Initial Visit Script (Revised per Cog Test)

APPENDIX X
INITIAL VISIT SCRIPT REVISED PER COGNITIVE TESTS

SCRIPT FOR INITIAL VISIT

START
COMPUTER

I am going to let my computer startup while we cover some preliminary items.
First I’d like to review the consent form with you. Then, I’ll ask you to read and sign the
form to show that that you agree to take part in the study.

CONSENT
FORM
POINT TO EACH
SECTION AS
YOU READ
SCRIPT



The top of the form explains the sponsor and purpose of the study.



Procedures to follow explains what we will ask you to do for the study. READ

SECTION.

 Incentives for participation explains the incentives that your household will
receive. READ SECTION.
 The back page explains that participation is voluntary, there are no
discomforts or risk from participation, and you can choose to terminate or
withdraw from the study at any time. READ TERMINATION SECTION 2ND
SENTENCE.
 The statement of confidentiality 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.
 Use of administrative data 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 take part in the study. If you agree, you should initial here. POINT
TO USE OF ADMINISTRATIVE DATA AND READ 1ST SENTENCE.
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 purpose of the study in more detail. If you
have any questions during the video, just let me know and we can pause it.

START VIDEO; PAUSE AT 2:00*
COMPLETE
INITIAL
INTERVIEW

AFTER INITIAL
INTERVIEW

I’m going to interview you by reading questions from the computer and entering your
responses in the computer. Do you have any questions before we begin?
The next part of the video explains what we would like you to do for the next week. We
ask you to keep track of all the foods and drinks that you get. The video explains how to
use this book. HAND PRIMARY RESPONDENT BOOK TO RESPONDENT. Use the book to
follow along with the video.

PLAY VIDEO TO 7:45

*All video times correspond to the English version

DAILY LIST
PRACTICE

Before we practice a Daily List page, I’d like you to write your name on the book and read
and sign the consent.
Now we’ll complete a practice page to see if you have any questions about the Daily List.
Remember that you will use the Daily List to tell us about the places where you got food.
Write the names of places, do not write the foods and drinks that you got.
Did you get any food from any places yesterday? IF
YESTERDAY.

NO, ASK ABOUT DAY BEFORE

Use the practice page to write the places where you got food.
IF R DOES NOT LIST SOMETHING IN SECTIONS A & B, PROBE FOR PLACES WHERE
THEY MIGHT GET FOOD TO LIST IN THOSE SECTIONS. EXPLAIN THAT THIS IS JUST AN
EXAMPLE AND NOT PART OF THE STUDY WEEK.
AFTER COMPLETING PRACTICE PAGE, USE 2 OR 3 EXAMPLES OF LOCAL PLACES AND
ASK RESPONDENT WHERE THEY WOULD WRITE THAT PLACE ON THE DAILY LIST.

Now I’ll restart the video and we’ll learn about the next section of the book.
PLAY VIDEO TO 13:30
RED PAGE
PRACTICE

Now let’s go through an example Red Page together to see if you have any questions.
Here is a McDonald’s receipt and pictures of items purchased for two people.
IF HHSIZE=1:

Let’s pretend that you and I went to lunch and you paid for both of our
lunches. Go ahead and complete the Red page. RESPONDENT SHOULD LIST ALL FOODS
AND DRINKS, THE TOTAL AMOUNT PAID, AND INDICATE THAT THEY BOUGHT FOOD
FOR 1 PERSON NOT IN THE HOUSEHOLD.
IF HHSIZE>1: Let’s pretend that you and [NAME OF OTHER PERSON IN HOUSEHOLD] went
to lunch together. Go ahead and complete the Red page.

It’s okay if you can’t fill out everything in this practice. Do you have any questions about
the Red page? SHOW THE MODEL RED PAGE W/RECEIPT TO CONFIRM THAT
RESPONDENT DID IT CORRECTLY OR TO SHOW THEM HOW TO IMPROVE.
How would you complete the page differently if you did not have the receipt?
SHOW THE MODEL RED PAGE WITHOUT RECEIPT.
I have two completed Red pages to show you perfect examples of completed Red pages.
The next section of the video is about Blue pages.
PLAY VIDEO TO 23:30
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 stepby-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.

Do you have any questions about the Blue page?

SHOW THE MODEL BLUE PAGE AND
PROVIDE GUIDANCE ON THINGS RESPONDENT MISSED, IF APPLICABLE.

DON’T FORGET TO
SCAN END OF
TRAINING
BARCODE

I’m scanning a barcode to indicate that we have finished the training and that all the
barcodes that you scan next will be items you get during the week SCAN END OF
TRAINING BARCODE ON CHECKLIST.
If you (or other household members) want to practice scanning during the week just scan
the practice barcode first so that we know you are practicing. SHOW RESPONDENT THE
PRACTICE BARCODE ON THE “HOW TO USE THE SCANNER” PAGE.
Now we’ll finish the video.

PLAY VIDEO TO END
ADULT AND
YOUTH BOOKS

I have Adult and Youth Books for other members of your household. Please ask all adults
over age 18 to read and sign the cover of the book to show that they are willing to take
part in the study. A parent or guardian should sign the Youth Book on behalf of children
under age 18.

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.

WRITE:



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. I’d like to make an
appointment now. Do you know when we can meet on DAY 8?

1.DAYS OF
WEEK

2.YOUR NAME
3.YOUR
PHONE#
4.DAY 8 APPT
5.DATES ON
BACK OF
FOOD
BOOK

You can put this magnet on your refrigerator to remind you to call in. Do you have any
questions about the schedule?
Before we move on, I’m going to copy the days and dates from the calendar to the back
page of the food book(s).
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.
INSTRUCTIONS ON BOTTOM.

POINT TO

We explain that:
MEALS AND
SNACKS FORM

(continued)

INCOME
WORKSHEET

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.
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
income 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 as you fill it out.
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.

RECAP

Do you have any questions about this worksheet? ANSWER QUESTIONS.
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 pages 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 during the study week.

CHECK
MATERIALS

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. POINT TO WEBSITE
ADDRESS ON INSIDE COVER OF FOOD BOOK.
HOUSEHOLD SHOULD HAVE:
4. TRAINING DVD
7. INCOME WORKSHEET
1. FOOD BOOKS
2. SCANNER
5. MAGNET
8. ONE CONSENT FORM
3. SCOTCH TAPE & PENS
6. MEALS AND SNACKS 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.