In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study
In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study
Appendix E_Screening Questionnaires__final_4_2_19
In-Home Food Safety Behaviors and Consumer Education: Annual Observational Study
OMB: 0583-0169
Appendix E:
Screening
Questionnaires
Appendix E1:
Web-Based Screening Questionnaire
Screen 1
Thank you for your interest in our research study, which is funded by the U.S. Department of Agriculture and conducted by researchers from North Carolina State University and RTI International.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0169 and the expiration date is xx/xx/xxxx. The time required to complete this information collection is estimated to average 8 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.
Screen 2
If you are eligible for the study, you will be asked to prepare a meal using pre-packaged frozen foods while being videotaped and participate in an interview. The study will last up to 90 minutes, and you will receive a $75 gift card and a small gift for taking part in the study.
To determine whether you are eligible, you will need to answer a few questions. These questions will take less than 10 minutes to complete. Your participation in this study is completely voluntary. All of your answers and your contact information will be kept private. Please click the “>>” arrows below if you would like to continue.
Question Screens
Have you received any type of food safety training, such as ServSafe, in the past 5 years?
Yes Ineligible. Terminate.
No
Have you cooked or worked professionally in a food preparation setting in the past 5 years?
Yes Ineligible. Terminate.
No
Yes Ineligible. Terminate.
No
Do you have any children living in your household who are less than 18 years of age?
Yes
No
Which of the following have you purchased in the past 6 months for your family to eat at home? (Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
Which of the following have you prepared at home in the past 6 months? (Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken breasts, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
[IF Q4 = YES] Which of the following have your children, 18 years or younger, prepared at home in the past 6 months? (Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken breasts, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
NOTE: Continue if Q6 = frozen breaded chicken nuggets/tenders or frozen stuffed chicken breasts OR Q7 = frozen breaded chicken nuggets/tenders or frozen stuffed chicken breasts (i.e., respondent or their child prepares these products).
How often do you prepare frozen breaded chicken nuggets or tenders for your family to eat at home?
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
How often do you prepare frozen stuffed chicken breasts for your family to eat at home?
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
[IF Q4 = Yes] How often do your children, 18 years or younger, prepare frozen breaded chicken nuggets or tenders to eat at home?
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
[IF Q4 = Yes] How often do your children, 18 years or younger, prepare frozen stuffed chicken breasts to eat at home?
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
When cooking a food product at home for the first time, how often do you read the cooking instructions on the package before you start cooking?
Always
Most of the time
Sometimes
Hardly ever
Never
Which of the following items do you have in your kitchen? (Select all that apply.)
Chef’s knife
Garlic press
Citrus zester
Food thermometer
Manual can opener
Vegetable peeler
Cheese grater
Wine opener
None of the above
Do you identify as …?
Female
Male
Other
Prefer not to answer
Are you…?
Hispanic or Latino
Not Hispanic or Latino
What is your race? Please select one or more.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
What is the highest level of education that you have completed?
Less than high school
High school graduate or GED
Technical or vocational school
Some college, but did not get a degree
2-year associates degree
4-year college degree
Post-graduate degree
Are you or any members of your household …? (Select all that apply.)
60 years of age or older
5 years of age or younger
Pregnant
Breastfeeding
Diagnosed with an allergy to any food or food ingredient
Diagnosed with diabetes or kidney disease
Diagnosed with a condition that weakens the immune system, such as cancer, HIV, or AIDS; a recipient of a transplant; or receiving treatments, such as chemotherapy, radiation, or special drugs or medications to treat these conditions
None of the above
Where did you hear about this study?
Craigslist
Email from a North Carolina extension program
Sign
Specify location: __________________________
Other
Specify location: __________________________
Don’t know
Great! You qualify for the study. Would you like to participate in the Convenience Food Study?
Yes
No Terminate.
Contact Screen 1
Great! Please enter your name and telephone number so that a study team member can call you and schedule an appointment for the Convenience Food Study at a day and time that works best for you. The study will last up to 90 minutes, and you will receive a $75 gift card and a small gift for taking part in the study.
[ENTER NAME]
[ENTER TELEPHONE NUMBER]
Contact Screen 2
Please enter your email address so we can send you a confirmation email with directions. [ENTER EMAIL ADDRESS; REQUIRE DOUBLE ENTRY FOR VERIFICATION].
No Email
[If no email] Please enter your mailing address. [STREET ADDRESS, CITY, NC, ZIP]
Thank you for your time. A study team member will call you in 1 or 2 days to schedule an appointment with you.
If you have any questions about the study or scheduling, you may contact Lisa Shelley at 919-659-8254. If you have concerns about your rights as a research participant, contact North Carolina State University’s Office of Research Protection at 919-515-8754 or via email at irb-director@ncsu.edu.
Ineligible/Terminate Screen
Thank you for your time. Unfortunately, you are not eligible to take part in our study. Have a great day.
Appendix E2:
Telephone Screening Questionnaire
Hello. My name is _______________. Thank you for your interest in our research study, which is funded by the U.S. Department of Agriculture and conducted by researchers from North Carolina State University and RTI International.
If you are eligible for the study, you will be asked to prepare two recipes while being videotaped and participate in an interview at a day and time convenient for you. The study will last no more than 90 minutes, and you will receive $75 and a small gift for taking part in the study.
To determine whether you are eligible, I need to ask you a few questions. These questions will take less than 10 minutes to complete. Your participation in this study is completely voluntary. All of your answers and your contact information will be kept private.
May I please ask you a few questions to determine whether you are eligible to participate in our study?
Yes
NoRefusal. Terminate.
Have you received any type of food safety training, such as ServSafe, in the past five years? (Select one.)
Yes Ineligible. Terminate.
No
Have you cooked or worked professionally in a food preparation setting in the past five years? (Select one.)
Yes Ineligible. Terminate.
No
Have you participated in any research studies about cooking in the past 2 years?
Yes Ineligible. Terminate.
No
Do you have any children living in your household who are less than 18 years of age?
Yes
No
Which of the following have you purchased in the past 6 months for your family to eat at home? (Read list. Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
Which of the following have you prepared at home in the past 6 months? (Read list. Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken breasts, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
[IF Q5 = YES] Which of the following have your children, 18 years or younger, prepared at home in the past 6 months? (Select all that apply.)
Frozen pizza
Frozen waffles
Frozen breaded chicken nuggets or tenders
Frozen stuffed chicken breasts, such as chicken Cordon bleu or chicken Kiev
Frozen pre-formed hamburger patties
Frozen vegetables
Frozen fruit
NOTE: Continue if Q7 = frozen breaded chicken nuggets/tenders or frozen stuffed chicken breasts OR Q8 = frozen breaded chicken nuggets/tenders or frozen stuffed chicken breasts (i.e., respondent or their child prepares these products).
How often do you prepare frozen breaded chicken nuggets or tenders for your family to eat at home? (Read list. Select one.)
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
How often do you prepare frozen stuffed chicken breasts for your family to eat at home? (Read list. Select one.)
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
[IF Q5 = Yes] How often do your children, 18 years or younger, prepare frozen breaded chicken nuggets or tenders to eat at home? (Read list. Select one.)
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
[IF Q5 = Yes] How often do your children, 18 years or younger, prepare frozen stuffed chicken breasts to eat at home? (Read list. Select one.)
Less than once a month
About once a month
Two or three times a month
About once a week
More than once a week
When cooking a food product at home for the first time, how often do you read the cooking instructions on the package before you start cooking? (Read list. Select one.)
Always
Most of the time
Sometimes
Hardly ever
Never
Which of the following items do you have in your kitchen? (Read list. Select all that apply.)
Chef’s knife
Garlic press
Citrus zester
Food thermometer
Manual can opener
Vegetable peeler
Cheese grater
Wine opener
None of the above
Do you identify as …? (Select one.)
Female
Male
Other
Prefer not to answer
Are you…? (Select one.)
Hispanic or Latino
Not Hispanic or Latino
What is your race? (Read list. Select all that apply.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
What is the highest level of education that you have completed? (Select one.)
Less than high school
High school graduate or GED
Technical or vocational school
Some college, but did not get a degree
2-year associates degree
4-year college degree
Post-graduate degree
Are you or any members of your household …? (Read list. Select all that apply.)
60 years of age or older
5 years of age or younger
Pregnant
Breastfeeding
Diagnosed with an allergy to any food or food ingredient
Diagnosed with diabetes or kidney disease
Diagnosed with a condition that weakens the immune system, such as cancer, HIV, or AIDS; a recipient of a transplant; or receiving treatments, such as chemotherapy, radiation, or special drugs or medications to treat these conditions
None of the above (DO NOT READ)
Where did you hear about this study? (DO NOT READ. Select all that apply.)
Craigslist
Email from a North Carolina extension program
Sign
Specify location: __________________________
Other
Specify location: __________________________
Don’t know
Great! You qualify for the study. Would you like to participate in the study?
Yes
No Terminate.
Great! We are conducting the study the week of [DATE] between [TIME] and [TIME]. The study will last no more than 90 minutes, and you will receive $75 and a small gift for taking part in the study. What day and time is convenient for you to participate?
[SCHEDULE DAY AND TIME]
I have you scheduled for [DATE] at [TIME]. Your participation will take up to 90 minutes. The study will be held on NC State’s campus. May I please have your name, telephone number, and email address so we can send you a confirmation email with directions?
[ENTER NAME]
[ENTER TELEPHONE NUMBER]
[ENTER EMAIL ADDRESS].
Thank you for your time.
If you have any questions about the study or need to reschedule or cancel, you may contact [NAME] at [PHONE NUMBER]. If you have concerns about how participants are being treated in the study, you may contact North Carolina State University’s Office of Research Protection at 919-515-4514.
Ineligible/Terminate Screen
Thank you for your time. Unfortunately, you are not eligible to take part in our study. Have a great day.
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0169 and the expiration date is 06/30/2018. The time required to complete this information collection is estimated to average 8 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. |
Appendix E3:
Screenshots for Web-Based Version of Screening
Questionnaire
Ineligible/Terminate Screen
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
© 2024 OMB.report | Privacy Policy