OMB Memo

Generic Information Collection Request

Request: The Census Bureau plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725) on behalf of the National Center for Health Statistics (NCHS). We propose to conduct an iterative cognitive evaluation of select questions, adapted for self-administered web, from the CAPI National Health Interview Survey (NHIS). NHIS consists of both the Adult and Child questionnaires; we will only be focusing on the adult questionnaire. The anticipated launch of a self-administered web mode for NHIS Adult and Child is scheduled to be in 2028, but the timeline is dependent on funding. As a part of this current submission, we are seeking approval for cognitive interviews conducted by Census Bureau staff. As the collection agent for NCHS, the Census Bureau will protect all data under the Confidential Information Protection and Statistical Efficiency Act or CIPSEA (44 U.S.C. 3561-3583).

Purpose: The cognitive testing goal is to test an adapted self-administered web mode of the NHIS, which is currently computer assisted personal interviewing (CAPI). Starting in 2028, the NCHS is planning to add a self-administered web mode to its existing data collection for the NHIS. NCHS has asked the Center for Behavioral Science Methods (CBSM) to conduct recruitment and cognitive interviews designed to evaluate an adapted version of the self-administered web mode. The purpose of the cognitive pretesting is to determine if participants are able to comprehend the questions and answer reliably and accurately in a self-administered mode.

Topic areas for pretesting include:

• Roster

• Household Composition

• Cardiovascular Conditions

• Cancer

• Diabetes

• Other Chronic Conditions

• Health Insurance

• Utilization

• Immunization

• Cigarettes and e-cigarettes

• Marital status

Population of Interest: To test the adapted self-administered web instrument, we will recruit a total of 40 participants aged 18 and above. We will strive to recruit a sample with a variety of demographic characteristics, including different ages, formal education levels, household sizes, and geographic areas.

Timeline: Testing will be conducted iteratively from May 2025 through December 2025. Recruiting will start in May 2025 after OMB approval.

Language: Testing will be conducted in English only.

Method: We will conduct remote user sessions using video conferencing software (Microsoft Teams) with up to 40 English-speaking participants. Participants will be able to complete the session using either a computer or smartphone.

Instructions on how to install Microsoft Teams will be sent as an attachment to the confirmation email once an interview has been scheduled (see Attachment I). All participants will also receive a link to a consent form to sign before the interview begins. Interviewers will use the scripted protocol seen in Attachment II. Participants will also give oral consent at the start of the interview.

Each interview will be 60 minutes in length. This will allow time for the participant to complete the select questions from the NHIS-Adult questionnaire and be administered a set of in-depth retrospective probes about a subset of questions. From prior experience, we anticipate needing to screen approximately 120 individuals to yield the 40 desired interviews.

Sample: Participants will be aged 18 and above. We plan on testing 40 participants. In addition to covering a spectrum of demographic characteristics, we aim to recruit participants who are aged 65 and older, live in households with extended family or unrelated roommates, live with at least one other adult 18 years or older who is not a spouse or partner, or received food stamps or government assistance for rent payments. There will be two rounds of testing with 20 participants in each round. Recruiting will begin one week prior to starting interviews and will last the duration of the round. Interview rounds will last four weeks.

Recruitment: Cognitive interview participants will be recruited using the following: Bureau of Commerce (BOC) broadcast email sent to Census employees, listservs, social media, and personal networks. See Attachment I for the language to be used in recruitment advertisements and for the eligibility screener. The screener will be available as a self-response web instrument, and a recruiter administered instrument should participants prefer to call in. Participants will receive information by email to remind them of their interview time and to sign the consent form.

Protocol:

Researchers from the Center for Behavioral Science Methods (CBSM) at the U.S. Census Bureau will carry out the cognitive interviews remotely. Between three and four staff members will be trained to conduct the interviews to allow flexibility in interview scheduling. All interviewers will be required to demonstrate a strong understanding of the interview protocol before beginning interviews. With participant permission, interviewers will record the screen containing the virtual session. This will allow interviews to review participants’ responses to the self-administered survey as well as verbal responses to probes when writing summaries and conducting analysis. The CBSM project leader will conduct interviewer training, supervise staff, and monitor data quality throughout the data collection period.

During each interview, regardless of round, participants will be instructed to self-respond to the web instrument (see Attachment III for the subset of the NHIS-Adult questionnaire to be administered). Participants will be instructed to think aloud as they respond to the survey, offering insight into their thought process and allowing interviewers to observe whether any questions are potentially problematic; the survey will be programmed in both Qualtrics and Questionnaire Design and Metadata (QDM) System. The interviewer will observe the participant as they answer the survey items, noting any questions or problems the participant has with regards to particular items. After completing the survey, participants will be asked a set of probing questions about some of the survey items, and about any questions or problems the participant had when answering the main survey questions. After all probing questions, interviewers will ask a set of debriefing questions. The survey questions will be iteratively tested within each of the two rounds, with the protocol and question wording being adapted based on the results from the previous round. See Attachment II of this submission for the full cognitive interview protocol.

Cognitive interviewing techniques allow researchers to evaluate potential response error and to assure that the survey provides valid data. In general, the goal of cognitive testing is to assess the participants’ comprehension of the questionnaire items, including question intent and the meaning of specific words and phrases in the item. Data from cognitive interviews can identify potentially problematic questions that are not understood as intended. This testing can also examine the participants’ retrieval of relevant information from memory, decision processes involved with answering a question, and questions that are difficult to answer due to cognitive burden.

Because the survey will be administered on the web, the cognitive interviews will assess issues such as:

• The subject’s understanding of terms, especially when reading rather than listening to the questions being read

• How they remembered the information they provided in factual questions

• Whether they found a response choice that fit their answer

• How easy or difficult it is to answer a question

• Issues with sensitive questions

• Consistency of answers within the questionnaire and in comparison to the expected range of answers

Use of Incentive: To ensure that we can recruit participants from all desired populations, and to thank them for completing the interview, each participant will be offered a $40 incentive to be redeemed digitally. After completion of the interview and signing of the consent form, the project lead will email a link to the participant for them to redeem their $40 digital incentive.

Estimate of Hourly Burden

Exhibit 1 summarizes the number of interviews to be conducted for both rounds, as well as the recruitment burden. Each interview will be 60 minutes in length and will allow time to complete a subset of NHIS-Adult questions and administer a set of in-depth retrospective probes about the survey questions. From prior experience, we anticipate needing to screen approximately 120 individuals to yield the 40 desired interviews.

Exhibit 1. Estimated Participants Burden of Cognitive Interviews

Response Type	Number of Participants	Burden Hours per Participant	Total Burden hours*
Recruitment Screener	120	.17	20
Consent Procedure/ Installation of Software	40	.17	7
Cognitive Interview	40	1	40
Total Burden Requested	120		67

*Some numbers have been rounded.

The contact person for questions regarding data collection and statistical aspects of the design of this research is listed below:

Kathleen Kephart

Center for Behavioral Science Methods

U.S. Census Bureau

Washington, D.C. 20233

(301) 763-8891

Kathleen.m.kephart@census.gov

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