W-Script for Initial Visit (cognitive test Version)

APPENDIX W
SCRIPT FOR INITIAL VISIT
(Cognitive test version)

06687.080 Field Interviewer Manual

Mathematica Policy Research

SCRIPT FOR INITIAL VISIT (INTERVIEW AND TRAINING)
Read red text only if household size is > 1
CONSENT FORM
I am going to let my computer startup while we cover some preliminary items. START COMPUTER.
First I’d like to review the consent form with you. After we review it, I’ll ask you to sign the form to
indicate that you agree to participate in the study.


This section explains what we will ask you to do for this study. POINT AND READ
PROCEDURES TO FOLLOW.



This section explains the incentives that your household will receive. POINT AND READ
INCENTIVES SECTION.



This section explains that participation is voluntary POINT TO VOLUNTARY
PARTICIPATION AND READ, there are no risks to participation, and you can choose to
withdraw from the study at any time. READ TERMINATION SECTION 2ND SENTENCE



POINT TO STATEMENT OF CONFIDENTIALITY. This section explains that all information
that you provide will be kept private and will be used only for statistical purposes. READ
2ND SENTENCE. The box explains that if we release your name or other information that

identifies you, we could be subject to a jail term or fines.


1ST SENTENCE. This section
explains that we may obtain information about you from State agencies that run food
assistance programs. You do not need to agree to this to participate in the study. If you
agree, you should initial here.

POINT TO USE OF ADMINISTRATIVE DATA AND READ

Take some time and read through the form. Please tell me if you would like me to read all or part of
this to you. If you agree to take part in the study, sign both copies POINT TO SIGNATURE LINE. You
keep one copy and I will take the other.
Now I’m going to play a video that explains the study in more detail.

START VIDEO
COMPLETE INITIAL INTERVIEW
Do you have any questions before we begin the interview?
COMPLETE INITIAL INTERVIEW.

AFTER COMPLETING INTERVIEW, START VIDEO.

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Mathematica Policy Research

DAILY LIST PRACTICE
WRITE RESPONDENT NAME ON PRIMARY RESPONDENT BOOK. ASK THEM TO READ AND SIGN
CONSENT.

Now we’ll complete a practice page to see if you have any questions about the Daily List.
Did you get any food yesterday? IF NO, ASK ABOUT DAY BEFORE YESTERDAY.
Use the practice page to write the places where you got food.
GIVE

BOOK TO R TO COMPLETE PAGE. IF R DOESN’T LIST SOMETHING IN SECTIONS
PROBE FOR PLACES WHERE THEY MIGHT GET FOOD TO LIST IN THOSE SECTIONS.

A & B,

RESTART VIDEO

RED PAGE PRACTICE
Now let’s go through an example Red Page together to see if you have any questions.
Let’s use one of the places that you wrote in Section A of the Daily List, and complete a Red Page. It’s
okay if you can’t fill out everything on the Red Page in this practice. You will see that completing a Red
Page would be a lot easier if you have a receipt.
EITHER USE THE RESPONDENT’S EXAMPLE OR MAKE UP AN EXAMPLE AND COMPLETE THE
PRACTICE RED PAGE.
RESTART VIDEO

BLUE PAGE PRACTICE
Did you see any mistakes in the video? The person in the video wrote Progresso Chicken Noodle on
the bottom of her blue page. This was a mistake. She should have written Progresso Chicken Noodle
Soup so that we know exactly what the item is.
Now we’ll do one practice Blue page all the way through, just like in the video. I brought a bag of
groceries and a receipt with me so that you can practice. Let’s start with the step-by-step guide across
from the Blue page.

ALLOW RESPONDENT TO FOLLOW THE STEP-BY-STEP GUIDE ON HIS/HER OWN. OFFER
ASSISTANCE AND ANSWER QUESTIONS AS NEEDED.
CONTINUE TO NEXT PAGE.

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06687.080 Field Interviewer Manual

Mathematica Policy Research

CALENDAR MAGNET
I have a magnet to help you remember what happens during the week. The study lasts 7 days starting
tomorrow. WRITE DAYS AND YOUR CONTACT INFORMATION ON MAGNET, THEN HAND IT TO THE

RESPONDENT.



Tomorrow is Day 1, the first day of the study. Starting tomorrow, you (and other members
of your household) will track the foods and drinks you get.



On Days 2, 5, and 7 (READ DAYS OF WEEK ON CALENDAR) we would like you to call our
toll-free number to tell us what your household has recorded in your book up to that point.
These calls usually last 15 minutes, and you receive $10 for each time you call us (a
maximum of $30 for three calls).



On the 8th day, I will come back to pick up all of the study materials, conduct a final
interview, and give you your check and gift cards.

You can put this magnet on your refrigerator to remind you to call in. Do you have any questions about
the schedule?
MEALS AND SNACKS FORM
Probably the easiest thing that you will do for us is to fill out the Meals and Snacks Form. SHOW FORM.
I’d like you to write the names of each member of your household on this form. (WAIT WHILE
RESPONDENT WRITES NAMES IN FIRST COLUMN.)


On this form, check the boxes to show which meals and snacks each person ate. This is the
only form where we ask what you ate. All other forms ask about what you get, not what you
eat.



If someone did not eat a meal, you leave that box blank. For example, if you skipped lunch
on Tuesday, do not check the box for lunch on Tuesday.



We have some instructions here to help you use the form POINT TO INSTRUCTIONS ON
BOTTOM. We explain that:
o Breakfast, lunch, and dinner are whenever you normally have them. If you eat breakfast
at noon, check breakfast.
o For snacks, we want to know if you had any snack within each of three time periods.
Morning is before noon, afternoon is from noon to 6 pm, evening is from 6 pm to
midnight. If you have two snacks in the evening, you just check the box once.

You should fill this out at the end of each day. You can use the magnet to put this form on your
refrigerator so that you remember it.

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06687.080 Field Interviewer Manual

Mathematica Policy Research

INCOME WORKSHEET
This is the last form that I have for you. It is a worksheet that you can fill out at any time during the
week.
When I return at the end of the week, I am going to do another interview with the computer.
One of the topics is your household income. We ask households about their finances in order to
understand how much money households have available to spend on food.
If you fill out this form, the final interview will go much faster. I am not going to collect this worksheet,
so feel free to write notes on it.
The worksheet has space to write the income of each household member. At the bottom of the page
there are definitions for the types of income to include in each category.
Do you have any questions about this worksheet? ANSWER QUESTIONS.
RECAP
After I leave, there are four ways to get answers to any questions that you have:
1. Common questions and answers are located in the back of the food book. The questions are
color-coded: questions about Daily List pages are in green, questions about Red Pages are in
red, and questions about Blue Page are in blue. General questions are in black.
2. Our toll-free telephone number is at the bottom of each page in the food books, and on all
other study materials.
3. My phone number is on the magnet. You can call me with any questions you have.
4. The DVD that I will leave with you contains the same video that we watched today. If you do
not have a DVD player, you can watch the video on the study website. The website address is
listed in your food book.
SCAN THE “END OF TRAINING BARCODE” ON YOUR CHECKLIST.
LEAVE THE FOLLOWING ITEMS WITH THE HOUSEHOLD:








CALENDAR MAGNET – SET FINAL VISIT APPOINTMENT & WRITE IT ON MAGNET
MEALS AND SNACKS FORM
SCANNER
HOUSEHOLD FOOD BOOK(S) – COMPLETE BACK PAGE; COPY DATES FROM MAGNET
SCOTCH TAPE, PENS
COPY OF THE CONSENT FORM

Okay, good luck! Remember to call the telephone center on DAY 2 and feel free to call me anytime this
week if you have questions or run into problems.
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