Vital and

Health Statistics

CognitiveAspects

of Reporting

Cancer Prevention

Examinations

Series 6:

Cognition and Survey

No, 7

and Tests

Measurement

This report explores the cognitive process used by women 50 years of age and

over to answer questions about their experiences during the past 5 years with

three cancer screening procedures: Pap smears, mammograms, and clinical

breast examinations, Focus groups and think-aloud interviews were conducted

to examine the cognitive processes used by respondents,

U,S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyaftsvllle, Maryland

October1994

DHHS Publication No, (PHS] 94-1082
n

Copyright Information

All material appearing in this report is in the public domain and may be

reproduced or copied without permlsston; citation as to source, however, IS

appreciated.

Suggested citetion

Sudman S, Warnacke R, Johnson T, et al. Cognitive aspects of report!ng cancer

prevention examinations and tests. National Center for Health Statwtlcs V!tal

Health Stat 6(7). 1984,

Ubrery of Congress Cstaloglng-in-Publlcatlon Dsta

Cogrwfive aspects of reporting cancer prevention examinations and tests.

p. cm. — (Wal and health statistics. Series 6, Cognition and survey

measurement ; no. 7) (DHHS publication ; no. (PHS) 94-1082)

By Seymour Sudman et al.

“October 1894’

Includes bibliographical references.

ISBN 0-8406-0499-8

1. Cancer—Prevention. 2, Aged wome~Medical examlnat!ons. 3. Health

surveys. 4. Medical screening. 5. Self-report inventories-Psychological

aspects. 6. Periodic heath examinations-Psychological aspects, 7, Health

behavior. 8. Cognitive styles. 1,Sudman, Seymour. II. National Center for Health

Statistics (U.S.) Ill. Series. IV. Series: DHHS publication ; no. (PHS) 94-1062

[DNLM: 1. Vaginal Smears41ization. 2. Breast Neoplasms+revernion

& control. 3. Mammqaphy+tilization. 4. Mass Screenin~ethods. 5.

Questionnaires. 6. Data Collectio~ethods. 7. Attitude to Heaith. W2 A

NI 481A no. 7 1994]

RC281 .W65C64 1994

616.99’40XC20

DNLM/DLC

for Library of Congress 9435224

CIP

For sale by the U.S. Government Printing Oftice

Superintendent of Documents

Mail Stop: SSr3P

Washington, DC 20402-9328
National Center for Health Statistics

Manning Feinleib, M.D., Dr.P.H., Director

Jack R. Anderson, Deputy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Robert A. Israel, Associate Director for International

Statistics

Stephen E. Nieberding, Associate Director for

Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology

Office of Research and Methodology

Monroe G. Sirken, Ph.D., Associate Director

Kenneth W. Harris, Special Assistant for Program

Coordination and Statistical Standards

Lester R. Curtin, Ph.D., Chiej Statistical Methods Staff

James T. Massey, Ph.D., Chiej Survey Design Staff

Andrew A. White, Ph.D., Chiej Statistical Technology Staff
We wish to express our appreciation to the RUSH-Anchor

HMO, which provided the sample and validation information

for this study. Their active participation in the study not only

made it possible but also helped to improve the study design.

We are particularly grateful to Rene Bucio, Jeanette Cunningham, and Veshane Smith for their assistance in abstracting

medical records, The investigators on this project are especially grateful to Dr. George Wilbanks, Chair of the Department of Obstetrics and Gynecology at Rush Presbyterian-St.

Luke’s Medical Center and members of the staff of that

department for their assistance in helping to frame the questions used in this study. We were fortunate to have the focus

groups led by Dr. Loretta Lacey, Professor of Community

Health Services at the University of Illinois. Professor Lacey

is also a registered nurse and has had substantial experience in

leading focus groups on health-related issues. Mary Kobialka

was instrumental in the conduct of data coding, matching, and

the construction of the data set for this study. We also wish to

thank Dr. Donald Hedeker and Siu Chi Wong of the University

of Illinois Prevention Research Center for their advice and

assistance in conducting our muhivariate statistical analyses.

Earlier drafts of this report benefited from comments by Dr.

Jared Jobe and two anonymous reviewers at the National

Center for Health Statistics. While we found their suggestions

very useful, we are, of course, responsible for the final version

of this report.The manuscript was prepared by Bernita Rusk

and Marya Ryan. Their professionalism is greatly appreciated.

This research was performed under U.S. Department of

Health and Human Services contract 200-91-7035 from the

National Center for Health Services to the University of

Illinois. Seymour Sudman, Ph.D., was the principal investigator. Jared B. Jobe, Ph.D., was the project officer and is the

technical editor and reviewer for Series 6.

...

Ill
Symbols

--- Data not available

. . . Catego~ not applicable

— Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

* Figure does not meet standard of

reliability or precision (more than

30-percent relative standard error in

numerator of percent or rate)

iv
Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cognitive aspects ofsurvey research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phase I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Focus group methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Think-aloud interview methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Better understanding ofthe survey process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phase II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Objectives and scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixes

I. Questionnaires and supplementary information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

II. Raw frequencies by outcome measures, tests, and year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Texttables

A. Data on validation studies ofprevious Pap smear, mammogram, andclinicd breast exams . . . . . . . . . . . . . . .

B. Phase I comparison of number of self-reported screening procedures with medical records: 1987–92 . . . . . .

C. Percent differences between self-reports and medical record data, by test and type of statistic: 1987-92 ...,

D. Percent distribution ofPhase I response-outcome measures for all exam types, byyear and type ofstatistic:

. . . . . . . .

. . . . . . . .

. . . . . . . .

987–92..

E. Demographic characteristics ofs~dy respondents: 1987–92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F, Data abstracted from medical records. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

G, Percent distribution of response-quality measures, by test and type of measure: 1987-92 . . . . . . . . . . . . . . . . . . . . . . . . .

H, Percent distribution of response-quality measures, by year and measure: 1987–92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

J. Percent distribution of response-quality measures, by type of test, test regdtity, and measure: 1987–92 . . . . . . . . . . . .

K. Percent distribution ofresponse-quality measures, by form and measure: 1987-92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L. Random effects logistic regression estimates and standard errors for report year, procedure type, test regularity, and

questionnaire form effects on gross accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

M. Net bias and gross error in reporting of dates of test procedures formatched data: 1987–92 . . . . . . . . . . . . . . . . . . . . . . .

N. Percent distribution oflevel ofreporting precision, by test and response pattern: 1987–92 . . . . . . . . . . . . . . . . . . . . . . . .

...

111

1

1

2

4

4

5

6

9

10

10

10

11

12

17

19

22

162

3

8

8

8

11

12

12

13

13

14

15

17

18

v
Cognitive Aspects of

Reporting Cancer Prevention

Examinations and Tests

by Seymour Sudman, Ph.D., Richard Warnecke, Ph.D.,

TimothyJohnson, Ph.D., Diane O’Rourke, M.A., Survey

Research Laboratoqr,Universityof Illinois,and Andrew

M. Davis, M.D., RUSH-Anchor HMO

Introduction

Background

As part of the initiative Healthy People 2000, the U.S.

Department of Health and Human Services has the goal of

significantlyincreasing national health promotion and disease

prevention (1), Among these goals is the reduction of mortality from several cancers, including breast and cervical cancer,

by detecting them in the earliest stages when treatment is most

likely to be effective (2).

Papanicolaou (Pap) smears, mammograms, and breast

physical examinations are widely accepted screening procedures commonly used to detect cancer at an early stage. These

procedures have been shown to reduce cervical and breast

cancer mortality (3,4). Currently, a majority of all adult

women are screened with a Pap test at regular intervals (5).

Only a minority of adult females, however, currently receive

screening mammograms (6).

Knowledge of cancer-screening practices in the general

population, of course, is based in large measure on self-reports

collected in survey interviews, such as the National Health

Interview Survey (NHIS). There are, however, continuing

questions about the accuracy of self-reports of cancer detection tests obtained by interview, particularly in the absence of

validation by medical records, For example, several investigators have validated self-reports of these early detection procedures using information from patient medical records as the

standard.

Much of this material has focused on Pap smears. Data

from 11 of these published studies have been summarized in

table A, As the third, fourth, and fifth columns in this table

show, these studies vary along several important dimensions.

For example, subjects have been identified from a variety of

sources, including random community samples (7–9), health

maintenance organization (HMO) membership rolls (10,11),

public health clinks (12), cancer tumor registries (13), and

case-control studies (14), and across a variety of geographic

locations. Consequently, the demographic profile of the subjects in these studies also varies in age, ethnicity, socioeconomic status, and urban-rural status. In addition, subjects were

asked to recall their screening histories across a variety of

intervals that ranged from immediately after a medical encounter up to the previous 5 years. Sufficient information was

nonetheless available to calculate a comparable set of measures (defined in the section “Results of phase I“) for each

study. Gross accuracy of respondent reports of Pap smear

history ranged tlom 0.39 through 0.80 (weighted average =

0.59). Although sensitivity was high (range = 0.71-0.97;

weighted average = 0.88), specificity was only moderate

(range = 0.21-0.65; weighted average = 0.52). Report-torecords ratios indicate that receipt of Pap smears was overreported in each study (range = 1.21–3.33 weighted average =

1.95). Additional reports of Pap smear validation are available

that do not contain information necessary for inclusion in

table A (15–18). The general findings reported in these studies

are nonetheless consistent with those being summarized here.

Table A also summarizes findings from five studies that

verified mammography reports. Note that these study populations were far more homogeneous in nature than were those

examined for Pap smears. Four of the five mammography

studies selected subjects from HMO rosters (10,11,19,20),

with one (21) coming from a random community survey.

These studies also examined a shorter range of recall intervals

(6 months-2 years), compared with the Pap studies reviewed,

and all were published during the 1990’s. Overall, these

studies report higher degrees of gross accuracy (range =

0,81-0.97; weighted average = 0.86), sensitivity (range =

0.92–1.00; weighted average = 0.91), and specificity (range =

0.58-0.94; weighted average = 0.74), compared with the Pap

smear validation studies. Although overreporting was also a

problem with mammography self-reports, report-to-records

ratios were smaller than among the Pap smear studies (range =

1.06-1.76; weighted average = 1.29).

Only two studies were identified in which attempts were

made to validate clinical breast examinations (table A). Gordon (10) reported a gross accuracy rate of 0.70 for this

procedure, with high sensitivity (0.9’7) but low specificity

(0.22). Because medical records validation data for this procedure are generally derived from physician notes rather than

pathology or radiology reports, as is the case with Pap smears

and mammograms, true reports for this procedure may have a

greater likelihood of being labeled as “false positives.” Consistent with the findings for the other two screening procedures, clinical breast exams were also likely to be overreported.

Cognitive aspects of survey research

One approach to improving the accuracy of self-reports in

surveys that has received considerable attention in recent years

is using the theories and methods of cognitive psychology

1
(22). The cognitive approach seeks to identify respondents’

errors in understanding and answering questions and to design

questions that minimize such errors.

It is now generally agreed by most researchers who use

cognitive methods to study survey methods that there are four

steps in the response process (23-25). Not every step is

equally important for all questions.

The first step is interpreting the question. Questions

dealing with specific screening procedures may well be subject to linguistic and interpretative difficulties. As examples,

not all respondents, especially those with less education, may

be sure of what a “Pap smear test” or a “blood stool test” is.

This may lead to incorrectly reporting either that a test

occurred when it did not or that it did not occur when it did.

The researcher can improve reporting by choosing the most

meaningful wording or possibly alternative wordings for different respondents,

The second step is retrieving either the answer to the

question or relevant information that will be used to construct

an answer. Here there has been substantial work reported

recently about the effects of different question wordings that

act as cues to improve retrieval (26).

Among the important findings are two: the use of schemas

and the effectiveness of using alternative aspects of an event to

recall it. Most cognitive psychologists believe that many

repetitive activities are not easily retrieved as individual

events but rather as schemas, which are generalizations. Thus,

an older woman who gets an annual physical examination

might remember months later that a Pap smear and stool

sample are part of that examination and how these are usually

conducted, without remembering the speciiics of a particular

test on a specific day (27). The accuracy of information

obtained from schemas depends on the regularity of the

behavior (28). Researchers may influence response accuracy

by asking questions that deliberately evoke or discourage the

use of schemas.

Brewer (29) has made a strong case that the date of an

event is the least well remembered attribute of that event,

relative to such other aspects as where the event occurred, who

was present, and what happened (see also Wagenaar [30] and

Means et al. [31]). The researcher may influence the accuracy

of reports by a question order that postpones asking about the

date until other better remembered aspects of the event are

reported.

A well-recognized problem in recalling when an event

occurred is called “telescoping.” This is remembering that an

event occurred but misremembering when it happened (32-

35). For a variety of reasons, forward telescoping (remembering that an event has occurred more recently than it actually

did) is more common than backward telescoping. This is also

a possible explanation for overreporting of diagnostic procedures. There have been studies of telescoping of health-related

activities (36) but apparently no studies of telescoping of

reported diagnostic tests such as Pap smears and mammography. The records checks for this study will make such an

analysis possible.

The third step in the response process is judgment formation. Computing judgments based on data retrieved from

memory is an important aspect of attitude formation and the

reporting of behavioral frequencies. Of particular interest in

this context is the question of whether respondents attempt to

count specific examinations or estimate based on a stored or

computed rate.

Finally, the fourth step involves the editing of answers by

respondents if they see certain answers as being more socially

desirable than others (37). Socially desirable information is

overreported, whereas undesirable behavior is underreported.

There do not appear to be any studies indicating whether

questions about specific disease prevention procedures are

seen as threatening or not, and, if threatening, whether that is

because having the tests done is seen as desirable or undesirable.

In the remainder of this report, findings are presented

from an exploration of the cognitive processes that older (50

years of age and over) female respondents employ in answering questions related to their experiences with several cancerscreening procedures.
Table A. Data on validation studies of previous Pap smear, mammogram, and clinical breast exams

Reoall

Refwti-te

study

Gross False Fskia

Number SampIe Location

records

petiti aocuracy Sensffivify Spesificily negafive poeifive ratio

Pap smears

Sawyer (7). . . . . . . . . . . .

Sowman (8) . . . . . . . . . . .

Gordon (lo) . . . . . . . . . . .

Walter .. . .. . . . . . . .

McKenna (13). . . . . . . . . .

Walter .. . .. . . . . . . .

Michielutfe(12). . . . . . . . .

Wamecke (9) . . . . . . . . . .

Loffus(ll), . . . . . . . . . . .

Mammograms

King .. . . . . . . . . . . .

Brown .. . . . . . . . . . .

Gordon (lo) . . . . . . . . . . .

Degnan (21). . . . . . . . . . .

Lofts. .. . . . . . . . . .

Breaat exams

Gordon (lo). . . . . . . . . . .

Lofts..., . . . . . . . .

Weighted means2

All exams . . . . . . . . . . . .

Papsmeara . . . . . . . . . . .

Mammograms. . . . . . . . . .

98

111

352

212

125

218

318

544

173

199

380

386

456

84

371

172

3,770

1,978

1,421

Random/

referredl

Random

HMO

Cervical

dysplasia

study

control

Tumorregiatryl

Cervioal cancer

study controls

Sexually

transmitted

disease

clinic

Randoml

HMO

HMO

HMO

HMO

Random

HMO

HMO

HMO

.-—

---

.-

North Carolina

Australia

NorIhem

California

Ontario

Chicago

Ontario

Los

Angeles

Buffalo

Washington

State

Pennsylvania

Massachusetts

Northern

California

NorIh

Carolina

Washington

State

Northern

California

Washington

State

— —

---

---

3 years

3 yeara

2 years

1 year

3 years

1 year

After exam

5 years

6 months

1 year

1-2 months

2 years

1 year

6 months

2 years

6 months

——-

-——

-——

0.80

0.78

0.78

0.75

0.65

0.59

0.47

0.39

-—-

0.97

0.87

0.84

0.81

—

0.70

—--

0.70

0.59

0.86

0.95

0.93

0.97

0.89

0.96

0.72

0.97

0.71

——-

1.00

0.92

0.96

0.99

———

0.97

---

0.92

0.88

0.97

0.47

0.55

0.35

0.65

0.41

0.45

0.32

0.21

---

0.94

0.85

0.58

0.71

-——

0.22

—--

0.47

0.32

0.74

0.05

0.07

0.03

0.11

0.04

0.08

0.03

0.29

---

0.00

0.08

0.02

0.01

--—

0.03

—--

0.08

0.22

0.03

0.53

0.45

0.85

0.35

0.59

0.55

0.68

0.79

———

0.06

0.15

0.42

0.29

---

0.78

——-

0.53

0.68

0.26

1.21

1.21

1.25

1.44

1.72

2.22

3.32

2.10

1.78

1.06

1,16

1.21

1.49

1.76

1.42

2.07

1.68

1.95

1.29

1Blackparsonscmly.

2),&ns for rsport.to-record ratloa Include WdS from bftuS (it).

NOTESHMOla health maintenance organization. Numbers in parentheses refer to entries in the reference list

w
Based on a review of the cognitive literature, four major

issues were identified, corresponding to the four cognitive

stages previously discussed:

●

●

●

●

Comprehension: Do older women know what the terms

“Pap smear, “ “mammogram, “ “breast examination,” and

“blood stool test” mean? Do they confuse procedures?

Are any of the questions planned prone to substantial

misinterpretation?

Information retrieval: How do older women retrieve information on medical screening examinations? Are tests

stored in discrete memory or do respondents use schemas?

If they use schemas, what are the schemas used?

Judgment formation How do older women form a judgment about the frequency of screening tests? Do they

count or estimate? How do they arrive at their count or

estimate?

Editing responses: How comfortable are older women

discussing their experiences with various screening procedures? Are they motivated to withhold sensitive personal

information or overreport socially prescribed behavior?

Focus group methodology

The use of focus groups has now become widespread as

part of the process of designing good questionnaires. Focus

groups enable researchers to learn how respondents think

about an issue, so that researchers can avoid imposing their

perspectives on respondents. Focus groups are also costeffective because much useful information is obtained at a low

cost. Although it is very dangerous to generalize from a focus

group with special sample characteristics to a broader population, experience has indicated that the use of such groups at

the beginning of the questionnaire-design process greatly

improves the final questionnaire. For this reason, two focus

groups were used to begin this research.

Sample selection

The first focus group was with black women and the other

was with white women 50 years of age and over. Eighteen

respondents were recruited from two sources: a health maintenance organization (HMO) that was collaborating in the

study (RUSH-Anchor HMO) and University of Illinois employees who were not faculty members. Persons currently employed

by health care facilities were specifically excluded from

participation. Selected respondents were reimbursed $50 for

participating.

The first focus group was held on Monday, December 16,

1991, in the Behavioral Laboratory of the University of

Illinois at Chicago. Of the 10 black women who had been

recruited, 8 attended. The second focus group was held on

Tuesday, December 17, 1991. Of the 11 white women who

had been recruited, 10 attended. Almost all the participants at

both focus groups were staff members of the University of

Illinois. About half of these were members of an HMO. Both

focus groups were observed by all members of the project

team.

Discussion guide and conducting of groups

A discussion guide for the focus groups was prepared and

is included in appendix II of this report. The major issues

covered in the discussion guide were:

. Healthy practices

● Relationships with providers

● Physical examinations and early detection

. Information retrieval

● Question threat

For the second focus group, it was decided to cut the

section on healthy practices because it consumed a substantial

amount of time and did not add much to the discussion of

health screening procedures, Instead, the moderator asked

what prompted participants to see a doctor and then proceeded

to the section on relationships with their health care providers.

Both groups found the topic very interesting, and vigorous, lively discussions took place. The information provided

resulted in significant changes in the way the think-aloud

interviews were conducted. Within the first group, almost all

of the women reported having regular, annual physical exams

that included Pap smears and mammograms. They remembered the tests as components of the physical examination and

not as individual events. In contrast to the first group, many

more women in the second group did not consistently report

having annual physicals that included Pap smears and mammograms. In fact, a few had not had a physical or any of the

tests for 3-5 years. One of the women had never had a

mammogram. It was also mentioned that irregular timing

might be caused by how providers schedule physical examinations and screening tests. One woman who had recently

4
called to make an appointment for a mammogram was scheduled for one 6 months later. These results suggested experimenting with the content of questions in the think-aloud

interviews, with one version asking about physical exams and

the procedures that were included and the second asking about

the procedures separately as in the existing National Health

Interview Survey (NHIS), A detailed discussion of the resuits

from the focus groups is given in the section “Results.”

Think-aloud interviewmethodology

Think-aloud interviews are widely used to understand the

processes used by respondents to answer questions and to

improve questionnaire quality. Essentially, respondents are

asked to think aloud as they answer a question and to say

everything that comes to mind. If they just answer the question

without reporting their thought processes, they are then asked

a question such as, “How did you come up with that answer?”

Respondents may also be asked to describe a question in their

own words so that the researcher can determine how words in

the question are being interpreted. For this reason, think-aloud

interviews were conducted after the focus groups.

Sample selection

The respondents for the think-aloud interviews were

selected tlom the computer files of the RUSH-Anchor HMO.

Eligible women were those 50 years of age and over who had

been members of the HMO for at least 5 years. Some of the

initial sample contacted were ineligible because they worked

in a medical facility or were no longer members of the HMO.

No effort was made to control for the race of respondents in

the sampling. Ultimately, the sample consisted of more black

than white women, reflecting the composition of the HMO

membership in that office.

Interviewers attempted to contact 74 women for the

think-aloud interviews. Of these 74, interviews were scheduled with 17, 16 were ineligible (most worked at a health care

facility), 11 could not be reached, and 30 were either unwilling

to participate or unavailable on the days scheduled. Nevertheless, the proportion willing to cooperate was substantially

higher than in a general population sample asked to participate

in such groups. Of the 17 interviews scheduled, 1 was

canceled because the respondent had the flu. The other 16

were completed. Respondents who participated were reimbursed $50,

Administration of think-aioud interviews

The think-aloud interviews were conducted in the oftlces

of the Survey Research Laboratory in Chicago on January 22,

23, 25, 27, and 28, 1992. Interview times ranged from 9:00

a.m. until 6:30 p.m., and 17 time slots were filled. The

intewiews were conducted by the members of the project team

and by the manager of field operations. In addition to the

interviewer, another member of the team was in the room to

assist by taking notes and asking additional questions at the

end of the interview. Other members of the team were in an

adjacent room where they could hear the interviews, as the

rooms were separated by only a partition that did not extend to

the ceiling. All interviews were tape-recorded with the permission of the respondents. After two interviews it was decided

that it would be useful to check the RUSH-Anchor medical

records of think-aloud respondents to validate their responses.

All the remaining 14 respondents gave written permission to

have their HMO records checked.

Think-aloud questionnaires

For the purpose of these interviews, two questionnaires

were developed. The tirst, based on the current NHIS supplements, asked about each of the four screening tests one at a

time; the other asked about health events, physical checkups,

and gynecological examinations during which the screening

tests were conducted. These are shown in appendix II as

version 1 and version 2, think-aloud interview questionnaires.

As is common in the use of think-aloud methods (38), the

questionnaires were modified continuously as new issues and

problems arose. Although not every change is mentioned here,

some of the major changes that resulted from the think-aloud

interviews are presented.

Version 1 (appendix II), which is based on the NHIS

supplements, contained questions that had been tested earlier,

and no major problems arose with it. For this reason, only four

of the think-aloud interviews used this version. Initirdly, there

had been a problem with question 2 of the original version,

which asked about how much a person can do to control a

range of diseases. Most respondents who were asked this

question had serious problems understanding what it meant

and keeping the scale in mind. The question was revised, and

a show card was developed to aid respondents. Comprehension improved, but there continued to be misunderstanding

about whether the question was asking about disease prevention or about controlling the disease after one got it. Finally, it

was decided to replace this question with a series of questions

about the usefulness and painfulness of the specific procedures. These new questions worked very well, and no one had

trouble with them.

Initially, question 29 in version 1 asked respondents about

how threatening the questions were. This question, which

formerly had been used in asking about the threat of questions

dealing with drug and alcohol use (37), did not discriminate

among respondents in the think-aloud interviews. None of the

respondents reported that the questions would make them very

uneasy, and only a few mentioned being a little uneasy. In the

end, this question was omitted.

For each of the screening procedures except breast examination, respondents were asked how they found out their

results. At this point, every respondent not only reveaied how

she found out, but what the result was. It was concluded that it

does not make cognitive sense to ask respondents how they

found out the results without also asking what the results were.

This question was added for each screening test.

Version 2 was more complex than version 1, and 12

think-aloud interviews were conducted, until no new problems

arose. Respondents who oniy had screening tests as part of a

regular physical or gynecological checkup had no trouble with

the initial draft. However, there were respondents who had

5
1’

screening tests because of a health condition who wanted to

talk about this after the initial question on health status. For

this reason, a section was added asking about continuing

health problems, major illnesses, or conditions. If the conditions were breast-related, questions were asked about whether

respondents received mammograms and breast examinations

for reasons related to the conditions. If respondents had

gynecological or urinary problems, they were asked about any

Pap smears received related to those conditions.

For respondents who reported screening examinations in

different sections of the questionnaire, it was necessary to

determine whether the exams were being reported twice. This

was accomplished by adding a summary sheet to the back of

the questionnaire where the total number of each kind of test

received and the date of the last test were recorded. At the end

of all the sections, these results were confirmed with the

respondent. This method worked well.

It should be pointed out that although version 2 looks

much longer than version 1, most respondents skipped several

sections so that the interview averaged only about 20-25

minutes, a few minutes more than version 1.

Initially, respondents were asked whether they received a

pelvic examination as part of their physical. There was some

concern that respondents would confuse Pap smears and

pelvic examinations. It turned out that all the respondents

knew exactly what a Pap smear was, but several were unsure

about what was meant by a pelvic examination. Pelvic examinations were dropped from the latest version because it

seemed clear that asking this question did not improve reporting of Pap smears but simply added confusion.

There was also some confusion between mammograms

and breast examinations. Some respondents thought that when

they were asked about breast examinations, they were being

asked about mammograms. In the final version, instead of just

being asked about breast examinations, respondents were

asked, “Besides the mammogram, do you ever have a breast

examination by a doctor or medical assistant when the breast

is felt for lumps?”

The initial version said, “As part of your physical exams,

do you usually have . . . (screening test)?” A yes answer,

however, still did not reveal how many tests respondents had

had in the past 5 years. In the revised version, respondents

were first asked, cc . . . do you ever have . . .?” and if the

answer was yes, as it most often was, they were then asked,

“How often do you get . . .?” and then, “In what month and

year was the last one?”

Initially it was asked whether any of the tests done as part

of a physical or gynecological checkup were done at a

different location or time. This obviously requires a lot of

retrieval by respondents and caused difficulties. In the final

version, these questions were asked at the end of the interview

only for the last Pap smear and mammogram.

Results

Comprehension

Of the four screening procedures, Pap smears and mammograms are very well understood by women 50 years of age

6

and over. There were no cases in which these terms were

misinterpreted or not known. Although there is no wish to

generalize to other populations, especially younger women,

there was really no reason to explain these two terms to

respondents or to be concerned about comprehension.

There was some confusion about the term “breast examination, ” as previously mentioned. Many women in the focus

group and think-aloud samples thought first of mammograms

when the term “breast examination” was used, rather than

about a physical examination of the breast by a physician.

Mammograms also appeared to be more distinctive, as they

were taken at a different location and many women reported at

least some discomfort. Some of the confusion about breast

examinations may be reduced by a more careful definition of

the term.

There was little confusion about the term “blood stool

test, ” but some respondents had never heard of this test. It is

unlikely that these respondents had ever lmd such tests. Those

respondents who claimed to have heard of the test knew what

it was.

As one might expect, respondents had different interpretations about the term “physical examination. ” Some defined

this to include only the comprehensive examinations in which

a broad range of tests are performed. Others included the

briefer examinations they received when they came in for

periodic checkups of their high blood pressure or diabetes. For

the version 3 questionnaire, the aim was to exclude these

briefer examinations unless for a breast or gynecological

condition, because screening tests are not usually done then.

For this reason, the phrase “physical examination” in the

think-aloud questionnaire was changed to “complete physical

checkup. ” This certainly helped, but it is not certain that the

problem was totally solved. Note that there was no attempt in

this study to measure how well women report getting physicals; however, if the woman considered physicals as more

comprehensive checkups, she would report them less frequently and on a more regular basis so that her frequency

judgments would be expected to be better. Some women were

uncertain about the phrase “gynecological examination. ” This

phrase was changed to “gynecological or female examination” in the last version of the think-aloud interviews. Perhaps

because of the policies of RUSH-Anchor and other HMO’s,

most women reported complete physical checkups of which a

gynecological examination was a part, while only a few

reported separate gynecological examinations, It is unlikely

that women who have had separate gynecological examinations do not know the term. The term “pelvic examination, ”

on the other hand, was unclear to a number of women who,

from other evidence, had had such examinations. The use of

this term was discontinued.

Retrieval

From the focus groups and from the think-aloud responses

to both versions of the questionnaire, it was clear that only a

few respondents were retrieving isolated individual screening

examinations. Instead, almost all respondents were relying on

schemas. The reasons for this are fairly clear. First, a majority
of respondents reported the behavior being studied as very

regular, with tests being done on an annual basis. (An examination of the records indicated that actual behavior was less

regular than what was remembered.) Second, 5 years is a long

period, which makes it diflicult to retrieve individual events

(some tables in this report show data for 6 years because the

data collection period extended over 6 months). Both regularity (28) and long time periods (39) have been shown to lead to

the retrieval of schemas rather than of individual episodes.

By far the most common schema used, even when

unprompted, was to associate screening tests with annual

complete physical checkups, Another major schema was associated with serious illnesses or conditions. Respondents who

had had such events in their lives wanted to talk about them,

but it was usually possible to limit the discussion to the past 5

years, If screening tests had been part of the detection of these

conditions or as part of followup procedures, it appeared easy

for respondents to remember that they had had such tests and

to count the number of tests. Gynecological examinations

were much less frequent than complete physical checkups, but

when such exams did occur, Pap tests, breast exams, and

mammograms were usually part of the process. Another

schema that was mentioned involved tests for which the

results were inconclusive. In this case, another test, and

sometimes even more tests, were required.

Although respondents appeared to have little trouble

retrieving schemas related to screening tests, there were some

indications of possibly faulty retrieval. Several respondents

reported getting regular annual checkups but in later discussion indicated that the time period between checkups varied

from 12 to 15 and sometimes even 18 months. A few reported

that they knew they were supposed to get the test amually but

skipped 1 or more years out of 5 for a variety of reasons. This

could, of course, have happened to others who no longer

remembered the exceptions. Even in such cases, however, the

schemas provided the basic structure for estimating frequencies,

Judgment formation

Obviously, respondents use the schemas to make their

judgments. Thus, nearly all judgments are based on estimation

and not on counting. The easiest and most common estimate

that was made was by women who reported an annual

physical every year without exception and who reported

having a Pap smear or mammogram each time. They simply

reported getting five tests in the 5 years. A few women used

this rate-estimation procedure but then adjusted for exceptions. Thus, one woman reported that she had just recently

reached 50 years of age and before that had not had a

mammogram, Another woman reported that she typically had

had an annual breast examination but that for some reason, her

doctor had not given her one the previous year. Thus, she

reported four breast examinations.

For the less common procedures, such as the blood stool

test, counting was more common, especially when there had

been only one or two tests. By far the most complicated

situation for a respondent involved summing over different

schemas that involved both counting and rates based on

schemas. Thus, one of the think-aloud respondents had had a

complete physical checkup annually but had also had breast

cancer, which resulted in another series of mammograms. As

she tried to report how many mammograms she had had in the

past 5 years as well as the dates, she had considerable trouble

keeping it all straight. Similar stories were heard in the focus

groups. It was for this reason that version 3 was developed, to

reduce the cognitive burden on respondents.

Editing

Respondents edit responses if they are concerned about

the social desirability of their answers. In neither the focus

groups nor the think-aloud interviews was there any evidence

that respondents found screening tests difficult to discuss and

report. On the contrary, almost all reported finding the topic

very interesting and involving. There was no behavioral or

oral indication of uneasiness when respondents were asked

directly whether the questions about screening tests would

make most women uneasy. A typical response was given in

one of the focus groups by a woman who said that these

questions might make teenage girls uneasy, but women who

have had children would not find any of the questions

threatening.

Finally, it must be recognized that screening tests for

these women are seen as something that is socially desirable,

so respondents may be reluctant to report not getting these

tests. Thus, overreporting of tests could occur.

Comparison with records

After the think-aloud interviews and a pilot test (described

on page 11) were completed, record checks were conducted

with 26 respondents. This was done as a test of the recordretrieval methods as well as to get a first sense of how reported

events compared with data from the medical records. Medical

records personnel at RUSH-Anchor were paid to abstract from

patient records the dates on which four cancer-screening

procedures were conducted or reported by the provider. (I’he

four procedures were Pap smear, breast examination by physician or other medical professional, mammogram, and fecal

occult blood test.) Abstracters were blind to respondents’

self-reports. Results were compared by project staff at Survey

Research Laboratory. In the process of doing this record

checlq it became clear that fecal occult blood tests were not

well reported in the records. It was decided to omit these tests

from the comparisons.

This comparison of self-reports with medical records had

several goals. The first was to assess the accuracy with which

respondents recalled the number of times they had received

each screening procedure during the past 5 years (since

January 1, 1987) and the most recent date on which each test

had been received. A second goal was to identify potential

problems that might be encountered in matching records from

RUSH-Anchor with survey responses. Also, because this was

the first attempt at using the abstracting form planned for use

in Phase II, it was important to learn how to improve its

design.

7
Table B. Phase I comparison of number of self-reported

screening procedures with medical racorda: 1987-92

Pap Breast

Type of statistic smear Mammogram exam

Average numberof screenings

self-reported. . . . . . . . . . . . . . 3.6 4.3 4.0

Average numberof screeningsin

reoords. . . . . . . . . . . . . . . . . . 2.4 3.3 3.3

Average dtierenca. . . . . . . . . . . . 1.2 1.0 0.7

Percentageagreement . . . . . . . . . 34.6 11.5 19.2

NOTE Numberof patients. 26.

Recalling numbers of screening procedures

The comparisons of reported numbers of screening procedures are presented in table B. On average, respondents tended

to overreport the number of times they had received each

screening test during the previous 5 years (average overreporting ranged tlom 0.7 for breast exams to 1.2 for Pap smears).

The proportion of respondents who were able to correctly

recall the number of times they had received each procedure

varied considerably, from about 35 percent for the number of

Pap smears to about 12 percent for the number of mammograms received. Distributions of the dtierences between selfreports and medical records data for each screening procedure

are presented in table C (definitions of each measure can be

found in the response-quality outcome measures beginning on

page 12). There is some indication that mammograms are

Table C. Percent differences between self-reports and medical

record date, by test and type of ststistkx 1987-92

Statistic Pap smear Mammogram Breast exam

Percent

Gross aoouracy. . . . . . . . . . . . . . 72.9 76.3 69.3

Matchsddada. . . . . . . . . . . . . . 30.3 42.1 29.4

Notest . . . . . . . . . . . . . . . . . . 42.6 34.2 39.9

False reporte . . . . . . . . . . . . . . . 23.2 17.6

omissions . . . . . . . . . . . . . . . . .

22.9

3.9 5.9 7.8

Number

Reportingyeare. . . . . . . . . . . . . . 6 6 6

Reports. . . . . . . . . . . . . . . . . . . 155 155 153

NOTE Numbsrof patients. 26.

better reported than Pap smears and breast examinations

(gross accuracy for mammograms is 76.3 percent, compared

with 72.9 percent and 69.3 percent for Pap smears and breast

exams, respectively), Table D shows the results by year for all

tests combined. No clear trends were observed.

Potential problems

Several potential problems were identified during both the

medical records abstraction and the matching phases of this

project. During records abstraction, the major problem reported

by the RUSH-Anchor staff concerned the availability of test

results from fecal occult blood examinations, Apparently, large

numbers of test result slips are never filed properly in the

medical records. Because patient identication number is not

routinely recorded on the fecal test cards that patients mail

back to the clinic, it often becomes difEcult to properly file

result slips once test results are known. When examining

patient charts, physician references to the results of fecal tests

(for example, “fecal test negative,” “fecal okay”) were

nonetheless found in the progress notes. In this study, such

references were classified as evidence the test had been

conducted, even if actual test results were not available.

Physician notes that the patient had been given the fecal occult

card to take home and return with specimen smears were not

by themselves considered evidence that the test had been

done, as the cards were often not returned by the patient. Also,

recent research has indicated that this procedure is not effective in detecting colorectal cancer (40). For these reasons,

fecal tests were excluded from additional analyses.

After the initial abstracting test, the records abstracters

also expressed concern about their ability to accurately identify all instances in which a breast examination had been

conducted by the physician or medical assistant. Abstracters

believed that the degree to which this information was recorded

varied with the health professional conducting the exam, and

they were somewhat frustrated by the requirement that there

be specific written documentation in the record that the

examination had been conducted. In contrast, abstracters

remained confident that they were able to identify all Pap tests

and mammograms that were performed in their facility.

During records-report matching, a serious concern was

correctly identifying the total number of mammograms that

Table D. Percent distribution of Phase I responas-outcome measures for all exam types, by year and type of statistic 1987-82

Statistic 1987 1988 1989 1990 1881 1892

Percentdistribution

All measures . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0

Groee accuracy. . . . . . . . . . . . . . . . . . . 82.1 53.8 71.4 75.3 70.3 64.2

Matcheddata . . . . . . . . . . . . . . . . . . 8.9 25.6 54.6 43.3 46.6

Notest . . . . . . . . . . . . . . . . . . . . . .

23.6

73.1 28.2 16.9 32.0 21.6

False reports . . . . . . . . . . . . . . . . . . . . 12.8

eO.5

43.6 23.4 19.5 17.6

Omissions. . . . . . . . . . . . . . . . . . . . . .

10.5

5.1 2.6 5.2 5.2 12.2 5.3

Number

Reportingyeare. . . . . . . . . . . . . . . . . . . 6 6 6 6

Reports. . . . . . . . . . . . . . . . . . . . . . . .

6 6

78 78 77 77 74 76

NOTES Figuresmeynotsddto 100.0 becauseof rounding.Numberof patients. 2(5.

8
had been performed. Because abstracters recorded dates when

these tests had been ordered or recommended as well as the

dates of lab results, instances arose in which there were more

lab results than referrals recorded in the record and there were

more referrals than test results available in the record. Although

these two sets of dates usually correlated very well, these

findings demonstrated that some information clearly was not

making its way into the medical records. Some of this may be

accounted for by the observation that reports of very recent

tests were not corroborated by the medical record, suggesting

that these test results may not yet have been filed in the

records. RUSH-Anchor staff indicated that results normally

are filed in patient records 1–2 weeks after the test. Other

instances were discovered in which the most recent reported

date for a mammogram matched well with the most recent

referral date found in the medical records but not with the

most recent date for which test results were available (using

decision criteria, these cases were classified as a mismatch).

Where there were more results than referral dates, the problem

appeared to have been physician failure to record that the

procedure had been recommended, In practice, this was less of

a concern, given the coding criteria for having received a

mammogram, which required evidence of test results (or

reference to them).

Changes in abstraction form

In preparation for the next phase of the study, the RUSHAnchor abstracters indicated that it would not be difficult to

provide counts of the total number of patient visits made on an

annual basis. They also indicated that it would be fairly easy to

identify the individual health care providers who had seen

each patient. Both of these items were included in a revised

draft of the abstracting form.

In terms of other changes in the abstracting form, the

RUSH-Anchor staff indicated that it was easier, given the

structure of their medical records, to record screening procedures beginning with the earliest event and moving forward.

Previously, they had been asked to begin with the most recent

event and code backward.

Finally, the abstracting form was restructured so that

space was provided for remarks to be included along with

each date recorded. During this initial test, abstracters were

asked to record relevant information in the margins next to

referral and screening dates. This information often proved

critical in making final matching-related decisions.

Better understanding of the survey process

This research had as its main purpose the improvement of

questionnaires dealing with health-screening procedures. It

also had the aim of improving the general understanding of the

cognitive processes that underlie surveys.

‘No important general contributions were derived from

Phase I. The first was an added understanding of how the

regularity of behavior affects the process of reporting its

frequency. It is now fairly widely known that respondents use

estimation when the number of events to be recalled goes

much above five. Many researchers, including members of this

team, might have expected that respondents would usually

count fewer than five events. The results from Phase I of this

study sharply contradicted this expectation.

What was observed was that regardless of the number of

events, for highly regdar and similar routine events, rdmost all

respondents estimated based on schemas. These results agree

with those found by Menon (28), but in her study, the events

(for example, washing one’s hair, bmshing one’s teeth) were

much more frequent, and a much shorter time period (1 week)

was used. These results are also consistent with results from

Lessler, Tourangeau, and Salter (41) on reporting of dental

visits. The results of this study indicate that even for few

events over a much longer time period, regular and similar

activities are estimated. Menon also found that regular, similar

events were estimated with good accuracy. The results of

Phase II also support this.

This research was also an illustration of the process by

which focus groups and think-aloud interviews can be used to

develop a questionnaire whose flow matches the actual retrieval

methods of most respondents. Many researchers have proposed that questionnaires be tailored to individual respondents

to improve data quality, but the mechanisms for doing this

have not typically been specified. Some anthropologists (42)

have pointed out problems that respondents have with traditional questionnaires and have proposed unstructured questionnaires that better match respondent needs. Unstructured

questionnaires have not been widely adopted, however, because

of concerns about interviewer variability and the major difficulties of processing questiomaires for large-scale samples.

The final version 3 (see appendix II) was developed

entirely from the focus groups and think-aloud interviews.

Version 3 is a structured questiomaire that attempts to be

responsive to different individual cognitive processes. It appears

longer and more complex than the traditional questionnaire

because it tries to follow the different retrieval paths that focus

group respondents reported using. The actual length of the

interview was not significantly longer, however, because most

respondents skipped many of the branching paths.

It was expected that this version would help respondents

for whom the retrieval task was complex, and this hypothesis

was tested in Phase 11.Some respondents may rdso have used

retrieval methods that did not fit the organization of version 3.

The focus group and think-aloud samples were small and

possibly nonrepresentative. It was expected, however, that

most of the RUSH-Anchor HMO sample would use retrieval

methods that were mentioned in the focus groups or thinkaloud interviews and were covered in version 3.

One major concern with respondents’ use of schemas is

that they may forget exceptions to the schemas and falsely

remember events. For this reason, version 4 was developed to

force respondents to adopt a counting strategy.
Introduction

After Phase I was completed and the results analyzed, a

field study was designed and executed to test the methods that

had been suggested and developed. As in Phase I, the RUSHAnchor HMO provided access to medical records for validation and for sample selection.

Objectives and scope

Cognitive methods were investigated to improve responses

to questions about health promotion and disease prevention,

focusing on predictors of accuracy in the reporting of three

early detection procedures: the Pap smear, mammography, and

breast physical examinations.

Researchobjectives

The objectives of this research were to measure how well

the experience of receiving cancer-screening procedures is

recalled by respondents and to determine what methods of

questioning are most likely to elicit accurate recall and

reporting of having received these procedures.

Hypotheses

Based on the results of Phase I and the literature review

mentioned in the previous section, five hypotheses were

formulated:

1.

2.

3.

4.

10

More accurate reporting will be found for diagnostic tests

that were conducted separately rather than as part of a

physical exam because separate events will be more salient

and easier to retrieve.

Controlling for frequency, more accurate reporting (less

over- and underreporting) will be found for respondents

for whom the diagnostic tests are conducted regularly

rather than irregularly because regular events are easier to

schematize accurately.

More accurate reporting will be found among respondents

using a questionnaire form that activatesschemasrelating

to health events, physical checkups, and gynecological

examinations, compared with a questionnaire that asks

about each of the screening tests separately.

For questionnaires that ask about each screening test

separately, more accurate reporting will be found for

5.

respondents of whom questions are asked about the details

of the procedure (for example, who performed it, where it

was performed, what happened) before questions about

when it happened.

For questionnaires that evoke schemas by asking about

health events, physical checkups, and ~necological examinations, more accurate reporting will be found if respondents are required to count individual episodes rather than

to give a rate.

Hypotheses 1 and 2 were based on characteristics of the

diagnostic procedures and the context in which they occur.

The method of delivery and its regularity cannot be directly

manipulated by researchers. However, both regularity and the

context in which such procedures are delivered can be ascertained from existing data. Hypothesis 1 was based on ideas

that respondents will be more aware of and better able to

retrieve irregular diagnostic tests when they are performed

separately because the way such tests are stored in memory

will more closely relate to the way that the question is asked

than if the tests are parts of a more general diagnostic

procedure. When the event occurs sporadically rather than as

part of a familiar process, recall is likely to be enhanced, The

respondent must have been specifically made aware that the

event occurred distinctly from other events that occurred at the

same time.

Hypothesis 2 was based on the work of Menon (28) and

others who suggest that the formation and use of schemas to

make estimates of one’s behavior is facilitated by the regularity of the behavior. In other words, when the behavior is

periormed regularly, the regularity itself promotes and enhances

recall. In such cases, the context in which the event occurs

facilitates the recall. Note that hypotheses 1 and 2 are not

contradictory, because hypothesis 1 relates to irregular behavior and hypothesis 2 to regular behavior.

Hypotheses 3 through 5 relate to procedures for questionnaire development that are under the control of the investigator. Hypothesis 3, which also is derived from the ideas of

schema formation, asserts that schemas will be easier to

retrieve and to use in estimation if they have already been

previously activated by questions that parallel the schemas

that most respondents use.

Hypothesis 4 was based on works of Brewer (29), Means,

Swan, Jobe, and Esposito (31), Herrmann (43), and Wagenaar

(30), who strongly suggest that time is the least well remembered aspect of an event. Asking about the better remembered
aspects first may provide additional cues as to when the event

occurred.

Hypothesis 5 was developed by observing that respondents sometimes remember events as being more regular than

they really were and forget the exceptions. For such cases,

getting respondents to count rather than using a rate should

increase accuracy.

Methodology

Target population

The population was women 50 years of age and over who

were members of the RUSH-Anchor HMO. Women in this age

group were selected because they are the group most likely to

misreport having received a Pap smear (17,18,44). Moreover,

women over 50 years of age are the primary target population

for mammograms and breast physical examinations. Screening

for women under this age is controversial, and data conflict as

to the value of these tests in routine case finding (45). After

carefid consideration of the sample characteristics of the

RUSH-Anchor population, it was decided to sample the list at

random and not stratify. Because the stratifying variables were

not computerized, stratification would have required individual record abstraction, which would have increased costs

significantly.

Pretest

Before the main data collection began, a small pretest was

conducted of the data collection procedures as well as of the

revised questionnaires. Using a recruitment script, interviewers telephoned a small number of women from the target

population to solicit cooperation and set up appointments for

face-to-face interviews in their homes. After 13 interviews

were conducted, a debriefing session was held with the

interviewers to discuss how the procedures and questionnaires

worked, It was decided that for the main data collection,

advance letters on RUSH-Anchor stationery would be sent out

prior to calling for interview appointments. In addition to

containing information about the project, the letter included

the name and telephone number of a person at the HMO who

could be called if the potential respondent wanted to confirm

the study’s authenticity.

As expected, the most diflicult interviewing task was

obtaining dates for tests that had been taken. Although the

questionnaires asked for the month and year that each test was

taken, a complete answer was not typically volunteered by the

respondent until the interviewer probed. Most survey researchers agree (see, for example, Fowler and Mangione [46]) that

probing is the hardest interviewing skill to learn because it

cannot be completely standardized. The pretest experience

confirmed this problem, and as a result, specific probes were

built into the final questionnaires for questions asking about

dates,

Face-to-face interviews

To obtain an approximately equal number of interviews

with each of the four questionnaire versions, each interviewer

was given a stack of blank questionnaires in rotating version

order (different for each interviewer) and told to use the top

questionnaire for each subsequent interview. One-half of the

sample was interviewed with a questionnaire based on schemas related to health events, physical checkups, and gynecological examinations. The other half used a questionnaire that

asked about each screening test separately.

Within the schema questionnaire, one-half of the respondents were asked questions that encouraged the use of a rate,

with possible adjustment for missed examinations (version 3,

final questionnaire). The other half were encouraged to count

individual events (version 4, final questionnaire).

Within the sample in which screening tests were asked

about separately (that is, episodically), one-half of the respondents were asked first about details of the diagnostic procedure

before being asked about when it occurred (version 2, final

questionnaire); the other half were asked first for when it

occurred, then about the details (version 1, final questionnaire). The new wordings developed in the cognitive laboratories were used for all respondents. The four alternative forms

that were used can be found in appendix II.

At the end of the interview, respondents were asked for

permission to examine their medical records at RUSHAnchoq 178 of 211 granted permission. These respondents’

interviews were then compared with the abstracted records.

The analyses are based on this sample of 178 respondents for

whom validation information was available. The demographic

characteristics of these 178 women are shown in table E.

Medical records abstraction

Table F lists the specific data collected from each eligible

patient record. Within each patient record, the following

Table E. Demographic characteristics of study respondents

1987-92

Characteristic Percent

Agel

50-59 years . . . . . . . . . . . . . . . . . . . . . 57.9

60-69 years . . . . . . . . . . . . . . . . . . . . . 33.7

70years and over . . . . . . . . . . . . . . . . . 8.4

Race

Black . . . . . . . . . . . . . . . . . . . . . . . 87.8

Whit e . . . . . . . . . . . . . . . . . . . . . . . . 8.4

Hispanic . . . . . . . . . . . . . . . . . . . . . . . 3.4

Asian/Pacific Islander . . . . . . . . . . . . . . . 0.6

Education

Less than high school graduate. . . . . . . . . 15.2

Highschwl graduate . . . . . . . . . . . . . . . 34.s

Some college . . . . . . . . . . . . . . . . . . . . 25.8

College graduate . . . . . . . . . . . . . . . . . . 24.2

Employment status

Employed full-time . . . . . . . . . . . . . . . . . 71.9

Employed part-time . . . . . . . . . . . . . . 5.6

Notemployed . . . . . . . . . . . . . . . . . . . . 22.5

1Mean age was 59.6 yeews.

NOTE Number of respondents= 178.

11
Table F. Data abatraeted from medical racords

Inrbrmation

Date item sought

Msdiial visits during previous 5 years. . . . . . . . . . . . Total number

Occurrence of full or partial hystereotomy. . . . . . . . . . Yes or no

Pap tests done during previous 5 years. . . . . . . . . . . Dates

Results of Paptesk . . . . . . . . . . . . . . . . . . . . . . . Normal orabnormal

Mammograms recommended during previous 5 years. . Dates

Mammograms completed during previous 5 years . . . . Dates

Results of mammograms. . . . . . . . . . . . . . . . . . . . Normal or abnormal

Breast examinations done during previous 5 years. . . . Dates

Results of breast examinations . . . . . . . . . . . . . . . . Normal or abnormal

sources were reviewed for information regarding these variables: physician progress notes, cytology reports, laboratory

reports, and radiology reports.

Reliability

The generally accepted procedure of validating selfreports by relying on medical records was used. However, in

so doing, it was recognized that many of those who rely on

records have reported that records are an incomplete and not

totally reliable source (47-49). A record reabstraction study

was undertaken to evaluate the reliability of information

derived from these medical records. The goal of the reabstraction study was to assess the degree to which complete

information was abstracted from medical reeords. A credentialed medieal records technician employed by the contractor

reabstracted 20 records, and the data were compared with the

data initially abstracted. Overall, 98 pereent of the reports

showed consistency between the initial and reabstracted data,

indicating a very high level of reliability.

The matching between the record and the questionnaire

was done by a medical records specialist. Initially, matching

was done regardless of discrepancies by date. The matching

protocol is included in appendix II. Once a match was

established, the difference in months between the record date

and the interview date was computed if a date was given on

the interview.

Results

Analysis

To test all the hypotheses, it was necessary to specify

what is meant by “accuracy.” There is no single measure

because accuracy is a multidimensional concept. Although

screening test information was collected for all tests reported

in a year, for the purposes of this report, only the first test was

used. Few respondents reported two or more tests a year, and

respondents had ditliculty distinguishing between two distinct

tests as opposed to the redoing of a single test because the

initial test was not performed properly or followup studies

were required.

Tables G–K show the statistics defined in the next section,

and more detailed tables are found in appendix II.

Response-quality outcome measures

The following four response-outcome measures are

reported

●

●

●

●

Matched datz The respondent reported receiving a screening test, and the test was verified in the medical records

(verified reports divided by total sample).

False reports: The respondent reported receiving a screening test and no matching test was found in the records

(unvetied reports divided by total sample). This measure

is ditlerent from and should not be confused with traditional epidemiologic measures of false positive and false

negative rates, also defined in this section.

Omissions The respondent reported no test but a test was

found in the records (unreported tests divided by total

sample).

No testi The respondent reported no test and no evidence

Table G. Percent distribution of response-quality measures, by test and type of measww 1987-92

All Pap Breast

Statistic tests smears exams Mammograms

All measures . . . . . . . . . . . . . . .

Matched data . . . . . . . . . . . . . . .

False reperk . . . . . . . . . . . . . . .

Omissions . . . . . . . . . . . . . . . . .

Notest . . . . . . . . . . . . . . . . . . .

Reporting test . . . . . . . . . . . . . . .

Test in records . . . . . . . . . . . . . .

Ratio . . . . . . . . . . . . . . . . . . . .

Gross accuraoy . . . . . . . . . . . . .

Sensitivity . . . . . . . . . . . . . . . . .

Spaeificify . . . . . . . . . . . . . . . . .

False negatives. . . . . . . . . . . . . .

Fakepositives . . . . . . . . . . . . . .

Respandenta . . . . . . . . . . . . . . .

Reports. . . . . . . . . . . . . . . . . . .

100.0

31.8

16.2

5.3

46.7

48.0

37.1

1.29

0.79

0.88

0.74

0.14

0.26

178

3,168

100.0

27.9

16.9

3.0

50.2

46.8

30.9

1.51

0.78

0.90

0.73

0.10

0.27

178

i ,059

Percent distribution

1W.o

28.6

18.5

8.4

43.3

Percent

48.3

38.2

1.26

0.73

0.76

0.70

0.22

0.30

Number

178

1,0s3

100.0

37.9

11.1

4.5

46,6

49.0

42.4

1.16

0.84

0.90

0.81

0.11

0.19

178

1,051

12
Table H. Percent distribution of response-quality meaaures, by year and measure: 1987-92

Measure 1987 1988 1989 1980 1991 19921

Percent distribution

All measures . . . . . . . . . . . . . . .

Matchad data . . . . . . . . . . . . . . .

False repmts. . . . . . . . . . . . . . .

Omissions . . . . . . . . . . . . . . . . .

Notest . . . . . . . . . . . . . . . . . . .

Reportlngtest . . . . . . . . . . . . . . .

Testin records . . . . . . . . . . . . . .

Ratio . . . . . . . . . . . . . . . . . . . .

Grossaccuracy . . . . . . . . . . . . . .

Sensitlvily . . . . . . . . . . . . . . . . .

Specificity . . . . . . . . . . . . . . . . .

Falsenegatives . . . . . . . . . . . . . .

Faleepositivee . . . . . . . . . . . . . .

Respondents . . . . . . . . . . . . . . .

Reports . . . . . . . . . . . . . . . . . . .

100.0

16.9

14.1

11.1

57.9

31.0

2e.o

1.11

0.75

0.60

0.80

0.40

0.20

178

532

100.0

34.9

17.4

8.4

39.3

52.3

43.3

1.21

0.74

0.81

0.69

0.19

0.31

178

524

100.0

40.5

19.7

5.0

34.8

80.2

45.5

1.32

0.75

0.89

0.64

0.11

0.36

178

522

Percent

Number

100.0

43.2

17.2

3.4

36.1

60.5

46.6

1.30

0.77

0.93

0.68

0.07

0.32

177

523

100.0

40.8

21.3

2.1

35.8

62.1

42.9

1.45

0.77

0.95

0.63

0.05

0.37

178

534

100.0

15.2

7.5

1.9

75.4

22.7

17.1

1.33

0.91

0.89

0.91

0.11

0.09

178

533

1Partial year.

NOTES figures msy not add to 100.0 because of rounding. Data shown are for all procedures oombined.

Table J. Percent distribution of response-quality measures, by type of test, test regularity, and measure: 1987-92

Papsmeara Breast exams Mammograms

Measure Regular h-regular Regular Irregular Regular Irregular

Percentc’iatribution

Allmeasures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 100.0

Matchaddata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67.1 20.1 52.8 24.7 63.9 30.3

False reparts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.0 23.2 6.9 23.2 7.1 14.0

Omissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 2.7 20.2 5.4 7.7 3.5

Notest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.7 54.0 20.1 48.7 21.3 62.2

Reportingtest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Testln records . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Qroseaccuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Specificity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False negatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Falsepositives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

78.1

72.3

1.08

0.84

0.93

0.60

0.07

0.40

43.3

22.8

1.90

0.74

0.88

0.70

0.12

0.30

Percent

59.7 47.9

73.0 30.1

0.82 1.59

0.73 0.71

0.92 0.82

0.75 0.67

0.28 0.18

0.25 0.33

71.0

71.8

0.99

0.85

0.89

0.75

0.11

0.25

44.3

33.8

1.31

0.83

0.90

0.79

0.10

0.21

Number

Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 128 39 131 50 117

Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 765 233 777 297 668

ofa test was found in the records (verified absences of . Report-to-records ratio (percent reportin~ dividedby pertests divided by total sample).

.- .-

cent records): a measure of net bias in teat reporting, a

Note that each of these measures was calculated using the similar measure has been previously used by Brown and

total sample (N= 178) as the denominator. Adams(51)

Using these response-outcome measures, the following . Sensitivity (matched data divided by [matched data plus

response-quality measures were estimated to summarize responomissions]): the number ofcorrectly recalled tests divided

dent reports:

by the number of cases in which tests were found in

medical records; in previous research, measures that are

. Gross accuracy (matched data plus no test): also com- operationally identical to sensitivity have been referredto

monly referred to as an indicator of “concordance” (50) or as a “measure of completeness” (52,53) and as a “medical

as the “rawagreementr ate’’( 51) records confirmation rate” (51)

13
Table K, Percent distribution of response-quality measures, by form and measurtx 1987-92

Measure Form II Form 22 Form @ Form 44

Percent distribution

All measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0

Matcheddata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

31.3 32.7

Falsereporte . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34.0 30.2

14.4 16.8

Omissions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16.0 16.2

5.1 4.5 6.5 5.3

Notest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49.2 46.0 41.5 43.3

Percent

Reportingtest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.7 49.5

Testinracords . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

52.0 46.4

Ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

36.4 37.2 40.5 35.5

1.26 1.33

Grossaoouraey . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.26 1.31

0.61 0.79

Sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.76 0.79

0.36 0.33

Spaeificity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.34 0.85

0.77 0.73 0.10

Falsenegatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.75

0.14 0.12

Falsepositives . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0.16 0.15

0.23 0.27 0.30 0.25

Number

Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 41 37 46

Reports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 246 221 286

lEpisodicque~”onformat dateoftestOaourrenserequestedfirst

2Epiticque~.on foms~dtilsofte~ rSqUEStSdfiMt

s~maque~on fom~enmura~ useofratesandadju~mk toestimatenumberofsvents.

4Sshernaquestionforrnatencouragedtooountlndm”dualevents.

NOTE Oats are for alltestsandyears combined.

●

●

●

●

●

Specificity (no test divided by [no test plus false reports]):

the numberofcorrectly reported ’’no tests” dividedbythe

number of cases in which no test was found in the medical

records

False negatives (1 minus sensitivity): the number of tests

not reported divided by the number ofcases inwhich tests

were found in medical record

False positives (1 minus specificity): the number of tests

reported divided by the number of cases in which no test

was found in the medical records

Percent reporting (matched data plus false positives): the

number ofrespondentswho reported during the interview

that they received the test in question

Percent records (matched data plus false negatives): the

number of respondent medical records that indicated that

they received the test in question

Hypothesis 1 proposes that tests conducted separately will

be better remembered. For this sample, almost ali Pap smears

and breast examinations appeared to have been conducted as

partsofthephysical orgynecologicalexamination. Theexceptions were too few to analyze. Mammograms were conducted

at a separate location across the street from the clinic, and

there was some variation in when this test was done. For

hypothesis 1, mammograms that were done elsewhere were

compared with Pap smears and breast examinations usually

done atthe timeof the physical. Differences in accuracyof

reportingofthese procedures may havebeen related, however,

to factors other than separateness.

For hypothesis 2, it was necessary to define what was

meant by “regularity.” Based on the results, respondents were

classified as regular if there was evidence in the medical

records that they were tested every year, every other year, or if

they received examinations during40fthe5 years includedin

the study. Other respondents were classified as irregular,

except those with no medical record evidence of cancerscreening examinations during the 5-year study period, who

were excluded from the comparison of regular and irregular

respondents.

For hypotheses 3 through 5, the analysis compared the

accuracy measures just described. Sampling errors were also

computed and tests of significance were performed.

Overreporting of screening tests

The basic iinding of this study is that respondents generally overreport having received screening tests, Aa maybe

seen in table G, which summarizes the data over the entire

6-year period (see section entitled “Objectivesa nds cope”),

the relative overreporting averages 29percent for all three

procedures and ranges from 16percent for mammograms to

51 percent for Pap smears. To put this another way, the percent

of false reports averages 16percent, and the percent of

omissions averages only about 5percent (table G). Detailed

data by year are given in table II in appendix II.

The null hypothesis that memory errors are unbiased

would lead to a test of whether the percentages of false reports

do not d~er significantly from the percentages of omissions,

To test this hypothesis, the McNemar test for related samples

was calculated for each type of examination for each reporting

year shown in table II (54), Overreporting (false reports) was

found to be significantly greater (p < 0.05) than underreporting

(omissions) for 6 of the 6 reporting years for Pap smears and

14
for 3 of the 6 reporting years both for clinical breast exams

and mammograms.

Effects of time

Table H shows the response-quality measures separately

by year for all three tests combined (detailed results are given

in table II in appendix II). The results differ between the false

reports and the omissions. There appears to be no effect of

time on the false reports (range= 14.1–21.3, excluding partial

1992 data), It appears that the false reports occur because most

respondents are using a schema (that they get the tests on a

regular, yearly basis) and forgetting possible exceptions. If

such schemas are used, and exceptions are not related to time,

then one would expect a consistent level of false reports, and

this is what was observed.

Respondents who did not get screening tests regularly

were forced to attempt to remember individual tests. It has

long been known that the rate of forgetting increases with

increased time (33). This is exactly what was seen with the

omissions. There was a steady increase of omissions from

2.1 percent in 1991 to 11.1 percent in 1987.

Gross accuracy remained relatively constant between 1987

and 1991 (range = 0.74-0.77), increasing only for 1992 (0.91).

Most respondents were interviewed during the second quarter

of 1992, so reports for that year were based on a shorter time

interval, which likely accounts for their higher accuracy.

Tests of hypotheses

Of the five hypotheses, two are related to the characteristics of the events and three are based on form manipulations.

In testing these hypotheses, both intuitive interpretation of the

measures presented in tables G-K and random-effects logistic

regression models were relied upon (55). This statistical

procedure was employed to adjust for the fact that all observations in these analyses were not independent of one another.

In fact, most of the 178 respondents contributed 18 selfreports (three screening procedures for each of 6 years) to the

analysis. The clustered nature of these data therefore requires

an analytic approach capable of testing these hypotheses while

simultaneously modeling this dependency. The model does

this by including random person-specific effects and then

estimating the variability associated with these random effects.

Note that this is similar to the way repeated-measures ANOVA

accounts for the dependency in the data resulting from repeated

observations of the same individuals across time; the logistic

regression model was used here because the dependent variables were dichotomous rather than continuous. For testing the

hypotheses in these regression analyses, gross accuracy was

selected as the dependent variable of interest. The null model

is presented in column 1 of table L. This model estimates two

parameters, one for reporting year and a second for the

variability (standard deviation) associated with the random

person-specific effect. Both of these terms are significant,

indicating that gross accuracy improves with time (resulting in

large part from the inclusion of partial data for 1992; estimate

= 0.16, standard error = 0.02, p < 0.001) and that there is a

clustering effect within these data (the intraperson correlation

observed in this model is 0.10; estimate = 0.60, standard error

= 0.07, p < 0.001). This model was employed as a baseline for

evaluating each of these hypotheses.

The first hypothesis was that more accurate reporting

would be found for respondents for whom the diagnostic tests

were conducted separately, rather than as part of a physical

examination, because separate events would be more salient

and easier to retrieve. Because of the special HMO population

used in this study, virtually all breast examinations and Pap

smears were given as part of a physical examination, while

mammograms were performed in a different location across

the street.

Table L. Random effects logistic regression estimates and standard errora for report year, procedure type, test regularity, and

questionnaire form effects on gross accuracy

[1 = yes]

Model

Item (1) (2) (3) (4)

Intercept. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Random effect standard deviation . . . . . . . . . . . .

Report year . . . . . . . . . . . . . . . . . . . . . . . . . .

Papsmeara . . . . . . . . . . . . . . . . . . . . . . . . . .

Breast exams . . . . . . . . . . . . . . . . . . . . . . . . .

Test regularity . . . . . . . . . . . . . . . . . . . . . . . . .

Question form contrasts

Form lversusform 2 . . . . . . . . . . . . . . . . . .

Form 3veraus form 4........ . . . . . . . . . .

Forms 1 and 2 versus

3and4 ............ ........ ......

Log L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Degrees of freedom . . . . . . . . . . . . . . . . . . . . .

*I .00 (0.0s)

*0.60 (0.07)

*0. I 6 (0.02)

. . .

. . .

. . .

. . .

. . .

. . .

-1,604.30

—

—

*I .42 (0.11)

*0.62 (0.07)

*0. I 7 (0.02)

*4.45 (0.11)

*4.74 (0.11)

. . .

. . .

. . .

. . .

-1 ,5S2.50

*43.6

(2)

*I .23(0.12)

‘0.54 (0.06)

+0.1 7 (0.02)

*-CI.45 (0.12)

*-O.70 (0.11)

%.2s (0.12)

. . .

. .

. . .

-1,539.79

*81 .4

(1)

*1 .21 (0.12)

-.52 (0.07)

-.17 (0.02)

*4.45 (0.12)

*-O.70 (0.11)

*0.30 (0.12)

-0.04 (0.09)

0.12 (0.09)

-0.17 (0.07)

–1,5s6.22

3.1

(3)

*p <.01

*p<,wl

NOTE3tsndarderrorsarsInparentheses.

15
Thus the hypothesis would suggest that mammograms

should be better reported than Pap smears and breast examinations, and, as seen in table G, this hypothesis was confirmed

using bias (report-to-records ratio), gross accuracy, or specificity measures. These results were consistent over time, as

seen in table H. Another difference is in the percentage of false

reports, which averaged 18.9 percent for Pap smears and

breast examinations and 11.1 percent for mammograms. This

hypothesis was tested in the random-effects logistic regression

model presented in column 2 of table L. For this analysis,

dummy variables representing Pap smear and breast exam

reports were added to the null model in order to contrast these

procedures with reports of mammograms. These two coefficients confirm the information in table G, in that mammograms were reported with greater accuracy than either Pap

smears (estimate = -0.45, standard error = 0.11, p < 0.001)or

clinical breast exams (estimate = -0.74, standard emor = 0.11,

p < 0.001). Additional analyses (not shown) found similar

results for the specificity of these reports ,

As previously noted, however, some of the better reporting of mammograms may have been related to other characteristics of the test, such as the pain of the procedure for some

women, in addition to test location. To test this alternative

hypothesis, respondents were asked whether or not they

thought mammograms were very painful, somewhat painful,

or not very painful. There were no differences between

respondents who thought the procedure was very or somewhat

painful and those who thought it was not painful (data not

shown). Similarly, there was no difference in accuracy of

reporting Pap smears by those who thought the procedure was

painful versus those who did not.

Hypothesis 2 was that more accurate reporting would be

found for respondents for whom the diagnostic tests were

conducted regularly rather than irre@arly because regular

events are easier to schematize accurately. This hypothesis

was partially supported.

Table J reveals that the major difference between regular

and irregular test recipients was that the percentage of false

reports was higher among irregular test recipients (11.0 percent compared with 23.2 percent for Pap smears; 6.9 percent

compared with 23.2 percent for breast exam$ and 7.1 percent

compared with 14.0 percent for mammograms). The cognitive

explanation of this finding makes it almost tautological. Many

respondents use regularity schemas in reporting about these

tests. Those respondents whose records indicated that indeed

the tests were received regularly would certainly have had a

lower level of false reports than respondents who had not

received the tests regularly but who thought they had.

There is no cognitive reason to have expected that the

percentage of omissions would have been significantly different for regular than for irregular test recipients, but it was for

breast examinations. One practical reason for this finding

could be the lower validity of the medical records for this

procedure. Although the record checks for Pap smears and

mammograms relied heavily on pathology and radiology

reports, respectively, evidence of breast examinations relied

solely on the notes of the physicians. It is possible that in some

cases, the physician checked off “breast examination” on the

physical examination form although one was not done. It is

also possible that if one was done, the patient did not

recognize or recall it as such. Given the speed with which

some physical examinations are conducted, both possibilities

are feasible.

Net reporting bias is shown in table J. Overall, the net

biases are far smaller for respondents who received tests

regularly for each procedure. Biases range from +8 percent for

Pap smears to –18 percent for breast examinations, with

mammograms reported with a net bias of only 1 percent for

those getting tests regularly. On the other hand, the net biases

for those getting the tests irregularly range from a low of

+31 percent for mammograms to +90 percent for Pap smears.

Review of gross accuracy measures suggests, though, that

regularity is most strongly associated with reports of Pap

smears.

Column 3 of table L provides an overall test of the effect

of test refydarity, controlling for test type, on gross accuracy.

Both the regression estimate for this variable (estimate = 0,28,

standard error = 0.12, p < 0.001) and the difference in

likelihood ratio chi-square for the overall model (Ax2 = 81,4,

degrees of freedom= 1, p c 0.001)indicate that test regularity

improves the accuracy with which cancer screening tests are

reported.

Hypothesis 3 proposed that more accurate reporting would

be found for respondents using a questionnaire form that

activates schemas related to health events, physical checkups,

and gynecological examinations compared with a questionnaire that asks about each of the screening tests separately.

The results, shown in table& do not support this hypothesis.

One problem in examining this hypothesis was that the

sample sizes for each of the four treatments were small,

ranging from 37 to 51 cases. Thus, it is not surprising that

there is substantial variability by year and between the three

screening tests. The most stable measure is simply the total

across all years and across all tests, which is shown in table K.

The more detailed results are given in table IV in appendix II.

It may be seen in table K that the report-to-records ratios

by form range from 1.26 to 1.33. There thus appears to be no

consistent pattern of superiority of any form over all three

screening tests or over years. In retrospect, it appears that the

treatment was ineffective because most respondents used

schemas in answering the questions regardless of the form. To

put it another way, schemas did not need to be activated by the

form of the question; they were already activated simply by

the topic.

Hypothesis 4 was also not supported. It stated that more

accurate reporting would be found on version 2, which asked

details about the procedure before asking about the date, than

on version 1, in which the date was asked first. As can be seen

in table ~ there were no practical differences. The retrospective explanation is that because respondents were using schemas to report events, the details of specific events were not

used in retrieval as they would have been if the respondents

had been attempting episodic recall.

Hypothesis 5 predicted that version 3, which asked respondents to count individual physical examinations first before

giving a total and specifically asked respondents whether they

16
had missed having a physical exam in any of the past 5 years,

would result in more accurate reporting (that is, a reduction in

the positive bias), compared with version 4, which simply

evoked a regularity schema.

Again, it may be seen that there were no significant

differences between forms 3 and 4 (table K). It is evident that

neither of the forms changed the process respondents used in

retrieving their schemas. In retrospect, this result is not too

surprising, because others (39,56) have also found it difficult

to change the retrieval procedures that respondents use.

Menon (28) found that it was possible to reduce overreporting by specifically asking respondents about exceptions to

regularity. Her questions, however, asked about a very short

time period. In this study, it is much more likely that respondents forgot about the nonoccurrence of a perceived regular

event several years earlier.

Hypotheses 3 through 5 were also tested using logistic

regression analysis with random effects (column 4, table L).

This analysis confirms that questionnaire form had no significant effect (A)C2 = 3.1, degrees of freedom = 3, not significant) on the gross accuracy of reports. Additional analyses

(not shown) also failed to identify any effects of questionnaire

form on sensitivity and specificity.

Event dating

To this point, the analysis has simply consisted of looking

at whether the events reported by the respondents and in the

records could be matched at all. To look further, one can now

turn to a comparison of the dates reported by respondents and

in the records for the subsample of events that were matched.

The data are presented in tables M and N. More detailed data

are given in tables V and VI in appendix II.

It may be seen in table M that the net biases are small

(range = 0.8-1,3), averaging less than 1 month, but are

consistently positive, meaning that there is a slight tendency

for respondents to remember the test as having occurred more

recently than the date given in the records. Many respondents,

however, date the procedure as having occurred earlier than

the date given in the records. The gross error averages about

3.5 months.

There appear to be no meaningful differences in dating

errors by procedure, year, or form. The sampling errors for the

Table M. Net bias and gross error in reporting of dates of test

procedures for matched datrx 1987-92

Type of test or form Net bias Gross error Number

Test Montha

Total. . . . . . . . . . . . . . . . . . . . . . . . . . 0.8 3.5

Papsmears . . . . . . . . . . . . . . . . . . . . . 0.8 3.4

Breast exama . . . . . . . . . . . . . . . . . . . . 1.1 3.7

Mammograms . . . . . . . . . . . . . . . . . . . . 0.6 3.8

Form

Version I . . . . . . . . . . . . . . . . . . . . . . . 1.3 3.2

V8rsion 2. . . . . . . . . . . . . . . . . . . . . . . 0.9 3.0

Version . . . . . . . . . . . . . . . . . . . . . . . 0.6 4.3

Version 4. . . . . . . . . . . . . . . . . . . . . . . 0.8 2.8

767

208

234

325

216

180

189

182

total sample in table M are about 5 months. Many women

reported getting their examinations during the same season

each year, and thus, should have been able to use this

information in reporting dates. The results suggest that there

was not much additional error in dating if the test had been

remembered correctly. Table N presents information on the

precision with which respondents reported dates. Although

women were asked for month and year, only about 19 percent

of them reported month and year for all tests. The most

common method used was to give the exact month for some

tests, and a season of the year when the exact month could not

be remembered. Consistent with the earlier information on

data accuracy, more women reported an exact month for

mammograms compared with Pap smears and breast examinations. Also, there was a greater likelihood for the exact month

to be reported on the most recent test than on tests from earlier

years.

Discussion and recommendations

It was noted based on the Phase I focus groups that most

women appeared to use schemas such as, “I get a mammogram every year” or “I get a Pap smear along with my annual

physical.” This same heavy use of schemas was noted in the

Phase II interviews. It was thought that this use of schemas

could by affected by revising the forms used, but that was

unsuccessful.

Schemas do not necessarily provide poor estimates. For

very regular behavior, schemas may provide better estimates

than efforts to remember individual episodes. Schemas can

result in overstatements of behavior when respondents forget

occasions when the regular behavior was interrupted. That is

the case for all of the health care behaviors studied in Phase II.

As was seen in table G, respondents, on average, overstated

receiving health care procedures by 29 percent, compared with

records. The overstatement was lowest for mammograms

(16 percent) and highest for Pap smears (51 percent) but was

found for all procedures. One consequence of using schemas

is that there is little difference in the level of false positives by

year, as there is with trying to recall individual events.

Researchers typically observe sharp increases in underreporting caused by forgetting for longer time periods. Such differences in false negatives are observed in table H. Because the

number of false positives is far larger, they dominate the net

results.

Based on the tidings from this study, it is not possible to

recommend any changes in the questions currently used in the

NHIS to obtain information about Pap smears, mammograms,

and breast examinations. These procedures are overreported

because many women use the schema of an annual checkup at

which time they always get these procedures. The assumption

of a complete amual checkup, however, is not correct and

may become an increasing problem as the U.S. health care

system becomes more competitive and pressed for time. Some

of the HMO physicians in the study noted that they have

become more likely to conduct physical examinations and

preventive services over several visits. This will create additional obstacles for accurate patient recall. None of the new

17
Table N. Percent distribution of level of reporting precision, by teat and response patterm 1987-92

Response pattern

Breast

All tests Pap smears Mammograms exams

Percent distribution

Allpattems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0

Always gave month andyear . . . . . . . . . . . . . . . . . . . . 19.3 35.3 46.4 43.9

Some month andyear, some season and year . . . . . . . . . 32.4 19.2 13.9 12.2

Some month andyear, someseason andyear, someyear . 17.6 3.9 2.4 3.7

Some month andyear, someyear . . . . . . . . . . . . . . . . . 7.4 6.4 6.6 4.9

Some month andyear, somedon’tknow. . . . . . . . . . . . . 6.6 4.5 5.4 3.0

Always gave seaeonand year. . . . . . . . . . . . . . . . . . . . 6.8 16.0 14.5

Some season andyear, someyear . . . . . . . . . . . . . . . .

13.4

4.0 1.9 2.4 1.8

Some season and year, some don’t know . . . . . . . . . . . . 2.3 5.6 1.2 4.9

Always gaveyearonly . . . . . . . . . . . . . . . . . . . . . . . . 1.1 4.5 3.0 4.9

Some year, some don’t know, or all don’t know . . . . . . . . . 2.3 2.5 4.2 7.3

Number

Number reporting teats . . . . . . . . . . . . . . . . . . . . . . . . 176 156 166

Number reporting notests . . . . . . . . . . . . . . . . . . . . . .

164

2 22 12 14

Mean number oftesta (allwomen) . . . . . . . . . . . . . . . . . 11.2 3.1 3.3 3.4

Mean number of tests (ii had one or more). . . . . . . . . . . . 11.3 3.6 3.6 3.6

NOTEN. 178 respondents.

forms tested appeared to change the way that women retrieved

this information.

Pap smears were the most overreported procedure, possibly because some women may have them regularly every 2

years. It might be possible to test a question on Pap smears

that made this explicit in the introduction. It had been speculated that women who had had hysterectomies would report

Pap smears more accurately, but that did not occur. Although

of course they reported fewer tests, the percentage of false

positives and negatives did not differ between women who had

and had not had hysterectomies.

It has been assumed that the major cause of overreporting

was the way information is retrieved. It should be pointed out,

however, that nothing in this study could rule out the possibility that some of the overstatement is caused by the perceived

social desirabilityy of preventive care behavior. This does not

mean that many respondents deliberately falsified their answers.

Rather, respondents who may have been uncertain about

whether they had a procedure every year said that they did

because they knew that this was what they should have done.

This sample was a desirable one because of the ability to

validate information from records. It may not be representative

of the general public, however, as HMO patients are more

likely to receive cancer-screening procedures than are patients

receiving care from fee-for-service physicians (57-59). It is

also possible that membership in an HMO results in more

regular behavior and greater use of schemas than is found in

the general population of women over 50 years of age. It

would be useful to replicate this study with a general population sample.

Broader implications for cognitive research on

survey response

Aside from a better understanding of how women report

on these three cancer-screening tests, the results also have

implications for future research on cognitive aspects of survey

response. First, these results strongly suggest that respondents

are likely to use schemas in reporting about behavior, even

when the total number of events is small, if they perceive the

events as regular. The use of schemas is even more likely as

respondents are asked about less recent events.

The use of schemas can lead to highly accurate reporting

if indeed the events are very re@ar. Schemas, however, will

lead to overreporting of behavior if respondents forget to

exclude exceptions. One might expect that the likelihood of

forgetting exceptions would increase with longer time periods,

but there was no evidence of this in this study. If schemas are

used, then the results would suggest that the order in which

questions are asked about details of an event would have no

effect on the accuracy of reporting that the event occurred.

Obviously, it would be desirable to tell respondents what

retrieval method they should use for greatest accuracy, but this

research is in agreement with past efforts that indicate that it is

enormously difficult to get respondents to change the way they

find easiest to retrieve information. This is not to say that it is

impossible to do so, but it was not possible in this study, even

though the focus groups and think-aloud interviews had given

a good understanding of what methods respondents were

actually using,

18
References

L

2.

3.

4.

5,

6.

7.

8.

9,

10.

11,

12,

13.

14.

15,

16.

17,

McGimis J. Health objectives for the nation. Am Psychol

46:520-524.1991.

Greenwald P, Sondik EJ. Cancer control objectives for the

nation: 1985-2000. National Cancer Institute Monographs 2,

NIH pub no 86-2880, Bethesda, Maryland National Cancer

Institute. 1986.

Miller AB, Lindsay J, Hill GB. Mortality from cancer of the

uterus in Canada and its relationship to screening for cancer of

the cervix. Int J Cancer 1%600-12. 1976.

Shapiro S, Venet W, Strax P, Venet L, Roeser R. Ten- to

fourteen-year effect of screening on breast cancer mortality. J

Natl Cancer Inst 69:34%55. 1983.

Hayward RA, Shapiro MF, Freeman HE, Corey CR. Who gets

screened for cervical and breast cancer? Arch Intern Med

148:1177-81.1988.

Centers for Disease Con@ol.Trends in screening mammograms

for women 50 years of age and older—Behavioral risk factor

surveillance system, 1987. MMWR 38(9)13740. 1989.

Sawyer JA, Earp JA, Fletcher RH, et al. Accuracy of women’s

self-report of their last Pap smear. Am J Public Health 79:103&

37.1989.

Bowman JA, Redman S, Dickinson J~ et al. The accuracy of

Pap smear utilization se~-repofi A methodological consideration in cervical screening research. Health Services Res 26:97–

107.1991.

Warnecke RB, Graham S. Characteristics of blacks obtaining

Papanicolaou smears, Cancer 37:2015–25. 1976.

Gordon NP, Hiatt R& Lampert DI. Concordance of selfreported data and medical record audit for six cancer screening

procedures. J Natl Cancer Inst 85:56(%70. 1993.

Loftus EF, Klinger MR, Smith KD, Fielder J. A tale of two

question~ Benefits of asking more than one question. Public

Opinion Q 54:330-45.1990.

Michielutte R, Dignan MB, Wells HE, et al. Errors in reporting

cervical screening among public health clinic patients. J Clin

Epidemiol 44:403-8.1991.

McKenna MT, Speers M, Mallin Kj Warnecke R. Agreement

between patient self-reports and medical records for Pap smear

histories, Am J Prev Med 8:287–91. 1992.

Walter SD, Clarke ~ Hatcher J, Stitt LW. A comparison of

physician and patient reports of Pap smear histones. J Clin

Epidemiol 41:401-10.1987.

Hochstim JR. A critical comparison of three strategies of

collecting data from households. JASA 62:976-89.1967.

Peters RK, Bear MB, Thomas D. Barriers to screening for

cancer of the cervix. Prev Med 18:13346.1989.

Warnecke RB, Intervention in black populations. In Mettlin C,

Murphy G, eds. Cancer among black populations. New York

Alan R, Liss, 167-83.1981.

18. Warnecke RB, Havlicek P~ Manfredi C. Awareness and use of

screening by older-aged persons. hx Yancik R, et al., eds.

Perspectives on prevention and treatment of cancer in the

elderly. New York Raven Press, 275-87.1983.

19. Brown JB, Adams ME. Patients as reliable reporters of medical

care process. Med Care 30:400-11.1992.

20. King ES, Rimer B~ Trock B, et al. How valid are mammography seti-reports? Am J Public Health 80:1386-88.1990.

21. Degnan D, Harris R, Rarmey J, et al. Measuring the use of

mammography ‘IWOmethods compared. Am J Public Herdth

821386-88.1992.

22. Jobe JB, Mingay DJ. Cognition and survey measurement History and overview. Applied Cognitive Psychol 5:175-92.1991.

23. Strack F, Martin, LL. Thinking, judging, and communicating A

process account of context effects in attitude surveys. In: Wppler

H-J, Schwarx N, Sudman S, eds. Social information processing

and survey methodology. New York Springer-Verlag, 123-48.

1987.

24. Tourangeau R. Attitude measurement A cognitive perspective.

h Hippier H-J, Schwarz N, Sudman S, eds. Social information

processing and survey methodology. New York SpringerVerlag, 149-62.1987.

25. Tourangeau R, Rasinski KA. Cognitive processes underlying

context effects in attitude measurement. Psychol Bull 103:299-

314.1988.

26. Schwarz N, Sudman S, eds. Autobiographical memory and the

validity of retrospective reports. New York: Springer-Verlag.

1994.

27. Hastie R. Information processing theory for the survey researcher.

In Hippier H-J, Schwarz N, Sudman S, eds. Social information

processing and survey methodology. New York SpnngerVerlag, 42–70. 1987.

28. Menon G. Judgments of behavioral frequencies: Memory search

and retrieval strategies. In: Schwarx N, Sudman S, eds. Autobiographical memory and the validity of retrospective reports. New

York Springer-Verlag, 161–72. 1994.

29. Brewer W. Distortions in autobiographical memory. In: Schwarx

N, Sudman S, eds. Autobiographical memory and the validity of

retrospective reports. New York: Springer-Verlag, 11–20. 1994.

30. Wagenaar WA My memory A study of autobiographical memory

over six years. C@nitive Psychol 18:2%52. 1986.

31. Means B, Swan GE, Jobe JB, Esposito JL. An alternative

approach to obtaining personal history data. h Biemer PP,

Groves RM, Lyberg LB, Mathiowetz N~ Sudman S, eds.

Measurement errors in surveys. New York Wiley, 167-83.

1991.

32. Sudman S, Bradbum NM, Effects of time and memory factors

on response in surveys. JASA 68:805-15.1973.

19
33. Sudman S, Bradburn NM. Response effects in surveys: A review

and synthesis. Chicago: AMine. 1974.

34. Hutienlocher J, Hedges L, Bradburn NM. Reports of elapsed

tinvx Bounding and rounding processes in estimation. J Exp

Psychol 16:196-213.1990.

35. Bradburn NM, Huttenlocher J, Hedges L. Telescoping and

temporal memory. Im Schwarz N, Sudman S, eds. Autobiographical memory and the validity of retrospective reports. New York

Springer-Verlag, 203-15.1994.

36. Sudman S, Larmom L. Health care surveys using diaries.

NCHSR Research Report. U.S. Department of Health and

Hmnan Services pub no (PHS) 80-3279. Hyattsville, Maryland

National Center for Health Services Research. 1980.

37. Bradbum NM, Sudmarr S, Associates. Improving interview

method and questionnaire desigrx Response effects to threatening questions in survey research. San Franciscw Jossey-Bass.

1979.

38. Willis GB, Royston P, Bercini D. The use of verbal report

methods in the development and testing of survey questionnaires. Applied Cognitive Psychol 5:251-68.1991.

39. Blair E, Burton S. Cognitive processes used by survey respondents in answering behavioral frequency questions. J Consumer

Res 14280-8.1987.

40. Ahlquist DA, Wieand HS, Moertel CG, et al. Accuracy of fecal

occult blood screening for cdorectal neoplasizx A prospective

study using hemoccult and hemoquant tests. JAMA 2691262–

67.1993.

41. Lessler JT, Tourangeau R, Salter W. Questionnaire design in the

cognitive research laboratory. National Center for Health Statistics. Mtal Health Stat 6(l). 1989.

42. Suchman L, Jordan B. Interfactional troubles in face-to-face

survey interviews. JASA 85:232–53. 1990.

43. Herrmann DJ. The validity of retrospective reporta as a function

of the directness of the retrieval processes. Irx Schwarz N,

Sudman S, eds. Autobiographicrd memory and the validity of

retrospective repxts. New York Springer-Verlag, 21–37. 1994.

44. Warnecke RB, Graham S. Characteristics of blacks obtaining

Papanicolaou smears. Cancer 3%2015-25. 1976.

45. Richert-Boe KE, Humphrey LL. Screening for cancers of the

cervix and breast. Arch Intern Med 1522405–11. 1992.

46. Fowler FJ Jr, Mangione TW. Standardized survey interviewing.

Newbury Park Sage. 1990.

47. Demlo LKj Campbell PM, Brown SS. Reliability of information

abstracted from patients’ medical records. Med Care 16995-

1005.1978.

48. Feigl P, Glaefke G, Ford L, Diehr P, Chu J. Studying patterns of

cancer care How useful is the medical record? Am J Public

Herdth 78:526-33.1988.

49. Romm F, Putnam S. The vrdidity of the medical record. Med

Care 19310-5.1981.

50. Gordon NP, Hiatt I@ Larnpert DI. Concordance of selfreported data and medical record audit for six cancer screening

procedures. J Natl Cancer Inst 85566-70.1993.

51. Brown JB, Adarns ME. Patients as reliable re~rters of medical

care process. Med Care 30:400-11.1992.

52. Jobe JB, White AAj Kelley CLj et al. Recall strategies and

memory for health-care visits. Mllbank Q 68:171-89.1990.

53. L&us EF, Smith KD, Klinger MR, Fielder J. Memory and

mismemory for health events. Irx Tanur JM, ed. Questions about

questions. New York Russell Sage, 102–37. 1992.

54. Daniel WW. Applied nonparametric statistics. Boston: Houghton

Mifflin. 1978.

55. Hedeker D, Gibbons RD. A random-effects ordinal regression

model for multilevel anrdysis. Biometrics. Forthcoming.

56. Means B, L&us EF. When personal history repeats itse~

Decomposing memory for recurring events. Applied Cognitive

Psychol 5:297–318. 1991.

57. Berstein MB, Thompson GB, Harlan LC. DitTerencesin rates of

cancer screening by usual source of medical care. Med Care

29:196.1991.

58. Kang SH, Bloom JR. Social support and cancer screening

among older black Americans. J Natl Cancer Irrst 85:737-42.

1993.

59. Udvarhelyi IS, Jennison Kj Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for fee-for-sewice and

prepaid patients. Ann Intern Med 115:394400.1991.

20
Appendixes

I. Questionnaires and supplementary information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion @ide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version 1, think-aloud interview questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version 2, think-aloud interview questionnaire.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version I, finrd questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version 2, final questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version 3, final questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Version 4, final questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medical record coding instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Matching protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11, Raw frequenciesby outcome measures, tests, and year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Appendixtables

L

II.

111,

IV

v

w.

Raw frequencies, by outcome measure, test, andyea~ 1987–92. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of response-quality measures and number and percent ofrespondents, by year, test, and outcome

measure: 1987-92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percent distribution of response-quality measures and number and percent of respondents, by year, test, and test

regularity : 1987-92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number and percent of respondents and percent distribution of response-quality measures, by test, questiomaire

version, and year: 1987-92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net bias and gross error in reporting of dates of preventive care tests for matched events, by test and yeac

1988-92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Net bias and gross error in reporting of dates of preventive care tests for matched events, by year and version of

questionnaire: 1988-92 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

22

22

24

37

68

88

105

132

158

160

162

162

163

164

166

170

171
Appendix I

Questionnaires and

supplementary information

DISCUSSIONGUIDE

MINUTES 1. Introduction

5-1o

Welcome

Discussion of focus group procedures

Observation

Read consent and ask for signature

10-15 2. Healthv Practices

Discuss life style patterns related to risk and for seeing

a physician.

What can people do to keep healthy?

(Lists) Things to do.

Things not to do

For each practice on list, do they follow the practice?

Sum up with discussion of where their ideas about healthy

life-style come from. Family, friends, interaction with

health care providers?

10-15

20-30

3. Relationship with their Providers

What kinds of health education do they get from their

contacts with the health care system?

How regular is the contact?

What kinds of contact do they have?

Are they likely to see a provider to get a check-up when

they are not ill?

Why? Why not? (Note: probe for ease of getting these;

time required; expenses uncovered--i.e. baby-sitting,

transportation)

4. Phvsical Examination and Earlv Detection

What happens in a physical examination?

How complicated is getting a physical?

Probes:

Length of time?

Number of separate visits for all procedures?

(Reaction?)

Location for procedures?

Discomfort or embarrassment?

What kinds of things might the doctor do to see if you

have cancer?

22
List kinds of early detection that might be done.

Who should get procedures?

Which procedures are best for detecting cancer early?

Which are best for you?

Which are usually done in a physical exam?

Performed by regular doctor or someone else?

Do they feel the doctor/provider explains what is

happening?

Does the provider specifically discuss early detection?

Does provider describe procedures?

Explain what they are for?

Do they feel they can ask questions?

Do they ask?

Do they understand what they are told?

Do they feel they can influence what happens in their

physical exam? Do they?

Probes:

Do they ask for early detection procedures?

Does the provider tell them what they need and why

they need-it?

Probe for understanding of what they are told.

Communication following physical.

Probes:

Do they hear about results whether positive or

negative?

How long do they wait for results?

How are they communicated?

Satisfaction with information provided?

Do they feel they receive adequate explanation of

what results mean?

15-20 5. Information Retrieval

Who do they think is responsible for keeping track of when

is time for a physical or early detection procedures to be

done?

How do they know when it is time to see a health care

provider?

Do they have special reminders for physical exam/early

detection?

Probe:

Can they remember when they had their last physical?

Can they remember when they had their last Pap?

Mammogram? Rectal exam? Fecal Occult Blood?

it

General Rrobe for comfort level with discussion about what early

detection procedures they qet and in how they describe them.

23
1/26/92

COGNITIVEASPECTS OF REPORTING HEALTH

PROMOTIONAND DISEASE PREVENTION

THINK-ALOUD

Universityof Illinois

Survey Research Laboratory

1. Would

good,

Case ID #

Study # 707

Version # 1

Intvr

you say that your health, in general, is excellent, very good,

fair, or poor?

Excellent . . . . . . 1

Verygood . . . ...2

Good . . . . . . . .3

Fair . . . . . . . .4

Poor . . . . . . . .5

2a. Have you had a health problem at any time in the past five years,

since January 1987, for which you consulted or are still consulting a

doctor on a regular basis?

Yes. . . . . . . . 1

No . . . . . . . . 2--> (SKIP TOQ.3a)

2b. What was the problem?

Breast related (SPECIFY) . . . . . 1

Gyne or urinary related (SPECIFY).2

Other (SPECIFY).. . . . . . . . . 3

-1-

24
3a. Have you had any major illnesses or conditions at any time in the

past five years, since January 1987, for which you consulted a

doctor?

Yes. . . . . . . . . . . . .1

No. . . . . . . . . . . . . 2 --> (SKIP TO Q.4a)

~ 3b. What was the problem?

Breast related (SPECIFY). . . . . . . . . 1

Gyne or urinary related (SPECIFY) . . . . 2

Other (SPECIFY) . . . . . . . . . . ...3

4a. Have you ever heard of a Pap smear test?

Yes. . . . . . . . . . .1

No . . . . . . . . . . . 2-->(SKIPTO Q.5a)

00N’TKNOW . . . . . . . 8-->(SKIP TO Q.5a)

4b. In your own words, what happens during a Pap smear test?

4C. How useful do you think Pap smear tests are for early detection of

disease? Would you say . . .

Very useful, . . . . . . 1

Somewhat useful, or . . 2

Not very useful? . . . . 3

DON’TKNOW . . . . . . . 8

-2-

25
-i3-

5a. (A Pap smear is a routine test, often part of

where the doctor uses a swab to take a sample

or cervix.) Have you ever M a Pap smear?

Yes ...,.

No . . . .

DON’T KNOW

.

●

✌

.

.

.

.

.

.

.

.

.

5b. Howmanv PaD smears have You had in

January”1987?

6a. In what month and year

6b. How did you come

Las;”ParJ

.

.

.

a pelvic

from the

examination,

mouth of the womb

Pap smears

DON’T KNOW

3.

.

.

.

. 1

. 2-->(SKIPTO Q.9)

. 8-->(SKIPTO Q.9)

did you have

up with that

4.

past five vears,

. . . . .

your ~

answer?

(KEEP ASKING FOR ALL PAPS IN PAST 5 YEARS -- NUMBER IN Q.5b)

6C. How

6d. How

PaD #

n

about the one before

did you come up with

&

5.

. . 8

Pap smear?

b.

that answer?

d.

How answered
-4-

7. Why did you get your last Pap smear?

Part of a routine checkup . . . . . . . . 1

Because of symptoms . . . . . . . . . . . 2

As followup to previous problem . . . . . 3

Other (SPECIFY) . . . . . . . . . . . ..4

8a. How did you find out the results of the Pap smear?

At next doctor’s visit . . . . . . . . . . . 1

By letter.. . . . . . . . . . . . . . . .2

Doctor’s office phoned R . . . . .. . . . . . 3

Rphoned doctor’s office . . . . . . . . . . 4

Was told would not hear unless there

wasaproblem . . . . . . . . . . . . . . .5

Never found out results . . . . . . . . . . 6

Other (SPECIFY) . . . . . . . . . . . ...7

8b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . 1

There was a problem . . . . . . 2

9. How painful do you think Pap smear tests are? Would you say they

are . . .

Very painful, . . . . . . . . .1

Somewhat painful, or . . . . . 2

Not very painful? . . . . . . . 3

DON’TKNOW . . . . . . . ...8

27
-3-

10a. Have you ever heard of a mammogram?

Yes.. . . . . . . . . .1

No . . . . . . . . . . . 2-->(SKIP TO Q.lla)

DON’T KNOW . . . . . . . 8-->(SKIP TO Q.lla)

10b. In your own words, what happens during amanwnogram?

10c. How useful do you think mammograms are for early detection of

disease? Would you say . . .

Very useful, . . . . . . 1

Somewhat useful, or . . 2

Not very useful? . . . . 3

DON’TKNOW . . . . . . . 8

ha. (A mammogram is an x-ray taken only of the breasts by a machine that

presses the breast against a plate.) Have you ever ~ a mammogram?

Yes. . . . . . . . . . 1

No . . . . . . . . . . 2-->(SKIP TO Q.16,P7)

DON’T KNOW . . . . . . 8-->(SKIP TO Q.16,P7)

llb. How many mammograms have you had in the past five Years, since

January 1987?

Mammograms

DON’T KNOW . . . . . . 8

12a. In what month andyear did you have your ~ mammogram?

12b. How did you come up with that answer?

b.

Last M~;moqram How answered
-6-

(KEEP ASKING FOR ALL MAMMOGRAMS IN PAST 5 YEARS -- NUMBER IN Q.llb)

12c. Howabout the one before that?

12d. Howdid you come up with that answer?

3.

4.

5.

13. Why did

Part

you get your last mammogram?

of a routine checkup . . .

Because of symptoms/lump . . .

As followup to previous problem

Other (SPECIFY) . . . . . . . .

.

●

✎

✎

14. Where did you get your last mammogram?

d.

How answered

.

●

✎

✎

●

✎

✎

✎

.

●

✎

●

1

2

3

4
-7-

15a. How did you find out the results of the mammogram?

At next doctor’s visit . . . . . . . . . . . 1

By letter . . . . . . . . . . . . . . ...2

Doctor’s office phoned R . . . . . . . . . . 3

Rphoned doctor’s office . . . . . . . . . . 4

Was told would not hear unless there

wasaproblem . . . . . . . . . . . . . . .5

Never found out results . . . . . . . . . . 6

Other (SPECIFY) . . . . . . . . . . . . ..7

15b. Was everythingOK or did they find a problem?

Everythingwas OK . . . . . . . 1

There was a problem . . . . . . 2

16. How painful do you think mammograms are? Would You say they

are . . .

Very painful, . . . . . . . . . 1

Somewhat painful, or . . . . . 2

Not very painful? . . . . . . . 3

DON’TKNOW . 0 . . . . . ...8

17a. Have you ever heard of a breast exam by a doctor or medical assistant?

Yes. . . . . . . . . . .1

No . . . . . . . . . . . 2-->(SKIP TO Q. 18a)

DON’TKNOW . . . . . . . 8-->(SKIP TO Q.18a)

17b. In your own words, what happens during a breast exam?

30
-8-

18a. (Abreast examinationis when the breast is

or medical assistant.) Have you ever m

medical assistant?

Yes . . . .

No . . . .

DON’T KNOW

.

.

.

.

.

.

18b. How many breast examinationshave

since January 1987?

.

.

.

a

.

.

.

felt for lumps

breast exam by

.

.

.

.

.

.

breast

DON’T KNOW . . . . . .

1

2-->(SKIP

8-->(SKIP

by a doctor

a doctor or

TO Q.22a,P9)

TO Q.22a,P9)

in the

exams

8

past five Years,

19a. In what month and year did you have your ~breast examination?

19b. How did you come up with that answer?

b.

Last breas;”examination How answered

(KEEPASKING FOR ALL BREAST EXAMS IN PAST 5 YEARS -- NUMBER IN Q.18b)

19C. How about the one before ~?

19d. How did you come up with that answer?

EE!as&

exam #

2.

&

d.

How answered

3.

4.

5.
-9-

20. Why did you get your last breast examination?

Part of a routine checkup . . . . . . . 1

Because of symptoms/lump . . . . . . . 2

As followup to previous problem . . . . 3

Other (SPECIFY) . . . . . . . . . . ..4

21. How did you find out the results of the breast exam?

At

By

next doctor’s visit . . . . . . . . . . . 1

letter . . . . . . . . . . . . . . . ...2

Doctor’s office phoned R . . . . . . . . . . 3

Rphoned doctor’s office . . . . . . . . . . 4

Was told would not hear unless there

wasaproblem . . . . . . . . . . . . . . .5

Never found out results . . . . . . . . . . 6

Other (SPECIFY) . . . . . . . . . . . ...7

22a. Have you ever heard of a blood stool test?

Yes. . . . . . . . . . .1

No . . . . . . . . . . . 2-->(SKIPTO Q.23a)

DON’T KNOW . . . . . . . 8-->(SKIP TO Q.23a)

22b. In your own words,what is a blood stooltest?

32
-1o22C. How useful do ,youthink blood stool tests are for early detection

of disease? Would you say . . .

Very useful,. . . . . . 1

Somewhat useful, or . . 2

Not very useful? . . . . 3

DON’TKNOW . . . . . . . 8

23a. (A blood stool test is where the stool is smeared on a card that is

mailed back to the doctor and examined to determine whether it contains

blood.) Have you ever~ a blood stool test?

Yes... . . . . . . . 1

No . . . . . . . . . . 2-->(SKIP TO Q.27,P12)

DON’TKNOW . . . . . . 8-->(SKIP TO Q.27,P12)

23b. How many blood stool tests have you had in the

since January 1987?

blood stool

DON’T KNOW . . . . . . 8

past five Years,

tests

24a. In what month and year did you have your last blood stool test?

24b. How did you come up with that answer?

b.

Last bloodahool test How answered

33
-11-

(KEEP ASKING FOR ALL BLOOD STOOL TEST IN PAST 5 YEARS -- NUMBER IN Q.23b)

24c. How about the one beforem?

24d. How did you come up with that answer?

Blood stool

test # &

2.

3.

4.

5.

25. Why did you get your ~blood stool

d.

How answered

test?

Part of a routine checkup . . . . . . . 1

Because of symptoms/blood . . . . . . . 2

As followup to previous problem . . . . 3

Other (SPECIFY) . . . . . . . . . . ..4

26a. How did you find out the results of the blood stool test?

At next doctor’s visit . . . . . . . .

By letter. . . . . . . . . . . . . .

Doctor’soffice phoned R . . . . . . .

R phoned doctor’s office . . . . . . .

Was told would not hear unless there

wasaproblem . . . . . . . . . . . .

Never found out results . . . . . . .

Other (SPECIFY) . . . . . . . . . . .

●

✎

✎

✎

✎

●

✎

●

✎

✎

●

✎

✎

✎

● 1

. 2

● 3

. 4

. 5

. 6

● 7
-12-

26b. Was everything OK or did they find a problem?

Everything was OK . . . . . 1

There was a problem . . . . 2

27. How painful do you think blood stool tests are? Would you say

they are . . .

Very painful, . . . . . . . 1

Somewhat painful, or . . . 2

Not very painful? . . . . . 3

DON’TKNOW . . . . . ...8

29. Now that we are almost through with this interview, I would like to ask

your feelings about it. As I mention groups of questions, please tell

me whether you think those questions would make most women very uneasy,

somewhat uneasy, or not at all uneasy. How about questions about . . .

a.

b.

c.

d.

29. DO

Not at

Very A little al1

U!lmsY> UM!sYs or uneasv? M

Pap smears?

Would these

questions

make most women . . 1 2 3 8

Mammograms? . . . . 1 2 3 8

Breast

examinations? . . . 1 2 3 8

Blood stool tests? . 1 2 3 8

You think it would make a difference to most women if they were asked

these questions by a man instead of a woman?

Yes . . . . . . . . . . . . . 1

NO ..0........00.2

35
30.

31.

How

get

How

-13-

much troubledo you have findingthe time to go to the doctor and

tests done? Do you have . . .

Alot of trouble, . . . . . 1

Some trouble, or . . . . . 2

Not much trouble? . . . . . 3

hard is it for you to travelto the doctorwhen you need to go? Is

it...

Very hard, . . . . . . . . 1

Somewhat hard, or . . . . 2

Not very hard? . . . . . . 3
1/28/92

COGNITIVE ASPECTS OF REPORTING HEALTH

PROMOTION AND DISEASE PREVENTION

THINK-ALOUD

University of Illinois

Survey Research Laboratory

Case ID#

Study # 707

Version# $

Intvr

1. Would you say that your health, in general, is excellent, very good, good, fair, or poor?

Excellent .

Very good .

Good . . .

Fair . . .

Poor . . .

2a. Have you had a health problem at any time in the past five years,

consulted or are still consulting a doctor on a regular basis?

Yes . . . .

No . . . .

. . .

. . .

. . .

. . .

. . .

since

. . .

. . .

. . . . . . . . . . . . 1

. . . . . . . . . . . . 2

. . . . . . . . . . . . 3

. . . . . . . . . . . . 4

● . ...* . ..*** 5

January 1987, for which you

1

2 --> (SKIP TO Q.3a)

-1-
2b. What was the problem?

Breast related (SPECIFY) . . . . . . . . . . . . 1

Gyne or urinary related (SPECIFY) . . . . . . . 2

Other (SPECIFY) . . . . . . . . . . . . . ...3

3a. Have you had any (other) ma.io~illnesses or conditions at any time in the past

January 1987, for which you consulted a doctor?

Yes . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . , . . . .

five years, since

1

2-->(SKIPTO BOX A)

3b. What was the problem?

Breast related (SPECIFY) . . . . . . . . . . . . 1

Gyneor urinary related (SPECIFY) . . . . . . . 2

Other (SPECIFY) . . . . . . . . . . . . . ...3

-2-
IF ANY BREAST PROBLEM, CONTINUE WITH Q.4.

A: IF ANY GYNE OR URINARY PROBLEM, SKIP TOQ.9, P.6.

IF NFITHER. SKIP TO 0.12. P.8.

(IF BREAST PROBLEM IS MENTIONED):

4. In what month and year did the (BREAST CONDITION) occur?

5a. Did you have any mammograms that were directly related to diagnosing or treating this condition?

Yes . . . . . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . . . . . . 2-->(SKIPTO Q.7a)

5b . How many mammograms did you have in connection with this condition?

mammograms

6a. In what month and year did you have your Jj@manvnogram that

condition?

was directly related to this

6b. How did you come up with that answer?

b.

Last M%moqrarn How answered

-3-
6C. How

6d. How

l@J!U!k

gram #

2.

3.

4.

5.

(KEEP ASKING FOR ALL OTHER

about the one before ~?

MAMMOGRAMS RELATED TO THAT CONDITION)

did you come up with that answer?

&

d.

How answered

7a. In treat ng or d agnosingthis breast condition,did you have any

Yes . . . . . . . . .

No . . . . . . . . . .

breast examinationsbesides the

. . . . . . 1

● . . . . . 2-->(SKIPTO BOX B)

7b. How many breast examinationsdid you have in connectionwith this condition?

breast examinations

-4-
8a. In what month and year did you have your ~breast examination in connection with this problem?

8b. How did you come up with that answer?

b.

Last breas~”examination How answered

8C. How

8d. How

=

2.

3.

4.

(KEEP ASKING FOR ALL OTHER BREAST EXAMINATIONS RELATED TO THAT CONDITION)

about the one before ~?

did you come up with that answer?

&

d.

How answered

5.

-5-
IF THE RESPONDENT HAD A GYNECOLOGICAL OR URINARY

B: TRACT PROBLEM, CONTINUE WITH Q.9.

IF NOT, SKIP TO Q.12.,P.8.

9. In what month and year did the (GYNE/URINARY PROBLEM) first occur?

lOa. Did you receive any pap smears that were directly related to that condition since it was diagnosed?

Yes . . . . . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . . . . . . 2-->(SKIP TO Q.12)

10b. How many pap smears related to this condition have you had?

pap smears

ha. In what month andyear did you have your ~pap smear in connection with this problem?

Ilb. How did you come up with that answer?

b.

Las;”Pa~ How answered

-6-
Pap #

2.

3.

4.

(KEEP ASKING FOR ALL OTHER PAPS SMEARS RELATED TO THAT CONDITION)

llC. How about the one before~?

lld. How did you come up with that answer?

&

d.

How answered

5.

-7-
12. Have you had a complete physical checkup in the past five Years, since January 1987? (IF BY

OB/GYN, CODE UNDER Q.19--GYNE CHECKUP.)

Yes . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . . 2-->(SKIPTO Q.19, P.11)

13a. Do you get checkups on a regular basis, or only when you have a health problem?

14.

15.

Regular basis . . . . . . . . . . . . . 1

Only for health problem . . . . . . . . 2--(SKIPTOQ.15)

13b. How often do you get a checkup?

Have you ever skirmedgetting a checkup during the past five years?

Yes . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . .2

DON’T KNOW . . . . . . . . . . . . . . . &->(sKIp TOQe16a)

How many complete physical checkups have you had during the past five years?

checkups

DON’T KNOW . . . . . . . . . . . . ...8

-8-
16a. In what month and year

16b. How did you come

&

did YOU

up with

have

that

your ~

answer?

16c. tiow

16d. ttow

c.

b.

How answered

(KEEP ASKING FOR ALL CHECKUPS IN PAST 5 YEARS -- NUMBER IN Q. 15)

about the one before

did you come up with

Checku~ # b

2.

3.

4.

tJli&?

that answer?

d.

How answered

A

(n

5.

-9-
17a. As part of your complete

physicalcheckups, since 1987

doyou~ have . . .

&

1. A Pap smear? (A Pap smear

is a routine test, often

part of a pelvic examination,

where the doctor uses a

swab to take a sample from

the mouth of the womb

or cervix.) . . . . . . 1

2. A mammogram? (A mammogram

is an x-ray taken only of

the breasts by a machine

that presses the breast

against a plate.) . . . 1

3. (Besidesthe mammogram,)

A breast examinationby a

doctor or medical assistant

when the breast is felt

for lumps? . . . . . . 1

4. A blood stool test where a

stool sample is put on a

card mailed back to the

doctor, and checked for

blood? . . . . . . . ..l

(IF YES TO Q.17a):

17b. How often do you get a (TEST)?

Every Other(How many times?) In what month and year

Y!2M .@!UMD was the last one?

1 2

1 2

1 2

1 2

-1o-
18.

19.

20a.

21.

Where was your ~checkup done?

Rush Presbyterian Hospital . . . . . . . 1

Professional Building . . . . . . . . . 2

AnchorHMO. . . . . . . . . . . . . . .3

Other (SPECIFY) . . . . . . . . . ...4

(Aside from your complete physical checkup(s)), have you had a (separate) gynecological or female

checkup in the past five years, since January 1987?

Yes . . . . . . . 1

No . . . . . . . 2-->(SKIP TO Q.26a,P14)

Do you get gynecological checkups on a regular basis, or only when

20b.

Have

Regular basis . . . . . 1

Only for health problem 2-->(SKIP TO Q.22)

How often do you get a gynecological checkup?

you have a health problem?

you ever ski~~ed getting a gynecological checkup during the past five years?

Yes . . . . . . . . . . 1

No . . . . . . . . . . 2

DON’T KNOW . . . . . . 8-->(SKIP TO Q.23a)

-11-
22. How many complete gynecologicalcheckups have you had during the past five years?

gynecologicalexams

DON’T KNOW

23a. In what month and year did you

. . . . . .

have yourj.@

8

gynecologicalcheckup?

23b. How did you come up with that answer?

b.

Last %eckup How answered

23c.

23d.

Gvne/CU #

2.

How

How

(KEEPASKING FOR ALL GYNECOLOGICAL

about the one before

did you come up with

&

tJl@?

that answer?

IN PAST 5

d.

How answered

3.

4.

-12-
z4a. As parx or your gynecological checkups since 1987,

do you= have . . .

~

-. . .- (IF YES TO Q.24a):

24b. How often do you get a (TEST)?

Every Other (How many times?) In what month and year

& Y&K .WKIIU was the last one?

1. A Pap smear? (A Pap smear

is a routine test, often

part of a pelvic examination,

where the doctor uses a

swab to take a sample from

the mouth of the womb

or cervix.) . . . . . . 1

2. A mammogram? (Mammogram

is an x-ray taken only of

the breasts by a machine

that presses the breast

against a plate.) . . . 1

3. (Besides the mammogram,)

A breast examinationby a

doctor or medical assistant

when the breast is felt

for lump? . . . . . . . 1

4. A blood stool test where a

stool sample is put on a

card mailed back to the

doctor, and checked for

blood?. . . . . . . . . 1

2

2

2

2

1 2

1 2

1 2

1 2

-13-
070

25. I#herewas your m complete gynecological checkup done?

Rush Presbyterian Hospital . . . . . . . 1

Professional Building . . . . . . . . . 2

AnchorHMO. . . . . . . . . . . . . . .3

Other (SPECIFY) . . . . . . . . . . . .4

26a. (In addition to the Pap smear(s) you already mentioned) have you had any (other) Pap smears in the

past five vears, since January 1987?

Yes . . . . . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . . .. ec2-->(sKIpT() Qe29a)

26b. How many (other) Pap smears have you had?

Pap smears

27a. In what month and year did you have your~ (other) Pap smear?

27b. How did you come up with that answer?

Las;.paD

-14-

b.

How answered
(KEEP ASKING FOR ALL OTHER PAPS IN PAST 5 YEARS -- NUMBER IN Q.26b)

27c. How about the one before~?

27d. How did you come up with that answer?

!?arM &

d.

How answered

2.

3.

4.

28. NOT ASKED

29a. (In addition to the mammogram(s)you already mentioned,) have you had any Jother),mammograms in the

past five vears, since January 1987?

Yes . . ...]

No . . . . . 2-->(SKIPTO Q.32a,P17)

29b. How many (other)mammogramshave you had?

mammograms

-16-
30a. In what month and year did you have your jj@ (other) mammogram?

30b. How did you come up with that

Last M%moaram

30c. How

30d. HoW

Mammoqram #

n

b.

How answered

(KEEP ASKING FOR ALL OTHER MAMMOGWS IN PAST5 YEARS -- NUMBER IN Q.29b)

about the one before

did you come up with

c.

3.

4.

d.

How answered

-17-
31.

32a.

33a.

NOT ASKED

(In addition to the breast exam(s) you alreadymentioned,)have you had any jother) breast exams in

the past five vears, since January 1987?

Yes . . . . . . 1

No . . . . . . 2-->(SKIPTO

32b. How many (other)breast exams have you had?

breast exams

In what month and year did you have your~ (other)breast

Q.35a)

exam?

33b. How did you come up with that answer?

b.

Last Br&t Exam How answered

-18-
B

2.

3.

4.

(KEEP ASKING FOR ALL BREAST EXAMS

33C. How about the one before w?

33d. How did you come up with that answer?

&

IN PAST 5 YEARS -- NUMBER IN Q.33b)

d.

How answered

34. NOT ASKED

35a. (In addition to the blood stool test(s)you already merit

tests in the past five Years, since January 19B7?

oned,) have you had any (otherlblood stoo

Yes . . . . . . 1

No . . . . . . 2-->(SKIPTO BOX C, P20)

35b. How many (other) blood stool tests hayeyou had?

blood stool tests

-19-
36a.

(KEEP

In what month and year did you have your J@ (other) blood stool test?

36b. How did

a.

Last Blood Stool Tes

th that answer?

b.

How answered

ASKING FOR ALL OTHER BLOOD STOOL TESTS IN PAST 5 YEARS--NUMBER IN Q.35b)

36c. How about the one before ~?

36d. How did you come up with that answer?

Blood Stool

w &

2.

3.

d.

How answered

4.

37. NOT ASKED

-20-
CHECK SUMMARY SHEET FOR PAPS.

IF NO PAPS, ASK Q.38a.

c:

IF 1 OR MORE PAPS,SKIP TOQ.39.

38a. Just to confirm, you’ve said that you have ~ had a pap smear in the last five years. Is that

correct?

38b. In what

38c. How did

Yes . . . . . . . . . . . . . . . 1-->(SKIPTO BOX F,P22)

No . . . . . . . . . . . . . . . . 2

month and year did you have your ~ Pap smear?

you come up with that answer?

b. c.

Last PaD How answered

EEEl

39. Just to confirm, you’ve said that in the last five years, since January 1987, you have had the

following pap smears: (READNUMBER FOR EACH TYPE AND DATE OF LAST TEST.) IS that correct?

Yes . . . . . . . . . 1

No . . . . . . . . . . 2-->(MAKECORRECTIONSON

SUMMARY SHEET)

-21-
40a. Iiowdid you find out the results of this last pap smear?

At next doctor’s visit

Doctor told R (PROBE) .

R asked doctor/nurse .

By letter . . . . . . . .

Doctor’s office phoned R .

R phoned doctor’s office .

. . . . . . . . . . 1

. . . . . . . . . . 2

. . . . . . ..*. 3

. . . . . . . . . . 4

. . . . . .*.*. 5

Was told would not hear unless there was

a problem . . . . . . . . . . . . . . . . . . 6

Never found out results . . . . . . . . . . . 7 --> (SKIP TO Q.40X)

Other (SPECIFY) . . . . . . . . . . . . ...8

40b. Was everything OK or did they find a problem?

Everything was OK . . . . . 1

There was a problem . . . . 2

40X. Where was this pap smear done?

Rush Presbyterian Hospital . . . . . . . 1

Professional Building . . . . . . . . . 2

AnchorHMO. . . . . . . . . . . . . . .3

Other (SPECIFY) . . . . . . . . . . . .4

-22-
Cn

co

D:

IF PART OF A COMPLETE PHYSICAL

EXAM, ASK(l.41a.

IF NOT, SKIP TO BOX F.

41a. Was this pap done on a different day than the rest of the checkup?

Yes . . . . . . . . . . . . . . . . . ● . ● ● 1

No . . . . . . . . . . . . . . . .“ “ “ ““a 2 --> (SKIP TO BOX E)

41b. Hhen was it done?

E:

CHECK SUMMARY SHEET FOR MAMMOGRAMS.

IF NO MAMMOGRAMS,ASK Q.42a.

IF 1 OR MORE MAMMOGRAMS.SKIP T00 .43.

42a. Just to confirm, you’ve said that you have@ had a mammogram in the last five years. Is that

correct?

Yes . . . . . . . . . . . . . .8 1-->(SKIPTO BOX G,P25)

No . . . . . . . . . . . . . . . . 2

-23-
**42b .

In what month and year did you have your ~mamogram?

43.

42c. How did you come up with that answer?

b.

Last Mammoaram How a;;wered

Just to confirm, you’ve said that in the last fiveyears, since January 1987, you have had the

following mammograms: (READ NUMBER FOR EACH TYPE AND DATE OF LAST TEST.) Is that correct?

Yes . . . . . . . . . 1

No . . . . . . . . . . 2-->(MAKECORRECTIONSON

SUMMARY SHEET)

-24-
44a. How did you find out the results of this mammogram?

At next doctor’s visit

Doctor told R(PROBE) . . . . . . . . ...1

R asked doctor/nurse . . . . . . . . . . . 2

By letter . . . . . ● ● ● ● c c ● ● “ ● ● ● “ 3

Doctor’s office phonedR . . . . . . . . . . . 4

R phoned doctor’s office . . . . . . . . . . . 5

Was told would not hear unless there was

a problem . . . . . . . . ● “ ● ● “ ● ● “ ● ● 6

Never found out results . . . . . . . . . . . 7 --> (SKIP TO Q.40X)

Other (SPECIFY).*..””=””” ● =” =*8

44b. Was everythingOK or did they find a problem?

Everythingwas OK . . . . . 1

There was a problem . . . . 2

45. Where was this mammogram done?

-25-
IF PART OF A COMPLETE PHYSICAL

H: EXAM OR GYNE EXAM, ASK Q.46a.

IF NOT, SKIP TO BOX I.

46a. Was this mammogramdone on a differentday than the rest of the checkup?

46b.

Yes . . . . . . . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . . . . . . . 2 -->(SKIP TO BOX I)

When was it done?

CHECK SUMMARY SHEET FOR BREAST EXAMS.

I:

IF NOBREAST EXAMS, ASK Q.47a.

~ 00

47a. Just to confirm, you’ve said that you have not had a breast exam in the last five years, since January

1987. Is that correct?

Yes . . . . . . . . . . . . . . . 1-->(SKIP TO BOXJ)

No . . . . . . . . . . . . . . . . 2

-26-
48.

**47b.

47C.

In what month andyear did you have your wbreast exam?

How did you come up with that answer?

b. c.

Last breast exam flowanswered

EiEEl

Just to confirm,you’ve said that in the last five years, since January 1987, you have had the

following breast exams: (READ NUMBER FOR EACH TYPE AND DATE OF LAST TEST.) Is that correct?

Yes . . . . . . . . . 1

No . . . . . . . . . . 2-->[MAKE . correctionsON

SUMMARY SHEET)

CHECK SUMMARY SHEET FOR BLOOD STOOL TESTS.

J:

IF NO BLOOD STOOL TESTS, ASK Q.49a.

IF 1 OR MORE BLOOD STOoL TEST$. $KIP TO Q.5~.

-27-
49a. Just to

January

**4gb .

confirm, you’ve said that you have not had a blood stool test in the last five years, since

1987. - ‘“ -

In what

49C. How did

1s that correct?

Yes . . . . . . . . . . . . . . . l-->(SKIP TO Q.52a,P29)

No . . . . . . . . . . . . . . . . 2

month and year did you have your ~ blood stool test?

you come up with that answer?

b.

Last Blood stool test How a;;wered

SKIP TOQ.51a

50. Just to confirm, you’ve said that in the last five years, since January 1987, you have had the

following blood stool tests: (READ NUMBER FOR EACH TYPE AND DATE OF LAST TEST.) Is that correct?

Yes . . . . . . . . . 1

No . . . . . . . . . . 2-->(MAKE CORRECTIONS ON

SUMMARY SHEET)

+

CHECK BLOOD STOOL TESTS.

K: PUT A* NEXT TO MOST RECENT ONE

AND SAY: “SO YOUR LAST BLOOD

STOOL TF$T WAS M

u)

(d -28-
51a. How did you find out the results of this blood stool test?

At next doctor’s visit

Doctor told R(PROBE) . . . . . . . . ...1

R asked doctor/nurse . . . . . . . . . . . 2

By letter . . . . . . . ● . ● “ ● ● “ ● ● ● “ 3

Doctor’soffice phonedR . . . . . . . . . . . 4

R phoned doctor’s office . . . . . . . . . . . 5

Was told would not hear unless there was

a problem . . . . . . . . . ● “ “ ““ ● ● ● “ 6

Never found out results . . . ● . . . “ “ ● “ 7 --> (SKIp ToQ=52a)

Other (SPECIFY) . . . . ...”” ““””””a

51b. Was everythingOK or did they find a problem?

Everythingwas OK . . . . . 1

There was a problem . . . . 2

52a. How useful do you think Pap smear tests are for early detection of disease? Would you say . . .

Very useful, . . . . . . 1

Somewhat useful, or. . . 2

Not very useful? . . . . 3

DON’TKNOW . . ..*.”8

-29-
52b. How painful do you think Pap smear tests are? Would you say they are . . .

Very painful, . . . . . . 1

Somewhat painful, or . . 2

Not very painful? . . . . 3

DON’TKNOW . . . . ...8

53a. How useful do you think mammograms are for early detection of disease? Nould you say . . .

Very useful, . . . . . . 1

Somewhat useful, or . . 2

Not very useful? . . . . 3

DON’TKNOW . . . . . . . 8

53b. How painful do you think mammograms are? Would you say they are . . .

Very painful, . . . . . . 1

Somewhat painful, or . . 2

Not very painfu’

DON’T KNOW . .

54. How useful do you think blood stool tests are for ei

?. . . .3

. . . . . 8

rly detection of disease? Would You say . .

Very useful, . . . . . . 1

Somewhat useful, or . . 2

Not very useful? . . . . 3

DON’TKNOW . . . . . . . 8

-30-
55.

56.

57.

How much trouble do you have making an appointmentto see the doctor? Do you have . .

A lot of trouble, . . . . . 1

Some trouble,or . . . . . 2

Not much trouble? . . . . . 3

How much trouble do you have finding the time to go to the doctor and get tests done? Do you have . .

A lot of trouble, . . . . . 1

Some trouble,or . . . . . 2

Not much trouble? . . . . . 3

How hard is it for you to travel to the doctor when you need to go? Is it . . .

Very hard, . . . . . . . . I

Somewhat hard, or . . . . 2

Not very hard? . . . . . . 3

-31-
PAPS

Conditions ._.

Checkups —.

Gyne _

Other

MAMmwu4s

Conditions

Checkups

Gyne _

Other _. _

BREAST EXAMS

Conditions

Checkups ._

Gyne _

Other ._

BLOOD ST(X)L TESTS

Wm?;:ions

Chfickups ._

Gyne — —

other _, —
4/28/92

Case ID #

Study # 707

version # ~

Interviewer #

COGNITIVE ASPECTS OF REPORTING HEALTH

PROMOTION AND DISEASE PREVENTION ACTIVITIES

Survey Research Laboratory

University of Illinois

This study is being conducted under authority of Section 306 of the Public

Health Service Act (42 USC 242k). Every reply is treated with the strictest

confidence and will only be heard by professionals involved in questionnaire

design research. The results of this study will be presented only in the form

of statistical tables that do not contain the identity of any respondents.

OMB Clearance No. 0920-0264

Expiration date: July31, 1993

Public reporting burden for this collection of information is estimated to

average 30 minutes per response. Send comments regarding this burden estimate

or any other aspect of information, including suggestions for reducing this

burden to PHS Reports Clearance Officer; ATTN: PRA: Hubert H. Humphrey Bldg.,

Rm. 721-H; 200 Independence Ave., SW; Washington, DC 20201, and to the Office

of Management and Budget; Paperwork Reduction Project (0920-0264); Wa~hington,

DC 20503.
TIME INTERVIEW BEGAN .

—— “— — (24-hour clock)

1. Would you say that your health, in general, is excellent, very good,

good, fair, or poor?

Excellent . . . . . . . ..l

Very good . . . . . . . . .2

Good . . . . . . . . ...03

Fair . . . . . . . . . . ..4

Poor . . . . . . . . . . ..5

2a. Have you had a health problem at any time in the past five years, since

(MONTH) 1987, for which you consulted a doctor on a regular basis?

Yes . . . . . . . . . . . .1

No . . . . . . . . . . . . .2 -->(SKIP TO Q.3a)

2b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . . ..3

69
-2-

3a. Have you had any (other) ma.iorillnesses or conditions at any time in the

past five years for which you consulted a doctor?

Yes. . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 -->(SKIP TO Q.4a)

3b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3

4a. A Pap smear is a routine test, often part of a pelvic examination, where

the doctor uses a swab to take a sample from the mouth of the womb or

cervix. Have you ever~a Pap smear test?

Yes. . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 -->(SKIP TO Q.9, P.5)

DON’TKNOW . . . . . . . . . 8-->(SKIPTOQ.9, P.5)

4b. How many Pap smear tests have you had in the past five Years, since

(MONTH) 1987?

Pap smear tests

(IF “O” SKIP TO Q.9, P.5)

DON’TKNOW . . . . . ...98

70
-3-

5a. In what month and year did you have your last Pap smear test?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

5b. How did you remember that date?

(KEEP ASKING FOR ALL PAPS IN PAST 5 YEARS -- NUMBER IN Q.4b)

5c. What about the one before that? In what month and year was it?

(IF

(IF

(IF

Pa~ #

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years-- 1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

2)

4)

5)

(IF R MENTIONS MORE DATES THAN PAP SMEAR TESTS):

5d. You said that you had (NUMBER IN Q.4b) Pap smear test(s) in the past

five years, but you gave me the dates for (NUMBER OF LINES FILLED IN

Q.5c.) Which number is correct?

(NUMBER IN Q.4b) . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.5c) . . . 2 -->(CORRECT Q.4b)
6. Why did you get your

(DATE OF LAST PAP IN

Part of

Because

-4-

~ Pap smear test? (IF NECESSARY): The one in

Q.5a).

a routine checkup . . . . . 1

ofsymptoms. ..o..o .2

As followup to previous problem . . 3

Special event . . . . . ..o . ..4

Other (SPECIFY) . . . . . . . . . . 5

7a. How did you find out the results of this 1ast Pap smear test? (CIRCLE

ONLY ONE;)

At next doctor’s visit

Doctor told R (PROBE)

R asked doctor/nurse

By letter . . . . . .

Doctor’s office phoned

. . .

. . . . . 1

● ...* . 2

. ..0. . 3

R.....4

R phoned doctor’s office . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . 6 -->(SKIPTO Q.9)

Never found out results . . . . . 7 -->(SKIP TO Q.9)

Other (SPECIFY) . . . . . . . . . 8

7b. Was everything OK or did they find a problem?

Everything was OK . . , . . . . . 1

There was a problem . . . . . . . 2

72
-5-

8. NOT ASKED

9. How useful do you think Pap smear tests are for early detection of

disease? Would you say . . .

Very useful, e........ 1

Somewhat useful, or . . . . . 2

Not very useful? . . . . . . . 3

DON’TKNOW . . . . . . . . . . 8

10. How painful do you think Pap smear tests are? Would you say they

are . . .

Very painful, . . . . . . . . 1

Somewhat painful, or . . . . . 2

Not very painful? . . . . . . 3

DON’TKNOW . .. *..0...8

73
ha. A mammogram

presses the

-6-

1s an x-ray taken only of the breasts by a machine that

breast against a plate. Have you ever ~a mammogram?

Yes . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . 2 -->(SKIP TO Q.17, P.9)

DON’TKNOW . . . . . . . ...8 -->(SKIP TO Q.17, P.9)

llb. How many mammograms have you had in the past five vears, since

(MONTH) 1987?

mammograms

(IF “O” SKIP TO Q.17, P.9)

DON’TKNOW . . . . . . ...98

12a. In what month and year did you have your last mammogram?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

12b. How did you remember that date?
-7-

(KEEPASKINGFOR ALL MAMMOGRAMS IN PAST 5 YEARS -- NUMBER INQ.llb)

12c.Whatabouttheonebeforethat? Inwhatmonthandyear was it?

(IF

(IF

(IF

Mammoqram#

UNABLETO GIVEYEAR):Wouldyousaythatitwasearlyinthe

lastfiveyears--1987or ’88,laterthanthat--l989or ’90,

ormorerecently--l99l or ’92?

UNABLETO GIVEMONTHSOR SEASONS):Wasitduring the winter,

the spring, the summer,or thefall?

UNABLETO GIVEONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

2)

3)

4)

5)

6)

(IFR MENTIONSMOREDATESTHANMAMMOGRAMS):

12d.You said that you had (NUMBER INQ.llb)mammogram(s)in the past

five years, but you gave me the dates for (NUMBEROFLINESFILLED

INQ.12c).Whichnumberiscorrect?

(NUMBER INQ.llb) . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES INQ.12c) . . . 2 -->(CORRECT Q.llb)

13. Why did you get your 1ast mammogram? (IF NECESSARY): The onein (DATE

OF LAST MAMMOGRAM INQ.12a).

Part of a routine checkup . . . . . . . 1

Because of symptoms/lump . . . . . . . 2

As followup to previous problem . . . . 3

Special event . . . . . . . . . . ...4

Other (SPECIFY) . . . . . . . . . . . .5

75
-8-

14. Where was this mammogram done?

RUSH Presbyterian Hospital . . . . . 1

Professional Building . . . . . . . . 2

Anchor HMO........,.. ..3

Other (SPECIFY) . . . . . . . . . . . 4

15a. How did you find out the results of this mammogram? (CIRCLE ONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . 1

R asked doctor/nurse . . . . . 2

Byletter . . . . . . . . ...3

Doctor’s office phoned R . . . . 4

Rphoned doctor’s office . . . . 5

Was told would not hear unless

there was a problem . . . . . . 6 -->(SKIP TO Q.17)

Never found out results . . . ● 7-->(SKIPTOQ.17)

Other (SPECIFY) . . . . . . . . 8

15b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . 1

There was a problem . . . . . . 2

76
-9-

16. NOT ASKED

17. How useful do you think mammograms are for early detection of disease?

Would you say . . .

Very useful, . . . . . . . . . . 1

Somewhat useful, or . . . . . . 2

Not very useful? . . . . . . . . 3

DON’TKNOW . . . . . . . . ...8

18. How painful do you think mammograms are? Would you say they

are . . .

Very painful, . . . . . . ...1

Somewhat painful, or . . . . . . 2

Not very painful? . . . . . . . 3

DON’TKNOW . . . . . . . . . . .8

77
-1o19a. A breast examination is when the breast is felt for lumps by a doctor or

medical assistant. Have you everhaJ a breast examination by a doctor

or medical assistant?

Yes . . . . . . . . . . . . . .1

No. . . . . . . . . . . . . . . 2 -->(SKIPTOQ.23a, P.12)

DON’TKNOW. . . . . . . . . . . 8 -->(SKIP TO Q.23a, P.12)

19b. How many breast examinations have you had in the past five vears,

since (MONTH) 1987?

breast exams

(IF “O” SKIP TO Q.23a, P.12)

DON’TKNOW . . . . . . . . . 98

20a. In what month and year did you have your last breast examination?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

20b. How did you remember that date?
-11-

(KEEPASKINGFOR ALL BREAST EXAMS IN PAST 5 YEARS -- NUMBER IN Q.19b)

20c. What about the one before that? In what month and year was it?

(IF

(IF

(IF

Breast Exam#

2)

3)

4)

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the.

middle, or the end of (those months/that season)?

5)

6)

\J R MENTIONS MORE DATES THAN BREAST EXAMS):

. You said that you had (NUMBER IN Q.19b) breast exam(s) in the past

five years, but you gave me the dates for (NUMBER OF LINES FILLED

IN Q.20c.) Which number is correct?

(NUMBER IN Q.19b) . . . . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.20c) . . . . . . 2 -->(CORRECT Q.19b)

21a. Why did you get your last breast examination? (IF NECESSARY): The one

in (DATE OF LAST BREAST EXAM IN Q.20a).

Part of a routine checkup . . . . . . . 1

Because of symptoms/lump . . . . . . . 2

As followup to previous problem . . . . 3

Special event . ..o . . . . . . ...4

Other (SPECIFY) . . . . . . . . . ...5

21b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . . . ..1

There was a problem . . . . . . . ...2 79
-12-

22. NOT ASKED

23a. A blood stool test is one where the stool

mailed back to the doctor and examined to

is smeared on a card that is

determine whether it contains

blood. Have you ever~a blood stool test?

23b.

Yes. . . . . . . . . . . . .1

No . . . . . . . . . . . . . 2 -->(SKIPTOQ.28, P.14)

DON’TKNOW . . . . . . . . . 8 -->(SKIP TO Q.28, P.14)

How many blood stool tests have you had in the past five vears,

since (MONTH) 1987?

blood stool tests

(IF “O” SKIP TO Q.28, P.14)

DON’TKNOW . . . . . ...98

24a. In what month and year did you have your -last blood stool test?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

.recently--l99lor ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, middle, or

end of (those months/that season)?

24b. How did you remember that date?
-13-

(KEEP ASKING FOR ALL BLOOD STOOL TESTS IN

24c. What about the one before that?

PAST 5 YEARS -- NUMBER IN Q.23b)

In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

j3100dStool Test #

2)

3)

4)

5)

6)

(IF R MENTIONS MORE DATES THAN BLOOD STOOL TESTS):

24d. You said that you had (NUMBER IN Q.23b) blood stool test(s) in

the past five years, but you gave me the dates for (NUMBER OF

LINES FILLED IN Q.24c). Which number is correct?

(NUMBER IN Q.23b) . . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.24c) . . . . . 2 -->(CORRECT Q.23b)

25. Why did you get your last blood stool test? (IF NECESSARY): The one

in (DATE OF LAST BLOOD STOOL TEST IN Q.24a).

Part of a routine checkup . . . . . . 1

Because of symptoms/blood . . . . . . 2

As followup to previous problem . . . 3

Special event . . . . . . . . . ...4

Other (SPECIFY) . . . . . . . . ...5

81
-14-

26a. How did you find out the results of this blood stool test? (CIRCLE

ONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . 1

R asked doctor/nurse . . . . . 2

By letter. . . . . . . . . . . . 3

Doctor’s office phoned R . . . . 4

R phoned doctor’s office . . . . 5

Was told would not hear unless

there was a problem . . . . . . . 6 -->(SKIP TO Q.28)

Never found out results . . . . . 7 -->(SKIP TO Q.28)

Other (SPECIFY) . . . . . . . . . 8

26b. Was everything OK or did they find a problem?

Everything was OK .

There was a problem

27. NOT ASKED

28. How useful do you think blood

disease? Would you say . . .

Very useful, . . .

Somewhat useful, or

Not very useful? .

DON’T KNOW . . . .

. .. **O 1

. . ..*O 2

stool tests are for early detection of

. . . . . , 1

. . . . . . 2

. . . . . . 3

..00, . 8
29a.

30 ●

31.

32.

-15-

Have you had a complete physical checkup or gynecological or female

examination in the past five years, that is since (MONTH) 1987?

Yes . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . z

29b. How many have you had during the past

checkups

DON’TKNOW . . . . . . . ...98

-->(SKIP TO Q.30)

five years?

How much trouble do you usually have making an appointment to see the

doctor? Do you have . .

Alotoftrouble, . . . . . . . 1

Some trouble, or . . . . . . . 2

Not much trouble? . . . . , . . 3

How much trouble do you usually have finding the time to go to the

doctor or get tests done? Do you have , .

Alot of trouble, . . . . . . . 1

Some trouble, or . .. . . . . . 2

Not much trouble? . . . . . . . 3

How hard is it for you to travel to the doctor when you need to see one?

Is it . . .

Very hard, . . . . . . . . . . 1

Somewhat hard, or . . . . . . . 2

Notveryhard? . . . . . . . . 3

83
-16-

33. Do you keep any of the following kinds of records of your visits to the

doctor? What about . . .

a. A datebook or calendar? . . . . . . . 1 2

b. A separate listing of

medical dates? . . . . . . . . . . . 1 2

c. Bills, checks or other

financial records? . . . . . . . . . 1 2

d Any other kinds of records? (SPECIFY) 1 2

34a. Are you currently . . .

Employed full time, . . . . . . . . 1 -->(SKIPTO Q.35a)

Employed part time, or . . . . . . 2 -->(SKIP TO Q.35a)

Not employed at all? . . . . . . . 3

34b. Are you . . .

Retired, . . . . . . . . . . . . .1

Disabled, . . . . . . . . . . . . .2

Temporarily unemployed, . . . . . . 3

A student, . . . . . . . . . . . . 4 -->(SKIPTO Q.36)

Keeping house, or . . . . . . . . . 5 -->(SKIPTO Q.36)

Not employed and not looking

for paid employment? . . . . . . . 6 -->(SKIP TO Q.36)

Other (SPECIFY) . . . . . . . . . . 7
-17-

(IF “RETIRED,” “DISABLED.” OR “Temporarily UNEMPLOYED.” ASK ABOUT MOST RECENT

~&lPATION) :

● What (is/was) your main occupation or job title?

35b. What kind of work (do/did) you do, that is, what (are/were) your

most important duties on the job?

35C. In what type of business or industry (is/was) this; that is, what

product (is/was) made or what service (is/was) given?

36. What is the hiqhest grade or year of school you have completed?

None . . . . . . . . . . . . . . . . . . .00

Elementary . . 01 02 03 04 05 06 07 08

High school . . . . . . . . . . 09101112

college. . . . . . . . . . . .13 14 15 16

Some graduate school . . . . . . . . . . . 17

Graduate or professional degree . . . . . . 18

85
-18-

37. What race do you consider yourself?

American Indian or Alaskan Native . . . 1

Asian or Pacific Islander . . . . . . . 2

Black, not of Hispanic origin . . . . . 3

White, not of Hispanic origin . . . . . 4

Hispanic . . . . . . . . . . . . . . . 5

Other (SPECIFY) . . . . . . . . . . ..6

38. In what year were you born? 19 _ _

(SHOW RESPONDENT THE RELEASE CONSENT FORM.)

39. As part of our research, we would like your permission to review your

records at the HMO. We will only be looking at the dates of various

tests that you have had, to see how they match your recall of them. The

information will be strictly confidential and we will never report any

information in connection with your name.

Please sign this consent form, print your name, and fill in today’s date

and your social security number. If any of your records might be

under another name, please fill in that information on the lines

provided.

1isteal

Thank you very much for your cooperation.

TIME INTERVIEW ENDED: __ . _—

. (24-hour clock)
-19-

40. DID THE RESPONDENT USE ANY OF THE FOLLOWING TO HELP HER REMEMBER

INFORMATION?

a.

b.

c.

d.

Adatebook or calendar

A separate listing of

medical events . . . .

Bills, checks or other

financial records . . .

Anything else (SPECIFY)

.

.

.

●

.

,

.

●

.

.

●

✎

.

.

●

✎

.

●

✎

✎

●

●

✎

✎

.

●

●

●

12

1 2

12

1 2

INTERVIEWER COMMENTS:
4/28/92

Case IO #

Study # 707

Version # ~

Interviewer #

COGNITIVE ASPECTS OF REPORTING HEALTH

PROMOTION AND DISEASE PREVENTION ACTIVITIES

Survey Research Laboratory

University of Illinois

This study is being conducted under authority of Section 306 of the Public

Health Service Act (42 USC242k). Every reply is treated with the strictest

confidence and will only be heard by professionals involved in questionnaire

design research. The results of this study will be presented only in the form

of statistical tables that do not contain the identity of any respondents.

OMB Clearance No. 0920-0264

Expiration date: July 31, 1993

Public reporting burden for this collection of information is estimated to

average 30 minutes per response. Send comments regarding this burden estimate

or any other aspect of information, including suggestions for reducing this

burden to PHS Reports Clearance Officer; ATTN: PRA: Hubert H. Humphrey Bldg.,

Rm. 721-H; 200 Independence Ave., SW; Washington, DC 20201, and to the Office

of Management and Budget; Paperwork Reduction Project (0920-0264); Washington,

DC 20503.
TIME INTERVIEWBEGAN . _ _,

. (24-hour clock)

1. Would you say that your health, in

good, fair, or poor?

Excellent

Very good

Good .

Fair .

Poor .

.

●

✎

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

●

✎

✎

✎

general, is

.

.

.

.

.

.

.

.

.

.

.

●

✎

✎

✎

.

.

.

.

.

.

●

✎

✎

✎

.

.

.

.

.

excellent, very good,

.

●

✎

✎

✎

1

2

3

4

5

2a. Have you had a health problem at any time in the past five years, since

(MONTH) 1987, for which you consulted a doctor on a regular basis?

Yes . . . . . . . , . . . . . . .1

No . . . . . . . . . . . . . . . .2 -->(SKIP TO Q.3a)

2b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3

-1- 89
-2-

3a. Have you had any (other) ma.iorillnesses or conditions at any time in the

past five years for which you consulted a doctor?

Yes . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . 2 -->(SKIPTOQ.4a)

3b. What was the problem?

I Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3

4a. A Pap smear is a routine test, often part of a pelvic examination, where

the doctor uses a swab to take a sample from the mouth of the womb or

cervix. Have you ever~ a Pap smear test?

Yes . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . 2 -->(SKIP TO Q.9, P.5)

DON’TKNOW . . . . ● . . . . . . .8 -->(SKIP TO Q.9, P.5)

4b. How many Pap smear tests have you had in the past five vears, since

(MONTH) 1987?

Pap smear tests

(IF “O” SKIP TO Q.9, P.5)

DON’T KNOW . . . . . . . . . . . 98

5. NOT ASKED

90
6. Why did you

-3-

get your last Pap smear test?

Part of a routine checkup . . . . 1

Because of symptoms . . . . . . . 2

As followup to previous problem . 3

Special event . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . 5

7a. How did you

ONLY ONE.)

find out the results of this last Pap smear? (CIRCLE

At next doctor’s visit

Doctor told R (PROBE)

R asked doctor/nurse

By letter . . . . . .

Doctor’s office phoned

● ✎ ✎

✎ ✎✎☛✎ 1

. . . . . 2

. . . . . ● 3

R.....4

R phoned doctor’s office . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . 6 -->(SKIP TO Q.8a)

Never found out results . . . . . 7 -->(SKIP TO Q.8a)

Other (SPECIFY) . . . . . . . . . 8

7b. Was everything OKordid they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

91
-4-

8a. In what month and year did you have your last Pap smear test?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the.summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

8b. How did you remember that date?

(KEEP ASKING FOR ALL PAPS IN PAST 5 YEARS -- NUMBER IN Q.4b)

8C. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

PaD #

2)

3)

4)

5)

6)

(IF R MENTIONS MORE DATES THAN PAP SMEAR TESTS):

8d. You said that you had (NUMBER IN Q.4b) Pap smartest in the

past five years, but you gave me the dates for (NUMBEROF LINES

FILLED IN Q.8c). Which number is correct?

(NUMBER IN Q.4b) . . . ● . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.8c) . . . 2 -->(CORRECT Q.4b)

92

.+
-5-

9. How useful do you think Pap smear tests are for early detection of

disease? Would you say . . .

10. How painful

are . . .

ha. A mammogram

presses the

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . z

Not very useful? . . . . . . . ..3

DON’TKNOW . . . . . . . . . ...8

do you think Pap smear tests are? Would you say they

Very painful, . . . . . . . ...1

Somewhat painful, or . . . . . . . 2

Not very painful? . . . . . . . . 3

DON’TKNOW . . . . . . . . . ...8

is an x-ray taken only of the breasts by a machine that

breast against a plate. Have you ever~ a mammogram?

Yes . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . 2 -->(SKIP TO Q.17, P.8)

DON’T KNOW . . . . . . . . . . . . 8 -->(SKIP TO Q.17, P.8)

llb. How many mammograms have you had in the past five vears, since

(MONTH) 1987?

mammograms

(IF “O” SKIP TO Q.17, P.8)

DON’T KNOW . . . . . ...98

12. NOT ASKED

93
-6-

13. Why did you get your ~ mammogram?

Part of a routine checkup . . . . . . . 1

Because of symptoms/lump . . . . . . . 2

As followup to previous problem . . . . 3

Special evento . . . . . . . . . . . . 4

Other (SPECIFY) . . . . . . . . . . . . 5

14. Where was this mammogram done?

RUSH PresbyterianHospital . . . . . . 1

ProfessionalBuilding . . . . . . . . . 2

Anchor HMO . . . . . . . . . . . . . .3

Other (SPECIFY) . . . . . . . . . . . . 4

15a. How did you find out the results of this mammogram? (CIRCLEONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . 1

R asked doctor/nurse . . . . . . . . 2

By letter. . . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . . 4

R phoned doctor’s office . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . 6 -->(SKIPTO Q.16a)

Never found out results . . . . . . . . 7 -->(SKIP TO Q.16a)

Other (SPECIFY) . . . . . . . . . . . . 8

15b. Was everythingOK or did they find a problem?

Everythingwas OK...... . . . . 1

There was a problem . . . . . . . . . 2

94
-7-

16a. In what month and year did you have your ~ mammogram?

(IF UNABLETOGIVEYEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLETO GIVE MONTHSOR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

16b. How did you remember that date?

(KEEP ASKING FOR ALL MAMMOGRAMS IN PAST 5 YEARS -- NUMBER IN Q. llb)

16c. What about the one before that? In what month and year was it?

(IF

(IF

(IF

Mammoaram #

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

2)

3)

4)

5)

6)

(IF R MENTIONS MORE DATES THAN MAMMOGRAMS):

16d. You said that you had (NUMBER IN Q.llb) mammogram(s)in the past

five years, but you qave me the dates for (NUMBER OF LINES FILLED

IN Q.16c). - Which nu~ber is correct?

(NUMBER IN Q. llb) . . . . . . . . . 1 -->(CORRECT DATESABOVE)

(NUMBER OF DATES IN Q.16c) . . . . 2 -->(CORRECTQ.llb)

95
-8-

17. How useful do you think mammograms are for early detection of disease?

Would you say . . .

Very useful, . . . . . . ...1

Somewhat useful, or . . . . . 2

Not very useful.? . . . . . . . 3

DON’TKNOW . . . . . ... ...8

18. How painful do you think mammograms are? Would you say they are . . .

Very painful, . . . . . . . . 1

Somewhat painful, or . . . . . 2

Not very painful? . . . . . . 3

DON’TKNOW . . . . . . . . . .8

19a. A breast examination is when the breast is felt for lumps by a doctor or

medical assistant. Have you everhaJ a breast examination by a doctor

or medical assistant?

Yes . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . 2 -->(SKIPTOQ.23a, P.1O)

DON’TKNOW . . . . . . . . . . 8 -->(SKIP TO Q.23a, P.1O)

19b. How many breast examinations have you had in the past five vears,

since (MONTH) 1987?

breast exams

(IF “O” SKIP TO Q.23a, P,1O)

DON’TKNOW . . . . . ...98

20. NOT ASKED

21a. Why did you get your last breast examination?

Part of a routine checkup . . . 1

Because of symptoms/lump . . . . 2

As followup to previous problem 3

Special event . . . . . . . . . 4

Other (SPECIFY) . . . . . . . . 5

21b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . 1

There was a problem . . . . . . 2
-9-

22a. In what month and year did you have your last breast examination?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

22b. How did you remember that date?

(KEEP ASKING FOR ALL BREAST EXAMS IN PAST 5 YEARS -- NUMBER IN Q.19b)

22c. What about the one before that? In what month and year was it?

(IF UNABLE TO GIVE YEAR): Would you say that it Was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Breast Exam #

2)

3)

4)

5)

(IF R MENTIONS MORE DATES THAN BREAST EXAMS):

22d. You said that you had (NUMBER IN Q.19b) breast exam(s) in the past

five years, but you gave me the dates for (NUMBER OF LINES FILLED

IN Q.22c). Which number is correct?

(NUMBER IN Q.19b) . . . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.22c) . . . . . 2 -->(CORRECT Q.19b)

97
23a.

24.

25.

26a.

-1oA blood stool test is one where the stool is smeared on a card that is

mailed back to the doctor and examined to determine whether it contains

blood. Have you ever~ a blood stool test?

Yes. . . . . . . . . . . 1

No . . . . . . . . . . . 2-->(SKIPTOQ.28, P.12)

DON’TKNOW . . . . . . . 8 -->(SKIP TO Q.28, P.12)

23b. How many blood stool tests have you had in the past five vears,

since (MONTH) 1987?

blood stool tests

(IF “O” SKIP TO Q.28, P.12)

DON’T KNOW . . . . . . 98

NOT ASKED

Why did you get your wblood stool test?

Part of a routine checkup . . . . . . . 1

Because of symptoms/blood . . . . . . . 2

As followup to previous problem . . . . 3

Special event . . . . . . . . . . . . . 4

Other (SPECIFY) . . . . . . . . . ...5

How did you find out the results of this blood stool test? (CIRCLE ONLY

ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . 1

R asked doctor/nurse . . . . . . . . 2

By letter . . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . 4

R phoned doctor’s office . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . 6-->(sKIpTo Q.27a)

Never found out results . . . . . . . 7 -->(SKIP TO Q.27a)

Other (SPECIFY) . . . . . . . . . . . 8

26b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . . . 1

There was a problem . . . . . . . . 2
-11-

27a. In what month and year did you have your~ blood stool test?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

27b. How did you remember that date?

(KEEP ASKING FOR ALL BLOOD STOOL TESTS IN PAST 5 YEARS -- NUMBER IN Q.23b)

27c. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the .. ...

middle, or the end of (those months/that season)?

Blood Stool Test #

2)

3)

4)

5)

6)

(IF R MENTIONS MORE DATES THAN BLOOD STOOL TESTS):

27d. You said that you had (NUMBER IN Q.23b) blood stool test(s) in the

past five years, but you gave me the dates for (NUMBER OF LINES

FILLED IN Q.27c). Which number is correct?

(NUMBER IN Q.23b) . . . . . . . . . 1 -->(CORRECT DATES ABOVE)

(NUMBER OF DATES IN Q.27c) . . . . 2 -->(CORRECT Q.23b) 99
-12-

28.

29a.

30 ●

31.

32.

How useful do you think blood stool tests are for early detection of

disease? Would you say . . .

Very useful, . . . . . ...1

Somewhat useful, or . . . . . 2

Not very useful? . . . . . . 3

DON’TKNOW .O . . . ..O.8

Have you had a complete physical checkup or gynecological or female

examination in the past five years, since (MONTH) 1987?

Yes. . . . . . . .. . . . . .1

No . . . . . . . . . . . . .2

29b. How many have you had during the past

checkups

DON’TKNOW . . . . . ...98

How much trouble do You usually have makinq

-->(SKIP TO Q.30)

five years?

an appointment to see the

doctor? Do you have-. .

A lot of trouble,

Some trouble, or

Not much trouble?

..*.* 1

. . . . . 2

..,** 3

How much trouble do you usually have finding the time to go to the

doctor or get tests done? Do you have . .

A lot of trouble, . . . . . 1

Some trouble, or . . . . . 2

Not much trouble? . . . . . 3

How hard is it for you to travel to the doctor when you need to see one?

Is it . . .

Very hard, . . . . . . . . 1

100

Somewhat hard, or . . . . . 2

Not very hard? . . . . . . 3
-13-

33 ● Do you keep any of the following kinds of records of your visits to the

doctor? What about . . . -

~NcJ

a. A datebook or calendar? . . . . . . . 1

b. A separate listing of

medical dates? . . . . . . . . . . . 1

c. Bills, checks or other

financial records? . . . . . . . . . 1

d Any other kinds of records? (SPECIFY) 1

2

2

2

2

34a. Are you currently . . .

Employed full time, . . . . . . . 1 -->(SKIPTOQ.35a)

Employed part time, or . . . . . 2 -->(SKIPTOQ.35a)

Not employed at all? . . . . . . 3

34b. Are you . . .

Retired, . . . . . . . . . . . . 1

Disabled, . . . . . . . . . ...2

Temporarily unemployed, . . . . . 3

A student, . . . . . . . . . . . 4-->(SKIPTOQ.36)

Keeping house, or . . . . . . . . 5 -->(SKIPTOQ.36)

Not employed and not

looking for paid employment? . . 6 -->(SKIP TO Q.36)

Other (SPECIFY) . . . . . . . . . 7

101
-14-

(IF “RETIRED.” “DISABLED,” OR “TEMPORARILY UNEMPLOYED.” ASK ABOUT MOST RECENT

OCCUPATION):

35a. What (is/was) your main occupation or job title?

35b. What kind of work (do/did) you do, that is, what (are/were) your

most important duties on the job?

35c. In what type of business or industry (is/was) this; that is, what

product (is/was) made or what service (is/was) given?

36. What is the hiqhest grade or year of school you have completed?

None . . . . . . . . . . . . . . . . . 00

Elementary 01 02 03 04 05 06 07 08

High school . . . . . . . . 09 10 11 12

College. . . . . . . . . . 13 14 15 16

Some graduate school . . . . . . . . . 17

Graduate or professional degree . . . . 18’

102
-15-

37. What race do you consider yourself?

American Indian or Alaskan Native . . . . 1

Asian or PacificIslander. . . . . . . . 2

Black, not of Hispanic origin . . . . . . 3

White, not of Hispanic origin . . . . . . 4

Hispanic . . . . . . . . . . . . . . . . 5

Other (SPECIFY) . . . . . . . . . . . . . 6

38. In what year were you born? 19 ,_ _

(SHOW RESPONDENT THE RELEASE CONSENT FORM. )

39. As part of our research, we would like your permission to review your

records at the HMO. We will only be looking at the dates of various

tests that you have had, to see how they match your recall of them. The

information will be strictly confidential and we will never report any

information in connection with your name.

Please sign this consent form, print your name, and fill in today’s date

and your social security number. If any of your records might be listed

under another name, please fill in that information on the lines

provided.

Thank you very much for your cooperation.

TIME INTERVIEW ENDED: ●

—— ● — — (24-hourclock)

103
-16-

40. DID THE RESPONDENT USE ANY OF THE FOLLOWING TO HELP HER REMEMBER

INFORMATION?

a. A datebookor calendar

b. A separate listing of

medical events . . . .

c. Bills, checks or other

financial records . . .

d. Anything else (SPECIFY)

.

.

●

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●

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✎

●

INTERVIEWER COMMENTS:

12

1 2

1 2

12

104
4/28/92

Case ID #

Study # 707

Version # 3

Interviewer #

COGNITIVE ASPECTS OF REPORTING HEALTH

PROMOTION ANDDISEASEPREVENTIONACTIVITIES

Survey Research Laboratory

University of Illinois

This study is being conducted under authority of Section 306 of the Public

Health Service Act (42 USC 242k). Every reply is treated with the

strictest confidence and will only be heard by professionals involved in

questionnaire design research. The results of this study will be presented

only in the form of statistical tables that do not contain the identity of

any respondents.

OMB Clearance No. 0920-0264

Expiration date: July 31, 1993

Public reporting burden for this collection of information is estimated to

average 30 minutes per response. Send comments regarding this burden

estimate or any other aspect of information, including suggestions for

reducing this burden to PHS Reports Clearance Officer; ATTN: PRA: Hubert

H. Humphrey Bldg., Rm. 721-H; 200 Independence Ave., SW; Washington, DC

20201, and to the Office of Management and Budget; Paperwork Reduction

Project (0920-0264); Washington, DC 20503.

105
Survey Research Laboratory

University of Illinois

Cognitive Aspects

VERSION 3

SUMMARY CHART

Number

CHECKUPS

Case ID #

Study # 707

Interviewer #

Last Date

(Q.7) (Q.8a)

PAPS

Checkups . . . (Q.9bl) (Q.9dl)

Other . . . . . (Q.llb) (Q.12a)

Confirmation

add-on . . . . (Q.14c/15) (Q.14b/15)

MAMMOGRAMS

Checkups . . . (Q.9b2) (Q.9d2)

Other . . . . . (Q.18b) (Q.19a)

Confirmation

add-on . . . . (Q.21c/22) (Q.21b/22)

BREAST EXAMS

Checkups . . . (Q.9b3) (Q.9d3)

Other . . . . . (Q.26b) (Q.27a)

Confirmation

add-on . . . . (Q.29c/30) (Q.29b/30)

BLOOD STOOL TESTS

Checkups . . . . (Q.9b4) (Q.9d4)

Other . . . . . . (Q.32b) (Q.33a)

Confirmation

106 add-on . . . . . (Q.35c/36) (Q.35b/36)
TIME INTERVIEWBEGAN . _

. (24-hour clock)

1. Would you say that your health, in

good, fair, or poor?

Excellent .

Very good .

Good .

Fair .

Poor .

. .

. .

. .

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

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.

.

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.

.

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.

.

.

.

.

.

.

.

.

.

●

✎

✎

✎

.

.

.

●

✎

excellent, very good,

.

.

.

.

.

1

2

3

4

5

2a. Have you had a health problem at any time in the past five years, that

is since (MONTH) 1987, for which you consulted a doctor on a regular

basis?

Yes. . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . 2 -->(SKIP TO Q.3a)

2b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3
-2-

3a. Have you had any (other) major illnesses or conditions at any time in

the past five years for which you consulted a doctor?

Yes . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . 2 -->(SKIP TO Q.4)

3b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3
-3-

4. Have you had a complete physical or gynecological (female) checkup in

the past five vears, since (MONTH) 1987?

Yes. . . . . . . . . . . . .1

No . . . . . . . . . . . . .2 -->(SKIP TO Q.lla, P.8)

5a. Do you get checkups on a regular basis, or only when you have a

health problem?

Regular basis . . . . . . . . 1

Only for health problem . . . 2 -->(SKIP TO Q.7)

5b. How often do you get a complete physical or gynecological

checkup?

Annually/Once a year . . . . 1

Other (SPECIFY) . . . . . . . 2 -->(SKIPto Q.6)

5C ● Does the time between checkups ever stretch out to more than a

year, because of any reason, including problems with making an

appointment?

Yes. . . . . . . . . . . . .1

No . . . . . . . . . . . . .2

6. Have you ever skio~ed getting your regular checkup during the past

five years?

Yes. . . . . . . . . . . . .1

No . . . . . . . . . . . . .2

DON’TKNOW . . . . . . ...8

109
-4-

*7. How many complete physical or gynecological checkups have you had during

the past five years? (ENTER NUMBER HERE AND ON CHART.)

checkups

(IF “O” SKIP TO Q.lla, P.8)

DON’TKNOW . . . . . ...98

*8a. In what month and year did you have your ~ checkup?

(IF‘UNABLETO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

8b. How did you remember that date?

(KEEP ASKING FOR ALL CHECKUPS IN PAST 5 YEARS -- NUMBER IN Q.7)

8C. What about the one before that? In what month and year was it?

(IF

(IF

(IF

Checku~#

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

2)

3)

4) -

5)

110
-5-

(IF R MENTIONS MORE DATES THAN NUMBER OF CHECKUPS):

8d. You said that you had (NUMBER IN Q.7) checkup(s) in the past five

years, but you gave me the dates for (NUMBER OF LINES FILLED IN

Q.8C). Which number is correct?

(NUMBER IN Q.7) . . . . . . . 1 --> (CORRECT DATES)

(NUMBER OF DATES) . . . . . . 2 --> (CORRECT Q.7

AND CHART)

111
-6-

9a. As’part of your (NUMBER IN Q.7) complete physical

or gynecological checkup(s) in the past five years,

have you had . . .

yeJ

1) A Pap smear test--which

is a routine test, often part

of a pelvic examination, where

the doctor used a swab to take

a sample from the mouth of the

womborcervix? . . . . . . . . . 1

2) A mammoqram--an x-ray

taken only of the

breasts by a machine that

pressed the breast against

a plate? . . . . . . . . . . . . 1

3) (Besides the mammogram,) A

breast examination by a doctor

or medical assistant when the

breast was felt for lumps? . . , 1

4) A blood stool test where a

stool sample was put on a card,

mailed or taken back to the

doctor, and checked for blood? . 1

M

8

8

8

8

9b. How many times since

1987 have you had a

(TEST) as part of your

checkup(s)? (ENTER

NUMBER HERE AND ON

CHART.)

*

*

*

*

112
-7-

(ASK QS.9b-e, IF APPLICABLE, BEFORE GOING ON TO NEXT TEST.)

IF NUMBEROF TESTS IS

GREATER THAN NUMBER OF

CHECKUPS ON CHART

(Q.7), ASK Q.9c.

9c. You said you’ve had

(NUMBER IN Q.7)

checkups and (NUMBER

IN Q.9b) (TESTS).Why

was that?

(IF INCORRECT,CHANGE

ANSWERS.)

9d. In what

month and year

was the last

(TEST) that was

part of a checkup?

(SEE PROBES BELOW.)

(ENTER DATE HERE

AND ON CHART.)

*

*

*

*

IF DATE OF TEST IS

MORE RECENT THAN MOST

RECENT CHECKUP ON

CHART (Q.8a) ASK Q.9e.

9e. You said your last

checkup was in (DATE

IN Q.8a) but this

(TEST) was in (DATE IN

Q.9d). Why is that?

(IF INCORRECT,CHANGE

ANSWERS.)

I

PROBES :

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last five years--

1987 or ’88, later than that--l989 or ’90, or more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the spring, the summer,

or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle, or the end of

(those months/that season)?

113
10.

ha.

-8-

Where was your last checkup done?

RUSH Presbyterian Hospital . . . . 1

Professional Building . . . . . . . 2

AnchorHMO . . . . . . . . . . . . 3

Other (SPECIFY) . . . . . . . . . . 4

[In addition to the (NUMBERIN Q.9bl) Pap smear test(s) you already

mentioned] have you had any -) Pap smear tests in the past five

-, since (MONTH) 1987?

Yes.. . . . . . 1

No . . . . . . . 2 -->(SKIP TO BOXA, P.1O)

How many (other) Pap smear tests have you had?

(ENTER NUMBER HERE AND ON CHART.)

Pap imear tests

114
*12a.

PaD #

2)

3)

4)

5)

6)

13.

-9-

In what month and year did you have [this test/the most recent of the

(NUMBER IN Q.llb) tests]? (ENTER DATE HERE AND ON CHART.)

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKING FOR ALL OTHER PAPS IN PAST 5 YEARS -- NUMBER IN Q. llb)

12b. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years-- 1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Why did you get the Pap smear test in (DATE IN Q.12a)?

Part of a routitlecheckup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . . . 4

Other (SPECIFY) . . . . . . . . . . 5

115
-1oCHECK SUMMARY SHEET FOR PAPS.

A: IF NO PAPS, ASK Q.14a.

IF 1 OR MORE PAPS, SKIP TOQ.15.

14a. Just to confirm, you’ve said that you have whad a Pap smear test in

the last five years. Is that correct?

tklobe

*14C.

Yes . . . . . . . . . . . . 1 -->(SKIPTOQ.18a, P.12)

No . . . . . . . . . . ...2

In what month and year did you have your last Pap smear test?

(ENTER DATE HERE AND ON CHART.)

How many Pap smear tests have you had in the past five vears,

since (MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

Pap smear tests

DON’TKNOW . . . . . . . . 98

I

SKIP TO Q.16a. I

15. Just to confirm, you’ve said that in the last five years, since (MONTH)

1987, you have had the fol1owing Pap smear tests: (READ NUMBER FOR EACH

TYPE FROM CHART) for a total of (SUM) and the last one was (READ DATE OF

LAST PAP). Is that correct?

Yes . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS ON

SUMMARY CHART)

116
-11-

16a. How did you find out the results of your last Pap smear test?

(CIRCLE ONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . 1

R asked doctor/nurse . . . . . . . . 2

By letter. . . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . . 4

R phoned doctor’s office . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . 6 -->(SKIPTO BOX B)

Never found out results . . . . . . . . 7 -->(SKIP TO BOX B)

Other (SPECIFY) . . . . . . . . . ...8

16b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . 1

There was a problem . . . . . . 2

B:

IF LAST PAP WAS PART OF A CHECKUP,

ASK Q.17a.

IF NOT,SKIPTOQ.18a.

17a. Wasthis Pap smear test done on a different day than the rest of the

checkup?

Yes. . . . . . . . . . . . 1

No . . . . . . . . . . . . 2 -->(SKIPTOQ.18a)

17b. How long before or after the checkup was it done?

117
-12-

18a. [In addition to the (NUMBER IN Q.9b2) mammogram(s) YOU already

fientioned,]have you-had any (otherl-mammograms-in the past five vears,

since (MONTH) 1987?

*18b.

Yes. . . . . . . . 1

No . . . . . . . . 2 -->(SKIPTO BOXC)

How many (other) mammograms have you had?

(ENTER NUMBER HERE AND ON CHART.)

mammograms

*19a. In what month and year did you have [this mammogram/the most recent of

the (NUMBER IN Q.18b) mammograms]? (ENTER DATE HERE ANDON CHART.)

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years-- 1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

(KEEP ASKING FOR ALL OTHER MAMMOGRAMS IN PAST 5 YEARS -- NUMBER IN Q.18b)

19b. What about the one beforem? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in

the last five years --1987 or ’88, later than that--l989 or

’90, or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the

winter, the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Mammoqram #

2)

3)

4)

6)

118
-13-

20. Why did you get the mammogram in (DATE IN Q.19a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

CHECK SUMMARY SHEET FOR MAMMOGRAMS.

c: IF NO MAMMOGRAMS, ASK Q.21a.

IF 1 OR MORE MAMMOGRAMS, SKIP TO Q.22.

21a. Just to confirm, you’ve said that you have~ had a

last five years. Is that correct?

akzlb,

*21C*

mammogram in the

Yes. . . . . . . . . . . . . . . . 1 -->(SKIP TO Q.26a, P.16)

No . . . . . . . . . . . . . . . .2

In what month and year did you have your last mammogram?

(ENTER DATE HERE AND ON CHART.)

How many mammograms have you had in the ast five vears, since

(MONTH) 1987? (ENTER NUMBER HERE AND ONPCHART.)

mammograms

DON’TKNOW. . . . . ...98

1====1

119
-14-

22. Just to confirm, you’ve said that in the last five years, since

(MONTH) 1987, you have had the fol1owing mammograms: (READ NUMBER FOR

EACH TYPE FROM CHART) for a total of (SUM) and the last one was (READ

DATE OF LAST-MAMMOGRAM). Is that correct?

Yes. . . . . . . . . . . . . . . . . . .1

No . . . . . . . . . ● . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

23a. Hotidid you find out the results of your last mammogram? (CIRCLE

ONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . . 1

R asked doctor/nurse . . . . . . . . . 2

By letter.. . . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . . . 4

Rphoned doctor’s office . . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . . 6 -->(SKIPTO Q.24)

Never found out results . . . . . . . . . 7 -->(SKIP TO Q.24)

Other (SPECIFY) . . . . . . . . . . ...8

23b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

120
24. Where

-15-

was this mammogram done?

RUSH Presbyterian Hospital . . . . . . . 1

Professional Building . . . . . . . . . . 2

AnchorHMO . . . . . . . . . . . . . . . 3

Other (SPECIFY) . . . . . . . . . . . . . 4

D:

IF LAST MAMMOGRAM WAS PART OF A

CHECKUP EXAM, ASK Q.25a.

IF NOT, SKIP TO Q.26a.

25a. Was this

checkup?

mammogram done on a different day than the rest of the

Yes.. . . . . . . . . 1

No . . . . . . . . . . 2 -->(SKIP TO Q.26a)

25b. How long before or after the checkup was it done?

121
-16-

26a. [In addition to the (NUMBER IN Q.9b3) breast examination(s) you

already mentioned,] have you had any (other) breast examinations in

the past five vears, since (MONTH) 1987?

Yes. . . . . . . . . . 1

No . . . . . . . . . . 2-->(SKIP TO BOX E)

.*26b. How many (other) breast examinations have you had?

(ENTER NUMBER HERE AND ON CHART.)

*27a. In what month

recent of the

CHART.)

breast examinations

and year did you have [this breast exam/the most

(NUMBER IN Q.26b) breast exams]? (ENTER HERE AND ON

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKING FOR ALL BREAST EXAMS IN PAST 5 YEARS -- NUMBER IN Q.26b)

27b. What about the one before that? In what month and year was it?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in

the last five years--l987 or ’88, later than that--l989

or ’90, or more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the

winter, the spring, the summer, or the fall?

(IF UNABLETOGIVEONE MONTH): Was it toward the beginning,

the middle, or the end of (those months/that season)?

Breast Exam #

2)

4)

5)

6)

122
-17-

28. Why did you get the breast examination in (DATE IN Q.27a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event. . . . . . . . . . . 4

Other (SPECIFY) . . . . . . . . . . 5

CHECK SUMMARY SHEET FOR BREAST EXAMS.

E: IF NO BREAST EXAMS, ASK Q.29a.

IF 1 OR MORE BREAST EXAMS, SKIP TO Q.30.

29a. Just to confirm, you’ve said that you have not had a breast exam in

the last five years. Is that correct?

Yes. . . . . . . . . . . . . . . . 1 -->(SKIPTO Q.32a)

No . . . . . . . . . . . . . . . .2

*2gb. In what month and year did you have your last breast exam?

(ENTER DATE HERE AND ON CHART.)

*29c. How many breast examinations have you had in the past five

m, since (MONTH)1987? (ENTERNUMBERHEREANDONCHART. )

breast exams

DON’TKNOW . . . . . . . . 98

123
30.

31.

-18-

Just to confirm, you’ve said that in the last five years, since

(MONTH) 1987, you have had the fol1owing breast exams: (READ NUMBER

FOR EACH TYPE FROM CHART) for a total of (SUM) and the last one was

(READ DATE OF LAST BREAST EXAM). Is that correct?

Yes . . . . . . . . . . . . 1

No . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

Was everything OK with your last breast exam or did they find a

problem?

Everything was OK . . . . . . 1

There was a problem . . . . . 2

32a. [In addition to the (NUMBER IN Q.9b4) blood stool test(s) you already

mentioned,] have you had any (m blood stool tests in the ~

five years, since (MONTH) 1987?

Yes. . . . . . . . . . . . . 1

NO . . . . . . . . . . ...2 -->(SKIP TO BOX F, P.20)

*32b. How many (other) blood stool tests have you had?

(ENTER NUMBER HERE AND ON CHART.)

blood stool tests

124
-19-

*33a. In what month and year did you have [this test/the most recent of

the

(IF

(IF

(IF

(NUMBER IN Q.3Zb) test~? (ENTERDATEHEREAND ON CHART.)

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years-- 1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKINGFOR ALL OTHER BLOOD STOOL TESTS IN PAST5 YEARS

--NUMBERIN Q.32b)

33b. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in

the last five years--1987 or ’88, later than that--l989 or

’90, or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the

winter, the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Blood Stool Test #

2)

3)

4)

6)

34. Why did you get the blood stool test in (DATE IN Q.33a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

125
-20-

F:

CHECK SUMMARY SHEET FOR BLOOD STOOL TESTS.

IF NO BLOOD STOOL TESTS, ASK Q.35a.

I

IF 1 OR MORE BLOOD STOOL TESTS, SKIP TO Q.36.

35a. Just to confirm, you’ve said that you have not had a blood stool test

in the last five years. Is that correct?

Yes. . . . . . . . . . . . . . . .1 -->(SKIP TO Q.38)

No . . . . . . . . . . . . . . . .2

*35b. In what month and year did you have your last blood stool test?

(ENTER DATE HERE AND ON CHART.)

*35C. How many blood stool tests have you had in the past five Years,

since (MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

blood stool tests

DON’TKNOW . . . . . . . . 98

m

36. Just to confirm, you’ve said that in the last five years, since

(MONTH) 1987, you have had the following blood stool tests: (READ

NUMBER FOR EACH TYPE FROM CHART) for a total of (SUM) and the W

one was (READ DATE OF LAST BLOOD STOOL TEST). Is that correct?

Yes . . . . . . . . . . ..l

No . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

126
-21-

37a. How did you find out the results of your last blood stool test?

At next doctor’s visit . . .

Doctor toldR (PROBE) . . . . . . . . . 1

R asked doctor/nurse . . . . . . . . . 2

By letter.. . . . . . . . . . . . . . ,3

Doctor’s office phoned R . . . . . . . . 4

R phoned doctor’s office . . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . . 6 -->(SKIP TO Q.38)

Never found out results . . . . . . . . . 7 -->(SKIP TO Q.38)

Other (SPECIFY) . . . . . . . . . . ...8

37b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

38. Now I’d like to go back to Pap smear tests for a moment. How useful

do you think Pap smear tests are for early detection of disease?

Would you say . . .

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . ..3

DON’TKNOW . . . ~ . . . . . . . .8

39. How painful do you think Pap smear tests are? Would you say they

are . . .

Very painful, . . . . . . . ...1

Somewhat painful, or . . . . . . . 2

Not very painful? . . . . . . . . 3

DON’TKNOW . . . . . . . . . . . .8

127
-22-

40. How useful do you think mammograms are for early detection of

disease? Would you say . . .

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . ..3

DON’TKNOW . . . . . . . . . ...8

41 ● How painful do you think mammograms are? Would YOU say they

are . . .

Very painful, . . . . . . . ...1

Somewhat painful, or . . . . . . . 2

Not very painful? . . . . . . . . 3

DON’T KNOW . . . . . . . . . . . . 8

42. How useful do you think blood stool tests are for early detection of

disease? Would you say . .

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . ..3

DON’T KNOW . . . . . . . . . . . . 8

43. How much trouble do you usually have making an appointment to see the

doctor? Do you have . .

Alotoftrouble, . . . . . ...1

Some trouble, or...... . ..2

Not much trouble? . . . . . . . . 3

44. How much trouble do you usually have finding the time to go to the

doctor or get tests done? Do you have . .

Alotoftrouble, . . . . . ...1

Some trouble, or...... . ..2

Not much trouble? . . . . . . . . 3

128
-23-

45. How hard is it for you to travel to the doctor when you need to see

one? Is it . . .

Very hard, . . . . . . . . . . ..1

Somewhat hard, or . . . . . . . . 2

Not very hard? . . . . . . . . ..3

46. Do you keep any of the following kinds of records of your visits to

the doctor? What about . . .

a.

b.

c.

d.

~~

A datebook or calendar? . . . . . . . 1 2

A separate listing of

medical dates? . . . . . . . . . . . 1 2

Bills, checks or other

financial records? . . . . . . . . . 1 2

Any other kinds of records? (SPECIFY) 1 2

47a. Are you currently . . .

Employed full time, . . . . . . 1 -->(SKIp TO Q.48a)

Employed part time, or . . . . . 2 -->(SKIp TO Q.48a)

Not employed at all? . . . . . . 3

47b. Are you . . .

Retired, . . . . . . . . . . . . 1

Disabled, . . . . . . . . . . . z

Temporarily unemployed, . . . . 3

A student, . . . . . . . . . . . 4 -->(SKIP TO Q.49)

Keeping house, or . . . . . . . 5 -->(sKIPTo Q.49)

Not employed and not looking

for paid employment? . . . . . . 6 -->(SKIP TO Q.49)

Other (SPECIFY) . . . . . . . . 7

129
-24-

(IF “RETIRED.” “DISABLED,” OR “TEMPORARILY UNEMPLOYED.” ASK ABOUT MOST

RECENT OCCUPATION):

48a. What (is/was) your main occupation or job title?

48b. What kind of work (do/did) you do, that is, what (are/were)

your most important duties on the job?

48c. In what type of business or industry (is/was) this; that is,

what product (is/was) made or what service (is/was) given?

49. What is the hicihestgrade or year of school you have completed?

None . . . . . . . . . . . . . . . . . 00

Elementary 01 02 03 04 05 06 07 08

High school . . . . . . . . 09 10 11 12

College. . . . . . . . . . 13 14 15 16

Some graduate school . . . . . . . . . 17

Graduate or professional degree . . . . 18

50. What,race do you consider yourself?

American Indian or Alaskan Native . . . . 1

Asian or Pacific Islander . . . . . . . . 2

Black, not of Hispanic origin . . . . . . 3

White, not of Hispanic origin . . . . . . 4

Hispanic . . . . . . . . . . . . . . . .5

Other (SPECIFY) . . . . . . . . . . ...6

130
-25-

51. In what year were you born? 19

(SHOW RESPONDENT THE RELEASE CONSENT FORM.)

52.

TIME

53.

As part of our research, we would like your permission to review your

records at the HMO. We will only be looking at the dates of various

tests that you have had, to see how they match your recall of them.

The information will be strictly confidential and we will never

report any information in connection with your name.

Please sian this consent form. r)rintvour name. and fill in todav’s

date and ~our social security”nhmber.- If any of your records

be listed under another name, please fill in that information

lines provided.

Thank you very much for your cooperation.

INTERVIEW ENDED: .

— — ● — — (24-hour clock)

mi~ht

on the

DID THE RESPONDENT USE ANY OF THE FOLLOWING TO HELP HER REMEMBER

INFORMATION?

~ ~

a. A datebook or calendar . . . . . . . 1 2

b. A separate listing of

medical events . . . . . . . . . . . 1 2

c. Bills, checks or other

financial records . . . . . . . . . . 1 2

d. Anything else (SPECIFY) . . . . . . . 1 2

INTERVIEWER COMMENTS:

131
4/28/92

Case ID #

Study # 707

Version # ~

Interviewer #

COGNITIVE ASPECTS OF REPORTING HEALTH

PROMOTION ANDDISEASEPREVENTIONACTIVITIES

Survey Research Laboratory

University of Illinois

This study is being conducted under authority of Section 306 of the Public

Health Service Act (42 USC 242k). Every reply is treated with the strictest

confidence and will only be heard by professionals involved in questionnaire

design research. The results of this study will be presented only in the form

of statistical tables that do not contain the identity of any respondents.

OMB Clearance No. 0920-0264

Expiration date: July 31, 1993

Public reporting burden for this collection of information is estimated to

average 30 minutes per response. Send comments regarding this burden estimate

or any other aspect of information, including suggestions for reducing this

burden to PHS Reports Clearance Officer; ATTN: PRA: Hubert H. Humphrey Bldg.,

Rm. 721-H; 200 Independence Ave., SW; Washington, DC 20201, and to the Office

of Management and Budget; Paperwork Reduction Project (0920-0264); Washington,

DC 20503.

132
Survey Research Laboratory

University of Illinois Case ID #

Cognitive Aspects

Study # 707

VERSION 4

SUMMARY CHART Interviewer #

Number Last Date

CHECKUPS

(Q.8e) (Q.8a)

PAPS

Checkups . . . (Q.9bl) (Q.9dl)

Other . . . . . (Q.llb) (Q.12a)

Confirmation

add-on . . . . (Q.14c/15) (Q.14b/15)

MAMMOGRAMS

Checkups . . . (Q.9b2) (Q.9d2)

Other . . . . . (Q.18b) (Q.19a)

Confirmation

add-on . . . . (Q.21c/22) (Q.21b/22)

BREAST EXAMS

Checkups . . . (Q.9b3) (Q.9d3)

Other . . . . . (Q.26b) (Q.27a)

Confirmation

add-on . . . . (Q.29c/30) (Q.29b/30)

BLOOD STOOL TESTS

Checkups . . , . (Q.9b4) (Q.9d4)

Other . . . . . . (Q.32b) (Q.33a)

Confirmation

add-on . . . . . (Q.35c/36) (Q.35b/36) 133
TIME INTERVIEW BEGAN .

—— “— — (24-hour clock)

1. Would you say that your health, in general, is excellent, very good,

good, fair, or poor?

Excellent. . . . . . . . . . . . .1

Very good. . . . . . . . . . . . .2

Good . . . . . . . . . . . . ...3

Fair . . . . . . . . . . . . . . .4

Poor . . . . . . . . . . . . . . .5

2a. Have you had a health problem at any time in the past five years, that is

since (MONTH) 1987, for which you consulted a doctor on a regular basis?

Yes. . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . ..2 -->(SKIP TO Q.3a)

2b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

134

Other (SPECIFY) . . . . . . . . . . . ...3

-1-
-3-

3a. Have you had any (other) ma.iorillnesses or conditions at any time in the

past five years for which you consulted a doctor?

Yes . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . , . 2 -->(SKIP TO Q.4)

3b. What was the problem?

Breast-related (SPECIFY) . . . . . . . . . 1

Gynecologic or urinary-related (SPECIFY) . 2

Other (SPECIFY) . . . . . . . . . . . ...3

4. Have you had a com[

past five vears, s’

Yes .

No .

lete physical or gynecological (female) checkup in the

nce (MONTH) 1987?

. .

. .

. . . .

. . . .

. . .

● ✎ ✎

. .

. .

.

.

. .

. .

.

.

1

2 -->(SKIP TO Q.lla, P.8)

5-7. NOT ASKED
-4-

*aa. In what month and year did you have your last checkup?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

8b.

8C.

How did you remember that date?

(KEEP ASKING FOR ALL CHECKUPS IN PAST 5 YEARS)

What about the one before that? In what month and year was it?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

CheckuD #

2)

3)

4)

5)

6)

136
-5-

8d. NOTASKED

INTERVIEWER:HAS R MENTIONED THE

NUMBER OF CHECKUPS YET?

Yes . . . . . 1

No . . . ...2

ese . (Then to confirm) How many complete physical or

gynecological checkups have you had during the past five

years? (ENTER NUMBER HERE AND ON CHART.)

checkups

(IF “O” SKIP TO Q.lla, P.8)

DON’T KNOW . . . . . . . 98

137
-6-

9a, As part of your (NUMBER IN Q.8e) complete physical

or gynecological checkup(s) in the past five years,

have-you had . . .

&

1) A Par)smear test--which

is a routine test, often part

of a pelvic examination, where

the doctor used a swab to take

a sample from the mouth of the

womb or cervix? . . . . . . . . . 1

2) Amammoqram--an x-ray

taken only of the

breasts by a machine that

pressed the breast against

a plate? . . . . . . . . . . . . 1

3) (Besidesthe mammogram,)A

breast examination by a doctor

or medical assistant when the

breast was felt for lumps? . . . 1

4) A blood stool test where a

stool sample was put on a card,

mailed or taken back to the

doctor, and checked for blood? . 1

2

2

2

2

8

8

8

8

9b. How many times since

1987 have you had a

(TEST) as part of your

checkup(s)? (ENTER

NUMBER HERE AND ON

CHART.)

*

*

*

*

138
-7-

(ASK QS.9b-e, IF APPLICABLE, BEFORE GOING ON TO NEXT TEST.)

IF NUMBER OF TESTS IS

GREATER THAN NUMBER OF

CHECKUPSON CHART

(Q.8e),ASK Q.9c.

9c. You said you’ve had

(NUMBER IN Q.8e)

checkups and (NUMBER

IN Q.9b) (TESTS).Why

was that?

(IF INCORRECT,CHANGE

ANSWERS.)

9d. In what

month and year

was the last

(TEST) that was

part of a checkup?

(SEE PROBES BELOW.)

(ENTER DATE HERE

AND ON CHART.)

*

*

*

*

I

IF DATE OF TEST IS

MORE RECENT THAN MOST

RECENT CHECKUPON

CHART (Q.8a)ASK Q.9e.

9e. You said your last

checkup was in (DATE

IN Q.8a) but this

(TEST)was in (DATE IN

Q.9d). Why is that?

(IF INCORRECT, CHANGE

ANSWERS .)

I

PROBES:

(1F

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the last five years--

1987 or ’88, later than that--l989or ’90, or more recently--l99lor ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the spring, the summer,

or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle, orthe end of

(those months/that season)?

139
10.

ha.

-8-

Where was your last checkup done?

RUSH Presbyterian Hospital . . . . . . 1

Professional Building . . . . . . . . . 2

Anchor HMO . . . . . . . . . . . ...3

Other (SPECIFY) . . . . . . . . . . ..4

[In addition to the (NUMBERIN Q.9bl) Pap smear test(s) you already

mentioned] have you had any (other) Pap smear tests in the past five

J!!2arSssince (MONTH) 1987?

Yes . . . ..e. l

No . . . . . . . 2 -->(SKIP TO BOX A, P.1O)

How many (other) Pap smear tests have you had?

(ENTER NUMBER HERE AND ON CHART.)

Pap smear tests

140
-9-

*12a.

w

2)

3)

4)

5)

6)

13.

In what month and year did you have [this test/the most recent of the

(NUMBER IN Q.llb) tests]? (ENTER DATE HERE AND ON CHART. )

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--l987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKING FOR ALL OTHER PAPS IN PAST 5 YEARS -- NUMBER IN Q.llb)

12b. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years-- 1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Why did you get the Pap smear test in (DATE IN Q.12a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previ~us problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

141
-1oA:

CHECK SUMMARY SHEET FOR PAPS.

IF NOPAPS, ASKQ.14a.

IF 1 OR MORE PAPS, SKIP TOQ.15.

14a. Just to confirm, you’ve said that you have @ had a Pap smear test in

the last five years. Is that correct?

*14b,

*14C*

Yes . . . . . . . . . . . . 1 -->(SKIPTOQ.18a, P.12)

No . . . . . . . . . . . ..2

In what month and year did you have your last Pap smear test?

(ENTER DATE HERE AND ON CHART.)

How many Pap smear tests have you had in the past five vears,

since (MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

Pap smear tests

DON’TKNOW . . . . . . . . 98

m

15. Just to confirm, you’ve said that in the last five years, since (MONTH)

1987, you have had the following Pap smear tests: (READ NUMBER FOR EACH

TYPE FROM CHART) for a total of (SUM) and the last one was (READ DATE OF

LAST PAP). Is that correct?

Yes . . . . . . . . . . ..l

No . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

142
-11-

16a. How did you find out the results of your last Pap smear test?

(CIRCLE ONLY ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . 1

R asked doctor/nurse . . . . . . . . 2

By letter.. . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . . 4

R phoned doctor’s office . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . 6 -->(SKIP TO BOX B)

Never found out results . . . . . . . . 7 -->(SKIPTO BOX B)

Other (SPECIFY) . . . . . . . . . ...8

16b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . 1

There was a problem . . . . . . 2

IF LAST PAP WASPARTOF A CHECKUP,

ASKQ.17a.

B:

IF NOT, SKIP TO Q.18a.

17a. Was this Pap smear test done on a different day than the rest of the

checkup?

Yes.. . . . . . . . . . . 1

No . . . . . . . . . . . . 2 -->(SKIP TO Q.18a)

17b. How long before or after the checkup was it done?

143
-12-

18a. [In addition to the (NUMBER IN Q.9b2) mammogram(s) you already

mentioned,] have you had any = mammograms in the past five vears,

since (MONTH) 1987?

Yes. . . . . . . . 1

No . . . . . . . . 2 -->(SKIP TO BOX C)

*18b. How many (other) mammograms have you had?

(ENTER NUMBER HERE AND ON CHART.)

mammograms

*19a. In what month and year did .VOUhave [this mammocmam/the most recent of

the

(IF

(IF

(IF

(NUMBER IN Q.18b) mammograms]? (ENTER DATE-HERE AND ON CHART.)

UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the middle,

or the end of (those months/that season)?

(KEEP

19b.

ASKING FOR ALL OTHER MAMMOGRAMS IN PAST 5 YEARS -- NUMBER IN Q.18b)

What about the one before that? In what month and year was it?

(IF UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or ’92?

(IF UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

(IF UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those monthslthat season)?

Mammoqram #

2)

3)

4)

5)

6)

144
-13-

20. Why did you get the mammogram in (DATE IN Q.19a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

c:

CHECK SUMMARY SHEET FOR MAMMOGRAMS.

IF NOMAMMOGRAMS, ASK Q.21a.

IF 1 OR MORE MAMMOGRAMS, SKIP TO Q.22.

21a. Just to confirm, you’ve said that you have I@ had a mammogram in the

last five years. Is that correct?

kzlb.

*21C.

Yes. . . . . . . . . . . . . . . .1 -->(SKIP TO Q.26a, P.16)

No . . . . . . . . . . . . . . . .2

In what month and year did you have your last mammogram? (ENTER

DATE HERE AND ON CHART.)

How many mammograms have you had in the past five vears, since

(MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

mammograms

DON’TKNOW . . . . . . . . 98

E

145
-14-

22. Just to confirm, you’ve said that in the last five years, since (MONTH)

1987, you have had the following mammograms: (READ NUMBER FOR EACH TYPE

FROM CHART) for a total of (SUM) and the last one was (READ DATE OF LAST

MAMMOGRAM) . Is that correct?

Yes. . . . . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

23a. How did you find out the results of your last mammogram? (CIRCLE ONLY

ONE.)

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . . 1

R asked doctor/nurse . . . . . . . . . 2

By letter. . . . . . . . . . . . . . . . 3

Doctor’s office phoned R . . . . . . . . 4

R phoned doctor’s office . . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . . 6 -->(SKIPTO Q.24)

Never found out results . . . . . . . . . 7 -->(SKIPTO Q.24)

Other (SPECIFY) . . . . . . . . . . . . . 8

23b. Was everything OK or did they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

146
24. Where

-15-

was this mammogram done?

RUSH Presbyterian Hospital . . . . . . . 1

Professional Building . . . . . . . . . . 2

AnchorHMO . . . . . . . . . . . . . . . 3

Other (SPECIFY) . . . . . . . . . . . ..4

IF LAST MAMMOGRAM WAS PART OF A

CHECKUP EXAM, ASK Q.25a.

D:

IF NOT, SKIP TO Q.26a.

25a. Was this mammogram done on a different day than the rest of the checkup?

25b.

Yes. . . . . . . . . . 1

No . . . . . . . . . . 2 -->(SKIP TO Q.26a)

How long before or after the checkup was it done?

147
-16-

26a. [In addition to the (NUMBER IN Q.9b3) breast examination(s) you already

mentioned,] have you had any (other) breast examinations in the ~

five vears, since (MONTH) 1987?

Yes . . . . . . 1

No . . . . . . 2 -->(SKIP TO BOX E)

*26b. How many (other) breast examinations have you had?

(ENTER NUMBER HERE AND ON CHART.)

breast examinations

*27a. In what month and year did you have [this breast exam/the most recent

of the (NUMBER IN Q.26b) breast exams]? (ENTER HERE AND ON CHART.)

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKING FOR ALL BREAST EXAMS IN PAST 5 YEARS -- NUMBER IN Q.26b)

27b. What about the one before that? In what month and year was it?

(IF

(IF

(IF

Breast Exam #

2)

UNABLETO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90,

or more recently--l99l or.’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

3)

4)

5)

6)

148
-17-

28. Why did you get the breast examination in (DATE IN Q.27a)?

Part of a routine checkup . . . . . 1

Because-of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

CHECK SUMMARY SHEET FOR BREAST EXAMS.

IF NO BREAST EXAMS, ASK Q.29a.

E:

IF 1 OR MORE BREAST EXAMS, SKIP TOQ.30.

29a. Just to confirm, you’ve said that you have not had a breast exam in the

last five years. Is that correct?

Yes. . . . . . . . . . . . . . . . 1 -->(SKIP TO Q.32a)

No . . . . . . . . . . . . . . . .2

*2gb. In what month and year did you have your last breast exam? (ENTER

DATE HERE ANDON CHART.)

*29c. How many breast examinations have you had in the past five vears,

since (MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

breast exams

DON’TKNOW . . . . . . . . . . . 98

m

149
30.

31.

-18-

Just to confirm, you’ve said that in the last five years, since (MONTH)

1987, you have had the following breast exams: (READ NUMBER FOR EACH

TYPE FROM CHART) for a total of (SUM) and the 1ast one was (READ DATE OF

LAST BREAST EXAM). Is that correct?

Yes . . . . . . . . . . . . . . . 1

No . . . . . . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARY CHART)

Was everything OK with your last breast exam or did they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

32a. [In addition to the (NUMBER IN Q.9b4) blood stool test(s) you already

mentioned,] have you had any (other) blood stool tests in the past five

m, since (MONTH) 1987?

Yes. . . . . . . . . . . . . . . .1

No . . . . . . . . . . . . . . . .2 -->(SKIPTO BOX F, P.20)

*32b. How many (other) blood stool tests have you had?

(ENTER NUMBER HERE AND ON CHART.)

blood stool tests

150
*33a.

-19-

In what month and year did you have [this test/the most recent of the

(NUMBER IN Q.32b) tests]? (ENTER DATE HERE AND ON CHART.)

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the last

five years--1987 or ’88, later than that--l989 or ’90, or more

recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter, the

spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

(KEEP ASKING FOR ALL OTHER BLOOD STOOL TESTS IN PAST 5 YEARS

--NUMBER IN Q.32b)

33b. What about the one before that? In what month and year was it?

(IF

(IF

(IF

UNABLE TO GIVE YEAR): Would you say that it was early in the

last five years--1987 or ’88, later than that--l989 or ’90, or

more recently--l99l or ’92?

UNABLE TO GIVE MONTHS OR SEASONS): Was it during the winter,

the spring, the summer, or the fall?

UNABLE TO GIVE ONE MONTH): Was it toward the beginning, the

middle, or the end of (those months/that season)?

Blood Stool Test #

2)

3)

4)

5)

34 ● Why did you get the blood stool test in (DATE IN Q.33a)?

Part of a routine checkup . . . . . 1

Because of symptoms . . . . . . . . 2

As followup to previous problem . . 3

Special event . . . . . . . . . ..4

Other (SPECIFY) . . . . . . . . . . 5

151
-20-

CHECK SUMMARY SHEET FOR BLOOD STOOL TESTS.

F: IF NO BLOOD STOOL TESTS, ASK Q.35a.

IF 1 OR MORE BLOOD STOOL TESTS, SKIPTO Q.36.

35a. Just to confirm, you’ve said that you have not had a blood stool test in

thellast five years. Is that correct?

*yjb .

*35C.

Yes.. . . . . . . . . . . . . . . 1 -->(SKIPTOQ.38)

No . . . . . . . . . . . . . . ..2

In what month andyear did you have your last blood stooltest?

(ENTER DATE HERE AND ON CHART.)

How many blood stool tests have you had in the past five Years,

since (MONTH) 1987? (ENTER NUMBER HERE AND ON CHART.)

blood stool tests

DON’TKNOW . . . . . . . . . . . 98

m

36. Just to confirm, you’ve said that in the last five years, since (MONTH)

1987, you have had the foilowing blood stool tests: (READ NUMBER FOR

EACHTYPE FROM CHART)for a totalof (SUM)and the 1ast one was (READ

tlATfOF LAST WIOB STOW TEST}. IS that correct?

Yes.. . . . . . . . . . . . . . . 1

No . . . . ● . . . . . . . . . . . 2 -->(MAKE CORRECTIONS

ON SUMMARYCHART)

152
-21-

37a. How did you find out the results of your last blood stool test?

37b.

At next doctor’s visit . . .

Doctor told R (PROBE) . . . . . . . . . 1

R asked doctor/nurse . . . . . . . . . 2

By letter. . . . . . . . . . . . . . . .3

Doctor’s office phoned R . . . . . . . . 4

R phoned doctor’s office . . . . . . . . 5

Was told would not hear unless

there was a problem . . . . . . . . . . . 6 -->(SKIPTO Q.38)

Never found out results . . . . . . . . . 7 -->(SKIP TO Q.38)

Other (SPECIFY) . . . . . . . . . . ...8

Was everything OK or did they find a problem?

Everything was OK . . . . . . . . 1

There was a problem . . . . . . . 2

38. Now I’d like to go back to Pap smear tests for a moment. How useful do

you think Pap smear tests are for early detection of disease? Would you

say . . .

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . ..3

DON’TKNOW . . . . . . . . . . . .8

39. How painful do you think Pap smear tests are? Would you say they

are . . .

Very painful, . . . . . . . ...1

Somewhat painful, or . . . . . . . 2

Not very painful? . . . . . . . . 3

DON’TKNOW . . . . . . . . . . . .8

153
-22-

40. How useful do you think mammograms are for early detection of disease?

Would you say . . .

Very useful, . . . . ..o.. ..1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . . . 3

DON’TKNOW . . . . . . . . . ...8

41. How painful do you think mammograms are? Would you say they

are . . .

Very painful, . . . . . . . ...1

Somewhat painful, or . . . . . . . 2

Not very painful? . . . . . . . . 3

DON’TKNOW . . . . . . . . . ...8

42. How useful do you think blood stool tests are for early detection of

disease? Would you say . .

Very useful, . . . . . . . . . . . 1

Somewhat useful, or . . . . . . . 2

Not very useful? . . . . . . . . . 3

DON’TKNOW . . . . . . . . . . . .8

43. How much trouble do you usually have making an appointment to see the

doctor? Do you have . .

Alotoftrouble, . . . . . ...1

Some trouble, or . . . . . . . . . 2

Not much trouble? . . . . . . . . 3

44. How much trouble do you usual1y have finding the time to go to the

doctor or get tests done? Do you have . .

Alot of trouble, . . . . . ...1

Some trouble, or...... . ..2

Not much trouble? . . . . . . . . 3

154
-23-

45. How hard is it for you to travel to the doctor when you need to see one?

Is it . . .

Very hard, . . . . . . . . . . ..1

Somewhat hard, or . . . . . . . . 2

Not very hard? . . . . . . . . ..3

46. Do you keep any of the following kinds of records of your visits to the

doctor? What about . . .

a. Adatebook or calendar? . . . . . . . 1 2

b. A separate listing of

medical dates? . . . . . . . . . . . 1 2

c. Bills, checks or other

financial records? . . . . . . . . . 1 2

d. Any other kinds of records? (SPECIFY) 1 2

47a. Are you currently . . .

Employed full time, . . . . . . 1 -->(SKIPTO Q.48a)

Employed part time, or . . . . . 2 -->(SKIP TO Q.48a)

Not employed at all? . . . . . . 3

47b. Are you . . .

Retired, . . . . . . . . . . . . 1

Disabled, . . . . . . . . . . . 2

Temporarily unemployed, . . . . 3

A student, . . . . . . . . . . . 4 -->(SKIPTOQ.49)

Keeping house, or . . . . . . . 5 -->(SKIP TO Q.49)

Not employed and not looking

for paidemployment?. . . . . . 6 -->(SKIP TOQ.49)

Other (SPECIFY) . . . . . . . . 7

155
-24-

(IF “RETIRED.” “DISABLED.” OR “TEMPORARILY UNEMPLOYED.” ASK ABOUT MOST RECENT

OCCUPATION):

48a. What (is/was) your main occupation or job title?

48b. What kind of work (do/did) you do, that is, what (are/were) your

most important duties on the job?

48c. In what type of business or industry (is/was) this; that is, what

product (is/was) made or what service (is/was) given?

49. What is the hicihestgrade or year of school you have completed?

None . . . . . . . . . . . . . . . . . 00

Elementary 01 02 03 04 05 06 07 08

High school . . . . . . ..O9 101112

College . . . . . . . . ..l3l4 1516

Some graduate school . . . . . . . . . 17

Graduate or professional degree . . . . 18

50. What race do you consider yourself?

American Indian or Alaskan Native . . . . 1

Asian or Pacific Islander . . . . . . . . 2

Black, not of Hispanic origin . . . . . . 3

White, not of Hispanic origin . . . . . . 4

Hispanic . . . . . . . . . . . . . . . .5

Other (SPECIFY) . . . . . . . . . . . . . 6

156
-25-

51. In what year were you born? 19

(SHOW RESPONDENT THE RELEASE CONSENT FORM.)

52. As part”of our research, we would like your permission to review your

records at the HMO. We will only be looking at the dates of various

tests that you have had, to see how they match your recall of them. The

information will be strictly confidential and we will never report any

information in connection with your name.

Please sign this consent form, print your name, and fill in today’s date

and your social security number. If any of your records might be listed

under another name, please fill in that information on the lines

provided.

Thank you very much for your cooperation.

TIME INTERVIEW ENDED: .

—— ● — — (24-hour clock)

53. DID THE RESPONDENT USE ANY OF THE FOLLOWING TO HELP HER REMEMBER

INFORMATION?

& &

a. A datebook or calendar . . . . . . . 1 2

b. A separate listing of

medical events . . . . . . . . . . . 1 2

c. Bills, checks or other

financial records . . . . . . . . . . I 2

d. Anything else (SPECIFY) . . . . . . . 1 2

INTERVIEWER COMMENTS:

157
Medical Record Coding Instructions

General Instructions

* all sections of the medical record, including consultant reports,

should be reviewed. Consultant reports are especially important if

the patient has a breast lump, discharge from the breast, abnormal

mammogram results, or undergoes a breast biopsy.

* please indicate if record appears to be incomplete for any time

period since January 1, 1987.

* references to stool guaiac and hemocult tests, where stool

samples are taken in the clinic, should ~ be counted as fecal

blood tests, in which the patient is given a card to take home,

place samples on, and mail back to the clinic.

Eliaibilitv

* only patients who: (1) are females, (2) aged 50 or older, and (3)

who have been enrolled with RUSH Anchor HMO since January 1, 1987

are eligible for this study.

* only patients meeting the above criteria have been sampled and

interviewed. However, if you find evidence in the medical record

that any patient has @ been enrolled at the HMO since at least

January 1, 1987, this record should be reported before any

abstraction of it is done.

Examination Dates

* for each type of examination, both test reports (i.e., from

Cytology or Radiology) and references to test results (i.e., Itpap

negative.”) in physician notes, should be considered evidence a

test was done. Record MD notes of test results verbatim. Do for

all tests, regardless of whether findings are normal, abnormal, or

inconclusive.

* for mammograms and fecal blood tests, all physician referrals for

testing should be recorded, irrespective of whether there is

evidence the test was ever completed.

* also for mammograms, read through all results to determine when

the previous (if any) mammogram was performed. This often helps

determine if any mammogram results are missing from the record.

* patient refusals to have tests done should also be recorded.

Number of Clinic Visits

* in counting number of visits per year to RUSH Anchor, stops in

two or more clinics in the same day should be counted as a single

visit.

158
* telephone calls should ~ be counted as clinic visits.

* regular visits for either chronic or acute conditions, and all

follow-up visits after surgical procedures, should be counted as

visits.

* instances in which the patient has an appointment but leaves

before the physician sees her should ~ be counted as clinic

visits.

* visits to pick up a prescription refill should @ be counted as

visits.

* psychiatric visits should also QQ& be counted as visits.

revised: July 24, 1992.

159
Matching Protocols

General Matchinq

* There must be evidence in the chart, either a test result report

(i.e., from Cytology or Radiology), or a references to the results

in the physician’s notes (i.e., I!class 11 paptl of ~*mammogram

okay”), before it can be assumed that a test was done. Evidence

that the physician referred the patient for a test, in the absence

of test results, is not sufficient (abstracters have been

instructed to record referral dates as well as test dates). Only

tests verified in this manner should be counted as part of the

total number of tests done.

* when matching, differences between reported and actual test dates

are to be recorded in months. When respondent reports are more

recent than test results, the difference in months should be

positive (i.e., if the chart says a test was done in August 1988,

and the respondent says it was done in December 1988, the

difference is +4 months). Likewise, when respondent reports are

less recent than the test results, the difference in months should

be recorded as negative (i.e., if the chart says test done in July

1991, and the respondent says January 1991, the difference is -6

months). An exact monthly match is codes as a difference of O

months.

* When more than three tests or examinations are reported or

abstracted for any given year, the first three tests received

during that year should be matched and recorded on the matching

form. ~ additional tests should be matched and recorded

separately for future analyses.

* When a test is reported by the respondent, but there is no

evidence of a corresponding test in the medical record, a ‘t90t1

should be recorded.

* When a medical record provides the date of a test, and the

respondent does not report a test that can be matched, a ‘191!!

should be recorded.

* When a test is reported by the respondent, but with the date

unknown, and a possible matching test is found in the medical

record, a ‘!92’!should be recorded.

* When a test is reported, but with the date unknown, and there is

no potential matching test in the medical record, a 1193!!is

recorded. This is recorded in the ‘ifloati.ngll variable for the test

in question, as the reference year (see below) is unknown.

* When both the respondent and the medical record agree that no

tests of a particular type where done since January 1, 1987, a ‘194!!

is recorded in the ‘tfloating”variable for that test.

160
* When the respondent was ~ asked about a particular test, and no

possible matching test is found, a “95” is recorded in the

“floating“ variable for that test.

* When a test is found in the medical record, and the respondent

was ~ asked about having received such a test, then a “96” is

recorded for the appropriate reference year.

* When respondent reports year of test only, a match should be

coded as “97.”

* If the respondent reports having a snecific test/exam at a nonRUSH facility, delete reference to that test only.

* For patients that were discovered to have had ~ of their care

provided at a facility other than Rush-Anchor, code 1199:Cunder each

of the four floating variables.

Reference Year

* The reference year for matching is the year the respondent

indicates an event took place. The only exceptions are when a test

is recorded but there is no test report for that year. In such

cases, the year of the test should be used as the frame of

reference. For example, if a respondent reports a test in March

1991 and the record indicates that the test was done in December

1990, the match code (+3 months) is recorded for 1991, as the year

reported by the respondent is considered the frame of reference.

In contrast, if a medical record indicates a test done in 1989, but

no tests are mentioned by the respondent that can be matched with

this date, the frame of reference becomes the actual test date -

1989.

Exact Dates Not Renorted

* when respondent provides season only, code Winter as Januaryl

Spring as April, Summer as July, and Autumn as October for purposes

of matching.

* when respondent reports test as occurring ~imid-year,itcode as

July for purposes of matching.

* When a respondent gives a range of months during which a test or

exam occurred, record the even-numbered month if a range of two

months is given, and record the middle month if a range of three

months is given.

‘U. S. Government Printing Officcr 1994 -S01-019/00012 161

Revised: September 9, 1992
Table I. Raw frequencies, by outcome measure, test, and year: 1987-92 

Test 

Matched False 

data reports Omissions 

No 

test Missing 

Papsmear 

1987-92 ............................ 

1987 ............................. 

1988 ............................. 

1989.....................- ....... 

1990 ............................. 

1991............................. 

1992 ............................. 

Number 

295 200 32 532 9 

34 30 13 100 1 

57 37 7 74 3 

60 43 7 64 4 

62 39 2 74 1 

58 41 3 76 0 

24 10 0 144 0 

Breast exam 

1987-92 ............................ 

1987 ............................. 

1988 ............................. 

1989 ............................. 

1990 ............................. 

1991............................. 

1992 ............................. 

315 196 89 458 10 

27 28 27 96 0 

64 34 19 58 3 

67 36 16 56 3 

70 30 13 61 4 

66 46 7 59 0 

21 22 7 128 0 

Mammogram 

1987-92 ............................ 

1987 ............................. 

1988 ............................. 

1989 ............................. 

1990 ............................. 

1991............................. 

1992 ............................. 

399 117 47 488 17 

29 17 19 112 1 

62 20 18 74 4 

84 24 3 62 5 

94 21 3 54 6 

94 27 1 56 0 

36 8 3 130 1 
Table II. Percent distribution 

measure: 1987-92 

response-quality measures and number and percent of respondents, bY year, test, and outcome 

All years 

Test and outcome measure combined 1987 1988 7989 1990 1991 1992 

Pap smears 

Number of respondents. .................. 

All measures ......................... 

Matched data. ........................ 

Notest ............................. 

False reports ......................... 

Omissions ........................... 

Reporting test. ........................ 

Test in records ........................ 

Ratio.. ............................ 

Breast exams 

Number of respondents. .................. 

All measures ......................... 

Matched data. ........................ 

Notest ............................. 

False reports ......................... 

Omissions ........................... 

Reporting test. ........................ 

Test in records ........................ 

Ratio.. ............................ 

Mammograms 

. Number of respondents. .................. 

All measures ......................... 

Matched data. ........................ 

Notest ............................. 

False reports ......................... 

Omissions ........................... 

Reporting test. ........................ 

Test in records ........................ 

Ratio.. ............................ 

All procedures 

Number of respondents. .................. 

All measures ......................... 

Matched data. ........................ 

Notest ............................. 

False reports ......................... 

Omissions ........................... 

Reporting test. ........................ 

Test in records ........................ 

Ratio.. ............................ 

1,059 177 

100.0 100.0 

27.9 19.2 

50.2 56.5 

18.9 16.9 

3.0 7.4 

46.8 36.1 

30.9 26.6 

1.51 1.36 

1,058 178 

190.0 100.0 

29.8 15.2 

43.3 53.9 

18.5 15.7 

8.4 15.2 

48.3 30.9 

38.2 30.4 

1.26 1.02 

1,047 173 

190.0 100.0 

37.9 16.4 

46.4 63.3 

11.1 9.6 

4.5 10.7 

49.0 26.0 

42.4 27.1 

1.16 0.96 

3,164 528 

100.0 100.0 

31.8 16.9 

46.7 57.9 

16.2 14.1 

5.3 11.1 

48.0 31 .o 

37.1 28.0 

1.29 1.11 

175 174 

Percent distribution 

100.0 100.0 

32.6 34.5 

42.3 36.8 

21.1 24.7 

4.0 4.0 

Percent 

53.7 59.2 

36.6 38.5 

1.47 1.54 

175 175 

Percent distribution 

100.0 100.0 

36.5 38.3 

33.2 32.0 

19.4 20.6 

10.9 9.1 

Percent 

55.9 58.9 

47.4 47.4 

1.18 1.24 

174 173 

Percent distribution 

100.0 100.0 

35.7 48.6 

42.5 35.8 

11.5 13.9 

10.3 1.7 

Percent 

47.2 62.5 

46.0 50.3 

1.03 1.24 

524 522 

Percent distribution 

100.0 100.0 

34.9 40.5 

39.3 34.8 

17.4 19.7 

8.4 5.0 

Percent 

52.3 60.2 

43.3 45.5 

1.21 1.32 

177 178 178 

100.0 109.0 100.0 

35.1 32.6 13.5 

41.8 42.7 80.9 

22.0 23.0 5.6 

1.1 1.7 0.0 

57.1 55.6 19.1 

36.2 34.3 13.5 

1.58 1.62 1.41 

174 178 178 

160.0 100.0 100.0 

40.2 37.0 11.8 

35.1 33.2 71.9 

17.2 25.9 12.4 

7.5 3.9 3.9 

57.4 62.9 24.2 

47.7 40.9 15.7 

1.20 1.54 1.54 

172 178 177 

100.0 100.0 100.0 

54.7 52.8 20.3 

31.4 31.5 73.4 

12.2 15.2 4.5 

1.7 0.6 1.7 

66.9 68.0 24.8 

56.4 53.4 22.0 

1.19 1.27 1.13 

523 534 533 

100.0 100.0 100.0 

43.2 40.8 15.2 

36.1 35.8 75.4 

17.3 21.3 7.5 

3.4 2.1 1.9 

60.5 62.1 22.7 

46.6 42.9 17.1 

1.30 1.45 1.33 
Table Ill. Percent distribution of response-quality measures and number and percent of respondents, by year, test, and test regularity: 

1987-92 

Number of 

Pap smears 

respondents. 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions ............................. 

Reporting test. .......................... 

Test in record. .......................... 

Report-to-records ratio ..................... 

Pap smears received regularly 

Number of respondents. .................... 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions ............................. 

Reporting test. .......................... 

Test in record ........................... 

Report-to-records ratio ..................... 

Breast exams received irregularly 

Number of respondents. .................... 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions ............................. 

Reporting test. .......................... 

Test in record. .......................... 

Report-to-records ratio ..................... 

Breast exams received regularly 

Number of respondents. .................... 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions ............................. 

Reporting test. .......................... 

Test in record. .......................... 

Report-to-records ratio ..................... 

Mammograms received irregularly 

Number of respondents. .................... 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions. ............................ 

765 128 

100.0 100.0 

20.1 13.3 

54.0 64.0 

23.2 18.0 

2.7 4.7 

43.3 31.3 

22.8 18.0 

1.90 1.74 

210 35 

100.0 100.0 

67.1 48.6 

16.7 11.4 

11.0 20.0 

5.2 20.0 

78.1 68.6 

72.3 68.6 

1.08 1 .oo 

777 131 

100.0 100.0 

24.7 12.2 

46.7 59.5 

23.2 19.1 

5.4 9.2 

47.9 31.3 

30.1 21.4 

1.59 1.46 

233 39 

100.0 100.0 

52.8 28.2 

20.2 25.6 

6.9 7.7 

20.2 38.5 

59.7 35.9 

73.0 66.7 

0.82 0.54 

668 116 

100.o 100.0 

30.3 14.6 

52.2 66.4 

14.0 12.1 

3.5 6.9 

126 125 

Percent distribution 

100.0 100.0 

23.8 24.0 

46.0 39.2 

25.4 32.0 

4.8 4.8 

Percent 

49.2 56.0 

28.6 28.8 

1.72 1.94 

35 35 

Percent distribution 

100.0 100.0 

77.1 85.7 

5.7 2.9 

14.3 8.5 

2.9 2.9 

Percent 

91.4 94.2 

80.0 88.6 

1.14 1.06 

128 129 

Percent distribution 

100.0 100.0 

29.6 33.3 

36.7 36.4 

25.8 25.6 

7.8 4.7 

Percent 

55.4 58.9 

37.4 38.0 

1.48 1.55 

39 38 

Percent distribution 

100.0 100.0 

66.7 63.2 

7.7 2.6 

2.6 7.9 

23.1 26.3 

Percent 

69.3 71 .I 

89.8 89.5 

0.77 0.79 

113 114 

Percent distribution 

190.0 100.0 

26.5 35.1 

51.3 43.7 

15.9 18.4 

6.2 2.6 

128 129 129 

100.0 100.0 100.0 

27.3 24.0 8.5 

43.0 46.5 84.5 

28.1 28.7 7.0 

1.6 0.8 0.0 

55.4 52.7 15.5 

28.9 24.8 8.5 

1.92 2.12 1.82 

35 35 35 

100.0 100.0 100.0 

77.1 77.2 37.1 

14.3 5.7 60.0 

8.6 11.4 2.9 

0.0 5.7 0.0 

85.7 88.6 40.0 

77.1 82.9 37.1 

1.11 1.07 1.08 

127 131 131 

100.0 100.0 100.0 

35.4 32.1 6.1 

37.0 34.4 75.6 

23.6 30.5 14.5 

3.9 3.1 3.8 

59.0 62.6 20.6 

39.3 35.2 9.9 

1.50 1.78 2.08 

39 39 39 

100.0 100.0 100.0 

64.1 61.6 33.3 

15.4 15.4 53.8 

0.0 15.4 7.7 

20.5 7.7 5.1 

64.1 77.0 41 .o 

84.6 69.3 38.4 

0.76 1.11 1.0 

112 117 116 

100.0 100.0 100.0 

44.6 48.7 12.9 

36.6 33.3 81 .O 

16.1 17.1 4.3 

2.7 0.9 1.7 

, 

164 
Table III. Percent distribution of response-quality measures and number and percent of respondents, by year, test, and test re 

1987-92-Cor~. 

All years 

Test and outcome measure combined 1987 1988 1989 7990 1991 1992 

Reporting test. .......................... 

Test in record .......................... 

Report-to-records ratio ..................... 

Mammograms received regularly 

Number of respondents. .................... 

All measures ........................... 

Matched data. .......................... 

Notest ............................... 

False reports ........................... 

Omissions. ............................ 

Reporting test. .......................... 

Test in record ........................... 

Report-to-records ratio ..................... 

44.3 26.7 42.4 

33.8 21.5 32.7 

1.31 1.24 1.30 

297 50 50 48 49 50 50 

100.0 1OO.o 100.0 100.0 100.0 100.0 100.0 

63.9 24.0 64.0 91.6 89.8 74.0 42.0 

21.2 54.0 10.0 2.1 4.1 12.0 50.0 

7.1 0.0 4.0 6.3 6.1 14.0 6.0 

7.7 22.0 22.0 0.0 0.0 0.0 2.0 

71 .o 24.0 

71.6 46.0 

0.99 0.52 

Percent 

53.5 

37.7 

1.42 

60.7 65.8 17.2 

47.3 49.6 14.6 

1.28 1.33 1.18 

Percent distribution 

68.0 

86.0 

0.79 

Percent 

97.9 

91.6 

1.07 

95.9 88.0 

89.8 74.0 

1.07 1.19 

48.0 

44.0 

1.09 

NOTE: Figures may not add to 100.0 because of rounding. 
Pap smears 

Version 1: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 2: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 3: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 4: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Breast exams 

Version 1: 

Number of respondents ................. 

306 51 51 51 51 51 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 

27.7 19.6 31.4 31.3 37.2 31.4 15.7 

52.4 64.7 45.1 33.4 41.2 49.0 80.4 

17.3 13.7 19.6 29.4 19.6 17.6 3.9 

2.6 2.0 3.9 5.9 2.0 2.0 0.0 

45.0 33.3 51 .o 

30.3 21.6 35.3 

1.49 1.54 1.44 

Percent 

60.7 

37.2 

1.63 

56.8 49.0 19.6 

39.2 33.4 15.7 

1.45 1.47 1.25 

246 41 41 41 41 41 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 190.0 100.0 

25.2 22.0 34.2 43.9 24.4 24.4 2.4 

52.4 51.2 46.3 22.0 48.0 56.1 90.3 

19.1 19.5 14.6 26.8 26.8 19.5 7.3 

3.3 7.3 4.9 7.3 0.0 0.0 0.0 

44.3 41.5 48.8 

28.5 29.3 39.1 

1.55 1.42 1.25 

Percent 

70.7 

51.2 

1.38 

51.2 43.9 9.7 

24.4 24.4 2.4 

2.10 1.80 4.0 

221 37 37 36 37 37 37 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 

29.4 16.2 37.8 41.7 29.8 35.2 16.2 

43.5 51.4 35.2 36.1 29.7 29.7 78.4 

23.9 21.6 24.3 22.2 37.8 32.4 5.4 

3.2 10.8 2.7 0.0 2.7 2.7 0.0 

53.3 37.8 62.1 

32.6 27.0 40.5 

1.63 1.40 1.53 

Percent 

63.9 

41.7 

1.53 

67.6 67.6 21.6 

32.5 37.9 16.2 

2.08 1.78 1.33 

286 48 46 46 49 49 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 100.0 

29.0 18.8 28.2 23.9 45.9 38.8 18.3 

51.4 56.2 41.4 54.3 45.8 34.7 75.6 

16.4 14.6 26.1 19.6 8.3 24.5 6.1 

3.2 10.4 4.3 2.2 0.0 2.0 0.0 

45.4 

32.2 

1.41 

33.4 

29.2 

1.14 

51 

54.3 

32.5 

1.67 

Percent 

43.5 

26.1 

1.67 

54.2 63.3 24.4 

45.9 40.8 18.3 

1.1% 1.55 1.33 

306 51 51 51 51 

I 

51 

166 
Table IV. Number and 

year: 1987-924on. 

of respondents and percent distribution of response-quality measures, by test, questionnaire version, and 

All years 

Pest, version, and outcome measure combined 

Percent distribution 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports, ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in records. ...................... 

Report-to-records ratio. ................. 

Version 2: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 3: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 4: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Repot-t-to-records ratio. ................. 

Mammograms 

Version 1: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

100.0 160.0 100.0 100.0 100.0 100.0 100.0 

28.1 11.7 29.4 31.4 37.2 43.2 15.7 

45.1 60.8 45.1 35.3 54.3 31.3 58.8 

18.0 11.8 15.7 19.6 19.6 23.5 17.7 

8.8 15.7 9.8 13.7 3.9 2.0 7.8 

46.1 23.5 45.1 

36.9 27.4 39.2 

1.25 0.86 1.15 

Percent 

51 .o 

45.1 

1.13 

56.8 66.7 33.4 

41 .I 45.2 23.5 

1.38 1.48 1.42 

246 41 41 41 41 41 

Percent distribution 

100.0 100.0 100.0 SW.0 100.0 100.0 100.0 

32.5 19.5 41.5 58.6 36.6 36.6 2.4 

41 .I 48.8 31.6 14.5 29.3 39.0 83.0 

21 .I 24.4 22.0 22.0 24.3 22.0 12.2 

5.3 7.3 4.9 4.9 9.8 2.4 2.4 

53.6 43.9 63.5 

37.8 26.8 46.4 

1.42 1.64 1.37 

Peroent 

80.6 

63.5 

1.27 

60.9 58.6 14.6 

46.4 39.0 4.8 

1.31 1.50 3.04 

220 37 37 37 37 37 

Percent distribution 

100.0 109.0 100.0 100.0 100.0 100.0 160.0 

32.8 13.5 40.6 37.1 45.9 35.1 24.3 

39.5 48.7 18.9 28.6 35.2 37.9 67.6 

17.7 18.9 18.9 25.7 10.8 27.0 5.4 

10.0 18.9 21.6 8.6 8.1 0.0 2.7 

50.5 32.4 59.5 

42.8 32.4 62.2 

1.18 1 .oo 0.96 

Percent 

62.8 

45.7 

1.37 

56.7 62.1 29.7 

54.0 35.1 27.0 

1.05 1.77 1.10 

286 49 46 45 49 49 

Percent distribution 

100.0 160.0 100.0 100.0 100.0 100.0 100.0 

26.9 16.3 36.9 29.2 42.2 32.6 6.1 

46.2 155.1 32.7 45.8 35.6 26.6 79.7 

17.5 10.2 21.7 16.7 13.3 30.6 12.2 

9.4 18.4 8.7 8.3 8.9 10.2 2.0 

44.4 26.5 58.6 

36.3 34.7 45.6 

1.22 0.76 1.29 

Percent 

45.9 

37.5 

1.22 

55.5 63.2 18.3 

51 .I 42.8 8.1 

1.09 1.48 2.26 

306 51 51 51 51 51 

Percent distribution 

100.0 100.0 100.0 100.0 100.0 100.0 109.0 

37.9 9.8 31.4 45.1 53.0 58.8 29.5 

50.3 76.5 56.9 41.2 31.3 31.4 64.6 

7.9 3.9 3.9 11.7 15.7 7.8 3.9 

3.9 9.8 7.8 2.0 0.0 2.0 2.0 

167 
Table B 

year: 1 

ber and percent of respondents and percent distribution of response-quality measures, by test, questionnaire version, and 

--Con. 

Test, version, and outcome measure 

All years 

combined 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 2: 

Number of respondents ................. 

45.8 13.7 35.3 

41.8 19.6 39.2 

1 .I0 0.70 0.90 

246 41 

All measures. ....................... 

Matched data ....................... 

Notest ........................... 

False reports. ....................... 

Omissions ......................... 

100.0 100.0 100.0 lw.o lw.o 100.0 100.0 

40.3 26.8 34.2 58.6 56.1 51.2 14.6 

45.1 51.2 48.7 26.8 26.8 39.0 70.5 

10.2 12.2 7.3 12.2 12.2 9.8 7.4 

4.4 9.8 9.8 2.4 4.9 0.0 7.4 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 3: 

Number of respondents ................. 

50.5 39.0 41.5 

44.7 36.6 44.0 

1 .I3 1.07 0.94 

216 36 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

100.0 100.0 100.0 lw.o lw.o 100.0 100.0 

39.8 13.9 52.8 42.8 61 .I 43.3 25.0 

41.7 58.3 30.6 34.3 30.6 27.0 69.4 

12.0 5.6 8.3 20.0 5.5 29.7 2.8 

6.5 22.2 8.3 2.9 2.8 0.0 2.8 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 4: 

Number of respondents ................. 

51.8 19.5 61.1 

46.3 36.1 61.1 

1.12 0.54 1 .w 

283 49 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

100.0 100.0 100.0 lw.o lw.o 100.0 100.0 

34.6 16.3 28.2 47.9 50.0 55.1 12.2 

47.4 63.3 30.5 39.1 36.4 28.6 83.7 

14.8 16.3 26.1 13.0 13.6 16.3 4.1 

3.2 4.1 15.2 0.0 0.0 0.0 0.0 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

All tests combined 

49.4 32.6 54.3 

37.8 20.4 43.4 

1.31 1.60 1.25 

Version I: 

Number of respondents ................. 918 153 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

100.0 109.0 100.0 100.0 lw.o lw.o 100.0 

31.3 13.7 30.7 35.9 42.4 44.4 20.3 

49.2 67.3 49.0 36.6 37.3 37.3 67.9 

14.4 9.8 13.1 20.3 18.3 16.3 8.5 

5.1 9.2 7.2 7.2 2.0 2.0 3.3 

Reporting test ....................... 45.7 23.5 

Test in record ....................... 36.4 22.9 

Report-to-records ratio .................. 1.26 1.03 

43.8 

37.9 

1 .I6 1.30 

Percent 

56.2 

43.1 

Percent 

56.8 

47.1 

1.21 

41 

Percent distribution 

Percent 

70.8 

61 .O 

1.16 

35 36 37 36 

Percent distribution 

Percent 

62.8 

45.7 

1.37 

46 44 49 49 

Percent distribution 

Percent 

60.9 

47.9 

1.27 

153 

Percent distribution 

68.7 66.6 33.4 

53.0 60.8 31.5 

1.30 1.10 1.06 

41 41 41 

68.3 61.0 22.0 

61 .O 51.2 22.0 

1.12 1 .I9 1 .oo 

66.6 73.0 27.8 

63.9 43.3 27.8 

1.04 1.69 1 .oo 

63.6 71.4 16.3 

50.0 55.1 12.2 

1.27 1.30 1.34 

153 153 153 

60.7 60.7 28.8 

44.4 46.4 23.6 

1.37 1.31 1.22 

168 
Table IV. Number and percent of respondents and percent distribution of response-quality measures, by test, questionnaire version, and 

year: 1987-92-Can. 

All years 

Test, version, and outcome measure combined 7987 1988 1989 1990 1991 1992 

Version 2: 

Number of respondents . . . . . . . . . . . . . . . . . 738 123 123 123 123 123 123 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 3: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Version 4: 

Number of respondents ................. 

All measures. ....................... 

Matched data ....................... 

No test ........................... 

False reports. ....................... 

Omissions ......................... 

Reporting test ....................... 

Test in record ....................... 

Report-to-records ratio. ................. 

Percent distribution 

100.0 lw.o 100.0 lw.o lw.o lw.o 100.0 

32.7 22.7 36.6 53.7 39.0 37.4 6.5 

46.0 50.5 42.3 21.1 35.0 44.7 82.9 

16.8 18.7 14.6 20.3 21 .l 17.1 9.0 

4.5 8.1 6.5 4.9 4.9 0.8 1.6 

49.5 41.4 51.2 

37.2 30.8 43.1 

1.33 1.34 1.19 

Percent 

74.0 

58.6 

1.26 

60.1 54.5 15.5 

43.9 38.2 8.1 

1.37 1.43 1.91 

657 110 110 106 110 111 110 

Percent distribution 

100.0 lw.o 100.0 lw.o loo.0 190.0 100.0 

34.0 14.6 43.6 40.5 45.4 37.8 21.8 

41.5 52.7 28.2 33.1 31.9 31.6 71.8 

18.0 15.4 17.3 22.6 18.2 29.7 4.6 

6.5 17.3 10.9 3.8 4.5 0.9 1.8 

52.0 30.0 60.9 

40.5 31.9 54.5 

1.28 0.94 1.12 

Percent 

63.1 

44.3 

1.42 

63.6 67.5 26.4 

49.9 38.7 23.6 

1.27 1.74 1.12 

855 146 138 140 137 147 147 

Percent distribution 

100.0 lw.o 100.0 lw.o lw.o lw.o 100.0 

30.2 17.1 31.2 33.6 46.0 42.2 12.3 

48.3 58.2 34.8 46.4 39.4 29.9 85.5 

16.2 13.7 24.6 16.4 11.7 23.8 1.5 

5.3 11.0 9.4 3.6 2.9 4.1 0.7 

46.4 30.8 55.8 

35.5 28.1 40.6 

1.31 1.10 1.37 

Percent 

50.0 

37.2 

1.34 

57.7 66.0 13.8 

48.9 46.3 13.0 

1.18 1.43 1.06 

NOTE: Figures may not add to 100.0 because of rounding. 

169 
Table V. Net bias and gross error in reporting of dates of preventive care tests for matched events, by test and year: 1988-92 

Test and year Net bias1 

Gross 

error Number 

All tests combined 

1992.. ............................ 

1991 .............................. 

1990 .............................. 

1989.. ............................ 

1988.. ............................ 

Average ............................ 

Papsmears 

1992.. ............................ 

1991 .............................. 

1990.. ............................ 

1989 .............................. 

1988.. ............................ 

Average ............................ 

Breast exams 

1992.. ............................ 

1991 .............................. 

1990.. ............................ 

1989.. ............................ 

1988.. ............................ 

Average ............................ 

Mammograms 

1992.. ............................ 

1991 .............................. 

1990.. ............................ 

1989.. ............................ 

1988.. ............................ 

Average ............................ 

1.0 1.8 80 

0.8 3.3 187 

0.4 3.4 196 

0.7 4.2 161 

1.4 3.9 143 

0.8 3.5 767 

0.8 1.3 23 

0.2 2.5 53 

0.1 3.4 51 

1.4 5.0 38 

1.8 4.1 43 

0.8 3.4 208 

0.1 2.6 20 

1.5 4.0 48 

0.4 3.6 59 

1.0 4.1 56 

1.4 3.4 51 

1.1 3.7 234 

0.9 1.6 37 

0.7 3.4 86 

0.6 3.2 86 

0.1 4.2 67 

1.1 4.1 49 

0.6 3.8 325 

Months 

‘A positive value indicates that respondents report test dates more recent than record shows. 

170 
Table VI. Net bias and gross error in reporting of dates of preventive care tests for matched events, by year and version of 

questionnaire: 1988-92 

Year and version Net bias 

Gross 

error Number 

All years combined: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1992: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1991: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1990: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1989: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1986: 

Version 1 .......................... 

Version 2 .......................... 

Version 3 .......................... 

Version 4 .......................... 

1.3 3.2 216 

0.9 3.0 180 

0.6 4.3 189 

0.8 2.8 182 

0.8 1.0 32 

-0.2 1.0 8 

2.1 3.7 23 

0.5 1.1 17 

-0.4 3.0 52 

0.7 3.1 43 

1.2 3.5 41 

1.2 3.5 51 

0.9 

4.1 

-0.4 

1.2 

1.3 5.7 41 

1.8 3.8 49 

4.9 4.6 38 

0.1 2.8 33 

2.2 4.3 37 

1.3 2.8 36 

1.2 5.2 42 

0.7 2.7 28 

Months 

3.7 

3.0 

4.5 

3.5 

54 

40 

45 

43 

‘U.S. Government Printing Office: 1994 - 301-019/00016 171 
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES &

SERIES 10,

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures–These reports

describe the data collection programs of the National Center

for Health Statistics. They include descriptions of the

methods used to collect and process the data, definitions,

and other material necessary for understanding the data.

Data Evaluation and Methods Research –These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliabihty of collected

data, and contributions to statistical theory. These studies

also include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies –These reports

present analytical or interpretive studies based on vital and

health statistics. These reports carry the analyses further than

the expository types of reports in the other series.

Documents and Committee Reports–These are final

reports of major committees concerned with Wal and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports –These

reports are analytical or descriptive reports that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Survey Measurement –These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to dasign, evaluate, and test survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disabili~ use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected In a

continuing national household interview survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey–

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributions of the population with respect to

physical, physiological, and psychological characteristics,

and (2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the Institutionalized Population Surveys –

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the Nationai Health Care Survey–These

reports contain statistics on health resources and the public’s

use of health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES

SERIES

4.

5.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and Facilities –

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

Data From Speciai Surveys –These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

cOmJJildiOnS of Advance Data From Vital and HeaIth

Statistics –Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10-13.

Data on Mortality-These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality, Marriage, snd Divorce–These reports

contain statistics on natality, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

Data From the National Mortality and Natality Surveys –

Discontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

Data From the National Survey of Family Growth –These

reports contain statistics on factors that affect birth rates,

including contraception, infertility, cohabitation, marriage,

divorce, and remarriage; adoption; use of medical care for

family planning and infertility and related maternal and infant

health topics. These statistics are based on national surveys

of childbearing age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy–

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Month/y Vita/ Statistics Reporf (MVSR). These reporta provide

highlights and summaries of detailed data subsequently

published in Vita/ Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact

Data Dissemination Branch

National Center for Health Statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436+500
DEPARTMENT OF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Dkease Control and Prevention

National Center for Health Statistics

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, .$300

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FOURTH CL4SS RATE

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PERMIT NO. G-281

DHHS Publication No. (PHS) 94-1082, Series 6, No. 7

4-0380 (10/94)