PRAMS Field Testing Questionnaire (English and Spanish)

Attachment 15b – PRAMS Field Testing Questionnaire English and Spanish

Form Approved

OMB No. 0920-1273

Exp. Date xx/xx/xxxx

PRAMS Field Testing Questionnaire

Screener Questions (English and Spanish):

Mothers are approached at health department clinics or pediatric offices and ask if they would like to participate on a project. If they agree, the recruiter will ask the following questions to determine their eligibility to participate. Mothers are eligible if they answer yes to both questions.

1. Are you 18 years of age or older?

2. Is your infant 12 months old or younger?

1. ¿Tienes 18 años o más?

2. ¿Su bebé tiene 12 meses o menos?

Demographic questions (English and Spanish)

Mothers will be asked to respond to these questions along with the PRAMS survey questions undergoing field testing. 

1. How old are you?

_______ Age (in years)

2. What is the highest level of education or grade you have completed?

• Less than high school

• High school diploma or GED

• Some college

• College degree or higher

3. Are you Hispanic or Latino?

• Yes

• No

4. What is your race?

• American Indian or Alaska Native

• Asian or Pacific Islander

• Black or African American

• White

• Other

1. ¿Qué edad tiene?

_____Años

2. ¿Cuál es el nivel de educación o grado escolar más alto que ha completado?

• Menos de escuela secundaria

• Diploma de secundaria o GED

• Algo de universidad pero sin titulo

• Título universitario o superior

3. ¿Es usted latino o hispano?

• Sí

• No

4. ¿Cuál es su raza?

• Indoamericana o Nativa de Alaska

• Asiática o raza nativa de las islas del Pacífico

• Negra o Afroamericana

• Blanca

• Otra

Field Testing Interview Questionnaire

After the respondent has completed the survey, debrief with her about what she thought of the survey questions. The purpose is for us to know how she interacted with the survey. In the debrief, be sure to cover the following topics:

English

1. Were the questions hard or easy to understand? What made the question(s) hard to understand – was it the skips, reading level was too high, language problems, etc?

2. Did you have any trouble choosing between the answer choices? Have her explain or give examples.

3. Were the instructions clear? If not, have her show you an example of poorly worded instructions. How would she word it differently?

4. Do you have any other comments or suggestions for improving the survey?

Spanish/Español

1. ¿Fueron las preguntas difíciles o fáciles de entender? ¿Qué hizo que la (s) pregunta (s) sea difícil de entender? ¿Fue el salto, el nivel de lectura fue demasiado alto, problemas de lenguaje, etc.?

2. ¿Tuviste algún problema para elegir entre las opciones de respuesta? Haga que explique o dé ejemplos.

3. ¿Fueron claras las instrucciones? Si no, pídale que le muestre un ejemplo de instrucciones mal redactadas. ¿Cómo lo expresaría de manera diferente?

4. ¿Tiene algún otro comentario o sugerencia para mejorar la encuesta?