Approval Request Form

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)
Message testing among public audiences in US Virgin Islands to test Zika prevention messages

2. Study Population: (Discuss study population and explain how they will be selected/recruited.)
Study population includes pregnant women, male partners of pregnant women, couples, community
members, and distributing partners. Participants will be intercepted in places where they are most likely to
be found. Sample will come from across three islands.
Respondent characteristics:
Number of subject: 60

Number of males:

30

Age range: Over 18 years of age

Number of females: 30

Racial/ethnic composition: A mix, though demographic information will not be collected
Special group status: (e.g., risk group, health care providers)
Type of group(s): Pregnant women, male partners of pregnant women, couples,
community members, and distributing partners
Geographic location(s): US Virgin Islands

3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Other (describe):

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no):

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)
To get feedback on Zika prevention messages from key audiences: (1) pregnant women; (2) male partners
of pregnant women; (3) couples expecting a baby; (4) community members; and (5) various partners who
are distributing materials. Findings will be used to inform implementation and communication efforts for
USVI’s Zika response.

6. Category of time sensitivity: (Please check one below)
Health emergency:
Press coverage correction:
Trend Tracking

Time-limited audience access:
Time-limited congressional/administrative mandate:
Ineffective existing materials due to historical event/social trends:

7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
As of November 2, 2016, the U.S. Virgin Islands has reported 1,508 cases of Zika with 590 laboratoryconfirmed cases. Sixty-seven of these cases are among pregnant women. Because Zika is an emerging
arboviral disease and a sexually transmitted disease that is known to cause microcephaly and other serious
birth defects in babies if a pregnant woman is infected during her pregnancy, collaborative response efforts
between USVI and CDC are underway. Testing messages is an urgent component of the CDC response.

8. Number of burden hours requested: 15

BURDEN HOURS
No. of
Participation
Respondents Time

Category of Respondent
Pregnant women, male partners of pregnant women, couples, community members, and

60

15/60 hours

Totals

Burden
15 hours

15 hours

9. Are you using questions from the approved question bank?

Yes

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)
16c, 69d, 74d, 80d, 1d, 3d, 4d, 6d, 8d, 15d, 29d, 5e, 11e, 12e, 33d, 24d, 65d, 110d

*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation: 6088
2. OADC confirmation of time-sensitivity:
Yes:
No:

Dawn B. Griffin
Project Officer

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