEAR AGO

3=AT LEAST 1 YEAR BUT LESS THAN 2 YEARS

4=AT LEAST 2 YEARS BUT LESS THAN 3 YEARS

5=AT LEAST 3 YEARS BUT LESS THAN 4 YEARS

6=AT LEAST 4 YEARS BUT LESS THAN 5 YEARS

7=5 OR MORE YEARS AGO

Findings:

One participant said she is more used to the term "well-being check-up" and not "well child check-up.

Recommendation:

No changes.

MODULE D: CONDITIONS

CON9x. How often {do you/does NAME} do light or moderate leisure-time physical activities for at least 10 minutes that cause heavy sweating or large increases in breathing or heart rate?

IF NEEDED: How many times per day, per week, per month, or per year do you do these activities?

__________TIME(S)

ENTER 88 IF UNABLE TO DO THIS TYPE OF ACTIVITY

ENTER 99 IF NEVER

Findings:

Participants understood what this question was asking about.

Recommendation:

No changes.

CON9y. About how long {do you/does NAME} do these light or moderate leisure-time physical activities each time?

__________

ENTER 88 IF UNABLE TO DO THIS TYPE OF ACTIVITY

ENTER 99 IF NEVER

Findings:

Participants understood what this question was asking about.

Recommendation:

No changes.

CON9z. [IF CON9z=88 OR 99 GO TO CON9N1, ELSE CONTINUE] How often {do you/does NAME} do vigorous leisure-time physical activities for at least 10 minutes that cause heavy sweating or large increases in breathing or heart rate?

IF NEEDED: How many times per day, per week, per month, or per year do you do these activities?

__________TIME(S)

ENTER 88 IF UNABLE TO DO THIS TYPE OF ACTIVITY

ENTER 99 IF NEVER

Findings:

One participant said she did not know what “vigorous” means. When asked what she thinks the question is asking, she said "how many times does she do hard work that makes her heart raise.

Recommendation:

No changes.

CON9N1. Now I will ask you first about TV watching and then about computer use.

On an average weekday, about how much time {do you/does NAME} usually spend in front of a TV watching TV programs, videos, or playing video games?

1=LESS THAN 1 HOUR

2=1 HOUR BUT LESS THAN 2 HOURS

3=2 HOURS BUT LESS THAN 3 HOURS

4=3 HOURS BUT LESS THAN 4 HOURS

5=4 HOURS OR MORE

6={DO/DOES NOT} WATCH TV OR VIDEOS

Findings:

When asked what the participants thought this question was asking, they all seemed to understand it well.

Recommendation:

No changes.

CON9n2. On an average weekday, about how much time {do you/does NAME} usually spend with computers, cell phones, handheld videogames and other electronic devices doing things other than work or school?

1=LESS THAN 1 HOUR

2=1 HOUR BUT LESS THAN 2 HOURS

3=2 HOURS BUT LESS THAN 3 HOURS

4=3 HOURS BUT LESS THAN 4 HOURS

5=4 HOURS OR MORE

6 =DO/DOES NOT USE AN ELECTRONIC DEVICE OUTSIDE OF WORK OR SCHOOL

Findings:

When asked what the participants thought this question was asking, they all seemed to understand it well.

Recommendation:

No changes.

CON8a3. (During the past 12 months, has a doctor or other health professional talked to you about things {you/NAME} can do to manage {your/his/her} weight, such as…)

An exercise program? Would you say, Yes at {REFERENCE HEALTH CENTER}, Yes at some other place, or No?

[ALLOW MULTIPLE RESPONSES FOR RESPONSE 1 AND 2]

1= YES - {REFERENCE HEALTH CENTER}

2= YES - SOME OTHER PLACE

3= NO

CON10c. [IF CON10=1 CONTINUE, ELSE GO TO CON11_hep]

Findings:

One participant hesitated because he understood the phrase, “An exercise program”, as a specific program or a going to a gym. He answered ‘No’ because he was only told to exercise more, but he was not on a specific exercise program.

One participant confused, explaining that the provider talked about exercising at home, not an "exercise program", and asked if that should count.

Recommendation:

The question is broad and may be intended to be broad. The fact that the providers recommend some exercise should be sufficient. We recommend leaving this to whatever it means to the respondent.

CON10c. During the most recent visit, were you told {you/NAME} had high blood pressure?

1=YES

2=NO

Findings:

One participant noted that he is on medications for high blood pressure, so his blood pressure was fine today, and wasn't told he had high blood pressure. Another participant noted that she and her doctor already knew she had high blood pressure, so she was not told she had it during this recent visit.

Recommendation:

We ask in CON10 whether they ever had high blood pressure. This is asking if they were told they have high blood pressure on their most recent visit, so there are no changes recommended.

CON11a_2. {Have you/ Has NAME} ever received the hepatitis B vaccine?

IF NEEDED: This is given in three separate doses and has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.

1=YES

2=NO

Findings:

One proxy participant hesitated. She was unsure if her son had the hepatitis vaccine. She answered “Yes” but was uncertain of the types of vaccines he had, and she repeated that her son had all vaccines required.

Recommendation:

We do offer a “Don’t know” response for any question if the respondent does not know the answer. No changes recommended.

CON11_hepb. [If CON11a_2=1 CONTINUE, ELSE GO TOCON11a_test]

Did {you/NAME} receive at least 3 doses of the hepatitis B vaccine, or less than 3 doses?

1=RECEIVED AT LEAST 3 DOSES

2=RECEIVED LESS THAN 3 DOSES

Findings:

On participant noted that he received whatever the standard was. He doesn't remember the number of doses.

Recommendation:

It is likely that they may not know. A “Don’t Know” response is always available to the respondent. No changes recommended.

CON12_FAM. Has your/ Has NAME’s} mother, father, brother, or sister ever been told by a doctor or other health professional that they have diabetes or sugar diabetes? Include only blood relatives. Do not include step-relatives or those unrelated by blood.

1=Yes

2=No

3=Unsure

Findings:

Interviewers asked the participants how confident they were of their answer. They all seemed to be quite confident that they could answer this question.

Recommendation:

No changes.

CON9z1a. A traumatic brain injury may result from a bump, blow, or jolt to the head or when an object pierces the skull and enters the brain tissue. Has a doctor or other health professional ever told you that {you have/NAME has} suffered a traumatic brain injury (TBI)?

1=YES

2=NO

Findings:

One participant had to think a little bit more about question. She did not catch the word "traumatic" as used in the question.

Recommendation:

Consider bolding the words “traumatic brain injury”.

CON27f. {Do you/ Does NAME} have any difficulty …

Walking or climbing stairs? (Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?)

1=NO DIFFICULTY

2=SOME DIFFICULTY

3=A LOT OF DIFFICULTY

4=UNABLE TO DO THIS ACTIVITY

Findings:

Two participants explained that they use a cane. They were not sure if they should answer about when they use a cane or without use of the cane.

Recommendation:

We recommend leaving the question as is and allowing the respondent to decide what it means to them.

CON28a. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

_______ NUMBER OF DAYS

Findings:

The interviewers asked what this question meant to the participants. Everyone understood what the question was asking.

Recommendation:

No changes.

CON30. [IF INTAGE GE 5 CONTINUE, ELSE GO TO CON30b] Because of a physical, mental, or emotional condition, {do you/ does NAME} have serious difficulty concentrating, remembering, or making decisions? Would you say no difficulty, some difficulty, a lot of difficulty, or are you unable to do this?

1=NO DIFFICULTY

2=SOME DIFFICULTY

3=A LOT OF DIFFICULTY

4=UNABLE TO DO THIS ACTIVITY

Findings:

One participant said that it depended on which activity. She has difficulty remembering, but not concentrating or making decisions.

Recommendation:

No changes.

CON30a. {Are you/Is NAME} limited in any way because of difficulty remembering or because {you/he/she} experience periods of confusion?

1=YES

2=NO

Findings:

The interviewers asked what this question meant to the participants. Everyone understood what the question was asking.

Recommendation:

No changes.

CON31a. [IF INTAGE GE 5 CONTINUE, ELSE GO TO CONF1]

In the past 12 months, {have you/ has NAME} fallen?

1=YES

2=NO

Findings:

The interviewers asked what this question meant to the participants. Everyone understood what the question was asking.

Recommendation:

No changes.

CON33. How many of these falls caused an injury that limited {you/NAME’s} regular activities for at least a day or caused {you/NAME} to go see a doctor or other health professional?

________ TIMES [ALLOW 00-99]

[SOFTCHECK: VALUE IN CON33 MUST BE LESS THAN OR EQUAL TO VALUE IN CON31b]

Findings:

One participant noted that he only indicated one fall in CON31b, but this question asks "how many of these falls.

Recommendation:

RTI can include skip logic on this question to automatically fill “1” if reported in CON31b.

MODULE E: CONDITIONS – FOLLOW-UP

CONF2. [IF CON10=1 AND CONF1=2 OR BLANK CONTINUE, ELSE GO TO CONF4]

Was any medication ever prescribed by a doctor or other health professional for {your/NAME’s} high blood pressure? Would you say, Yes at {REFERENCE HEALTH CENTER}, Yes at some other place, or No?

[ALLOW MULTIPLE RESPONSES FOR RESPONSE 1 AND 2]

1= YES - {REFERENCE HEALTH CENTER}

2= YES - SOME OTHER PLACE

3= NO

Findings:

One participant wasn't sure how to answer this. His previous doctor started prescribing him the medicine and now his current doctor prescribes the medicine.

Recommendation:

This is an interviewer training issue. The respondent is allowed multiple responses and should select both 1 and 2. No changes.

CONF3. Do you regularly check {your/his/her} blood pressure?

1=YES

2=NO

Findings:

Several participants explained that the doctor checks the blood pressure, but the participants don’t check it on their own.

Recommendation:

This is an interviewer training issue. The interviewer should repeat the question emphasizing “you”. Interviewers are trained for these types of situations. No changes.

CONF3b. (During the last 6 months, have you received any of the following to teach you how to take care of {your/his/her} high blood pressure…)

An appointment with a nurse at {REFERENCE HEALTH CENTER}?

1=YES

2=NO

Findings:

One participant wasn't sure how to answer this. He noted that the appointment wasn't specifically about taking care of his high blood pressure.

Recommendation:

No changes.

CONF5c. Glycosylated (GLY-CO-SYL-AT-ED) hemoglobin or the “A one C” test measures the average level of blood sugar over the past 3 months, and usually ranges between 5 and 14.

During the past 12 months, how many times has a doctor or other health professional checked {you/NAME} for glycosylated hemoglobin or A one C?

NEVER=0

______ TIMES [ALLOW 0-9]

Findings:

One participant had diabetes but said she did not know anything about the glycosylated hemoglobin or A one C, but they test diabetes at health center.

Recommendation:

No changes.

CON22c. (To lower {your/his/her} blood cholesterol, {have you/has NAME} ever been told by a doctor or other health professional…)

To increase your physical activity or exercise?

1=YES

2=NO

Findings:

One participant was a little confused by the word "increase" and wasn't sure if she should take it literally. The doctor did tell her to exercise not "increase" exercise.

Recommendation:

No changes.

MODULE F: CANCER SCREENING

No issues found.

MODULE G: HEALTH CENTER SERVICES

HEA17. In the last 12 months, did you make any appointments for a check-up or routine care with this health center?

1=YES

2=NO

Findings:

One participant noted that she didn't make the appointment, the clinic did. She hesitated, not knowing how to answer this question.

Recommendation:

No changes.

HEA32. In the last 12 months, how often did a doctor or other health professional at this health center seem to know the important information about your medical history? Would you say…

1= Never

2=Sometimes

3=Usually

4=Always

Findings:

One participant said she was not sure what "…seem to know the important information about your medical history" and she was not sure how to answer the question. She said doctors and nurses just read aloud her medical history mostly and she couldn't tell if they really understood her medical history.

Recommendation:

No changes.

HEA57. Please look at this showcard. Many healthcare providers use information technologies to communicate with and provide care services to their patients.

SHOWCARD HEA5

Have you ever used any of the services listed on this card, if provided by {REFERENCE HEALTH CENTER}? You may select all that apply.

SELECT ALL THAT APPLY

1=CALLED TO REMIND {YOU/HIM/HER} OF APPOINTMENT

2=Sending you reminders of appointments or prescription refills by emails or texts

3=Providing a website that allows you to manage {your/HIS/HER} healthcare needs, such as making appointments and checking test results

4=Providing a mobile app that allows you to manage {your/HIS/HER} healthcare needs, such as making appointmentS and checking test results

5=Using social media to provide service information and healthcare advice

6=Another form of communication [excluding telephone calls, in-person communication, or through U.S. mail]

7=THIS HEALTH CENTER DOES NOT PROVIDE ANY OF THESE SERVICES

Findings:

The interviewers asked what this question meant to the participants. Everyone understood what the question was asking. A few participants explained that the showcard was difficult to read. They felt it was long.

Recommendation:

We would recommend changing the showcard booklet responses to a mix of upper and lower case as responses are currently in ALL CAPS. We believe this would aid in reading responses.

MODULE H: HEALTH INSURANCE

INS3a. {IF ONLY ONE OF THE FOLLOWING (INS2, INS4, INS5, INS6, INS7 OR INS8 = 1 OR INS9 = 2 Does this plan OR ONLY ONE RESPONSE (1-7) IN INS14: Did this plan/ IF MORE THAN ONE OF THE FOLLOWING (INS2, INS4, INS5, INS6, INS7 OR INS8 = 1 OR INS9 = 2 Do any of these plans OR MORE THAN ONE RESPONSE (1-7) IN INS14: Did any of these plans} pay for any of the costs for medicines prescribed by a doctor?

1=YES

2=NO

Findings:

Instead of yes or no, the participant answered, "part of the cost".

Recommendation:

This is an interviewer training issue. Interviewers are instructed to repeat the question, and in this case, emphasizing “… any of the costs”. No changes.

INS21. [IF INS19=1 CONTINUE, ELSE GO TO INS22]

How much is the annual deductible per person under {your/ NAME’s} current health coverage?

Would you say it is…?

1=Less than $100

2=Between $100 and $499

3=Between $500 to $999

4=Between $1,000 to $1,999

5=Between $2,000 to $2,999

6=Between $3,000 to $4,999

7=Between $5000 to $9,999

8=$10,000 or more

Findings:

One participant hesitated explaining, "There is a different deductible depending on the type of health service received". Regular appointments require a lower deductible than hospital stays. He considered the maximum deductible for this question.

Recommendation:

No changes as this is a question used in 2014 and does not appear to be problematic for most respondents.

MODULE I: PRESCRIPTION MEDICATION

PRS5a [IF PRS5=1 CONTINUE, ELSE GO TO PRS7a]

Did a doctor or other health professional from {REFERENCE HEALTH CENTER} talk with you about all the prescription and over-the-counter medicines you were taking?

1=YES

2=NO

Findings:

Interviewers asked if participants had any challenges answering this question. Participants all seemed to be able to answer this question.

Recommendation:

No changes.

PRS6a. [IF PRS6=2 OR 3 CONTINUE, ELSE GO TO PRS7]

Can you tell me where you normally get {your/NAME’s} prescriptions filled outside of {REFERENCE HEALTH CENTER}?

1=Drugstore Pharmacy

2=Pharmacy Not attached to A drugstore

3=Health Clinic, Hospital OR Health Center

4=Mail Order Pharmacy

5=Other

Findings:

On participant wasn't sure which category to choose. She gets medication shipped to her from Express Scripts

Recommendation:

No changes.

PRS7b. [IF PRS7a = 1 CONTINUE, ELSE GO TO PRS8]

During the past 30 days, for about how many days did pain make it hard for {you/ NAME} to do {your/ his/her} usual activities?

________ # OF DAYS [ALLOW 0-30]

Findings:

Interviewers asked if it was difficult to recall the number of days. The participants explained that it was not at all difficult.

Recommendation:

No changes.

PRS7e. During the past 30 days, how often was {your/NAME’s} pain well controlled? Would you say never, sometimes, usually, or always?

1 = Never
2 = Sometimes
3 = Usually
4 = Always

Findings:

Interviewers asked what “pain well controlled” meant to the participant. The participants provided examples and understood what the question was asking.

Recommendation:

No changes.

PRS10. [IF INTAGE=18 OR OLDER CONTINUE, ELSE GO TO DENPRE]

During the past 12 months, were any of the following true for you?

…You skipped medication doses to save money.

1=YES

2=NO

Findings:

Interviewers asked if it was difficult to recall. The participants explained that it was not at all difficult.

Recommendation:

No changes.

MODULE J: DENTAL

No issues found with this module.

MODULE K: MENTAL HEALTH

MEN2_HAVAUT. {Do you/Does NAME} have autism, asperger’s disorder, pervasive developmental disorder, or autism spectrum disorder?

1=YES

2=NO

Findings:

Interviewers asked if the participants understood this question as asked. A few were not familiar with these disorders, but most did not have any difficulty.

Recommendation:

No changes recommended. It is likely they would know these disorders if they had been diagnosed, else they would respond, “No’.

MEN2b. Has a doctor or other health professional ever told you that you had generalized anxiety?

1=YES

2=NO

Findings:

Two participants did not understand what was meant by “generalized anxiety”

Recommendation:

No changes recommended as this is validated scale used in the past.

MEN13. During the past 12 months, did you try to kill yourself?

1=YES
2=NO

Findings:

Interviewers asked whether the participants felt the suicide questions were sensitive and whether they would answer them in the actual interview. Some participants were not comfortable with them but felt it was important to ask on a health study and would answer them.

Recommendation:

No changes.

MODULE L: SUBSTANCE USE

SUB1_ECIG1. Electronic cigarettes (e-cigarettes) and other electronic “vaping” products include electronic hookahs (e-hookahs), vape pens, e-cigars, and others. These products are battery-powered and usually contain nicotine and flavors such as fruit, mint, or candy.

Have you ever used an e-cigarette or other electronic “vaping” product, even just one time, in your entire life?

1=Yes

2=No

Findings:

Interviewers asked whether the participants understood the question. One participant felt the intro was long, but they all seemed to feel it was a good explanation of the types of vaping products.

Recommendation:

No changes.

MODULE M: PRENATAL CARE/ FAMILY PLANNING

No issues found with this module.

MODULE N: HIV TESTING

HTG4. Has anyone at {REFERENCE HEALTH CENTER} ever talked to you about ways to protect yourself and others from getting the HIV virus?

1=YES

2=NO

Findings:

One participant noted that he's been provided with flyers and wasn't sure if this counted.

Recommendation:

No changes.

MODULE O: LIVING ARRANGEMENTS

LIV15f. In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money for food?

1=YES

2=No

Findings:

The interviewers asked if the participant was thinking of themselves or the household. The participants were mostly split between thinking of themselves or thinking of the household.

Recommendation:

Consider revising or deleting this question. If the focus is on the participant, then we should make that clear in the question, else focus the question on the household.

MODULE P: NEIGHBORHOOD CHARACTERISTICS

NEI3. How would you rate the condition of the street in the block where you live?

1=Very good - recent resurfacing, smooth

2=Moderate - kept in good repair

3=Fair - minor repairs needed

4=Poor - potholes and other evidence of neglect

Findings:

An interviewer felt the responses are hard to read and recommended changing the descriptions to full sentences.

Recommendation:

We recommend full sentences for the response categories. For example, “Very good, that is the street has been recently resurfaced or is smooth”.

MODULE Q: INCOME AND ASSETS

INC3e. (During {LAST CALENDAR YEAR IN 4-DIGIT FORMAT}, did {you/NAME} or anyone else in {your/his/her} household receive any of the following forms of public assistance?)

Project-based Section 8?

1=YES

2=NO

Findings:

Interviewers asked participants how well they understood this question. Most of them did not know what “Project-based Section 8”.

Recommendation:

Participants are likely to answer “No” if they do not know. However, if they do receive Section 8 then they would likely know and answer “Yes’ to this. No changes.

MODULE R: DEMOGRAPHICS

No issues found with this module.

32