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pdfHealth Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)
Domestic Readiness Initiative on Zika Virus Disease.
2. Study Population: (Discuss study population and explain how they will be selected/recruited.)
This is an as-needed mechanism to collect data. Questions may be targeted to a range of audiences
including pregnant and non-pregnant women, single and partnered males, general public, and healthcare
providers. Respondents to be recruited using methods like electronic/online, phone and in-person contact.
Respondent characteristics:
Number of subject: 575
Number of males:
245
Age range: 18 years of age or older
Number of females: 330
Racial/ethnic composition: Potentially all racial/ethnic groups
Special group status: (e.g., risk group, health care providers)
Type of group(s): pregnant women, non-pregnant women, single males, male
partners, the general public, and healthcare providers
Geographic location(s): TX, FL, New York City, Los Angeles, Chicago, Puerto Rico
3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)
Consumers in CONUS will receive $25 to participate in a 60-minute online interview. Consumers in
Puerto Rico will receive $75 for participation in an in-person 90-minute focus group. Providers in CONUS
and Puerto Rico will receive $75 to complete an online survey.
4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Focus group:
Individual in-depth interview (cognitive interview):
(CATI used: yes or no): Yes
Other (describe): Online data collection methods may also be used for surveys, focus groups, and interviews
5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)
CDC is developing and implementing an as-needed mechanism to collect qualitative and quantitative data
to provide rapid feedback on new messages developed by CDC’s Joint Information Center (JIC)/
Emergency Operation Center (EOC) as part of its response to Zika virus disease. These Health Marketing
Service requests may be initiated for a variety of audiences. CDC is also developing focus groups for male
partners of pregnant women in Puerto Rico as part of this 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.)
Zika virus disease is an emergent health issue with serious health consequences particularly for pregnant
women and their fetuses. There is much that is still unknown about Zika virus disease but there is an
urgent need to disseminate critical preventive health information for risks that are currently known.
8. Number of burden hours requested: 342
BURDEN HOURS
No. of
Participation
Respondents Time
Category of Respondent
Burden
Screener
575
10/60
96.
Participants age >18
245
3
246
Totals
342.00
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)
Some of the questions in the information collection forms are adapted from HMTS question bank
questions.
*** 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
Print Form
File Type | application/pdf |
File Title | HMTS Expedited Review Form Domestic Readiness - Zika.pdf |
Author | fqv3 |
File Modified | 2017-01-19 |
File Created | 2017-01-18 |