Request for Change

Change Request

Pregnancy Risk Assessment Monitoring System

(OMB Control No. 0920-1273; Exp. date 11/30/2022)

Mar 22, 2022

Summary

CDC request OMB approval to implement a 12-question supplement on social determinants of health (SDOH) for the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in jurisdictions that elect to participate. The module includes questions previously approved by OMB for use by other Federal surveys. The questions recently underwent cognitive and field testing with women who delivered a live born infant and who were ≤12 months postpartum. Cognitive and field testing resulted in minor changes to some of the questions.

Background and Justification

The Pregnancy Risk Assessment Monitoring System (PRAMS) provides data that is not available from other sources. PRAMS is approved to collect information on maternal behaviors and experiences before, during and shortly after pregnancy on a variety of topics, including those related to the social context of childbearing. The COVID-19 pandemic has widely exposed the impact of structural factors in the environments where individuals live, learn, work, and play on access to health services and health outcomes. PRAMS is a key data source used by CDC, states, jurisdictions, and researchers to monitor prevalence of maternal behaviors and experiences, investigate emerging issues in the field of reproductive health and to assess impacts of programs and policies aimed at reducing health problems among mothers and babies.

PRAMS is approved to provide states the option of collecting supplemental modules to address emerging and priority topics. If approved, the Social Determinants of Health (SDOH) Supplemental Module, with pre-tested questions on the social determinants of health (Appendix C), will be made available to states.

Given this module is only adding a limited number of questions that are harmonized to include existing OMB-approved questions from other Federal surveys, and the overall approved burden hours will not be impacted, this module is submitted as a non-substantive change.

Cognitive and Field Testing

CDC in collaboration with the Council for State and Territorial Epidemiologists sub-contracted or cognitive and field testing of the SDOH supplement that was completed from December 2021 through January 2022. The sub-contractor coordinated with two local pediatric clinics to identify eligible cognitive and field test participants. The participants for cognitive and field testing consisted of women who delivered a live born infant and who were ≤12 months postpartum. Both practices had large, diverse patient populations. The testing emphasis included obtaining data on the phrasing of the timeframe, and the use of Likert-scale responses. Testing was conducted in two phases--cognitive testing followed by field testing.

Cognitive testing was conducted to assess respondents’ ability to understand standardized terminology and ensure the survey questions capture the scientific intent to ensure validity and appropriateness of proposed supplement. Cognitive testing methodology utilizes respondent narratives, which are collected using verbal probing techniques. Cognitive testing was conducted with 9 persons.

Field testing of survey instruments was conducted with 10 persons to provide data that assist with refining and improving the questionnaire layout and survey questions. Field testing data was used to identify issues that may affect implementation of module or quality of the data collected and make further refinements to the data collection instruments as needed. Burden hours, methodology and questions for field testing of new and revised questions are included in the current PRAMS OMB PRA approval.

Testing was conducted using all four questionnaire versions: English mail and phone, and Spanish mail and phone. Phone surveys were read to participants, while mail surveys were printed and given to participants to be filled out on their own, answering at their pace. For more details on the cognitive testing and field-testing methodology, please see the full report titled ‘Cognitive and Field Testing Evaluation of the Pregnancy Risk Assessment Monitoring System (PRAMS), Social Determinants of Health Supplement’ (Appendix A).

Findings from Cognitive and Field Testing

Results from cognitive and field testing indicated that the SDOH questions examined were able to be readily understood by English and Spanish respondents and did not elicit major suggestions for changes from respondents. There were no reports of difficulty answering the questions or expressions of confusion or misunderstandings.

Findings indicated the need for two primary types of changes:

1. For potential issues surrounding the use of alternating the timeframe phrasing (“During the past 12 months”, “During the last 12 months”, and “In the last 12 months”), which affected seven questions within the supplement, respondents recommended using a standardize timeframe phrasing (i.e., “During the last 12 months”) throughout survey instruments.

2. For order of the scaled options, respondents suggested using a consistent scale throughout all questions to minimize confusion (e.g., Always, Usually, Sometimes, Rarely, Never).

Twenty questions were submitted for cognitive and field testing, but ultimately 12 were selected to ensure the SDOH module can be completed within approved burden hours for supplemental modules in PRAMS, content aligns with National Center for Chronic Disease Prevention and Health Promotion priorities and Behavioral Risk Factor Surveillance System content for survey year 2022. See Appendix B, ‘Question Changes Resulting from Cognitive and Field Testing, PRAMS Social Determinants of Health (SDOH) Supplemental Module’, for all the questions included in cognitive and field testing (noting the original Federal survey on which the question initially appeared) and for the specific changes made to each question after testing. Appendix C includes the final versions of the 12 questions in both English and Spanish to be provided to states as an option to implement as a PRAMS supplemental module either via the phone or mail mode. Appendix D (‘PRAMS Social Determinants of Health (SDOH) Supplemental Module, Web Mode’) includes screen shots of the SDOH supplemental module from the web mode of data collection for any states participating in both the initial roll out of the web mode and who elect to use the SDOH supplemental module.

Burden Estimate

No change to the burden estimate is requested.

Effect of Proposed Changes on Currently Approved Instruments and Attachments

Non-substantive change for supplemental data collection module on Social Determinants of Health.

OMB approval is requested, effective immediately.

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