Methods

Missouri Pregnancy Related Assessment and Monitoring System (MoPRA)

Each month mothers who are state residents and have recently delivered a live-born infant during the preceding 2-6 months are randomly selected from a file of birth certificate records using stratified systematic sampling. Mothers, who are mentally incapacitated, have died, or had a multiple birth greater than three gestations are excluded from the sampling frame. Mothers who are at increased risk for adverse pregnancy outcomes are over sampled. The Missouri state stratification variables are: birth weight (low birth weight and no-low birth weight) and geographical location (major metro, minor metro and rural). The sampled mothers are then mailed a series of materials in the following order:

i. Preletter. This is a brief letter that is sent a few days to one week in advance of the questionnaire. It informs the woman that a survey is forthcoming while providing only minimum detail about the project itself.

ii. First Questionnaire Mailing. The questionnaire is sent with a cover letter that describes the project. Other appropriate materials (e.g., informed consent document, incentive, question-and-answer brochure, resource list, calendar, return envelope) are included as well.

iii. Tickler (Reminder Letter). This letter is sent to non-respondents 7 to 10 days after the questionnaire to remind the woman to complete the questionnaire and to offer thanks in case she has already replied.

iv. Second Questionnaire Mailing. Another questionnaire is mailed one to two weeks after the tickler. A cover letter informs the person that the previous questionnaire has not been returned and includes a stronger appeal for participation. Research does not support the inclusion of another incentive in this mailing packet. However, the informed consent document, question-and-answer brochure, resource list, calendar, and return envelope should be included with this mailing.

v. Third Questionnaire Mailing. One to two weeks after the second questionnaire is mailed, a third and final questionnaire is mailed to the person. A cover letter informs the person that the previous questionnaire has not been returned and includes a stronger appeal for participation. Research does not support the inclusion of another incentive in this mailing packet. However, the informed consent document, question-and-answer brochure, resource list, calendar, and return envelope should be included with this mailing.

vi. Telephone Follow-up. Seven to ten days after the final mailing, telephone calls are initiated with any mail non-respondents. Multiple telephone calls are made in an attempt to reach the mother and persuade her to complete a telephone interview. Participants entering the telephone survey are not eligible for the incentive.

The timing and nature of the mail and telephone contacts is designed to elicit the best response rates possible. To maintain data integrity, the entire data collection period will not exceed 95 days from the date of the pre-letter. The PRAMTrac software will assist in setting and managing the contact schedule. The MoPRA survey will be conducted as per the guidelines provided in the CDC PRAMS model surveillance protocol distributed in September 2003. The complete protocol can be accessed at the following web address: http://www.cdc.gov/prams/.