PRAMS Interviewer Training Phase 6 Questionnaire

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PRAMS Interviewer TrainingPhase 6 Questionnaire
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1. Overview of PRAMS
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What is PRAMS?

• Pregnancy Risk Assessment Monitoring System

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PRAMS is

• A population-based surveillance system that
  collects state-specific data on maternal
  behaviors and experiences that occur before,
  during, and after pregnancy.
• Action oriented, meaning the data are used for
  policy and program.

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Background

• Established in 1987 as part of an Infant Health
  Initiative
• Congressional funding to CDC to establish
  state-based programs
• Initially 6 sites awarded funding
• Data collection began in 1988

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Goal

• Reduce infant morbidity and mortality and
  maternal morbidity by impacting
• maternal and infant health programs
• policies
• maternal behaviors

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Objectives of PRAMS

• To promote the collection of population-based
  data of high scientific quality
• To conduct methodological and content analyses
• To translate results into useable information
• To assist states in building capacity

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History of PRAMS 2009
2006
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States Participating in PRAMS, 2009
Newly funded in 2006
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PRAMS Methodology

• Standardized data collection protocol
• Don Dillmans Total Design Method multiple
  contacts improve response!
• Two or three mailed surveys
• Phone follow-up for non-responders

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Sampling

• Target population women who have had a recent
  live birth
• Frame file of birth certificate records
• Stratified samples (e.g., birth weight, race,
  geography)
• Monthly sample drawn 2-6 months after birth of
  infant

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Data Collection in States

• Multiple mailings each month
• Preletter introducing the survey
• Mail survey packet including response incentive
• Reminder/Thank you letter
• 2nd survey packet for nonresponders
• 3rd survey packet for nonresponders

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Data Collection in States

• Telephone follow-up
• 15 call attempts are made to each number before
  giving up
• Trying to reach a specific person need to use
  multiple and varied contacts
• Standardized, Web-based Computer Assisted
  Telephone Interviewing (Web-CATI) implemented in
  2006

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PRAMS Questionnaire

• 14-pages, booklet format for mail, modified
  version for phone surveys
• English and Spanish versions
• Core questions common to all states (75)
• State specific questions (25)
• Standard topic modules that states can select
  from
• State developed questions

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Selected Topics in PRAMS

• Prenatal care
• Folic acid awareness
• Physical abuse
• Cigarette smoking and alcohol use
• Medicaid and WIC participation
• Breast-feeding
• Infant health and care
• Infant sleep position

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PRAMS Data in Action

• Conducting needs assessments
• Obtaining resources
• Developing or modifying programs
• Informing policies

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PRAMS Website

• http//www.cdc.gov/prams/

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Training Objectives

• By the end of this training, participants will
  be able to
• Describe the history of PRAMS and the data
  collection methods
• Conduct a PRAMS telephone interview
• Correctly fill out all forms/complete all WebCATI
  screens related to PRAMS telephone interviews
• Identify problems that result from not following
  interview protocol

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4. Getting the Right Mom
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Initiating Contact

• When calling a household use WebCATIs programmed
  telephone introduction and Case Management System
  
• Use copy of scripted telephone introduction and
  phone codes list (for paper survey)
• Protect mothers confidentiality do not reveal
  the nature of the survey to other household
  members
• Verify that you have reached the correct mother

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Initiating Contact

• Answering Machines
• Put in your states answering machine protocol
  here
• Will Mail
• Mothers rarely mail survey in
• Encourage mother to complete survey now
• Remind mothers they will be called back if their
  completed survey is not received
• Wrong Numbers
• Search another source for a good number
• Disconnected numbers should be tried again

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5. Obtain Informed Consent
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Obtaining Informed Consent

• Read the complete introduction script
• It contains all the required elements of informed
  consent.
• Must be read exactly as written
• Consent information can allay fears or answer
  questions about the study
• It may also bring up reasonable concerns

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Elements of Informed Consent for PRAMS

• A statement that PRAMS involves research and the
  CDC provides support for the research, the
  purpose of the research and its procedures, and
  expected duration
• An explanation of how the mother was chosen and
  the reason for the identification number on the
  questionnaire
• Notification that data may be linked to other
  sources
• Any foreseeable risks or discomforts to the
  mother, including a statement that some of the
  questions may be sensitive
• Benefits to the participants and others
  (incentive or reward, improve the health of women
  and children)

• Protection of confidentiality to the extent
  provided by law
• Contact information for questions about the study
  and rights of participants
• Voluntary participation, may choose not to answer
  certain questions or not to participate, no
  penalty or loss of benefits
• If state child abuse reporting law requires that
  self reported abuse to teens be reported to the
  state, and the state does not have a separate
  questionnaire for teens, the requirement for
  reporting must be explicitly included in the
  letter
• Explicit prompt for permission to continue with
  the interview (phone).

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Questions about PRAMS Consent Script

• Do I have to say all that?
• Youve heard it a lot its her first and maybe
  only time
• If I say that, shell say no
• Its important for her to know that participation
  is voluntary
• Do I have to say all that?
• If you do not, it is considered a breach in
  protocol

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Conduct the Interview
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Interviewer Responsibilities

• Know the PRAMS Surveillance System
• Understand the content of the interview
• Questions
• Response choices
• Instructions
• Execute the interview accurately
• Record accurate and thorough information

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Interviewer Responsibilities (2)

• Familiarize yourself with
• Questions on the questionnaire word
  pronunciation
• Interviewer Instructions
• Skip patterns in questionnaire (do not read skip
  directions to mother if doing a phone survey on
  paper)
• Answers/responses to Frequently Asked Questions
  (FAQ)
• Referral numbers policies for your state in
  case the mother asks for help or assistance
• WebCATI status codes and queues

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Before you begin the Interview

• Remember
• Youre a strange voice to the mother
• Its probably the first time the mother has heard
  of PRAMS, so its all new information
• Since the mother cant see the survey, she can
  only rely on what she hears you say
• Review the call history for each mom so you know
  what has happened with her previously

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Interviewing Techniques

• Create rapport with mother
• Avoid biasing the interview
• Administer the survey consistently
• Presentation
• Vocal Delivery
• Pace
• Defining, Clarifying Using Probes
• Providing Feedback

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Create Rapport with Mother

• Convey confidence
• Speak with enough energy and enthusiasm to be
  felt over the phone
• Positive attitudes show up in your voice and
  words
• Sit-up straight
• Take a deep breath
• Put on your smile!

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Create Rapport with Mother

• Be aware of asymmetry in relationship with
  mother
• YOU are engaging in professional activity
• SHE is reporting about her private life
• Be mindful that a mothers perception of what
  makes a question sensitive depends on her
• Culture, personal background and experience
• Situation, environment, how question is asked

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What is bias?

• Bias is systematic error in the data.
• Variability among interviewers
• Variability between interviews conducted by a
  single interviewer
• Variability between mail and phone survey
• Bias can be dealt with through careful design and
  implementation of a studylike training
  interviewers!

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Avoid Bias

• Phone Mail interviews must be consistent
• Each question is carefully designed and
  pre-tested to fulfill its exact purpose
• to obtain specific information
• to be understood by the maximum number of
  respondents

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Techniques to Avoid Bias

• Read questions as exactly as they are written
• Read questions with a neutral voice
• Emphasize only the words italicized or bolded in
  survey and pause only at commas

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Techniques to Avoid Bias

• Never let your own opinions influence how you
  read a question
• Avoid engaging in personal conversation during an
  interview
• Avoid revealing your opinions or giving advice on
  study topics

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Presentation

• Read all questions as they appear, even if a
  mother already provided the answer earlier in the
  interview
• You can preface a question by saying
• I realize we may have touched on this earlier,
  but I need to ask each question in the survey.
• Always address concerns raised by the mother.
• Let the mother know that you hear what she is
  saying but you must follow standardized
  interviewing techniques.

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Presentation

• Keep the interview on track
• If a mother talks about an issue before a
  question on that issue is asked
• Response Okay, well we will get to that topic
  in a minute.
• If a mother interrupts
• Response Thats important to know and I can
  make note of that at the end of the survey, the
  next question is
• If a mother asks for information on a topic
  during the survey
• Response We can discuss that more when we
  finish the interview.

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Vocal Delivery

• Use inflection to keep your speech flowing
  naturally
• Avoid nervous pauses and ums
• Try for a smooth delivery
• Avoid sounding choppy or too staccato
• Avoid up-speak having your voice rise as you
  read
• Makes statements sound like questions and gives
  the impression youre not sure what youre
  talking about
• This is particularly an issue when you are
  reading the introduction.

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Pace

• All questions must be read at a slower than
  conversational pace
• Never sound rushed or hurried
• Read each word distinctly, so that each syllable
  is enunciated clearly
• Try to sound like youre engaging her in
  conversation, rather than reading a script

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Defining and Clarifying

• If a mother asks for the meaning of a specific
  word, group of words or seems confused by a
  question
• Repeat the question
• If available, read the definition or probe listed
  in the survey verbatim
• Never give your own definition or interpretation
• Refrain from providing too much help
• Move on to the next question if the concept still
  is not understood

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Using Probes

• Probes are neutral prompts provided on the
  questionnaire
• Avoid directive probes
• Dont direct or lead her to an answer
• Use nondirective probes
• Be neutral
• Limited use of probes

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Avoid Directive Probes

• Do not re-phrase questions or provide your own
  definitions
• Do not lead or suggest a response
• Its okay if mother cannot or will not answer a
  question
• Do not interpret a response for her

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Use Nondirective Probes

• Acceptable nondirective probes include
• Silence or pause
• Repeat the question
• Repeat the mothers response
• Ask the mother what she would like recorded

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Feedback

• Standardized, neutral feedback should be given
  periodically during the interview
• Encourages further thoughtful participation from
  the mother.
• Feedback is given by saying a short phrase to the
  mother after an acceptable response is given
• Feedback needs to be given in a neutral voice, so
  that you avoid influencing the mothers answers

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Top Ten List of Things to Remember

1. Always read the script and survey exactly as
   written
2. Remember the purpose of PRAMS
3. Never begin an interview without preparation
4. Present a neutral front
5. Demonstrate aware hearing
6. Think about appearance (who you represent)
7. Interview in a comfortable place
8. Be respectful
9. Practice, practice practice some more
10. Be cordial and appreciative of mother

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Recording Responses

• Close-ended questions
• Limited number of responses to choose from
• Each response has a specific numeric code or
  radio button (if using mouse entry)
• Example
• 8. Before you got pregnant with your new baby,
  did you ever have any other babies who were born
  alive?
• 1NO
• 2YES
• 8REFUSED
• 9DK/DR

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Recording Responses

• Open-ended questions
• Defined response options not provided
• Interviewer records any response given by the
  mother
• Example
• How many weeks or months pregnant were you when
• you were sure you were pregnant?
• 1 ______ WEEKS OR
• 2 ______ MONTHS Range 1-40 weeks/1-9 months
• 7DON'T REMEMBER
• 8REFUSED

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Recording Responses

• Comments
• All comments should be recorded verbatim
• Additional information shared about the mothers
  experiences that is not specifically asked for in
  interview questions
• Mother may share information at the end of the
  interview

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Ending the Interview

• Remember to thank the mother
• Reiterate how useful/important her contribution
  has been
• Provide referrals or educational materials (only
  if the mother requests) as determined locally
• Terminate the call

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Review of Phase 6 Survey

• Read all of the questions exactly as written
• Repeat the question
• Use probes provided
• Repeat the stem (for long lists)
• Bold italicized type is used to call something to
  your attention
• Time periods
• Choose one

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Review of Phase 6 Survey

• Be aware of what to read and what not to read
• WebCATI and Paper Phone survey Instructions
  that are not to be read aloud are all CAPITALIZED
  or included in an Interviewer instruction box
• Long lists of questions
• Pause after each one for the mom to answer
• Repeat the stem after every 2-3 items
• Long list in response option
• Read them all
• Tell mom you have to read them all even if she
  answers before you finish.

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Review of Phase 6 Survey

• Be aware of Units
• Tobacco (cigarettes per day)
• Alcohol (drinks per week)
• Binge drinking (4 drinks at one sitting)
• Height (feet/inches vs. meters)
• Weight (pounds vs. kilos)
• Dates (month/day vs. day/month)

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Pronunciation

• (you may want to insert a slide here to review
  some of the words in the pronunciation guide)

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7. Wrapping up the Interview
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After Terminating the Call

• WebCATI system will guide the interviewer through
  several more screens where
• line level comments can be entered
• summary of the final disposition of that mother
  entered
• All operational and questionnaire information
  will be saved in the system

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After Terminating the Call

• For Surveys Completed on Paper
• Review and edit the interview code sheet for
  coding errors
• Check for completeness and legibility
• Call the mother back, if necessary
• Record the operations data
• Put the interview and consent forms in a secure
  place
• Record call attempt info and survey responses in
  WebCATI using external events feature

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Monitoring (1)

• The PRAMS protocol requires that phone
  interviewers be monitored 10 of the time they
  are placing calls
• To ensure that consent is properly obtained
• To ensure that phone codes are being used
  properly
• To ensure that the survey is administered
  correctly

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Monitoring (2)

• Insert some information about who will be doing
  monitoring, whether the interviewers will know
  they are being monitored, and any other details
  of the monitoring process you think is important.
  See the manual development box in Section 4.4

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Proof of Learning

• By the end of the training interviewers will
  have
• Practiced successfully contacting a participant
  and obtained informed consent
• Conducted a PRAMS interview
• Completed WebCATI screens/filled out all PRAMS
  forms
• Identified problems and potential solutions