Telephone survey within 3-5 days after airport survey

Form Approved

OMB No. 0920-0932

Expires 05/31/2015

Appendix B: Telephone survey within 3-5 days after airport survey

1. General Introduction

Hello, is [name] available? I wanted to follow-up on a survey we did with them at [airport name] a few days ago.

IF correct person: CONTINUE

IF not correct person: Is [name] available to talk now?

• IF YES, continue

• IF NO, Is there a good time to call back? [RECORD TIME]

Hello [respondent name]. My name is _________ and I am working with the Centers for Disease Control and Prevention (CDC). Someone spoke with you about your experience with the Ebola screening process at the [insert name] airport on [insert day]. At the end of your survey on [day originally surveyed] you said you would be willing to be called again. Are you still willing to do this?

Is now a good time to talk? This will take about 10 minutes. [INTERVIEWER: IF YES, GO TO SECTION B. IF NO, ASK…]

1. When would be a good time to call you back?[INTERVIEW RECORD TIME FOR CALL BACK]

2. Introduction

Great! Thank you for being willing to sharing your opinions with me. Your opinions will help us improve the process. Before I begin I want to go over a couple of items:

• This survey is voluntary. You do not have to answer any question that you don’t want to answer. You can decline to answer any question. You can stop the survey at any time for any reason.

• There are no right or wrong answers. This is not a test. I am interested in your opinion. If you don’t understand the question, let me know and I can ask it another way.

• The information you provide today will be kept confidential, which means we will not link your answers to your name.

• Whether you take part in the survey or not and anything you say will not affect your monitoring for Ebola.

3. Survey Questions

First, I’d like to talk to you a little bit about your experience with monitoring and reporting for Ebola so far.

1. Has the health department contacted you about what you need to do for monitoring and reporting for Ebola?

1 Yes

2 No [If no, skip to question 5]

Please tell me how much you agree or disagree with the following statement

2. It is clear to me how I should report my temperature and symptoms to the health department.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

3. At which phone number did they contact you?

1 CARE Phone

2 Personal phone

3 Other: [INTERVIEWER: RECORD RESPONSE VERBATIM]

4. Did you need the CARE phone that was provided for you? (PROBE: That is, did you need the phone because possibly you did not have a US cell phone?)

1 Yes, I needed the phone

2 No, I did not need the phone

1. Why did you [insert travelers response] [need, or not need] the phone? [RECORD VERTBATIM RESPONSE]

5. On what date did the health department say you can stop checking yourself for symptoms of Ebola?

1. [INTERVIEWER RECORD RESPONSE [MM/DD/YYYY]

   1. SCHEDULE 2^nd follow-up for two days prior to this date]

2. I don’t know

   1. Has your health department asked you to monitor yourself for 3 weeks, that is, 21 days?

      1. Yes [Continue and schedule 2^nd telephone follow-up 18 days after intercept]

      2. No [SKIP to Q 37 “What suggestions do you have for helping us get important information to travelers who may come in the future.”]

3. Health Department said I don’t need check and/or report my symptoms. [SKIP to Q 37 “What suggestions do you have for helping us get important information to travelers who may come in the future.”]

6. Have you opened your CARE Kit?

1 Yes

2 No [INTERVIEWER: IF NO, SKIP TO Q6; OTHERWISE, CONTINUE TO PROBE BELOW]

1. What did the information say you need to do?

[INTERVIEWER: CHECK ALL MENTIONED BY RESPONDENT]

1 Take temperature twice daily

2 Check for symptoms twice daily

3 Record symptoms and temperature in log

4 Report to health department every day or twice a day

5 Keep CARE Card on person

6 Contact health department immediately if temperature is above 100.4 degrees Fahrenheit or 38 degrees Celsius or if showing symptoms of Ebola [Note to interviewer: Any mention to a high temperature or fever is acceptable; the exact number given to traveler may vary from state to state.]

7 How to take temperature correctly

8 Need to check for symptoms of Ebola for 21 days after leaving an Ebola outbreak country

9 List of states and local health department phone numbers to contact if they do not contact you within 24 hours

10 Do not exercise, eat, or drink at least 30 minutes before taking your temperature

11 Other: [INTERVIEWER: RECORD RESPONSE VERBATIM]

2. How easy or difficult has it been for you to do these things?

1 Very difficult

2 Difficult

3 Easy

4 Very easy

3. Why has it been [INSERT RESPONSE FROM Q5.b)] (very difficult, difficult, easy, very easy)? [INTERVIEWER: RECORD RESPONSE VERBATIM]

7. Was there any information in the CARE Kit that was unclear or confusing to you?

1 Yes

2 No

1. What about the information was [INSERT TRAVELERS RESPONSE] (clear or unclear and confusing)?[INTERVIEWER: RECORD VERBATIM RESPONSE]

8. Over the next few weeks, how often should you take your temperature?

1 Once

2 Once a day

3 Twice a day

4 Unsure

9. After you left the airport, how often have you and your family members talked about Ebola?

1 Not at all

2 Only once or twice

3 Sometimes

4 Often

5 Every day

10. Did you check your temperature twice yesterday?

1 Yes

2 No

11. Did you report your temperature and symptoms to the health department yesterday?

1 Yes

2 No

12. Describe how you are using the thermometer to take your temperature? [OPEN ENDED RESPONSE] [PROBE: Do you do anything different before you take your temperature? Where are you putting the thermometer to take your temperature? How do you know when it’s done taking your temperature ?]

[INTERVIEWER SELECTS FOLLOWING RESPONSES IF MENTIONED in CATI system;]:

1. Stick under tongue

2. Stick under armpit

3. Don’t take temperature after eating or drinking

4. Don’t take temperature after physical activity/exercise

5. Other INTERVIEWER: RECORD RESPONSE VERBATIM]

13. Are you using the thermometer you got at the airport?

1 Yes

2 No

14. Yesterday did you check yourself for any other symptoms that were mentioned in the CARE Kit?

1 Yes

2 No

15. Yesterday did you record or write down your temperature and any symptoms mentioned in the CARE Kit?

1 Yes

2 No

16. Did you carry your CARE Card with you everywhere you went yesterday?

1 Yes

2 No

17. How serious of a health concern is Ebola to you personally?

1 Not serious at all

2 Somewhat serious

3 Serious

4 Very serious

18. How serious of a health concern is Ebola to the world?

1 Not serious at all

2 Somewhat serious

3 Serious

4 Very serious

19. In your opinion, how likely do you think it is that you will get sick with Ebola?

For this question, 1 is very unlikely, 2 is somewhat unlikely, 3 is likely, and 4 is very likely.

1 Very unlikely

2 Somewhat unlikely

3 Likely

4 Very likely

1. What makes you think you are [INSERT RESPONSE TRAVELER] (very unlikely, somewhat unlikely, likely, very likely) to get Ebola? [INTERVIEWER: RECORD RESPONSE VERBATIM]

20. How confident are you that you can check yourself for Ebola for the next few weeks?

1 Not confident at all

2 Somewhat unconfident

3 Confident

4 Very confident

1. What makes you feel [INSERT RESPONSE FROM TRAVELER] (Not confident at all, somewhat unconfident, confident, very confident) that you can check yourself for symptoms?[INTERVIEWER: RECORD RESPONSE VERBATIM]

21. How likely is it that you will report your temperature and symptoms to the health department every day for the next few weeks?

1 Very unlikely

2 Somewhat unlikely

3 Likely

4 Very likely

22. Based on what you’ve heard so far, how many days do you need to do health checks for Ebola symptoms since arriving in the U.S.?

_____ days [INTERVIEWER RECORDS NUMBER]

23. What might make it hard for you to report your health checks to the health department every day? [INTERVIEWER: RECORD VERBATIM RESPONSE]

24. If you had a temperature of 1004 F or 38.0 C, how likely would you be to seek medical care?

1 Very unlikely

2 Somewhat unlikely

3 Likely

4 Very likely

1. Which (other) symptoms would make you should seek medical care?

[INTERVIEWER: CHECK ALL MENTIONED BY RESPONDENT; RECORD ORDER]

0 No other symptoms

1 Fever

2 Stomach pain

3 Diarrhea or running stomach

4 Vomiting

5 Red eyes

6 Muscle pain

7 Headache

8 Feeling weak or tired

9 Other [INTERVIEWER: RECORD RESPONSE VERBATIM]

What would you do to seek medical care? [INTERVIEWER: CHECK ALL MENTIONED BY RESPONDENT; RECORD ORDER]

1 Call 911

2 Call the health department

3 Go to the doctor

4 Go to the emergency room (ER)

5 Call the number on the CARE Card

6 Call the CDC

7 Stay put

8 Other [INTERVIEWER: RECORD RESPONSE VERBATIM USING AUDIO RECORD TOOL]

Please tell me how much you agree or disagree with the following statements

25. People who are important to me, like friends or family, approve of me checking myself for Ebola symptoms.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

1. What makes you think your family and friends disapprove of you checking yourself for Ebola symptoms [INTERVIEW RECORD VERBATIM RESPONSE]

26. The people who wrote the CARE Kit materials care about me as a person.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

27. The CARE Ambassador who talked with me about the actions I must take cared about me as a person.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

28. The CARE Ambassador was knowledgeable as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

29. I still have confidence in the CARE Ambassador as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

30. I still trust the CARE Ambassador as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

31. The CARE Ambassador was a credible source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

32. The people at the health department care about me as a person.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

33. The people at the health department are knowledge as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

34. I have confidence in the people at the health department as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

35. I trust the people at the health department as a source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

36. The people at the health department are a credible source of information about Ebola.

1 Strongly disagree

2 Disagree

3 Neither agree nor disagree

4 Agree

5 Strongly agree

37. How have you usually reported your temperature and any symptoms to the health department?

[INTERVIEWER: RECORD ONLY ONE. IF NEEDED, EXPLAIN THAT WE ARE LOOKING FOR HOW THEY USUALLY COMMUNICATED THEIR TEMPERATURE AND SYMPTOMS TO THE HEALTH DEPARTMENT]

1 CARE Phone (the phone given to you at the airport)

2 Personal phone (cellphone or landline)

3 Work/Office phone

4 Other phone

5 Online (including video conference such as Skype or Facetime)

6 In person

7 Other [INTERVIEWER: RECORD RESPONSE VERBATIM

38. What suggestions do you have for helping us get important information to travelers who may come in the future? [INTERVIEWER: RECORD VERBATIM RESPONSE]

I have just a few more questions for you.

39. Can I call you on the phone within the next few weeks to ask you a few more questions about your experience with active monitoring? This would be the final set of questions.

1 Yes

1. Do you have your CARE ID card with you? If so, can you look at the card and give me your CARE ID #? [INTERVIEWER: RECORD CARE ID]

2. Is this the best phone number to reach you within the next few weeks?

   1. If No, What is the best phone number to reach you in the next few weeks? [INTERVIEWER: RECORD phone number]

3. Who should I ask for when I call this phone number? You could use your name or another name if you wish to be anonymous. [Write down name provided]

2 No

Thank you so much for your participation. We will call you soon to hear more about your experience.

Public reporting burden of this collection of information is estimated to average 10 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/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74,  Atlanta, Georgia 30333; ATTN:  PRA (0920-0932).