Campaign to Increase Postpartum Depression Symptom Reporting. Office on Women's Health, Division of Strategic Communications

ID # __________

OWH Quantitative Survey: SCREENER FOR RECRUITERS
2022 Video Testing for PPD Campaign

Hello, my name is ___________________ I am with ___________________, a marketing research firm.
On behalf of NORC at the University of Chicago, LTG Associates and the U.S Office on Women’s Health, we
are recruiting women across the nation to share their feedback on messages and materials for a campaign
being developed for new moms. The survey will be conducted online. We’d like to ask you some screening
questions to see if you qualify to participate.
Everything you say is private. You can choose not to answer any question and you can stop the screener at
any time. Your answers will be kept separate from your name and other identifying information. We assign a
number to your answers instead of using your name.

1. How old are you? ……………………………………………_____________ RECORD AGE
a. Less than 18

1 THANK & TERMINATE

b. 18-44

2 CONTINUE

c. 45 or Over

3 THANK & TERMINATE

d. Refused

99 THANK & TERMINATE

2. Have you given birth to a baby in the past year (12 months)?
a. Yes

1 CONTINUE

b. No

2 THANK & TERMINATE

c. Not a live birth or baby is deceased

3 THANK & TERMINATE

[TERMINATION SCRIPT]: Thank you for your time today. Unfortunately, you are not eligible to participate in
this survey. We appreciate your participation. If you have questions, you can contact
momshealth@norc.org. Thank you!

ID # __________

IF ELIGIBLE:
Thank you for answering my questions. We will be capturing feedback from moms like you to help create a
special health campaign for new moms focusing on postpartum feelings. The survey will be conducted
online and should take about 25 minutes to complete. Questions will ask you about your experience being a
mom with your new baby and your feelings during this time. You will see some images and text and share
your feelings about them.
The topics have the possibility to bring up sensitive emotional responses. If any uncomfortable feelings
come up, you can take a break or leave at any time. We want everyone to participate in a way that makes
them comfortable, and we want to know if anything we share might trigger difficult emotional responses.
Do you agree to participate in the online survey?
Yes

1

No

2 → THANK & TERMINATE

Do you have any questions for me at this time?
If you need help with any serious mental health or emotional concerns, or are concerned about your drug or
alcohol use, call 911 in case of emergency. I also have some contact information for organizations that
provide free and confidential help. Would you like for me to share that information with you at this time?
If you need to talk to someone about:
•

Feelings of depression, including

•

Sadness or crying most of the time

•

Feeling unconnected to your baby

•

Not being able to take care of yourself,
including sleeping, eating, or bathing

•

Getting help with a mental health
condition

•

Getting help with drug or alcohol use

•

Call or text:
•

Postpartum Support International
1-800-944-4PPD (4773) and leave a
message. A volunteer will call back as
soon as possible

•

Substance Abuse and Mental Health
Services Administration's national
helpline
1-800-662-HELP (4357)

Any type of crisis

•

Text HOME to 741741
from anywhere in the USA

•

Thoughts of hurting or killing yourself

•

•

Thoughts of hurting your baby or
anyone else

National Suicide Prevention Lifeline
1-800-273-TALK (8255)

•

911

Should you have any other questions, you may contact the New Mom’s Health and Wellness Team
at momshealth@norc.org or 1-877-229-4783.