Generic 10-Day Letter to Margo Schwab

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, Maryland 20782

July 31, 2008

Margo Schwab, Ph.D.

Office of Management and Budget

725 17th Street, N.W.

Washington, DC 20503

Dear Dr. Schwab:

The staff of the NCHS Questionnaire Design Research Laboratory (QDRL) plans to conduct research to test and evaluate questions for the National Health and Nutrition Examination Survey (NHANES) audio computer assisted self-interview (Audio-CASI) questions on alcohol, sexual behavior, sexually transmitted diseases, and reactions to race under (OMB No. 0920-0222, exp. 02/28/10). We propose to advertise for volunteer participants starting August 25, and to start testing as soon as possible after that.

Background Information about Cognitive Testing of Questionnaires

The methodological design of this proposed study is consistent with the design of typical cognitive testing research. The purpose of cognitive testing is not to obtain survey data, but rather to obtain information about the processes people use to answer survey questions as well as to identify any potential problems in the questions.

Data collection procedures for cognitive interviewing are quite different from survey interviewing. While survey interviewers strictly adhere to scripted questionnaires, cognitive interviewers use survey questions as starting points to begin a more detailed discussion of questions themselves: how participants interpret key concepts, their ability to recall the requested information, and the appropriateness of response categories. Because the interviews generate narrative responses rather than statistics, results are analyzed using qualitative methodologies. This type of in-depth analysis reveals problems in particular survey questions and, as a result, can help to improve the overall quality of surveys.

Proposed project: Testing and evaluation of audio computer assisted self-interview (Audio-CASI) questions on alcohol, sexual behavior, sexually transmitted diseases, and reactions to race for National Health and Nutrition Examination Survey (NHANES)

The NHANES, first conducted in 1960, is the only source of examination and biologic specimen data on a nationally representative sample of the American people. The survey is based on data collected most years in 15 randomly-selected sites (county or cluster of counties) throughout the country. Interviewers screen each household in a selected segment of the county for basic demographic information. Selected persons first complete a household interview, then undergo a physical examination at a mobile examination center (MEC). During the course of each survey year, approximately 5,000 examinations are conducted.

The Audio-CASI section of the NHANES is a private interview occurring in the MEC. The questions are administered via Audio-CASI because they are considered to be sensitive. For this project, we will test a subset of the Audio-CASI questions that focus on alcohol, sexual behavior, sexually transmitted diseases, and reactions to race.

Responses to these questions complement biological assessments of HIV, STDs, and other laboratory measurements and serve as covariates in analysis. NHANES collects information on the sexual history of respondents in order to get analytically useful measures of sexual risk. Detailed behavioral questions are asked in order to differentiate types of sex since some types are riskier than others. Also, numbers of lifetime partners and partners in the last 12 months are collected to perform analyses of the link between sexual behaviors and lab data on viral (e.g. HSV-2) and bacterial (e.g. GC, CT) sexually transmitted diseases (STDs). These questions were revised in 2005 and used in the field from 2005 - early 2008 which led to poor data quality and responses that were not consistent with previous years. The purpose of this cognitive testing is to improve questions and revise them accordingly. Questions in the other modules (Alcohol, Reactions to Race) are also useful for modeling the relationships of various attitudes, behaviors and experiences to health and disease outcomes, and modeling estimates of health risks.

This project will conform to the usual QDRL procedures for cognitive testing of a questionnaire module. We propose to recruit 30 adults (aged 18 to 59) through newspaper advertisements, flyers, word-of-mouth, or by contacting participants from past QDRL projects who have expressed interest in participating in upcoming projects. Within these constraints, we hope to recruit participants with some demographic variety (particularly in terms of gender, education, race/ethnicity, and income). The newspaper advertisement/flyer is shown in Attachment 1. We have specifically designed the newspaper advertisement/flyer around the testing of “sensitive” health topics rather than listing the specific topic areas to be tested. Those individuals calling in for the study will be informed of the specific topic areas that will be tested, i.e., alcohol, sexual behavior, sexually transmitted diseases, and reactions to race through the telephone screener.

Interviews will be conducted in the QDRL, or in a private room of a community-based organization. Interviews will consist of two parts: 1) a brief training session about answering Audio-CASI questions, followed by answering the NHANES Audio-CASI questions using a computer with headphones and; 2) a face-to-face debriefing, using typical cognitive probes about comprehension of terms, recall processes, and so forth.

With the consent of the participants, the interviews will be audio recorded. Participants will be informed of taping procedures (including observation if applicable) in the process of reviewing the consent forms, and the equipment will be turned on once it is clear that the procedures are understood and agreed upon. Interviews will be conducted with as many as 30 adults. The interviewer’s introduction and the NHANES Audio-CASI questions are shown in Attachment 2. At the end of the interviews, participants will be paid and provided with copies of all papers they signed.

We propose paying participants $40, which is our standard payment. In total, for this project, the maximum respondent burden will be 30 hours of interviewing in addition to travel time. An updated burden table for this project is shown below:

Projects	Number of Participants	Number of Responses/ Participant	Average hours per response	Response burden
QDRL Interviews
1) NCHS Surveys	30	1	1	30

Attachments (2)

cc:

M. Moien

M. Daneshvar

S. Perryman

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