Attachment 13d List of Changes in 2022 Field Test Questionnaire

Attachment 13d: List of Changes in 2022 Field Test Questionnaire

Proposed Action/ Justification	Current question	New question
Health Care Access
The question was used to replace the previous health care coverage question in the 2021 BRFSS core and continues in use for 2022. The phrase “health care coverage” was changed to “health Insurance” to improve understanding of the term by respondents.	What is the current primary source of your health insurance?
This question was used through 2020 as the BRFSS core question. It will be used in the field test with the preceding question to capture respondents with health care coverage.		Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, or Indian Health Service?
Cognitive Decline Optional Module Changes:
The introduction was shortened to: Reduce time needed to administer. Remove mention of specific activities from the current introduction (i.e. “forgetting how to do things you’ve always done”). These activities were removed to avoid priming respondents to answer one way or another.	Introduction: The next few questions ask about difficulties in thinking or remembering that can make a big difference in everyday activities. This does not refer to occasionally forgetting your keys or the name of someone you recently met, which is normal. This refers to confusion or memory loss that is happening more often or getting worse, such as forgetting how to do things you’ve always done or forgetting things that you would normally know. We want to know how these difficulties impact you.	Introduction: The next few questions ask about difficulties in thinking or memory that can make a big difference in everyday activities. We want to know how these difficulties may have impacted you.
The revised wording: Removed “confusion.” Current research on subjective cognitive decline (SCD) does not suggest confusion is a major component of SCD. “Difficulties with thinking or memory” was a specific suggestion for phrasing by the individuals living with early-stage dementia and reflected how they would have first described their subjective symptoms with cognition.	1. During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse? Yes No [Go to next module] Don’t Know [Go to Q2] Refused [Go to next module]	Q1. During the past 12 months, have you experienced difficulties with thinking or memory that are happening more often or are getting worse? Yes No [go to next module] Don’t know [go to next module] Refused [go to next module]
This is a new question. Current research on subjective cognitive decline (SCD) suggests a strong correlation between those who express worry about their difficulties with thinking or memory and future risk of developing dementia. This data will further identify population burden of cognitive impairment.	n/a	Q2. Are you worried about these difficulties with thinking or memory? Yes No Don’t know Refused
Based on current research on subjective cognitive decline (SCD), the proposed activities listed align well with difficulties first noted by those experiencing SCD. Clinical researchers on the advisory group noted that the cognitive effort required for “paying bills” was different than the effort required to “clean.” Further, the input from those living with early-stage dementia cited “managing medications” and “paying bills” as two of the activities when they first noticed cognitive issues in themselves. “keeping track of appointments” was added as another example that required similar cognitive load. The decision to change “given up” to “interfered with” was to resolve the ambiguity around what “given up” meant. The advisory group noted that “interfered with” would be easier for respondents to answer.	2. During the past 12 months, as a result of confusion or memory loss, how often have you given up day-to-day household activities or chores you used to do, such as cooking, cleaning, taking medications, driving, or paying bills? Always Usually Sometimes Rarely Never Don’t Know Refused	Q4. During the past 12 months, have your difficulties with thinking or memory interfered with day-to-day activities, such as managing medications, paying bills, or keeping track of appointments? Yes No Don’t know Refused
This question was deleted. There was little difference in responses between current questions 2 and 3, indicating that past respondents viewed the question in similar terms. Similarly, the advisory group noted that in practical and programmatic terms, there is little difference between experiencing this kind of interference and need assistance for it.	3. As a result of confusion or memory loss, how often do you need assistance with these day-to-day activities? Always Usually Sometimes Rarely [Go to Q5] Never [Go to Q5] Don’t Know Refused CATI note: If Q3 = 1, 2, or 3, continue. If Q3 = 4 or 5, go to Q5.	n/a
This question was deleted. There are too many factors for why help is not received to be actionable. The advisory group noted that without additional information, it was not possible to utilize this data for programmatic action.	4. When you need help with these day-to-day activities, how often are you able to get the help that you need? Always Usually Sometimes Rarely [Go to Q5] Never [Go to Q5] Don’t Know Refused	n/a
This question was simplified to ascertain additional burden among those experiencing subjective cognitive decline (SCD). “engage in social activities” was removed due to mild confusion over what the phrase meant. “outside the home” was removed since respondents may work or volunteer from home.	5. During the past 12 months, how often has confusion or memory loss interfered with your ability to work, volunteer, or engage in social activities outside the home? Always Usually Sometimes Rarely [Go to Q5] Never [Go to Q5] Don’t Know Refused	Q5. During the past 12 months, have your difficulties with thinking or memory interfered with your ability to work or volunteer? Yes No Don’t know Refused
The change to “provider” is to align with other questions on the BRFSS. The proposed change of order — to move the question to third rather than last — is to improve the flow of questions and place similar/cascading questions next to one another.	6. Have you or anyone else discussed your confusion or memory loss with a health care professional? Yes No Don’t Know Refused	Q3. Have you or anyone else discussed your difficulties with thinking or memory with a health care provider? Yes No Don’t know Refused
COVID Vaccination Module Optional Module Changes
With new recommendations for additional and booster doses possible by 2023, some respondents could have received as many as 5 recommended doses	How many COVID-19 vaccinations have you received? 1 One 2 Two 3 Three 4 Four or more 7 Don’t know / Not sure 9 Refused	How many COVID-19 vaccinations have you received? 1 One 2 Two 3 Three 4 Four 5 Five or more 7 Don’t know / Not sure 9 Refused
Since the creation of this optional module, CDC has changed the definition of “up to date” for COVID-19 vaccination to include booster doses, so adding clarifying language to the question to explain that it includes booster doses and not just the initial COVID-19 vaccine series	Which of the following best describes your intent to take the recommended COVID vaccinations… Would you say you have already received all recommended doses, plan to receive all recommended doses or do not plan to receive all recommended doses?	Which of the following best describes your intent to take COVID vaccinations? Would you say you have 1 Already received all recommended doses, including boosters 2 Plan to receive all recommended doses 3 Do not plan to receive all recommended doses?
By 2023 it will be >2 years since most people received their initial vaccine series and the month of vaccination is no longer of interest	During what month and year did you receive your (first) COVID-19 vaccination?	Propose to eliminate question
By 2023 it will be >2 years since most people received their initial vaccine series and the month of vaccination is no longer of interest	During what month and year did you receive your second COVID-19 vaccination?	Propose to eliminate question
Emerging Core Long Term COVID Effects Changes.
2nd year module to assess chronic conditions related to COVID With the increased use of home tests over the past year, a health care provider might not have been involved in delivering positive test results. This question is the one used in the Census Bureau’s Household Pulse Survey fielded in June, 2022	1. Has a doctor, nurse, or other health professional ever told you that you tested positive for COVID 19	1. Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?” 1 Yes 2 No 7 Don’t know / Not sure 9 Refused
The 2022 question assessed period prevalence (from start of pandemic to survey date). Point prevalence will be more useful in 2023 for assessing health care needs because it will more closely reflect ongoing the burden of long-term symptoms as transmission wanes. Symptoms are only read by interviewer if necessary.	2. Did you have any symptoms lasting 3 months or longer that you did not have prior to having coronavirus or COVID-19?	2. Do you currently have symptoms lasting 3 months or longer that you did not have prior to having coronavirus or COVID-19? 1 Yes 2 No 7 Don’t know / Not sure 9 Refused
Assessment of functional impairment is necessary to describe the impact of long-term COVID effects and inform and inform the public health response. In 2023, assessing the impact of symptoms on daily activity is now a higher priority (has more information value), as frequencies of various symptoms following COVID will have been well-studied by then. This question will be used on the Census Bureau’s Household Pulse Survey in August/September 2022	3. Which of the following was the primary symptom that you experienced? Was it…. 1 Tiredness or fatigue 2 Difficulty thinking or concentrating or forgetfulness/memory problems…	(If yes to question 2) 3. Do these long-term symptoms reduce your ability to carry out day-to-day activities compared with the time before you had COVID-19?” 1 Yes 2 No 7 Don’t know / Not sure 9 Refused