Source: U.S. Environmental Protection Agency
I. Pretest QuestionsAs you probably are aware, Toms River is the site of a pilot project designed to inform residents about potential environmental hazards associated with the Superfund site, and to encourage their involvement in EPA's decision-making process for cleanup of the site.
We would appreciate your willingness to share your reactions to the attached fact sheet by reading it and answering a few questions. We do not ask your name, and all information you provide will remain confidential.
Because only a few Toms River citizens are being asked to help judge this material, your response is particularly valuable.
Before you begin, please check the appropriate answers to these four questions.
1. How much would you say you know about the Toms River Superfund study?
A little ___ Some_____ A lot_____
2. Is there anything in particular you want to know about the study?
Yes______ No_______
If yes, please specify.
(Note: more knowledge questions can be added here.)
3. Are you or any member of your family an employee/former employee of (Superfund site company)?
Yes______ No________
4. Are you a member of any group particularly concerned about the environment?
Yes______ No________
Now, please turn the page and read the fact sheet.
II. Posttest Questions
Now that you have finished reading the fact sheet, please answer the questions below. You may refer back to the fact sheet as you consider your response if you wish.
1. In your own words, what would you say is the purpose of the Superfund study?
(Note: additional knowledge questions can be added here.)
2. How much of the information in the fact sheet was new to you?
Most of it______ Some of it______ None_______
3. Do you have questions about the Superfund study which were not answered in the fact sheet?
Yes_______ No________
If yes, please list:
4. Was there anything you particularly liked about the fact sheet? Yes_______ No______
If yes, what?
5. Was there anything you particularly disliked about the fact sheet, or found confusing?
Yes______ No_________
If yes, what?
6. This fact sheet is most appropriate for (check all that apply):
General public__ College graduates____ Professionals______
7. Would you recommend the fact sheet to a friend or family member?
Yes_______ No_______
8. The following are a series of phrases describing the fact sheet. Please circle the one choice on each line that most closely reflects your opinion.
a. very interesting, somewhat interesting, not at all interesting
b. very informative, somewhat informative, not informative
c. accurate partially, accurate inaccurate
d. very clear, somewhat clear, confusing
e. very useful, somewhat useful, not useful
f. unbiased, biased towards govnmnt., biased towards ind.
g. easy to read, understandable, hard to understand
h. complete, somewhat complete, incomplete
9. Would you like to say anything else about the fact sheet? Please comment:_____________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
Thank you very much for your help in reviewing this fact sheet.
Source: National Heart, Lung and Blood Institute
_____________________________________
(Respondent's name and ID No.)
_____________________________________
(Location: Houston = 1, Chicago = 2)
_____________________________________
(Phone Number)
IntroductionGood afternoon (evening).
My name is (interviewer's initials), and I'm with Quick Test, a marketing research firm. We are conducting a research study in this mall with people who are between 25 and 55 years of age. Would you be willing to spend a few minutes answering some questions?
ScreenerS.1
What is your age?_________________(RECORD)
1. Under 25 (THANK AND TERMINATE)
2. Between 25 and 40 (CONTINUE)
3. Between 41 and 55 (CONTINUE)
4. Over 55 (THANK AND TERMINATE)
S.2Have you ever been told you have any of the following?
YES or NO
1. Diabetes
2. High blood pressure
3. High cholesterol
S.3Which of the following best describes the highest level of education you've completed (CIRCLE ONE)
1. Elementary or grade school (CONTINUE)
2. Some high school (CONTINUE)
3 High school graduate (CONTINUE)
4. Some college (CONTINUE)
5. College graduate (CONTINUE-MAXIMUM OF 2 PER SUBGROUP)
6. Some graduate work (THANK AND TERMINATE)
7. Graduate degree (THANK AND TERMINATE)
S.4Respondent's sex
1. Male
2. Female
S.5Respondent's race
1. White (CONTINUE)
2. Black (CONTINUE)
3. Other (THANK AND TERMINATE)
S.6I would like to show you three television messages which have been produced as a public service and get your reactions to them. This will not take more than 15 minutes and we would like to offer you an appreciation of $2 as a means of saying "thank you" for your time. If you would like to see these public service messages, would you please come with me into our viewing room?
1. No (THANK AND TERMINATE)
2. Yes (CONTINUE)
NOTE: Participants are to be recruited in the following subgroups:
15 black males, ages 25-40
15 white males, ages 25-40
15 black males, ages 41-55
15 white males, ages 41-55
15 black females, ages 41-55
15 white females, ages 41-55
In each of the subgroups listed above, one-third of the respondents should follow Order 1, one-third should follow Order 2, and one-third should follow Order 3, as specified below:
ORDER 1:
Show "Randy" first and administer questionnaire. Then show "Red Balloon" and administer questionnaire, followed by "Wild Horse" and questionnaire. Thank and pay $2 appreciation.
ORDER 2:
Show "Red Balloon" and administer questionnaire. Then show "Randy" and administer questionnaire. Show "Wild Horse," administer questionnaire, and thank and pay $2 appreciation.
ORDER 3:
Show "Wild Horse" and administer questionnaire. Then show "Red Balloon" and administer questionnaire, followed by "Randy" and questionnaire. Thank and pay $2 appreciation.
CHECK ORDER BEING USED:
___ORDER 1 ("Randy," "Red Balloon," "Wild Horse")
___ORDER 2 ("Red Balloon," "Randy," "Wild Horse")
___ORDER 3 ("Wild Horse," "Red Balloon," "Randy")
FOR EACH RESPONDENT, FASTEN TOGETHER THE SCREENER, "RANDY" QUESTIONNAIRE, "RED BALLOON" QUESTIONNAIRE AND "WILD HORSE" QUESTIONNAIRE IN THAT ORDER IN PREPARATION FOR COMPUTER ENTRY. REMEMBER TO RECORD TIME OF FINISH AT BOTTOM OF SCREENER.
Time start: _________
Time finish:________