1 Cognitive Interview Informed Consent

Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA)

Cognitive Interview Informed Consent_1.6.2020 Submission

OMB: 0915-0379

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Informed Consent - Cognitive Interview


What is the purpose of this cognitive interview?


John Snow, Inc. (JSI), an independent public health firm, has been contracted by HRSA (Health Resources and Services Administration) to develop an employee well-being, burnout, and job satisfaction survey for use in HRSA-funded Health Centers called the HRSA Health Center Workforce Survey. The purpose of this cognitive interview is to gather health center employee feedback on questions included in the draft HRSA Health Center Workforce Survey, such as clarity or wording of the questions, and to update the questions based on the feedback provided. JSI will ask you to complete the draft HRSA Health Center Workforce Survey prior to your scheduled cognitive interview. During the interview, you will be asked about the survey questions and if the wording and purpose makes sense, and what can be made more clear. The information that we gather will help us to build a more valid and comprehensive survey that will provide useful information for health center administrators and HRSA to enhance workforce well-being, recruitment, retention, and patient quality of care. Participation in the cognitive interview should take approximately 90 minutes of your time, including the time to complete the survey.


How will my responses be used?


Your responses during the cognitive interview will help HRSA and JSI develop and refine the HRSA Health Center Workforce Survey to ensure that the questions are understandable and elicit a response that is aligned with the question. This refinement will help prepare the final survey for dissemination nationally across all 1,400 HRSA funded health centers for the purpose of assessing the causes, effects, and extent of employee burnout, well-being, and job satisfaction. Data from the final HRSA Health Center Workforce Survey will provide individual health centers and HRSA with valuable information on health center workforce well-being related to these factors so that targeted efforts to improve identified areas of need can be provided.

We strive to keep the information you tell us in the cognitive interview as confidential as possible by not sharing your name, Health Center, or any individual answers to any persons outside of the JSI project staff. JSI will protect your privacy by not reporting results in ways that could directly identify participants. Instead we will only report on themes and summaries of answers participants give.


What is the risk of taking part in the cognitive interview?


There are few risks. You will be asked to complete the draft HRSA Health Center Workforce Survey prior to the interview and asked questions about elements of those questions during the interview. If any of these questions make you feel uncomfortable, you can choose not to answer. JSI will keep all answers private to prevent any risk to your professional relationships.


What are the benefits of taking part in the cognitive interview?


The answers you provide during the cognitive interview will help refine an instrument that will help HRSA and JSI better understand the causes, impact and extent of burnout, well-being, and job satisfaction for health center employees. Feedback from the cognitive interviews will help us to build a more valid HRSA Health Center Workforce Survey to be used by Health Centers across the country to enhance workforce well-being. As a token of appreciation for your participation, you will be sent a $100 electronic-gift card.


Who should I call if I have questions?


On behalf of HRSA, this project is directed by Thomas Mangione, PhD at JSI. You may call him at (617) 385-3839 if you have questions about this activity. If you have questions about your rights as a participant or if you feel you have been harmed, call Laurie Kunches, PhD, Chair of the JSI Institutional Review Board at (617) 385-3735.


Can I refuse to be part of the cognitive interview?


Participation in the session is up to you. Your decision to participate or not has no effect on your employment. Also, you can decide not to answer any question during the interview as you choose. However, by participating and sharing your opinions/experiences, you will help us to build a more valid survey.


Do I need to sign the Consent Form?


There is no need to sign and return this document. Your participation in the cognitive interview will serve as your agreement to the information provided in this informed consent document.



Cognitive Interview Informed Consent

HRSA Health Center Workforce Survey

OMB Control No. 0915-0379

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAnn Keehn
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File Created2023-12-11

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