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______________________________________________

 

XII. Appendix

Example

Supply Checklist 
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Respondent contact sheet,

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directions to interview location

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Paper Questionnaire

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Consent and information

bullet

release Forms

bullet

Laptop

bullet

Sharpened Pencils

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Eraser

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Box of Tissues

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Diskette and Stamped Envelop

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Respondent payment and payment form

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Watch

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Other_________________________

Exercise #1

Exercise in Contacting Respondent:

For each pair of statements below, circle the letter of the one you might use 
during an introduction.

1.      a.   Since this week is busy, when would be a better time?  
b.   Since this week is busy, I can call you back next Monday, between
        10 & 12, to see if you would have time next week.

2.      a.   Good morning.  I’m Sally Doe calling you in regard to the Consumer 
        Operated Services Project being conducted at the [Site] by the [site].

        b.   Good morning.  I’m an Interviewer calling from a large social research center.  

3.      a.  The interview would consist of answering a set of questions about your 
        health, your daily living situation, and your participation in the services 
        at the [Site].

b.  The interview will ask you a bunch of questions about your life.   

4.      Now, compose your own introduction:

__________________________________________________

__________________________________________________

__________________________________________________

Notes:

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Exercise #2

Exercise in Standard Responses:

Below are some commonly asked questions.  Think about how you would answer 
each question and then write your response. 

 

1.      What is the survey about?

______________________________________
______________________________________
______________________________________
______________________________________
______________________________________

 

2.  How did you get my name? ________________
______________________________________
______________________________________
______________________________________
______________________________________

 

3.  What will you do with my answers and who will see this information? _____

_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________

 

 

 

4.  Who is conducting this project? _______________________________
_______________________________________________________
_______________________________________________________

 

 

5.  Why do you need me to participate? __________
______________________________________
______________________________________
______________________________________
______________________________________
______________________________________

6.  It is really important for me to participate? _____
_______________________________________________
Notes:
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Exercise #3  
xercise in Probes:  

In each example below, decide whether the respondent has answered the
question and indicate Yes or No in the blank.  

1.  Interviewer:  “How much choice do you have about how you will 
spend your free time?”            

1

2

3

4

No choice

Not too much

Some

A Lot of

                                    Choice                    Choice                  Choice

 

R:  “I don’t have any free time.”  

                                    YES     NO (Circle One)

2.  Interviewer: How do you feel about the way things are between you and your family?

 

1 2 3 4 5 6 7
Terrible Unhappy Dis
Satisfied		 Mixed Mostly
Satisfied		 Pleased Delighted

R:  I haven’t seen my family in a long time.

                                    YES     NO (Circle One)  

3.  Interviewer:  Overall, how do you feel about the amount of friendship in your life?

 

1 2 3 4 5 6 7
Terrible Unhappy Dis
Satisfied		 Mixed Mostly
Satisfied		 Pleased Delighted

R:  I have a lot of friends.

                                    YES     NO (Circle One)  

4.  Interviewer:  In the past four months have you received individual therapy?  

______ Yes  

______ No  

R:  I have been seeing my therapist for eight years.  

                                    YES     NO (Circle One)  

6.  Interviewer:  In the past four months, have you received group therapy?  

______ Yes  

______ No  

R:  Yes, I go to group therapy twice a month.  

                                    YES     NO (Circle One)  

Notes:

   

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Exercise #4

Exercise in Probes: Pausing and repeating the question

Study the following interview situation.  

Exact question: About how many times have you been hospitalized for
 psychiatric reasons in your lifetime?  

________  (Number of psychiatric hospitalizations)

R:  “Let me think…that is a difficult question.”  

Interviewer:  [Pause]  

R:  “I’m trying to think…twice.”  

In this example, how did the pause help to get answer? ___________________

What does a pause by the interviewer indicate to the respondent?

__________________________________  

Interviewer:  During the past week, how often did you spend time with friends
 or family in recreational activities?  This does not include mental health system 
sponsored activities or activities at the peer support program.  

1 2 3 4 5
Not at all Once 2-3 Times 4-6 Times Once or
more/day

 

R:  I’m not sure…  
Interviewer:  Let me repeat the question (RQ). During the past week,  
how often did you spend time with friends or family in recreational activities?  
This does not include mental health system sponsored activities or activities
 at the peer-support program.

R:  Oh, okay,  I guess about two to three times. Was repeating the question 
effective in this situation? Why or why not?

_______________________________________  

Name another situation in which the Interviewer might repeat the question to
 the respondent?

_____________________________________ 

  Notes:  

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Exercise #5

Exercise in Probes: Repetition

Part I:  Study the following example:

 

Interviewer: How do you feel about the things you do with other people?
  Terrible, unhappy, mostly dissatisfied, mostly mixed, satisfied, pleased, or delighted?

Respondent:  I feel sort of okay.

Interviewer:  Would that be mostly mixed, satisfied, pleased, or delighted?

Respondent:  I would say satisfied.

It is important to provide repetition of the misunderstood 
portion of the question.  

Part II:  Use the Repetition Probe on the following examples.

1.  Interviewer: How do you feel about the amount of time you spend with other people?

 

1 2 3 4 5 6 7
Terrible Unhappy Mostly
Satisfied		 Mostly
Mixed		 Satisfied Pleased Delighted

Respondent:  People seem to call me often and ask me to do things and 
that makes me feel good.

In the above question, what is the topic? __________________________

Did the respondent answer the question?__________________________

Put parentheses around the misunderstood portion.

Write the correct probe here: ___________________________________

________________________________________________________  

2.  Interviewer: How do you feel about the people you see socially?

 

1 2 3 4 5 6 7
Terrible Unhappy Mostly
Satisfied		 Mostly
Mixed		 Satisfied Pleased Delighted

 

R:  I don’t get out that often.  

In the above question, what is the topic? ____________________________

Did the respondent answer the question?____________________________

Put parentheses around the misunderstood portion.

Write the correct probe here:

________________________________________________________ 

Notes:

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Exercise #6

 

Exercises in Probes:

What do you mean?  Could you tell me what you mean 
by that? (WM)

Read the following situation and answer the questions below.
(WM) is used if respondent gives an unacceptable response to an open question.)

Interviewer: Do you believe you have been discriminated against?

Respondent: Well, discrimination is a fact of life.

Interviewer:  Could you tell me what you mean by that (WM)?

Why did the Interviewer use the probe (WM) in this situation?

______________________________________________________

______________________________________________________

Interviewer:   Are you currently looking for a new or paying job?

Respondent:  Oh sure, I’m always looking for a quick buck.

Interviewer:  What do you mean? (WM)

Why did the Interviewer use the probe (WM) in this situation?

________________________________________________________

________________________________________________________

Notes:


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Exercise #7

Exercise in Probes:

Which would be closer to the way you feel? (WC)

 

Read the situation below and answer the questions that follow.

(WC is used when the respondent has narrowed the choices to two or a range between two.) 

1.  Interviewer: How do you feel about the things you do with other people?

 

1 2 3 4 5 6 7
Terrible Unhappy Mostly
Satisfied		 Mostly
Mixed		 Satisfied Pleased Delighted

Respondent:  Somewhere between satisfied and pleased.

Interviewer:  Which would be closer to the way you feel?  Would you 
say that you are more satisfied or more pleased? 

What was wrong with the respondent’s answer?

__________________________________________________

How did the WC probe help to isolate the respondent answer?

__________________________________________________
What other probe could the Interviewer have used.

__________________________________________________ 

 

Interviewer:  The people who work here believe I can grow, change and recover.

 

1 2 3 4 5
Strongly
Agree		 Agree Neutral Disagree Strongly
Disagree

 

Respondent:  Sometimes I would agree that is true, but other times I am not so sure. 

Interviewer:  Which would be closer to the way you feel most of the time?

What was wrong with the respondent’s answer?

___________________________________________________

How did the WC probe help to isolate the respondent’s answer?

___________________________________________________

___________________________________________________

Notes:  
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Exercise #8

Exercise in Feedback  

Part I:

Read the example below and answer the following questions.

Interviewer:  How long have you been attending this peer-support program?  
If you can, please tell me the date you first started coming here.

Respondent:  Well, I guess it was about three months ago when I first came here.

Interviewer:  I see…Now, during a typical week, how often do you attend this program?

Respondent:  I suppose about four times.

 

In the above example, the Interviewer uses the brief phrase, “I see,” as feedback.  Why? 

(Circle the letter of the correct response(s) below.)

a.       Because it indicates to the respondent that he is doing a good job.

b.      Because it tells the respondent his answers are heard and understood, and thus
 he will be more likely to give an answer to the next question as well. What other 
feedback phrase could the Interviewer have used?   What other feedback could the 
Interviewer have used in combination with this response?  

Notes:

 

Part II:

List Two Short and Two Long Feedback Phrases:

1.

2.

3.

4.

 

Part III:

Below is a list of possible feedback phrases.  Cross out phrases 
that should never be used because they comment on content 
instead of performance.

a.       This is helpful information

b.      What a good idea.

c.       I see.

d.      That’s very interesting.

e.       Okay.

f.        It’s important to find out what people think about this.

g.       I agree with you there.

h.       Uh-huh.  Thanks.  It’s important to get your opinion on that.

i.         All right.

j.        Uh-huh.

k.      Fine.

l.         Good.

 

Part IV:

Now, get with a partner and go through the following exercise.  
Each partner will ask four sample questions to the other.  While 
one partner is asking the questions, the other partner will keep 
score of the feedback responses (one point for each feedback response).  
Write down which feedback phrase is used.  Also note any interviewer 
effects or non-verbal behavior which may be occurring.  Each person 
should try to give feedback for every other question.

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Question Set #1:

 

Have you ever been employed?                       

 

_____Yes        _____No                                            

 

Phrase:______________________________

 

 Are you currently doing any work for pay or on a volunteer basis?

 

_____Yes        _____No

 

Used Feedback Phrase: Yes     No     (Circle One)

 

Phrase:______________________________

 

Is having a paying job important for you?

 

_____Yes        _____No

padding:0in;mso-padding-alt:1.0pt 4.0pt 1.0pt 4.0pt"> Used Feedback Phrase: Yes   No     (Circle One)

 

Phrase:______________________________

  Are you currently looking for a new or paying job?

 

_____ Yes       ______ No

 

Used Feedback Phrase: Yes     No    (Circle One) Phrase:__________________________

 

 

Total Points for Question Set #1: _____________________

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Notes:
Question Set #2

 

Where do you currently live?

 

______ an apartment                            ______ a shelter  

______ a house                                    ______ a hotel or motel  

______ transitional living center            ______ the street 
                                                                                      or half-way house

 

______ group home/board and care

 

______ other   Please specify ________________________

 

Used Feedback Phrase: Yes     No    (Circle One) Phrase:______________________________

 

Who currently lives in your residence with you?

Interviewer: Check all that apply.

 

______ parents                                    ______ adult children

 

______ spouse or partner                     ______ no one (respondent lives alone)

 ______ friends                         ______ other  Please specify__________________

 

______ other peers

 

______ minor children

 

Used Feedback Phrase: Yes     No     (Circle One) Phrase:_________________________

 

  Do you receive any help in managing your money?

_____Yes        _____No

 

            If yes, ask:

From whom do you receive help (check all that apply)?

            _____People at this peer program.

            _____Staff from another program

_____Family

_____Friends

_____Spouse or Partner

_____Other (Please specify) __________ 

  Used Feedback Phrase: Yes     No     (Circle One)

Phrase:______________________________ 

 

Do you receive any help with cooking?

_____Yes        _____No

 

If yes, ask:

From whom do you receive help (check all that apply)?

            _____People at this peer program.

            _____Staff from another program

_____Family

_____Friends

_____Spouse or Partner

_____Other (Please specify) __________ 

  Used Feedback Phrase: Yes     No     (Circle One)

Phrase:______________________________

 

Do you receive any help with housekeeping?

_____Yes        _____No

  Used Feedback Phrase: Yes     No    (Circle One)

Phrase:______________________________

 

bulletAre you currently working for pay?  
_____Yes        _____No

  Used Feedback Phrase: Yes     No (Circle One) 
Phrase:______________________________
 

Total Points for Question Set #2: _________________________

Notes:  
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Example

Control Sheet

Project ID______________     

Status                                       Date                 Signature

Interview Completed                _________      _______________

Edit Completed                        _________      _______________

Corrections Completed __________    ________________

Data Entry Completed              __________    _________________  

Example

Telephone Contact Record

Project ID:____________      

Baseline[   ]      1st follow-up[   ]           2nd follow-up [   ]          3rd follow-up [   ]

Respondent telephone number:________________

Interviewer:______________________

Contact Attempt           Date     Time of Call      Outcome Code

1.  
2.  
3.  
4.  
5.  
6.  
Notes:  

Outcome Codes:

IS=Interview Scheduled            BZ=Busy Signal

RF=Refusal                              AM=Answering Machine

NA=No Answer                      DS=Disconnected

RC=Returned Call                    WN=Wrong Number

(Adapted from Frey and Oishi, p. 140)  

Example

Field Contact Record  -  Baseline  Interview

Interviewer:_________________

           

Project ID: Interview 
Date:		 Interview
Time Start		 Interview
End		 Outcome
Code
 

 

 

 

 

Outcome Codes:

CI=Completed Interview          IT=Interviewer Terminated Interview

RF=Refused Interview  RT=Respondent Terminated Interview

Submit copy of field contact record to field coordinator every week for signature:

Date:___________                  Field Coordinator:________________


Example
REIMBURSEMENT FORM Supervisor to Interviewer
The purpose of this form is to chart the payment to be given to interviewers 
to disperse to respondents.    

Supervisor signature: _____________________________   Date: ____/____/________  

 

Interviewer signature:   _____________________________    Date: ____/____/________

 
Example

REIMBURSEMENT FORM Interviewer to respondent

The purpose of this form is to chart the payment to be given to respondents for
compensation.

Name of respondent: ___________________________________________

SS# or respondent: _____-_____-__________

Address of respondent: _____________________________________
                                        _____________________________________

Respondents signature: _____________________________________

Date: ____/____/______

Interviewer signature: ___________________________________________

     

 [Site Address]

Example

 

Peer Survey Consent Form 

bullet

 I understand that the questions I answer are solely for the purpose of evaluating 
the effectiveness and appropriateness of the peer support services I receive.

bullet

I also understand that the Consumer Operated Services Project is interested in 
how well the peer support services are meeting my own special needs and 
problems. I have been informed that my participation in the evaluation will 
consist of participating in a personal interview in which I answer some 
multiple choice and short answer questions about how I am doing, my life 
situation, my activities, and my satisfaction with the peer services I receive.  

bullet

I understand that my answers to the survey and certain information about me 
and my progress in the peer support program will be used by the [site] 
project staff for use in their evaluation of the peer support program services.  
All information will be treated as strictly confidential.  No results will be 
disclosed by my name.

bullet

 I understand that I will be paid twenty-five dollars for my responses to the survey.

bullet

I understand that I may decline to participate in this survey project and it will
 not affect my continued use of peer services in any way whatsoever.  I also 
understand that I can decide not to continue participation in the evaluation
 at any time, and that this will not affect my continued use of peer services. 

bullet

I understand that this permission expires on August 30th, 1999 unless I withdraw 
before this date. 
   

bullet

  I agree to participate in the evaluation under the above conditions. 

 

Date: ___/____/____               Peer Signature: ________________________________

 

Date: ___/____/____               Interviewer:      ________________________________


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Example

Dear Participant,  

We are from the [site]’s Program in Consumer Studies and Training.