24 Attachment 25-2 AHS Phase IV Health Follow-up CATI Proxy

Agricultural Health Study: A Prospective Cohort Study of Cancer and Other Diseases Among Men and Women in Agriculture

Attachment 25-2. AHS Phase IV Health Follow-Up CATI Participant Survey Script

Phase IV Follow-up CAWI Survey, CATI Script or Paper/Pen

OMB: 0925-0406

Document [pdf]

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25-2. AHS Phase IV Health Follow-Up CATI Participant Survey Script

OMB No.: 0925-0406
Expiration Date: 09/30/2016
Collection of this information is authorized by The Public Health Service Act (42 USC 285l). Rights of study
participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for
not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in
any way. The information collected in this study will be kept private to the extent provided by law. Names and
other identifiers will not appear in any report of the study. Information provided will be combined for all study
participants and reported as summaries. You are being contacted by mail or telephone to complete the health
follow-up survey for members of the Agricultural Health Study because continued involvement in this study can
help us learn more about how agricultural and environmental factors may affect the health of farmers and their
families.
Public reporting burden for this collection of information is estimated to average 25 minutes per response for
members of the Agricultural Health Study cohort and about 10 - 15 minutes per response for those answering
on behalf of the cohort member, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925-0406). Do not return the completed form to this address.

AHS_PhIV_AU_ScrnShots_20160226.docx

AHS PHASE IV - CATI CALL SCRIPT
MAIN INTRODUCTION
MN1.

Hello, this is [INTERVIEWER NAME] calling on behalf of the Agricultural Health
Study. May I please speak with [Mr/Ms] [FIRST/LAST NAME/SUFFIX]?
YES...........................................[STS1]................................1
NOT AVAIL/TEMP ILL
BY R OR PROXY.......... [APPT/CB] ............................2
WRONG NUMBER [WN] ............ ......................................3
DECEASED ............................ [DEC1] ...............................4
TOO ILL/INCAPABLE
PERM BY PROXY ............. [MN2] ................................5

[IF PERSON WITH WHOM YOU ARE SPEAKING EXPLICITLY VOLUNTEERS
THAT R IS PERMANENTLY INCAPABLE OF PARTICIPATING, ENTER “5” AND
PROCEED TO “TOO ILL/INCAPABLE PERMANENTLY” BLOCK; IF NOT SURE IF
R IS PERMANENTLY UNABLE TO PARTICIPATE, ASK MN2:]
MN2.

Will [Mr/Ms] [FIRST/LASTNAME], be available sometime over the next
month or so to talk with us about possibly participating in a follow up
interview for the Agricultural Health Study?
YES ................................ [APPT/CB] ............................1
NO ....................................... [ILL1] ................................2

SET THE STAGE
STS1.

Occasionally, we contact everyone in the Agricultural Health Study to update
information about their health. Now is the time for our next follow up.
Involvement of people, just like you, helps us learn about how agricultural and
environmental factors may affect the health of farmers and their families.
Did you receive the follow up questionnaire in the mail?
YES..........................................[STS3]................................1
NO ...........................................[STS2]................................2

STS2.

I have your mailing address as [MAILADD1]. Is this correct?
YES......................................................................................1
NO .............................[UPDATEMAILADD1] ..................2

STS3.

We can complete the interview by phone now, or we can schedule a time that is
more convenient for you. The call should take approximately 25 minutes.
YES, COMPLETE CATI NOW [STS4] ..............................
YES, COMPLETE CATI LATER [APPT/CB]....................

08/30/2012

1
2

NO, PLEASE RE-MAIL HARD COPY ....................... [STS3a]

STS3a.

We will mail the study letter and another copy of the questionnaire. Please return
it in the envelope provided to you. The letter will also include your username
and password to complete this survey online if that is your preference. If you
have any questions, or decide you would prefer to complete the follow up by
phone, please call our toll-free number 1-XXX-XXX-XXXX. Thank you for
your time. [END CALL]

STS4.

Do you have any questions before we begin?
YES .............................................................................1
NO............................................................................... 2

[IF STS4 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]

08/30/2012

TOO ILL/INCAPABLE PERMANENTLY
ILL1.

I am very sorry to hear that. Occasionally, we contact everyone in the
Agricultural Health Study to update information about their health. Now is the
time for our next follow up. It is important for us to get this information so we
can continue to learn about how agricultural and environmental factors may
affect the health of farmers and their families. Would you be willing to answer
some questions about his/her health? This call should take approximately 15
minutes.
YES, COMPLETE NOW [ILL2]........................1
YES, SCHEDULE CB [APPT/CB] ....................2
NO ........................... [ILL3] ................................2

ILL2.

[IF ILL2 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
ILL3.

Is there someone else we might call you could answer our questions?
YES .............................................................................1
NO [REF2].................................................................. 2

[IF ILL3 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION
FOR PROXY/END CALL]

08/30/2012

DECEASED
DEC1.

I am very sorry to hear that. We try to contact everyone in the Agricultural
Health Study to update information about their health, and now is the time for
our next follow up. It is important for us to get this information, especially
regarding those who have passed away, so we can continue to learn about how
agricultural and environmental factors may affect the health of farmers and their
families. Would you be willing to answer some questions about his/her health up
to the time he/she died? This call should take approximately 15 minutes.
YES, COMPLETE NOW [DEC2] ......................1
YES, SCHEDULE CB [APPT/CB] ....................2
NO .......................... [DEC3] ...............................2

DEC2.

[IF DEC2 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
DEC3.

[IF DEC3 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION
FOR PROXY/END CALL]

08/30/2012

REFUSAL
REF2. [IF PARTICIPANT/PROXY HAS NOT OFFERED A REASON OF REFUSAL

ASK: Would you be willing to tell me why you do not want to participate at this time?]
I DON’T HAVE ENOUGH TIME..............................................................1
I AM TOO ILL TO PARTICIPATE ...........................................................2
I’M JUST NOT INTERESTED ..................................................................3
I DON’T WANT TO BE IN THE AG HEALTH STUDY AT ALL ............. 4
OTHER..........................................................[REF2sp]..............................5
REF2sp.

[SPECIFY OTHER REASON FOR REFUSAL]

[REFER TO QUESTIONS AND CONCERNS DOCUMENT FOR REFUSAL CONVERSION]

REF3. (We will try to call you at some point in the future in case things change.) Thank you for

your time. Have a good (day/afternoon/evening). [END CALL]

[IF R EXPLICITLY STATES THAT WE SHOULD NOT CALL BACK, RECORD
THE REQUEST IN THE COMMENTS FOR THIS CALL]

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
MAILADD1 = ADDRESS SENT IN SMS
PRE-LOAD MAILADD1 DATA FROM WESTAT

UA1. What part of the address is incorrect?
[MAILADDRESS1]
[MAILADDRESS2]
[CITY], [ST] [ZIP]
CHECK ALL THAT APPLY
STREET ADDRESS
CITY
STATE
ZIP
*IF UA1 INCLUDES STREET ADDRESS*
UA1a. What is your correct street address?
ENTER FIRST LINE OF STREET ADDRESS
*IF UA1 INCLUDES STREET ADDRESS*
UA1b. (What is your correct street address?)
ENTER SECOND LINE OF STREET ADDRESS, IF NECESSARY, OR PRESS
[ENTER] TO SKIP
 IF CITY/STATE/ZIP ALL CORRECT, GO TO UA1f
*IF UA1 INCLUDES CITY*
UA1c. What is the correct city for this address?
ENTER CITY
 IF STATE AND ZIP CORRECT, GO TO UA1f
*IF UA1 INCLUDES STATE*
UA1d. What is the correct state for this address?
ENTER STATE
 IF ZIP CORRECT, GO TO UA1f
*IF UA1 INCLUDES ZIP*
UA1e. What is the correct ZIP code for this address?
ENTER ZIP CODE

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
“PHONE1” IS THE NUMBER RECEIVED FROM WESTAT AND CAN ONLY BE UPDATED
THROUGH THE WRONG NUMBER MODULE
“ALTPHONE1” IS ADDED WHEN A PARTICIPANT REPORTS THERE IS A BETTER
NUMBER TO REACH HIM OR HER – ADDING AN ALTPHONE1 DOES NOT OVERRIDE
PHONE1
UALTP1a.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER AREA CODE AS ###
UALTP1b.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER PREFIX AS ###
UALTP1c.

Can you please give me a better telephone number to reach you, starting with area code?

ENTER LINE AS ####

08/30/2012

AHS PHASE IV - CATI CALL SCRIPT
**NOTE: MN1 is the starting point of all interviews as it is defined as the initial question in the
standard scheduler for all CATI instruments. To accommodate this, the program will rely on a
flag to recognize whether a case is a new contact or a resumption of a previous contact. The
script below assumes that this flag indicates the case is being re-entered.
MN1.

Hello, this is [INTERVIEWER NAME] calling on behalf of the Agricultural Health
Study. May I please speak with [Mr/Ms] [FIRST/LAST NAME/SUFFIX]?
YES [IF STS3, ILL1 OR DEC1 = 2, GO TO CB2, IF STS3, ILL1 OR
DEC1 = 3, GO TO CB3]........... ......................................1
NOT AVAIL/TEMP ILL
BY R OR PROXY......... [APPT/CB1] ...........................2
WRONG NUMBER [WN] ............ ......................................3
DECEASED ............................ [DEC1] ...............................4
TOO ILL/INCAPABLE
PERM BY PROXY ............. [MN2] ................................5

CB1.

When would be a good time to reach him/her?
CONTINUE

CB2.

Good [morning/afternoon/evening]. (This is [INTERVIEWER NAME] calling on behalf
of the Agricultural Health Study.) We spoke to you earlier about participating in this
study.
CONTINUE

CB3.

 [APPT/CB]

 [LAUNCH CATI]

Good [morning/afternoon/evening]. Recently, we mailed you a copy of the AHS follow
up questionnaire. We have not yet received this from you. I am calling to complete the
interview by phone. This call will take approximately (15/25) minutes.
YES, COMPLETE NOW [CB4].........................1
YES, SCHEDULE CB [APPT/CB] ....................2
NO ........................... [CB5].................................2

CB4.

Do you have any questions before we begin?
YES .............................................................................1
NO .......................................................................... 2

[IF CB4 = 1, THEN INTERVIEWER REFER TO FAQS AND CONTINUE]
CB5.

Is there someone else we might call you could answer our questions?
YES .............................................................................1
NO [REF2] ............................................................. 2

[IF CB5 = 1, THEN INTERVIEWER RECORD NAME AND CONTACT INFORMATION
FOR PROXY/END CALL]

08/30/2012

WRONG NUMBER SCRIPT
WN1. Is this [PHONE NUMBER]?
YES
NO



GO TO WN3

WN2. Our records show that [PS NAME] lives at this number. Is this correct?
YES
NO, BUT KNOWS HOW TO CONTACT R
NO, DON’T KNOW R
WN3.

 GO TO MN1
 GO TO WN4
 GO TO WN4

Phone number: [PHONE NUMBER]
I apologize for the inconvenience. I do need to redial this number in order to determine the source
of the problem. If your phone should ring, please answer it. Thank you.
HANG UP AND RE-DIAL NUMBER.
SAME PERSON
DIFFERENT PERSON

WN4.

 GO TO WN5

I’m sorry to have disturbed you. Thanks (again) for your help. Goodbye.
*IF WN2 = KNOWS HOW TO CONTACT R*
RECORD NEW CONTACT INFORMATION AND GIVE TO SUPERVISOR
WHAT IS WRONG WITH THIS NUMBER?
DOUBLE WRONG NUMBER
R NOT KNOWN AT THIS NUMBER
NEW CONTACT INFO FOR R OBTAINED

WN5.

Have I reached [PHONE NUMBER]?
CORRECT
INCORRECT

WN6.

 Record Comments. END.
 Record Comments. END.
 Record Comments. END.

 GO TO MN1

I’m sorry to have disturbed you. Thanks (again) for your help. Goodbye.
CONTINUE

WN7. WHAT IS WRONG WITH THIS NUMBER?
DOUBLE WRONG NUMBER
R NOT KNOWN AT THIS NUMBER
NEW CONTACT INFO FOR R OBTAINED

08/30/2012

 Record Comments. END.
 Record Comments. END.
 Record Comments. END.

File Type	application/pdf
File Title	Microsoft Word - AHSPhaseIV_OMB_TitlePage_PptCATI_21Mar2016
Author	erevak
File Modified	2016-03-21
File Created	2016-03-21