KAP Survey - Shelter Workers

Form Approved

OMB Control No.: 0920-XXXX

Expiration date: XX/XX/XXXX

Knowledge, Attitudes, and Practices (KAP) about body lice- and flea-borne diseases:

Survey for Shelter Workers

Instructions to Interviewer: Please read the italicized information to the participant before starting the block of survey questions. Read the participant the entire question and then ask the participant to choose the answer. If needed, you may prompt them with the answer options. If any material is in bold within the question box, please do not read that portion to the participant (bolded text is instructional for you). You may also need to remind participants that questions about lice are about BODY lice, not head lice. Some homeless service sites prefer the term “guests” rather than “clients”; please adjust your terminology accordingly. As a reminder, participants can choose to skip any question that they prefer not to answer.

Location ID: ________

Participant ID: ______

“Thank you for your time and participation. We are working with [local public health/academic partner(s)] to learn more about vector-borne disease among people experiencing homelessness. People can get vector-borne diseases after being bitten by infected bugs such as lice and fleas. This survey will help us provide useful information about these diseases to workers and volunteers in shelters serving people experiencing homelessness. Your participation in this survey is completely voluntary; feel free to skip any questions that you don’t want to answer or to stop the survey at any time.”

“First, I’d like to ask you some questions about body lice and fleas.”

KL1	Which of the following pictures shows body lice? Show participant the laminated photo page.	☐ Image A ☐ Image B ☐ Image C ☐ Image D ☐ None of these images ☐ I don’t know ☐ Prefer not to say
KF1	Which of the following pictures shows flea bites? Show participant the laminated photo page.	☐ Image A ☐ Image B ☐ Image C ☐ Image D ☐ None of these images ☐ I don’t know ☐ Prefer not to say

“I have a few questions about body lice. Please let me know if you think that each sentence is ‘True’ or ‘False’. You can also say “I don’t know.”

KL2	Body lice can spread directly from person-to-person.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL3	Body lice lay their eggs in seams of clothing.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL4	Sharing clothes, sleeping bags, or bedding can lead to body lice moving from one person to another.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL5	Body lice live on cats and dogs.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF6	Body lice live on mice and rats.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL7	Washing clothes and bedding can kill body lice. Instructions to Interviewer: If people ask, state that this question assumes washing with HOT water and with drying on high heat.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL8	Body lice live outside in wooded areas.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL9	Showering or bathing can prevent body lice.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL10	Medicines applied to the skin must be used to treat severe body lice.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KL11	The best treatment for severe body lice is permethrin. Some other names for permethrin are Nix and Elimite.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say

“Now I have a few questions about fleas. Please let me know if you think that each sentence is ‘True’ or ‘False’. You can also say “I don’t know.”

KF2	Fleas can spread directly from person-to-person.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF3	Fleas may lay their eggs in seams of clothing.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF4	Sharing clothes, sleeping bags, or bedding can lead to fleas moving from one person to another.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF5	Fleas live on cats and dogs.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF6	Fleas live on mice and rats.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF7	Washing clothes and bedding can kill fleas.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF8	Fleas live outside in wooded areas.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say
KF9	Showering or bathing can prevent fleas.	☐ True ☐ False ☐ I don’t know ☐ Prefer not to say

“Now I’d like to ask you some questions about some bugs that can affect people experiencing homelessness. Body lice and fleas are two of these bugs. Here are some pictures of body lice and their eggs, or ‘nits’, which are often found in the seams of clothing. We’re talking about body lice, which are often found in the seams of clothing, not head lice, which are often found in hair.”

PL1	Have any clients here ever had body lice? IF Yes, GO TO PL2 IF No, I don’t know, OR Prefer not to say, GO TO PL3	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
PL2	About what percentage of clients have had body lice in the last 12 months?	☐ ____% of clients ☐ Have not worked or volunteered here during past 12 months ☐ Prefer not to say
PL3	What happens at this shelter when a client is found to have body lice? ___________________________________________	☐ (Free response) ☐ I don’t know ☐ Prefer not to say
PL4	Do shelter workers check clients for body lice? IF Yes, GO TO PL5 IF No, I don’t know, OR Prefer not to say, GO TO PL6	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
PL5	How often do these checks occur?	☐ At admission ☐ At regular intervals ☐ Only when body lice are suspected ☐ I don’t know ☐ Other ________ ☐ Prefer not to say
PL6	If a person is found to have body lice, are they kept away from other people? IF Yes, GO TO PL7 IF No, I don’t know, OR Prefer not to say, GO TO PF1	☐ Yes, individually ☐ Yes, kept separate with other people who have lice infestation ☐ No ☐ I don’t know ☐ Other ________ ☐ Prefer not to say
PL7	For how long are people with body lice kept separate?	☐ _______ Days ☐ I don’t know ☐ Other ________ ☐ Prefer not to say

“Now I’d like to ask a few questions about fleas. Fleas are small bugs that can bite humans. Here are some pictures of fleas which can cause bites that look like this.”

Show laminated photos of fleas and flea bites.

PF1	Have any clients here ever had fleas or flea bites? IF Yes, GO TO PF2 IF No, I don’t know, OR Prefer not to say, GO TO PF3	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
PF2	About what percentage of clients have had fleas or flea bites in the last 12 months?	☐ ____% of clients ☐ Have not worked or volunteered here during past 12 months ☐ I don’t know ☐ Prefer not to say
PF3	What is done when a client is found to have flea bites? ___________________________________________	☐ (Free response) ☐ I don’t know ☐ Prefer not to say
PF4	Do shelter workers check clients for fleas or flea bites? IF Yes, GO TO PF5 IF No, I don’t know, OR Prefer not to say, GO TO PF6	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
PF5	How often do these checks occur?	☐ At admission ☐ At regular intervals ☐ Only when fleas or flea bites are suspected ☐ I don’t know ☐ Other ________ ☐ Prefer not to say
PF6	If animals such as pets, companion animals, or service animals, are allowed, are these animals screened for fleas and flea bites?	☐ Yes, at admission ☐ Yes, at regular intervals (specify) _________ ☐ No ☐ N/A (animals are not allowed) ☐ Prefer not to say

PF7	Are steps taken to treat fleas at this shelter?	☐ Yes, at admission for all people and animals ☐ Yes, at admission for any person or animals found to have fleas ☐ Yes, at regular intervals for all people or animals (specify) __________ ☐ Yes, at regular intervals for any person or animal found to have fleas (specify) __________ ☐ No ☐ I don’t know ☐ Prefer not to say
PF8	If a person is found to have fleas or flea bites, are they kept away from other people? IF Yes, GO TO PF9 IF No, I don’t know, OR Prefer not to say, GO TO PF10	☐ Yes, individually ☐ Yes, kept separate with other people who have flea infestation ☐ No ☐ I don’t know ☐ Other ________ ☐ Prefer not to say
PF9	For how long are people kept separate?	☐ _______ Days ☐ I don’t know ☐ Other ________ ☐ Prefer not to say
PF10	If an animal found to have fleas or flea bites, are they kept away from other people and animals? IF Yes, GO TO PF11 IF No OR Prefer not to say, GO TO PG1	☐ Yes, individually ☐ Yes, kept separate with other animals with flea infestations ☐ No ☐ I don’t know ☐ Prefer not to say
PF11	For how long are animals kept separate?	☐ _______ Days ☐ I don’t know ☐ Other ________ ☐ Prefer not to say

“Now I’d like to ask you some questions about diseases that can be spread by body lice.”

LBDA1

Which of the following diseases can be transmitted by body lice? Choose all that apply. It’s also OK to say that you don’t know. Please read participant all answer options. Check all that apply.

☐ Typhoid fever ☐ HIV ☐ Bartonella quintana, also known as Trench Fever ☐ Rickettsia typhi; also known as murine typhus ☐ Malaria ☐ Lyme disease ☐ Epidemic typhus ☐ Plague ☐ Tularemia ☐ Cat-scratch disease ☐ Hepatitis A ☐ Hepatitis B ☐ Hepatitis C ☐ Other _____________ ☐ No diseases are transmitted by body lice ☐ I don’t know ☐ Prefer not to say

“Now I’d like to ask you some questions about diseases that can be spread by fleas.”

FBDA1

Which of the following diseases can be transmitted by fleas? Choose all that apply. It’s also OK to say that you don’t know. Please read participant all answer options. Check all that apply.

☐ Typhoid fever ☐ HIV ☐ Bartonella quintana, also known as Trench Fever ☐ Rickettsia typhi; also known as murine typhus ☐ Malaria ☐ Lyme disease ☐ Epidemic typhus ☐ Plague ☐ Tularemia ☐ Cat-scratch disease ☐ Hepatitis A ☐ Hepatitis B ☐ Hepatitis C ☐ Other _____________ ☐ No diseases are transmitted by fleas ☐ I don’t know ☐ Prefer not to say

“I’m going to read a few sentences. Let me know how much you agree with each statement using a scale of 1 to 5, 1 being least and 5 being most.”

LBD1	Body lice are a problem for people experiencing homelessness.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree or Don’t Know) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
LBD2	I know about Bartonella quintana infection, sometimes called “trench fever”	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
LBD3	Bartonella quintana infection is a risk for people experiencing homelessness.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree or don’t know) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
LBD4	I know about epidemic typhus (Rickettsia prowazekii infection) infection.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
LBD5	Epidemic typhus (Rickettsia prowazekii infection) is a risk for people experiencing homelessness.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree or don’t know) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say

FBD1	Fleas are a problem for people experiencing homelessness.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree or don’t know) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
FBD2	I know about flea-borne typhus (Rickettsia typhi infection), sometimes called “murine typhus”	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say
FBD3	Flea-borne typhus is a risk for people experiencing homelessness.	☐ 5 (Strongly Agree) ☐ 4 (Agree) ☐ 3 (Neither Agree nor Disagree or Don’t Know) ☐ 2 (Disagree) ☐ 1 (Strongly Disagree) ☐ Prefer not to say

“Now I’d like to ask you some questions about how you would like to learn more about diseases that can affect people experiencing homelessness.”

PLM1

How do you prefer to learn new information? Choose all that apply. Read answer options.

☐ In-person trainings ☐ Online modules (self-guided; available at any time) ☐ Online seminars or workshops (at specific times/dates with live content) ☐ Printed material (e.g. posters, handouts, books, journal articles) ☐ Online material (e.g. websites, journal articles) ☐ Other: ____________ ☐ Prefer not to say

PLM2

Of these options, which is your favorite way to learn new information? Read answer options.

☐ In-person trainings ☐ Online modules (self-guided; available at any time) ☐ Online seminars or workshops (at specific times/dates with live content) ☐ Printed material (e.g. posters, handouts, books, journal articles) ☐ Online material (e.g. websites, journal articles) ☐ Other: ____________ ☐ Prefer not to say

“Now, I’d like to ask you some questions about yourself. Remember that you can skip any question that you would prefer not to answer.”

D1	How old are you?	☐ ______ years ☐ Prefer not to say
D2	Do you identify as male, female, transgender, non-binary, or something else?	☐ Male ☐ Female ☐ Transgender ☐ Non-binary ☐ Something else ☐ Prefer not to say
D3	How long have you worked or volunteered at this shelter?	☐ ______ years ☐ Prefer not to say
D4	On average, about how many hours did you work or volunteer each week at this shelter in the last month?	☐ ______ hours ☐ Prefer not to say
D5	Please describe your current job position and role. __________________________________________	☐ Write-in (question box) ☐ Prefer not to say
D6	How long have you worked with people experiencing homelessness?	☐ ______ years ☐ Prefer not to say
D7	During your career, at how many programs serving persons experiencing homelessness have you worked?	☐ ______ ☐ Prefer not to say
D8	In the past 12 months, have you been homeless at any time? By homeless, I mean you were living on the street, in a shelter, in a single occupancy hotel room, or in a car. IF Yes, GO TO D9 IF No, OR Prefer not to say, GO TO D10	☐ Yes ☐ No ☐ Prefer not to say
D9	Are you currently experiencing homelessness?	☐ Yes ☐ No ☐ Prefer not to say
D10	Have you ever been diagnosed with a Bartonella infection, sometimes called “cat-scratch disease” or “trench fever”? IF Yes, GO TO D11 IF No, I don’t know, OR Prefer not to say, GO TO D12	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
D11	Where do you believe that you got this infection? __________________________________________	☐ Write-in (question box) ☐ Prefer not to say
D12	Have you ever been diagnosed with a ricketssial infection, sometimes called “murine typhus” or “typhus”? IF Yes, GO TO D13 IF No, I don’t know, OR Prefer not to say, GO TO LB1	☐ Yes ☐ No ☐ I don’t know ☐ Prefer not to say
D13	Where do you believe that you got this infection? __________________________________________	☐ Write-in (question box) ☐ Prefer not to say

“Finally, I’d like to ask you about any barriers or challenges that your shelter faces regarding body lice and fleas.”

LB1. What are the barriers or challenges that your shelter faces? (Free response)

PROBE: How do you currently learn information about diseases that affect people experiencing homelessness (e.g., curriculum for new staff; training sessions)? How do clients currently learn information about diseases that might affect them (e.g., day programs, lectures, posters, etc.)?

“This is the end of the survey. Thank you for your time and participation. Results from this survey and new educational materials will be shared after completion of this project, within 12 months.”

Public reporting burden of this collection of information is estimated to average 45 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-XXXX