Includes: a) OVERALL (pg.1) b) GENERAL SURVEY (pgs. 2-4) c) INTERVENTION SURVEY (pg.5) d) INTERVENTION OVERALL (pg.6) OVERALL: 1. It feels like I just did the first survey, has it really been a year? We need to complete the second survey shortly after your child s most recent annual check-up. If your child s previous check-up was less than a year ago then it is possible that it has been less than a year since you completed the first survey. 2. My child has lost weight, are we still part of the study? YES! You are still part of the study and we are thankful for your continued participation. 3. What is this study about? The goal of High Five for Kids is to learn the best ways to promote healthy growth in young children through good eating habits and active play. 4. Who is sponsoring/ funding this study? The National Institutes of Health are funding the study, which a joint for project of Use Harvard Vanguard Medical Associates, the Department of Ambulatory Care and Prevention, and Harvard Medical School. We are also working with your child s doctor in this effort. 5. Do I have to participate? Your participation is voluntary, and you can leave the study at any time. But your participation in this research would help us find the best way for primary care practices to promote healthy growth in children. This study may help your child s health, and it will help us learn how best to care for the health of all children 6. Will whether or not I participate affect my child s care? Being part of High Five for Kids will not affect your child s other medical care in any way. 7. I was not aware my child is overweight! You are being invited because the height and weight measurements taken at (-----) last primary care visit may be above average for his or her height. 8. Why did you pick Johnny? Do you want information about my other children? We are looking to get information on only one child per household. When there was more then one eligible we selected the oldest for participation. 1
GENERAL SURVEY: Questions 4-6 1. Why do you need to know my height/ weight information? I know this is a very personal question but the information gathered will help us understand the weight and height relationship between parents and children. Question 8e-8g 1. What if I dilute my child s juice? Can you please tell me if it is more then half water or more then half juice. Questions 10, 27, 29 1. What makes a restaurant a fast food restaurant? Some examples of fast food restaurants include; McDonalds s, Burger King, Taco Bell, Dunkin Donuts, pizza, or the like. Fast food restaurants generally do not offer table service. 2. When I buy food from Domino s or from another pizza place, does this count as fast food? Yes, pizza at these places is generally considered fast food. 3. I went more often this month than normal. Do you still want me to give you this month only, or how often I normally go? for Use Please answer according to your general habits. 4. Does a family restaurant such as Friendly s or Newport Creamery count as fast food? No, these restaurants do not count as fast food. 5. Are drive thru and fast food restaurants the same? Yes, drive thru and fast food restaurants are the same. 6. Does Subway or ABP count as a fast food restaurant or another restaurant? Subway, Au Bon Pain, and Dunkin Donuts are all considered fast food because they are generally quick, inexpensive, and do not offer table service. 7. Does Chinese food count as fast food? If the food is inexpensive, prepared quickly, and the establishment does not provide table service, then it is generally considered fast food. Questions 11, 28, 30 1. What is considered any other restaurant? These restaurants are typically more expensive than fast food places and have an option to sit down and receive table service. 2. Does Subway or ABP count as a fast food restaurant or another restaurant? 2
Subway, Au Bon Pain, and Dunkin Donuts are all considered fast food because they are generally quick, inexpensive, and do not offer table service. 3. Does Chinese food count as fast food or an other restaurant? If the food is inexpensive, prepared quickly, and the establishment does not provide table service, then it is generally considered fast food. 4. When I buy food from Domino s or from another pizza place, does this count as fast food or an other restaurant? Pizza at these places is generally considered fast food. Question 23-24 1. What constitutes time spent playing outdoors? Time spent playing outdoors refers to a child s active playtime out of the home during which he or she is engaging in continuous physical activity ( i.e., jumping rope, playing tag, riding a bike, swimming, team sports, playing catch, or building a snowman.) 2. What if my child is in summer camp/ out of school for the summer? Do you want the time spent playing outdoors during the school year or summertime? Please think about your child s lifestyle in the past month. Questions 29-30 1. Do I include all my children or just one child? for Use Please include the total amount for everyone that was at that meal. 2. Do I include children that are not my own but I take there with my children in the total amount? Or should I just give you the amount for my child? Please include everyone that was at that meal. 3. When I am giving you the total amount, am I including my husband and myself or just the amount for what I spent on the children meals? Please provide the total amount. Question 31 1. What constitutes groceries? Do you want me to include separate visits when I don t buy food but I buy grocery products such as mouthwash and toilet paper? Please consider times when purchasing food was the primary reason for the trip and the majority of money spent was on food. 2. When I am giving you the total amount spent, am I giving the entire amount for everything or just the amount for food products? The total amount is fine. 3. Should I include the total amount spent where just my wife and I shop for specialty food for the two us? Or should I include the amount spent for the children s food? 3
Just for food shopping that includes the whole family. 4. When I shop at a wholesale market place such as BJ s, am I including this in my total amount? If you frequently shop at such wholesale markets for food, please include those costs. Question 32 1. When I am preparing meals, I am able to do other things not related to food prep while the food is thawing or baking, how do I include this time? Just consider any time spent physically preparing food, such as cleaning produce or chopping. 2. Should I include the time it takes me to prepare the meals of my wife and me, since we eat separate meals from our children? Or should we just include time to prepare our children s meals? If meal prep is separate, just for kids meals is fine. 3. Does time spent preparing food include packing lunches? Or do you mean how long does it take me to make dinner each night? Please include time spent preparing all meals (breakfast, lunch, dinner, and snacks) for both weekdays and weekends. Questions 37-39 for Use 1. What does my demographic or personal information have to do with my child s health/weight? If any question makes you uncomfortable, you do not need to answer it. We are interviewing hundreds of people for this study and we want to be sure to gather information from people of all different backgrounds. 2. Do you need to know my income information? If any question makes you uncomfortable, you do not need to answer it. We are interviewing hundreds of people for this study and we want to be sure to gather information from people of all different backgrounds. 4
INTERVENTION SURVEY: Question 1a 1. I don t know what survey you re talking about. The High Five survey was a brief survey with 8 questions about your child s eating, activity, and TV watching. Question 6 1. How come I didn t have any calls with my nurse practitioner? Given the busy schedules of the nurse practitioners, not all are able to make outreach calls. Questions 7-12 TV allowance 1. Why didn t my nurse practitioner mention/give/tell me that? The High Five nurse practitioners have lots of materials and other High Five items to choose from, so not all participants get all things. Next time you see your nurse practitioner feel free to ask about it. Question 15 1. What if I have a nanny at home? Please answer only for childcare that extra. Not childcare that is for already in place. Use Question 16 1. I thought the study paid for co-pays, why hasn t this happened? The study does cover study visit co-pays and there are a number of reasons why this may not have happened. When we are done with the survey I m can transfer you to the Research Assistant, Meghan, who can help explain the process. If you would like to call her directly her number is 617-509-9905. (3-9905) 2. What if the study covered the co-pay and visit costs? Please answer only what YOU spent on a co-pay or other visit costs. 3. Should I include transportation costs? No, I will ask about those in the next question. Question 17 1. Do I include the $4/visit that was paid by the study? We are trying to get at all YOUR out of pocket transportation costs for that visit on that day. Please give the total that you spent upfront on transportation that day. 2. What about mileage or what I paid for gas? Please do not include your mileage or what you paid for gas. We are just looking for how much you spent on taxis, tolls, parking or public transportation. 5
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INTERVENTION OVERALL: 1. I haven t been to a study visit but would like to schedule one, how do I do this? When we are done with the survey I m can transfer you to the Research Assistant, Meghan, who can help explain the process. If you would like to call her directly her number is 617-509-9905. (3-9905) 2. Is this the last survey? No it is not the last survey. We will be calling you once more in about a year for the final survey, when your child has completed their next annual check-up. for Use 7