09520-0950 Dietary Interview Front End Instrument

[NCHS] National Health and Nutrition Examination Survey (NHANES)

Attachment_6i_Dietary Front End Instrument_2024JULY16

Day 1 and Day 2 Telephone Dietary Recall & Follow-up

OMB: 0920-0950

Document [docx]
Download: docx | pdf




Attachment 6i


Dietary Interview Front End Instrument

Attachment 6i: Dietary Interview Front End Instrument

Form Approved

OMB No. 0920-0950

Exp. Date XX/XX/20XX

Notice – CDC estimates the average public reporting burden for this collection of information as 3 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road, MS H21-8, Atlanta, GA 30333; ATTN: PRA (0920-0950).

Assurance of Confidentiality – We take your privacy very seriously.  All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes.  NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583).  In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note) which protects Federal information systems from cybersecurity risks by screening their networks.



LEAD_IN

ASK

All respondents

Display:

  • Case Level Status

  • Line Level Status

  • Case-Level Comments

  • Date of last Call

  • Last Appointment

  • [FILL NAME OF PERSON TO CALL]

  • [FILL SP Name of Child] (for reference)

  • [FILL SP Name Adult 18+ who has a proxy] (for reference)

  • SP Age

  • Needs FCBS? [YES/NO]

  • Needs MEC Scheduled? [YES/NO]

SPANISH

N/A

QUESTION TYPE

Text display

FILLS

FILL NAME OF PERSON TO CALL:

  • FILL SP NAME IF (SP AGE 18+ YEARS AND NO PROXY)

  • FILL PROXY NAME IF (SP AGE IS <18 YEARS) OR (SP AGE IS 18+ AND YES PROXY)


NOTES


HELP SCREEN


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

TW





TW

ASK

All Respondents

WHAT DO YOU WANT TO DO?


  1. CONTINUE WITH THIS CASE

  2. REVIEW RECORD OF EVENTS

  3. REVIEW ROSTER OF NUMBERS AND NAMES

  4. REVIEW/ENTER CASE LEVEL COMMENTS

  1. SAVE THE CURRENT CASE; GET ANOTHER CASE OR EXIT CATI-CMS

  2. SCHEDULE A CALLBACK

  3. CHOOSE A NEW NUMBER TO CALL

  1. CALL-IN CASE

  1. SPECIAL OPTIONS

SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF TW=1: AUTO_DIAL FOLLOWED BY DIAL1

IF TW=2: RECORD OF EVENTS

IF TW=3 OR 8: ROSTER LINES

IF TW=4: CASE COMMENTS

IF TW=6: SAVE AND EXIT CASE

IF TW=7: LAUNCH WEB SCHEDULER

IF TW=13: CALL_IN

IF TW=90: SPECIAL OPTIONS















DIAL1

ASK

TW=1

PHONE NUMBER TO CALL: [FILL PHONE NUMBER]


DID A PERSON ANSWER THE PHONE (NOT OPERATOR)?


  1. YES

  2. NO

  1. CALL-IN CASE

SPANISH

N/A

QUESTION TYPE

Radio button

FILLS

FILL PHONE NUMBER FROM [TBD]

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL1=1: INTRO1C

IF DIAL1=2: DIAL2

IF DIAL1=9: CALL_IN






















DIAL2

ASK

IF DIAL1=2

WHAT IS THE RESULT OF THIS CALL?


1264. VOICEMAIL

1266. HANG UP / DID NOT SPEAK TO ANYONE

1201. RING NO ANSWER

1202. BUSY SIGNAL / ALL CIRCUITS BUSY

1273. DISCONNECTED NUMBER / CALL CANNOT BE COMPLETED AS DIALED

1274. TEMPORARILY DISCONNECTED / LINE TROUBLE

1271. RECORDING CHANGED NUMBER

1272. WRONG NUMBER

1275. BLOCKED LINE / # DOES NOT ACCEPT INCOMING CALLS

1281. MODEM / FAX MACHINE

1282. BEEPER / PAGER

1287. PRIVACY MANAGER

1543. TDD (DEVICE FOR THE DEAF) REQUIRED.


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2=1264: DIAL2C

IF DIAL2 = (1201, 1202, 1266, 1272, 1281, 1282, 1543), GO TO END

IF DIAL2 = (1273, 1274, 1271, 1275), GO TO DIAL2A

IF DIAL2 =1287, GO TO DIAL2E



DIAL2C

ASK

IF DIAL2 = 1264 OR DIAL2A = 1264 OR DIAL2E = 1264

THE RECORDING:


  1. MENTIONED THE SUBJECT’S NAME

  2. VERIFIED ONLY THE PHONE NUMBER

  3. DID NOT PROVIDE ANY INFO

  4. BUSINESS VOICEMAIL (NOT A BUSINESS FROM HOME)

  5. RECORDING IN A FOREIGN LANGUAGE

  6. COULD NOT LEAVE A MESSAGE / VOICEMAIL FULL / NOT SET UP

  1. TDD (TELEPHONE DEVICE FOR THE DEAF) OR TTY (SOUNDS LIKE LITTLE BELLS)


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2C = (1, 2, 3): GO TO DIAL2D

IF DIAL2C = (4,6,9): GO TO END

IF DIAL2C = 5: GO TO LANG



DIAL2E

ASK

IF DIAL2 = 1287 OR DIAL2A = 1287

PRIVACY MANAGER SCREEN:


If asked to state name: Centers for Disease Control and Prevention (CDC) national health study

If asked to state ph#: 800-344-1386


  1. SOMEONE PICKS UP

  1. RING NO ANSWER

  2. BUSY SIGNAL / ALL CIRCUITS BUSY

  1. BLOCKED LINE / # DOES NOT ACCEPT INCOMING CALLS

  1. VOICEMAIL

SPANISH

PRIVACY MANAGER SCREEN:


If asked to state name: Estudio nacional de salud de los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés)

If asked to state ph#: 800-344-1386


  1. SOMEONE PICKS UP

  1. RING NO ANSWER

  2. BUSY SIGNAL / ALL CIRCUITS BUSY

  1. BLOCKED LINE / # DOES NOT ACCEPT INCOMING CALLS

1264. VOICEMAIL

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2E = 1: INTRO1C

IF DIAL2E = 1264: DIAL2D

ELSE: END OF MODULE





DIAL2A

ASK

IF DIAL2 = (1273, 1274, 1271, 1275)

PLEASE MANUALLY REDIAL THE NUMBER.


WHAT IS THE RESULT OF THE CALL?


  1. A PERSON ANSWERED THE PHONE (NOT OPERATOR)

  1. VOICEMAIL

  1. DISCONNECTED NUMBER / CALL CANNOT BE COMPLETED AS DIALED

  1. PHONE COMPANY RECORDING GIVES A NEW NUMBER

  1. BEEPER / PAGER

  1. TEMPORARILY DISCONNECTED / LINE TROUBLE

  1. PRIVACY MANAGER

  1. BLOCKED LINE / # DOES NOT ACCEPT INCOMING CALLS

  1. COMPUTER MODEM / FAX MACHINE

  1. TDD (DEVICE FOR THE DEAF) OR TTY (SOUNDS LIKE LITTLE BELLS)

SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2A = 1, GO TO INTRO1C

IF DIAL2A = 1264, GO TO DIAL2C

IF DIAL2A = 1273, GO TO DIAL2B

IF DIAL2A = 1287, GO TO DIAL2E

IF DIAL2A = 1271, GO TO END AND ADD A NEW NUMBER ON THE ROSTER LINE SCREEN

ELSE, GO TO END



DIAL2B

ASK

IF DIAL2A = 1273

DID THE PHONE COMPANY RECORDING SAY


  1. TEMPORARILY DISCONNECTED

  2. DISCONNECTED

  3. CANNOT BE COMPLETED AS DIALED

  4. NUMBER HAS BEEN CHANGED TO A NON-PUBLISHED NUMBER

  5. NUMBER HAS BEEN CHANGED AND GIVES A NEW NUMBER, WILL NEED TO ADD A NEW PHONE NUMBER

  6. NUMBER DOES NOT ACCEPT INCOMING CALLS


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2B = 5, GO TO END AND ADD NEW NUMBER ON THE ROSTER LINE SCREEN

ELSE, GO TO END



INTRO1C

ASK

IF DIAL2E = 1 OR DIAL2A = 1 OR DIAL2D = 2 OR DIAL1 = 1

[TALKING TO A LIVE PERSON, OUTGOINGCALL]



Hello, my name is [Interviewer Name]. I’m calling from RTI International about a national health study sponsored by the Centers for Disease Control and Prevention (CDC). For training and quality assurance purposes, this call may be monitored or recorded. May I please speak to <TEXT FILL 1>


  1. SPEAKING TO TARGET RESPONDENT

  2. TRANSFERRED TO NAMED PERSON / NAMED PERSON COMING TO PHONE (WAIT FOR R TO COME TO PHONE BEFORE CONTINUING)

  3. TRANSFERRED TO PERSON-SPECIFIC VOICEMAIL

  4. TRANSFERRED TO GENERIC VOICEMAIL

  5. NAMED PERSON NOT AVAILABLE / GATEKEEPER CAN TAKE MESSAGE

  6. NAMED PERSON NOT AVAILABLE / NO ONE TO TAKE MESSAGE

  7. NAMED PERSON UNKNOWN TO GATEKEEPER

  8. MORE CODES


INTERVIEWER: SELECTING “MORE CODES” WILL PROVIDE MORE OPTIONS TO RECORD DETAILED BUT LESS COMMON OUTCOMES SUCH AS MOVED, PASSED AWAY



SPANISH

[TALKING TO A LIVE PERSON, OUTGOINGCALL]



Buenos días/Buenas tardes, mi nombre es [Interviewer Name]. Le hablo de RTI International acerca de un estudio nacional de salud patrocinado por los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés). Esta llamada podría ser supervisada o grabada con fines de capacitación y control de calidad. ¿Puedo hablar con <TEXT FILL 1>?


  1. SPEAKING TO TARGET RESPONDENT

  2. TRANSFERRED TO NAMED PERSON / NAMED PERSON COMING TO PHONE (WAIT FOR R TO COME TO PHONE BEFORE CONTINUING)

  3. TRANSFERRED TO PERSON-SPECIFIC VOICEMAIL

  4. TRANSFERRED TO GENERIC VOICEMAIL

  5. NAMED PERSON NOT AVAILABLE / GATEKEEPER CAN TAKE MESSAGE

  6. NAMED PERSON NOT AVAILABLE / NO ONE TO TAKE MESSAGE

  7. NAMED PERSON UNKNOWN TO GATEKEEPER

  8. MORE CODES


INTERVIEWER: SELECTING “MORE CODES” WILL PROVIDE MORE OPTIONS TO RECORD DETAILED BUT LESS COMMON OUTCOMES SUCH AS MOVED, PASSED AWAY



QUESTION TYPE

Radio button

FILLS

TEXT FILL 1: FILL “[SP’s NAME]” IF (SP AGE 18+ AND NO PROXY)

ELSE, FILL “[PROXY’S NAME]”

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF INTRO1C = (1, 2), GO TO PDR1

IF INTRO1C = (3, 4): DIAL2D

IF INTRO1C = 5: PROMPT_HHM_MESSAGE

IF INTRO1C = 6: INTRO2A

IF INTRO1C = 7: RUNKNOWN

IF INTRO1C = 8: OTHER_CODES


PDR1

ASK

(IF INTRO1C = 1 OR 2) OR (CALL_IN = 1 OR 2)

<TEXT FILL 1>


I am calling to complete <TEXT FILL 2> first of two dietary surveys. During this survey, we will ask about the foods and beverages <TEXT FILL 3> ate and drank in the last 24 hours, as well as the use of supplements and antacids in the last 30 days. This interview will take about 25 to 45 minutes. As a reminder, <TEXT FILL 3> will receive an additional $30 on <TEXT FILL 4> gift card upon completion.


Is now a good time for me to speak with <TEXT FILL 5>?


  1. YES

  2. NO, SET CALLBACK

  1. REFUSED

  1. MORE CODES

SPANISH

<TEXT FILL 1>


Estoy llamando para completar la primera de dos encuestas sobre alimentación para <TEXT FILL 2>. Durante esta encuesta, preguntaremos sobre los alimentos y bebidas que <TEXT FILL 3> ha comido y bebido en las últimas 24 horas, así como el uso de suplementos y antiácidos en los últimos 30 días. Esta entrevista tomará entre 25 y 45 minutos. Para recordarle, <TEXT FILL 3> recibirá $30 dólares adicionales en su tarjeta de regalo al finalizar.


¿Ahora es un buen momento para hablar con <TEXT FILL 5>?


  1. YES

  2. NO, SET CALLBACK

  1. REFUSED

  1. MORE CODES

QUESTION TYPE

Radio button

FILLS (ENG)

TEXT FILL 1: FILL “Hello, my name is [INTERVIEWER NAME]. I’m calling from RTI International about a national health study sponsored by the Centers for Disease Control and Prevention (CDC).” IF INTRO1C=2

ELSE, FILL IS EMPTY


TEXT FILL 2: FILL “your” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[SP NAME]’s” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

TEXT FILL 3: FILL “you” IF SP AGE 18+ AND NO PROXY

FILL “[SP’s NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 4: FILL “your” IF SP AGE 18+ AND NO PROXY

FILL “their” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 5: FILL “you” IF SP AGE 18+ AND NO PROXY

FILL “you and [SP’s NAME]” IF SP IS 6-11 YEARS OLD

FILL “[SP NAME]” IF SP IS 12-17 YEARS OLD

FILLS (SPA)

TEXT FILL 1: FILL “Buenos días/Buenas tardes, mi nombre es [INTERVIEWER NAME]. Le hablo de RTI International acerca de un estudio nacional de salud patrocinado por los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés).” IF INTRO1C=2

ELSE, FILL IS EMPTY


TEXT FILL 2: FILL “usted” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[SP NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

TEXT FILL 3: FILL “usted” IF SP AGE 18+ AND NO PROXY

FILL “[SP’s NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 4: FILL “BLANK” IF SP AGE 18+ AND NO PROXY

FILL “BLANK” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 5: FILL “usted” IF SP AGE 18+ AND NO PROXY

FILL “you and [SP’s NAME]” IF SP IS 6-11 YEARS OLD

FILL “[SP NAME]” IF SP IS 12-17 YEARS OLD

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF PDR1=1: CELL_RESP

IF PDR1=2: INTRO2A

IF PDR1=6: REFCONVERT

IF PDR1=9: OTHER_CODES



INTRO2A

ASK

IF INTRO1C = 6 OR RUNKNOWN = 1 OR CELL_RESP = 1 OR IF PDR1=2 OR CALL_IN = 6 OR REFCONVERT = 2

When would be a good day and time to call back to speak with <TEXT FILL 1>?


INTERVIEWER: IF ANOTHER TIME IS NOT PROVIDED, THE SYSTEM WILL SCHEDULE A RANDOM CALLBACK AS APPROPRIATE.


INTERVIEWER: SELECT CONTINUE TO SCHEDULE A NEW APPOINTMENT IN WEB SCHEDULER

SPANISH

¿Qué día y hora serían convenientes para volver a llamar y hablar con <TEXT FILL 1>?


INTERVIEWER: IF ANOTHER TIME IS NOT PROVIDED, THE SYSTEM WILL SCHEDULE A RANDOM CALLBACK AS APPROPRIATE.


INTERVIEWER: SELECT CONTINUE TO SCHEDULE A NEW APPOINTMENT IN WEB SCHEDULER

QUESTION TYPE

Radio button

FILLS (ENG)

TEXT FILL 1: FILL “you” IF SP AGE 18+ AND NO PROXY

FILL “you and [SP’s NAME]” IF SP IS 6-11 YEARS OLD

FILL “[SP NAME]” IF SP IS 12-17 YEARS OLD

FILLS (SPA)

TEXT FILL 1: FILL “usted” IF SP AGE 18+ AND NO PROXY

FILL “usted y [SP’s NAME]” IF SP IS 6-11 YEARS OLD

FILL “[SP NAME]” IF SP IS 12-17 YEARS OLD

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

LAUNCH WEB SCHEDULER





















CELL_RESP

ASK

IF PDR1=1

Are you driving a vehicle at the moment?


IF YES, ASK FOR A BETTER TIME TO CALL AND SET A CALLBACK IN WEB SCHEDULER.


IF YES AND RESPONDENT INDICATES S/HE IS WILLING TO TALK NOW, SAY, “I’m sorry but for your safety I’m not able to conduct the survey while you’re driving. When would be a better time to call you?”


  1. YES, SCHEDULE A CALLBACK IN WEB SCHEDULER

  2. NO, CONTINUE WITH THE INTERVIEW

SPANISH

¿Está conduciendo un vehículo en este momento?


IF YES, ASK FOR A BETTER TIME TO CALL AND SET A CALLBACK IN WEB SCHEDULER.


IF YES AND RESPONDENT INDICATES S/HE IS WILLING TO TALK NOW, SAY, “Lo siento, pero por su seguridad no puedo realizar la encuesta mientras conduce. ¿Cuándo sería un mejor momento para llamarlo(a)?”


  1. YES, SCHEDULE A CALLBACK IN WEB SCHEDULER

  2. NO, CONTINUE WITH THE INTERVIEW

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF CELL_RESP=1: INTRO2A

ELSE: LAUNCH SURVEY












CALL_IN

ASK

IF TW=13 OR DIAL1=9

(Thank you for returning our call.) As we mentioned in the message we left, we are calling from RTI International about a national health study sponsored by the Centers for Disease Control and Prevention (CDC).


Before we continue, can I confirm that I am speaking with <TEXT FILL 1> ?


  1. SPEAKING TO TARGET RESPONDENT

  2. TRANSFERRED TO NAMED PERSON / NAMED PERSON COMING TO PHONE (WAIT FOR R TO COME TO PHONE BEFORE CONTINUING)

  3. TRANSFERRED TO PERSON-SPECIFIC VOICEMAIL

  4. TRANSFERRED TO GENERIC VOICEMAIL

  5. NAMED PERSON NOT AVAILABLE / GATEKEEPER CAN TAKE MESSAGE

  6. NAMED PERSON NOT AVAILABLE / NO ONE TO TAKE MESSAGE

  7. NAMED PERSON UNKNOWN TO GATEKEEPER

  8. MORE CODES


INTERVIEWER: SELECTING “MORE CODES” WILL PROVIDE MORE OPTIONS TO RECORD DETAILED BUT LESS COMMON OUTCOMES SUCH AS MOVED, PASSED AWAY

SPANISH

(Gracias por devolvernos la llamada). Como le mencionamos en el mensaje que le dejamos, lo(a) estamos llamando de RTI International acerca de un estudio nacional de salud patrocinado por los Centros para el Control y la Prevención de Enfermedades (CDC).


Antes de continuar, ¿puedo confirmar que estoy hablando con <TEXT FILL 1> ?


  1. SPEAKING TO TARGET RESPONDENT

  2. TRANSFERRED TO NAMED PERSON / NAMED PERSON COMING TO PHONE (WAIT FOR R TO COME TO PHONE BEFORE CONTINUING)

  3. TRANSFERRED TO PERSON-SPECIFIC VOICEMAIL

  4. TRANSFERRED TO GENERIC VOICEMAIL

  5. NAMED PERSON NOT AVAILABLE / GATEKEEPER CAN TAKE MESSAGE

  6. NAMED PERSON NOT AVAILABLE / NO ONE TO TAKE MESSAGE

  7. NAMED PERSON UNKNOWN TO GATEKEEPER

  8. MORE CODES


INTERVIEWER: SELECTING “MORE CODES” WILL PROVIDE MORE OPTIONS TO RECORD DETAILED BUT LESS COMMON OUTCOMES SUCH AS MOVED, PASSED AWAY

QUESTION TYPE

Radio button

FILLS

TEXT FILL 1: FILL “[SP’s NAME]” IF (SP AGE 18+ AND NO PROXY)

ELSE, FILL “[PROXY’S NAME]”

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF CALL_IN = (1, 2), GO TO PDR1

IF CALL_IN = (3, 4): DIAL2D

IF CALL_IN = 5: PROMPT_HHM_MESSAGE

IF CALL_IN = 6: INTRO2A

IF CALL_IN = 7: RUNKNOWN

IF CALL_IN = 8: OTHER_CODES





DIAL2D

ASK

IF DIAL2C = (1, 2, 3) OR INTRO1C = (3, 4) OR DIAL2E = 1264 OR CALL_IN = (3, 4)

[THIS IS THE VOICEMAIL MESSAGE SCRIPT]


Hello, my name is [INTERVIEWER NAME]. I’m calling on behalf of a study sponsored by the Centers for Disease Control and Prevention (CDC). We are calling to complete <TEXT FILL 1> scheduled dietary survey appointment. As a reminder, <TEXT FILL 2> will receive an additional $30 if you complete this survey. Please call us back at 844-340-9367. Again, that number is 844-340-9367. Any member of our team can assist you. Thank you and have a great day.



  1. LEFT VOICEMAIL MESSAGE

  2. PERSON PICKED-UP DURING MESSAGE

  1. UNABLE TO LEAVE MESSAGE

SPANISH

[THIS IS THE VOICEMAIL MESSAGE SCRIPT]


Buenos días/Buenas tardes, mi nombre es [INTERVIEWER NAME]. Estoy llamando sobre un estudio patrocinado por los Centros para el Control y la Prevención de Enfermedades (CDC). Estamos llamándole para completar <TEXT FILL 1> para la encuesta sobre alimentación. Para recordarle, <TEXT FILL 2> recibirá(n) $30 dólares adicionales si completa esta encuesta. Puede llamarnos al 844-340-9367. Nuevamente, el número es 844-340-9367. Cualquier miembro de nuestro equipo puede ayudarle. Gracias y que tenga un buen día.


  1. LEFT VOICEMAIL MESSAGE

  2. PERSON PICKED-UP DURING MESSAGE

  1. UNABLE TO LEAVE MESSAGE

QUESTION TYPE

Radio button

FILLS (ENG)

TEXT FILL 1: FILL “your” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[SP NAME]’s” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 2: “you” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “they” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

FILLS (SPA)

TEXT FILL 1: FILL “su cita programada” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “la cita programada de [SP NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)


TEXT FILL 2: “usted” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “ellos” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF DIAL2D=2: INTRO1C

ELSE: END




PROMPT_HHM_MESSAGE

ASK

IF CALL_IN=5 OR INTRO1C=5

Could you please let <TEXT FILL 1> know that I called about a national health study sponsored by the Centers for Disease Control and Prevention (CDC). We are calling to complete their scheduled survey appointment for the national health survey. Please have <TEXT FILL 1> call us at 844-340-9367. Again, that number is 844-340-9367. Any member of our team can assist them.


  1. CONTINUE


SPANISH

¿Podría, avisarle a <TEXT FILL 1> que lo(a) llamé acerca de un estudio de salud nacional patrocinado por los Centros para el Control y la Prevención de Enfermedades (CDC)? Lo(a) estamos llamando para completar su cita programada para la encuesta nacional de salud. Pídale a <TEXT FILL 1> que nos llame al 844-340-9367. Nuevamente, el número es 844-340-9367. Cualquier miembro de nuestro equipo puede ayudarle.


  1. CONTINUE


QUESTION TYPE

Radio button

FILLS

TEXT FILL 1: FILL “[SP’s NAME]” IF (SP AGE 18+ AND NO PROXY)

ELSE, FILL “[PROXY’S NAME]”

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

END


REFCONVERT

ASK

IF PDR1=6

Are there any questions or concerns that I can help you with?


(IF RESPONDENT NEEDS REMINDER ABOUT STUDY IMPORTANCE: Your participation is very important to understanding whether what people eat and drink in America meets nutritional needs. The data also helps policymakers create dietary recommendations to promote health and prevent disease.)


[INTERVIEWER:

  • ADDRESS ANY CONCERNS OR QUESTIONS TO THE BEST OF YOUR ABILITY.

  • OFFER TO RESCHEDULE APPOINTMENT IF THEY WANT TO CANCEL.]


  1. WILL DO INTERVIEW NOW

  2. SCHEDULE CALL BACK

  1. REFUSED

  1. MORE CODES


SPANISH

¿Hay alguna pregunta o inquietud con la que pueda ayudarlo(a)?


(IF RESPONDENT NEEDS REMINDER ABOUT STUDY IMPORTANCE: Su participación es muy importante para comprender si lo que las personas comen y beben en los Estados Unidos satisface las necesidades nutricionales. Los datos también ayudan a los legisladores a crear recomendaciones nutricionales para promover la salud y prevenir enfermedades.)


[INTERVIEWER:

  • ADDRESS ANY CONCERNS OR QUESTIONS TO THE BEST OF YOUR ABILITY.

  • OFFER TO RESCHEDULE APPOINTMENT IF THEY WANT TO CANCEL.]


1.WILL DO INTERVIEW NOW

2.SCHEDULE CALL BACK

4.REFUSED

9.MORE CODES


QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF REFCONVERT = 1: LAUNCH SURVEY

IF REFCONVERT = 2: INTRO2A

IF REFCONVERT = 4: WHO_REF

IF REFCONVERT = 9: OTHER_CODES



WHO_REF

ASK

IF OTHER_CODES = (7, 8) OR BACK_FROM_BLAISE = 3 OR REFCONVERT =4

(Thank you very much for your time.)


INTERVIEWER: WAS THE REFUSAL BY THE SP OR SP’S PROXY?


  1. YES, SP OR SP’S PROXY REFUSED. VERIFIED NAME.

  2. NO / DON’T KNOW

SPANISH

(¡Muchas gracias por su tiempo!)


INTERVIEWER: WAS THE REFUSAL BY THE SP OR SP’S PROXY?


  1. YES, SP OR SP’S PROXY REFUSED. VERIFIED NAME.

  2. NO / DON’T KNOW


QUESTION TYPE

Radio button

FILLS

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

PREREF



PREREF

ASK

IF OTHER_CODES = (7, 8) OR BACK_FROM_BLAISE = 3 OR REFCONVERT =4

INTERVIEWER, DETERMINE THE STRENGTH OF REFUSAL:


  1. REFUSAL

  2. HOSTILE REFUSAL


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

REF1




REF1

ASK

IF OTHER_CODES = (7, 8) OR BACK_FROM_BLAISE = 3 OR REFCONVERT =4

INTERVIEWER: DESCRIBE WHAT HAPPENED DURING REFUSAL (CHECK ALL THAT APPLY):


  1. NO REASON GIVEN

  2. NO INTEREST

  3. TOO BUSY / NO TIME

  4. SURVEY TOO LONG

  5. DOES NOT PARTICIPATE IN TELEPHONE SURVEYS

  6. GOVERNMENT CONCERNS / MISTRUST OF GOVERNMENT

  7. CDC CONCERNS / MISTRUST OF CDC

  8. PRIVACY / CONFIDENTIALITY CONCERNS

  9. QUESTIONS / SUSPICIONS ABOUT LEGITMACY

  10. ALREADY PARTICIPATED ENOUGH

  11. NO PHONE AND WON’T CALL IN

  12. OTHER SPECIFY


SPANISH

N/A

QUESTION TYPE

Multi-select

FILLS

NOTES

IF RESPONSE OPTION 12 (OTHER SPECIFY) IS SELECTED, DISPLAY TEXT BOX TO CAPTURE OTHER REASON. ALLOW 100 CHARACTERS.

HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF REF1=MORE THAN ONE REASON: REF2

ELSE: END


REF2

ASK

IF REF1=MORE THAN ONE REASON

SELECT THE MAIN REASON FOR REFUSAL


  1. NO REASON GIVEN

  2. NO INTEREST

  3. TOO BUSY / NO TIME

  4. SURVEY TOO LONG

  5. DOES NOT PARTICIPATE IN TELEPHONE SURVEYS

  6. GOVERNMENT CONCERNS / MISTRUST OF GOVERNMENT

  7. CDC CONCERNS / MISTRUST OF CDC

  8. PRIVACY / CONFIDENTIALITY CONCERNS

  9. QUESTIONS / SUSPICIONS ABOUT LEGITMACY

  10. ALREADY PARTICIPATED ENOUGH

  11. NO PHONE AND WON’T CALL IN

  12. OTHER SPECIFY


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS

NOTES

ONLY DISPLAY IF MORE THAN ONE REASON GIVEN IN REF1


LIST POPULATES THE REASONS SELECTED FROM REF1


IF OTHER SPECIFY SELECTED PREVIOUSLY, INCLUDE IN RESPONSE LIST BUT DO NOT INCLUDE TEXT BOX

HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

END



OTHER_CODES

ASK

IF INTRO1C = 8 OR PDR1=9 OR CALL_IN = 8 OR REFCONVERT = 9 OR OTHER_CODES SELECTED FROM HELP

SUBJECT’S NAME: <TEXT FILL 1>


  1. PHONE NUMBER NOT ASSOCIATED WITH SUBJECT

  2. OUT OF THE COUNTRY

  1. INCARCERATED OR INSTITUTIONALIZED

  2. OTHERWISE UNAVAILABLE

  3. DECEASED

  4. LANGUAGE BARRIER

  5. REFUSED

  6. HUNG UP

  7. DISCONNECTED

  8. OTHER, SUPERVISOR REVIEW

  9. HEARING IMPAIRED

SPANISH

N/A

QUESTION TYPE

Radio button

FILLS

TEXT FILL 1: FILL “[SP’s NAME]”

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF OTHER_CODES = (1, 2, 3, 4, 5, 9, 10, 11), GO TO END

IF OTHER_CODES = 6, GO TO LANG

IF OTHER_CODES = (7, 8) GO TO WHO_REF



LANG

ASK

IF OTHER_CODES = 6 OR DIAL2C = 5

INTERVIEWER: CLASSIFY LANGUAGE BARRIER


  1. SPANISH LANGUAGE BARRIER

  2. OTHER LANGUAGE BARRIER

SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

WHO_LANG


WHO_LANG

ASK

IF OTHER_CODES = 6 OR DIAL2C = 5

INTERVIEWER: WAS THE LANGUAGE BARRIER FOR THE…


  1. SP

  2. SP’S PROXY

  3. SOMEBODY ELSE

  4. UNKNOWN


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

THANK_EVT


RUNKNOWN

ASK

IF INTRO1C = 7 OR CALL_IN = 7

Our records indicate that <TEXT FILL 1> could be reached at this number about an upcoming appointment <TEXT FILL 2>. Are you or anyone else at this number familiar with <TEXT FILL 3>?


  1. YES

  2. NO


SPANISH

Nuestros registros indican que se puede llamar a este número para comunicarnos con <TEXT FILL 1> sobre una próxima cita <TEXT FILL 2>. ¿Usted o alguien más que use esta línea conoce a <TEXT FILL 3>?


  1. YES

  2. NO

QUESTION TYPE

Radio button

FILLS (ENG)

TEXT FILL 1: FILL “[SP’s NAME]” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[PROXY’S NAME]”


TEXT FILL 2: FILL “for [SP’s NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

ELSE, BLANK


TEXT FILL 3: FILL “[SP’s NAME]” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[PROXY’S NAME]”

FILLS (SPA)

TEXT FILL 1: FILL “[SP’s NAME]” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[PROXY’S NAME]”


TEXT FILL 2: FILL “para [SP’s NAME]” IF SP AGE <18 OR (AGE 18+ AND YES PROXY)

ELSE, BLANK


TEXT FILL 3: FILL “[SP’s NAME]” IF SP AGE 18+ AND NO PROXY

ELSE, FILL “[PROXY’S NAME]”

NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

IF RUNKNOWN=1, GO TO INTRO2A

IF RUNKNOWN=2, GO TO THANK_EVT




THANK_EVT

ASK

WHO_LANG = (1, 2, 3, 4) OR RUNKNOWN=2

(Thank you very much for your time.)


PLEASE PRESS “NEXT” TO CONTINUE.


SPANISH

(Muchas gracias por su tiempo.)


PLEASE PRESS “NEXT” TO CONTINUE.

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

END



BACK_FROM_BLAISE

ASK

IF

INTERVIEWER: WHAT WAS THE OUTCOME OF THE INTERVIEW?


  1. BREAKOFF, SET CALLBACK

  2. SURVEY COMPLETE

  3. REFUSAL


SPANISH

N/A

QUESTION TYPE

Radio button

FILLS


NOTES


HARD CHECK


SOFT CHECK


VERSION NOTES


NEXT

END OF QUESTIONNAIRE


6i-19


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AuthorJeanne Snodgrass
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File Created2024-10-28
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