Form 0920-0743 Attachment 4a Screening Part A-English

Form Pending Approval

OMB #: 0920-0743
Exp. Date: MM/DD/YYYY

Screening Part A

Screening telephone call script to identify the appropriate survey contact person at eligible facilities

The majority of hospitals will be contacted via email using the business contact information collected during the previous survey cycle’s administration. A screening call will be made to hospitals that meet at least one of the following criteria:

• Hospitals without an email address (most likely because they did not participate in the previous survey

• Hospitals with business contact information that is no longer valid

Callers will obtain the name and business contact information of an individual who is knowledgeable about infant feeding practices at the hospital (contact person). The call will be administered as a computer-assisted telephone interview. As a result, data entry will be performed as part of the interview process and the skip-logic will be electronic. The screening should take 3 minutes to complete.

Qualified Level	Definition	Instructions
1	Contact not identified	SKIP TO INTRO
2	Possible contact identified	IF REACH VOICEMAIL, SKIP TO POS_CONTACT_VM; OTHERWISE, SKIP TO INTRO_2
3	Contact identified/information collected

INTRO

[READ IF NECCESARY (E.G. NOT TRANSFERRED DIRECTLY FROM REMINDER CALL): Hello, my name is [INTERVIEWER NAME] and I am calling from Abt Global on behalf of the Centers for Disease Control and Prevention regarding the Maternity Practices in Infant Nutrition and Care, or mPINC, survey, a survey funded by the Centers for Disease Control and Prevention (CDC). The mPINC survey includes questions about infant nutrition, such as breastfeeding, use of formula by healthy newborns, and feeding routines.] Can I verify that I have reached [HOSPITAL_NAME] located at [ADDRESS], correct?

1. YES SKIP TO LOGIC AFTER NEW_NAME_2

2. NO SKIP TO PREVIOUS_NAME

3. DON’T KNOW SKIP TO PREVIOUS_NAME

4. REFUSED SKIP TO CLOSING_1

PREVIOUS_NAME:

OK, no problem. Can you tell me if you were ever called [HOSPITAL_NAME]?

1. YES SKIP TO NEW_NAME

2. NO SKIP TO NEW_NAME_2

3. DON’T KNOW SKIP TO NEW_NAME_2

4. REFUSED SKIP TO CLOSING_1

NEW_NAME

Can you tell me what the new name is?

Hospital new name: [NEW_HOSPITAL_NAME]

1. DON’T KNOW

2. REFUSED

IF [NEW_HOSPITAL_NAME] <> “” OR DON’T KNOW/REFUSED THEN SKIP TO LOGIC AFTER NEW_NAME_2 ELSE SKIP TO CLOSING_1

NEW_NAME_2

Thank you for this information. Can you please provide me with your hospital’s name and address?

Hospital name: [DIFFERENT_HOSPITAL_NAME]

Address: [DIFFERENT_HOSPITAL_ADDRESS] Street [DIFFERENT_ADDRESS_1]

Apt [DIFFERENT_ADDRESS_2]

City [DIFFERENT_CITY]

State [DIFFERENT_STATE]

Zip Code [DIFFERENT_ZIP_CODE]

1. DON’T KNOW

2. REFUSED

SKIP TO CLOSING_1

IF NAME IS AVAILABLE FOR THE MAIN POINT OF CONTACT, GO TO NEXT QUESTION; OTHERWISE, GO TO LACTATION_SERVICES

ASK_NAME

Could you please connect me with [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME]?

1. YES SKIP TO CONTACT_MANAGER

2. NO CYCLE TO NEXT POSSIBLE CONTACT; SKIP TO LACTATION_SERVICES

3. DON’T KNOW SKIP TO LACTATION_SERVICES

4. REFUSED SKIP TO CLOSING_1

5. CONTACT NO LONGER WORKING AT HOSPITAL CYCLE TO NEXT POSSIBLE CONTACT; SKIP TO LACTATION_SERVICES; SET QUALIFIED LEVEL=1

LACTATION_SERVICES

Could you please connect me with the lactation services coordinator, if your hospital has one?

1. YES SKIP TO CONTACT_MANAGER

2. NO/HOSPITAL DOESN’T HAVE ONE SKIP TO MOTHER-BABY_MANAGER

3. HOSPITAL DOESN’T OFFER MATERNITY CARE SKIP TO CLOSING_2

4. DON’T KNOW SKIP TO MOTHER-BABY_MANAGER

5. REFUSED SKIP TO CLOSING_1

MOTHER-BABY_MANAGER

Can you please connect me with the mother-baby nurse manager?

1. YES SKIP TO CONTACT_MANAGER

2. NO SKIP TO NURSE_MANAGER

3. HOSPITAL DOESN’T OFFER MATERNITY CARE SKIP TO CLOSING_2

4. DON’T KNOW SKIP TO NURSE_MANAGER

5. REFUSED SKIP TO CLOSING_1

NURSE_MANAGER

Can you please connect me with the nurse manager for the labor and delivery unit?

1. YES SKIP TO CONTACT_MANAGER

2. NO SKIP TO OTHER_MANAGER

3. HOSPITAL DOESN’T OFFER MATERNITY CARE SKIP TO CLOSING_2

4. DON’T KNOW SKIP TO OTHER_MANAGER

5. REFUSED SKIP TO CLOSING_1

OTHER_MANAGER

Can you please connect me with someone who could answer questions about the care of mothers and babies delivered at your hospital?

1. YES SKIP TO CONTACT_MANAGER

2. NO SKIP TO CLOSING_1

3. HOSPITAL DOESN’T OFFER MATERNITY CARE SKIP TO CLOSING_2

4. DON’T KNOW SKIP TO CLOSING_1

5. REFUSED SKIP TO CLOSING_1

CONTACT_MANAGER

Thank you! Can you please give me their name, phone number, and email address so going forward I can contact them directly?

1. YES SKIP TO POS_CONTACT

2. NO SKIP TO INTRO_2

3. DON’T KNOW SKIP TO INTRO_2

4. REFUSED SKIP TO CLOSING_1

POS_CONTACT

INTERVIEWER: COLLECT CONTACT’S NAME, PHONE NUMBER, EMAIL ADDRESS, AND ADDRESS. IF UNABLE TO COLLECT EMAIL, CODE ABLE TO COLLECT EMAIL? = “NO”.

First name: [POS_CONTACT_FIRSTNAME]

Last name: [POS_ CONTACT _LASTNAME]

Phone number: [POS_ CONTACT_NUMBER]

Email: [EMAIL]

Street [ADDRESS_1]

Apt [ADDRESS_2]

City [CITY]

State [STATE]

Zip Code [ZIP_CODE]

ABLE TO COLLECT EMAIL?

1. YES

2. NO

SET PHONE NUMBER TO [POS_CONTACT_NUMBER]

IF ABLE TO COLLECT EMAIL? = 1 SET QUALIFIED LEVEL = 3 (CONTACT IDENTIFIED/INFORMATION COLLECTED) AND SKIP TO CLOSING_EMAIL

IF ABLE TO COLLECT EMAIL? = 2 (POSSIBLE CONTACT IDENTIFIED) SET QUALIFIED LEVEL = 2 AND SKIP TO TRANSFER_1

TRANSFER_1

Thank you for providing me with [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME]’s contact information. Can you please transfer me to [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME]?

1. YES SKIP TO INTRO_2; SET RESULT TO “forward”

2. NO SKIP TO CLOSING_1; SET RESULT TO “forward”

INTRO_2

Hello [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME], my name is [INTERVIEWER NAME] and I am calling from Abt Global on behalf of the Centers for Disease Control and Prevention regarding the Maternity Practices in Infant Nutrition and Care, or mPINC, survey, a survey funded by the CDC. The mPINC survey includes questions about infant nutrition, such as breastfeeding, use of formula by healthy newborns, and feeding routines. Once data collection and analysis are complete, we send participating hospitals an individualized report with a summary of their survey results and a comparison of their results to the nation, the region, and to other hospitals of similar size, showing specific changes the hospital can make to support breastfeeding mothers. Hospitals can use this information to improve care practices and policies to better support their maternity patients.

You were identified as a knowledgeable person to complete the mPINC survey, which asks questions about infant feeding practices and policies, for your facility.

To make completing the survey as easy as possible, we would like to send an e-mail directly to you with an invitation and a link to the survey, which can then be completed securely online. Can you please give me your email address?

INTERVIEWER: COLLECT CONTACT’S NAME, PHONE NUMBER, AND EMAIL ADDRESS. IF UNABLE TO COLLECT EMAIL CODE ABLE TO COLLECT EMAIL? = “NO”.

First name: [CONTACT_FIRSTNAME]

Last name: [CONTACT _LASTNAME]

Phone number: [CONTACT_NUMBER]

Email: [CONTACT_EMAIL]

ABLE TO COLLECT EMAIL ADDRESS 2?

1. YES SKIP TO CLOSING_EMAIL

2. NO SKIP TO CLOSING_1; SET QUALIFIED LEVEL = 1; SET PHONE NUMBER BACK TO SWITCHBOARD NUMBER; CYCLE TO NEXT POSSIBLE CONTACT

CLOSING_1

Thank you for your time. Goodbye.

SET RESULT = “try_again”

SET STATUS = “in_call_process”

INTERVIEWER NOTE: PLEASE COMPLETE A STUDY ACTION FORM (SAF)

CLOSING_2

I’m sorry, but our survey focuses on maternity care. To learn more about CDC's work, visit cdc.gov/breastfeeding-data. Thank you for your time. Goodbye.

SET STATUS = “ineligible_phone”

SET RESULT = “ineligible”

CLOSING_EMAIL

IF ABLE TO COLLECT EMAIL= 1: Thank you for providing me with [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME]’s contact information. An email invitation to the mPINC 2026 survey has been sent to [EMAIL]. To ensure that [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME] receives all future mPINC survey emails, please have them add [email protected] and [email protected] as secure contacts.

IF ABLE TO COLLECT EMAIL 2= 1: Thank you for providing me your contact information. To ensure that you receive all future emails regarding the mPINC study, please add the study email [email protected] as a secure contact. If you do not see the email invitation to the survey in your inbox shortly, please also check your spam/junk folders.

That is all the information I need at the moment. Thank you very much for your time and assistance. If you have any questions regarding the study, please call our study hotline at [PHONE NUMBER]. Goodbye.

SEND EMAIL_INVITATION

SET RESULT TO “eligible”

SET STATUS TO “eligible_phone”

POS_CONTACT_VM

VOICEMAIL WILL BE LEFT ON THE FIRST, THIRD AND FIFTH ATTEMPTS

IF [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME] <> “”

(Hello, I am calling for [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME]. We are trying to contact you regarding the Maternity Practices in Infant Nutrition and Care, or mPINC, survey, sponsored by the Centers for Disease Control and Prevention.

You were identified as a knowledgeable person who could complete the mPINC survey. We would like to send you an e-mail with an invitation and a link to the survey, which can then be completed securely online. Please give us a call at our toll-free number [PHONE NUMBER] or email [email protected] and refer to Hospital ID [XXXXXX]. Thank you.)

IF [POS_CONTACT_FIRSTNAME] [POS_CONTACT_LASTNAME] = “”

(Hello. We are trying to contact your hospital regarding the Maternity Practices in Infant Nutrition and Care, or mPINC, survey, sponsored by the Centers for Disease Control and Prevention.

We would like to send an e-mail with an invitation and a link to the survey, which can then be completed securely online. Please give us a call at our toll-free number [PHONE NUMBER] or email [email protected] and refer to Hospital ID [XXXXXX]. Thank you.)

CONTACT ATTEMPTS

Call attempt	Possible contact attempt (POS_CONTACT_ATTEMPT)	Instructions/notes
1-5	POS_CONTACT_ATTEMPT= 1	Call attempts to identify first contact; hospital has not refused and has not provided email
6-10	POS_CONTACT_ATTEMPT=2	Call attempts to identify second contact; hospital has not refused and has not provided email
11-15	POS_CONTACT_ATTEMPT=3	Call attempts to identify third contact; hospital has not refused and has not provided email. Record is deactivated; result set to “max_calls_reached”; hospital status set to “max calls”

CALL RESULT CODES

Call result	Description
“refused”	Hospital refused
“try_again”	Qualified level=1 (contact not identified) and hospital has not refused
“forward”	Qualified level=2 (possible contact identified) and hospital has not refused
“email_sent”	Qualified level=3 (contact identified/information collected) and hospital has not refused
“max_calls_reached”	Call attempt=15 and hospital has not refused and not provided email

HOSPITAL STATUS CODES

Status	Description
“refused”	Hospital has refused
“in_email_process”	Email invitation sent
“in call process”	Call_attempt<15 and hospital has not refused and not provided email
“max_calls”	Max calls reached

Public reporting burden of this collection of information is estimated to average 3 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 Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30329, ATTN: PRA (0920-0743). Do not send the completed form to this address.