U.S. Department of Health and Human Services (HHS) OMB Control # 0920-0932
Centers for Disease Control and Prevention (CDC) Expiration Date 05/31/2015
TravAlert Evaluation Interview Guide
ID: <airport code. interviewer initials, number of person approached (e.g., 12th person approached)>
Date:
DEMOGRAPHIC INFORMATION |
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1. |
[MARK THE SEX OF THE PERSON APPROACHED] |
Female Male |
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2. |
Do you live in the United States? |
Yes [Go to 4] No [Go to 3] |
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3. |
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a. In what country do you live?
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b. Did you visit any countries before arriving in the U.S.? Where? |
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c. Are you visiting any other countries after the U.S.? Where?
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d. How long do you plan on staying in the U.S.? |
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4. |
What country (countries) did you visit on your trip? |
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5. |
What is (if non U.S. resident)/was (if U.S. resident) the main reason for your trip? |
Visiting family and or friends Business Vacation/tourism School Mission or volunteering Other _______ |
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ENVIRONMENT |
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6. |
In this airport, did you see any electronic monitors or screens with health or disease information? |
Yes [Go to 7] No [Go to 6a] |
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a. If no, where in the airport could we put monitors or screens with health information or disease information to get your attention?
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[GO TO ITEM 13] |
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7. |
Where did you see them? |
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8. |
What would be the best place(s) in the airport to put monitors or screens showing health or disease information? |
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MESSAGE TESTING |
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9. |
Do you remember the main topic of the message? |
Yes [Go to 9a] No [Go to 10] |
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a. List: |
[If answer = measles, go to 11] [If answer ≠ measles, go to 12]. |
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10. |
I’m going to read four (other) health topics to you. Please tell me if you saw any of these messages on the monitors or screens (select all that apply). |
Healthy Eating [GO TO 13 if “Measles” IS NOT ALSO SELECTED] Flu [GO TO 12 if “Measles” IS NOT ALSO SELECTED] Exercise [GO TO 12 if “Measles” IS NOT ALSO SELECTED] Measles [GO TO 11] None of these [GO TO 12 if “Measles” IS NOT ALSO SELECTED] |
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11. |
What did the message say? |
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12. |
What is a better way we could have provided health or disease information? |
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BEHAVIOR |
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13. |
If you thought you had measles after this trip, what would you do? Would you do anything else? |
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14. |
Have you been vaccinated for measles? |
Yes [Go to 15] No [Go to 14a and 14b] Don’t know [Go to 15] |
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a. If no, why not? |
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b. How likely are you to get a measles vaccine in the future? Would you say you are: |
Very likely Somewhat likely Not sure Somewhat unlikely Very unlikely |
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15. |
One last question. What is your age? |
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[Interviewer Script: “Thank you for your time, your answers will be very helpful.”]
Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor a project, 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-0932.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | CDC User |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |