Form 0920-0314 INTERVIEW OBSERVATION FORM

NSFG OMB Attachment L OMB No. 0920-0314

Interview Observation Form

Interviewer Instructions:

Circle one response number only unless otherwise indicated

The following questions are about how you perceive the respondent and the housing unit. We are asking for your best, common-sense judgment. People could have different opinions about some of these things, but we would like to know your views, since you have spent some time with the respondent. Please do the best you can. Survey experience has shown that such observations are often useful, even if they are subjective.

Sample ID:

Iwer ID:

Date: (MM/DD/YY)

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/

Time: (HR:MIN)

:

AM

PM

1. Where was the interview conducted?

1. Inside R’s HU

2. Immediately outside R’s HU (e.g., porch) (skip to 2)

3. In Iwer’s car (skip to 2)

4. At R’s worksite (skip to 2)

5. In a restaurant/fast food place (skip to 2)

6. At a library (skip to 2)

7. In a HU of a neighbor, friend, or relative (skip to 2)

8. At another location (Specify ___________) (skip to 2)

1a. In which room(s) was the interview conducted? (Circle ALL that apply)

1. Living room/family room/den

2. Kitchen/dining room

3. Bedroom

4. Office

5. Foyer/hallway

6. Basement

7. Other (Specify _____________)

2. Mark the appropriate answer about whether other persons were within hearing range at any time during the interview:

1. No other person was present at any time

(skip to 5)

2. One or more persons were present in the interview location but were not within hearing range (skip to 5)

3. One or more persons were present within hearing range at some portions of the interview

4. One or more persons were present within hearing range during the entire interview

3. Relationship to the R of other people present or within hearing range during the interview (Circle ALL that apply)

1. Parent(s)

2. Spouse / significant other

3. Other adult(s)

4. Child(ren) 4-17 years old

5. Child(ren) under 4 years old

6. Other

4. In what ways did the other people’s presence influence the interview? (Circle ALL that apply)

1. Person(s) came into the room and you paused the interview until they left

(skip to 5)

2. Person(s) came into the room, you or R answered their question or explained that privacy was needed, and they left (skip to 5)

3. Person(s) stayed in the room but did not participate in interview

4. Person(s) stayed in the room and offered R help with answers

5. Person(s) stayed but was too young to understand the interview (skip to 5)

6. Other (Specify: ___________________)

4a. During which, if any, of the following sections or questions were the other person(s) within hearing range? (Circle ALL that apply)

1. Monthly contraceptive method history (Female interview only)

2. # of sexual partners

3. Detailed questions about previous partners

4. None of these sections

5. During the interview, was the atmosphere at the interview site:

1. Extremely chaotic and noisy; disruptive to interview

2. Some noise or interruptions but interview went reasonably smoothly

3. Very quiet and calm, ideal for interview

6. What types of distractions or interruptions were present during the interview? (Circle ALL that apply)

1. Television on during interview but R not watching

2. Television on during interview with R watching at least some of the time

3. R received 1 or 2 phone calls

4. R received 3 or more phone calls

5. Children present needed attention

6. Other (Specify: ___________________)

7. No distractions or interruptions present

7. In what language did you administer the CAPI (interviewer- administered) part of the interview?

1. English

2. Mix of English and Spanish

3. Spanish

8. In general, how did the R act toward you during the interview?

1. Hostile

2. Neither hostile nor friendly

3. Friendly

9. How attentive was the R to the questions during the interview?

1. Not at all attentive

2. Somewhat attentive

3. Very attentive

10. Was the R upset during the interview?

1. Yes, upset because of interview content

2. Yes, upset but NOT related to interview content

5. No, not upset (skip to 12)

11. Was the R still upset at the end of the interview?

1. Yes

5. No

12. At the end of the interview, did the R seem to be tired?

1. Yes, tired because of interview

2. Yes, tired but NOT because of interview

5. No, not tired

13. To what extent did the R use the Life History Calendar (LHC) during the interview?

1. Male R, no LHC in interview (skip to 18)

2. Used LHC as instructed throughout

3. Began using LHC but stopped because it wasn’t needed

4. Began using the LHC but stopped because of frustration

5. Did not use LHC at the beginning but began using it later in the interview

6. Did not use LHC at all (skip to 17)

14. In your opinion, which category best describes R’s experience with the LHC?

1. Calendar was easy to use

2. Calendar was somewhat difficult to use

3. Calendar was extremely difficult to use

15. In your opinion, which category best describes the usefulness of the LHC?

1. Calendar was essential

2. Calendar was helpful, but not essential

3. Calendar was neither helpful nor unhelpful

4. Calendar was not helpful

16. 

    (skip to 18)

    Did the LHC prompt the R to change responses?

1. Yes

2. No

17. In your opinion, what are some reasons the R did not use the LHC? Select all that apply.

1. R was confused how to use it

2. R used own calendar or app

3. R did not need it (few events to report)

4. R refused to use the calendar

5. Other (Specify) __________

18. Overall, what is your opinion of the quality of the information provided by this R? Was it of:

1. Excellent quality (skip to 20)

2. Good quality (skip to 20)

3. Fair quality

4. Poor quality

19. The interview was of fair or poor quality because the R was: (Circle ALL that apply)

1. Bored, disinterested

2. Embarrassed

3. Hostile or suspicious

4. Not serious

5. Not truthful

6. Distracted / could not concentrate

7. Not able to remember dates

8. R did not understand questions due to low literacy, language problems, etc.

9. Other (Specify: ___________________)

20. For most of the CAPI part of the interview, how would you describe your seating arrangement with the R?

1. Next to R (facing the same way)

2. Next to R (facing at a right angle)

3. Across from R

4. Some other arrangement

21. Was the R able to see the computer screen during the CAPI part of the interview?

1. R could see the screen during all of CAPI

2. R could see the screen on most, but not all CAPI questions

3. R could see the screen on a few CAPI questions

4. R could never see the screen during CAPI

22. What support did you have for the laptop during the CAPI part of the interview:

1. Table

2. Lap

3. Other (Specify: ______________)

23. Did you or the R encounter any difficulty during the interview because of the CAPI application? (Circle ALL that apply)

1. Hardware problem

2. Confusion about question referent: biological vs. adoptive parent

3. Confusion about question referent: first sex partner vs. first consensual sex partner

4. R got questions that s/he should not have gotten and you couldn’t skip past them

5. Other (Specify:___________________)

6. No difficulties encountered

The next set of questions asks about the CASI (self-administered) part of the interview. Please base your answers on the real CASI questions, not the practice questions.

24. Please choose the answer that best describes your seating arrangement during the CASI (self-administered) part of the interview.

1. Next to R (facing the same way)

2. Next to R (facing at a right angle)

3. Seated across from R

4. Some other arrangement

25. Were you able to see the computer screen during the CASI part of the interview?

1. I could see the screen during all of CASI

2. I could see the screen on most, but not all CASI questions

3. I could see the screen on a few CASI questions

4. I could never see the screen during CASI

26. How would you describe your mood at the beginning of this interview?

1. Happy

2. Neutral

3. Sad/Unhappy

27. Why do you think the R completed the interview? ____________________________________________________________________________________________________________________________________________________________