Protocol for the NM Community Survey - New Mexico ...
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By PIRE for OSAP 2021 FY 2021
Protocol for the NM
Community Survey
Data Collection Protocol and Planning
Template
This document is intended to be used by NM OSAP grantees expected to collect
community-level data using the NM Community Survey. PIRE recommends using a
rigorous time and venue-based sampling methodology to provide as much rigor as
possible to convenience-based sampling. The document provides
recommendations for venues to conduct data collection and a template for
planning purposes.
NOTE:
Given the ongoing public health threat of COVID-19, we anticipate that most data
collection will take place online. However, there may be certain populations and
situations which would require face-to-face recruitment and/or administration,
and you may then elect to include face-to-face interactions in your protocol. In
these cases, you MUST follow the most current guidelines set forth by the State of
New Mexico and the U.S. Centers for Disease Control, and any relevant city,
community, municipality, and/or tribal guidelines. In the case that the advice
differs, you must follow the advice which is most restrictive of face-to-face
interactions. In these cases you MUST ALSO maintain these basic standards: 1) all
people engaged in any face-to-face interaction must be wearing masks; 2) these
people must be at least 6 feet apart while interacting; AND 3) any interactions in
closed spaces (e.g., indoors) must not be longer than 10 minutes. WE WANT
EVERYONE INVOLVED WITH DATA COLLECTION TO BE SAFE AND IN NO WAY
CONTRIBUTE TO THE FURTHER SPREAD OF DISEASE.
Written by: Pacific Institute for Research and Evaluation
for the NM Office of Substance Abuse PreventionTABLE OF CONTENTS
Summary of Responsibilities for Prevention Staff and Community Partners ...................................... 3
General Background Information on the NMCS .................................................................................. 4
Selecting Modules........................................................................................................................... 4
Adding Questions............................................................................................................................ 5
Timeline ................................................................................................................................................ 5
Data Collection Methodology/Protocol Overview ............................................................................... 6
Collecting Data Online ......................................................................................................................... 8
Will Any Aspects of FY21 NMCS be “In-Person” this Year? ............................................................. 8
Recruiting Participants in Person .......................................................................................................... 9
Collecting Data In-Person Via Paper/Pencil or Via App ...................................................................... 9
“Paper and Pencil” versus “iPad App” versus “Online Browser” versions of the survey ............ 10
Key issues for implementing the survey on-line using the URL or QR code............................... 11
Key issues for implementing the survey using the Qualtrics app ................................................. 11
Qualtrics App Download .............................................................................................................. 12
Incentives for Face-to-Face Administration ....................................................................................... 12
Protecting Human Subjects ................................................................................................................. 13
A Note about Budgets ......................................................................................................................... 13
Community Data Collection Protocol ................................................................................................. 13
Using the NMCS app on a private device ..................................................................................... 19
NMCS App Protocol ..................................................................................................................... 20
PIRE Contact Information .................................................................................................................. 23
https://tinyurl.com/nmcs2021
2Summary of Responsibilities for Prevention Staff and Community Partners
▪ Attend annual data collection (webinar) training in February 2021 or watch recorded presentation on
nmprevention.org.
▪ Complete local data collection protocol and submit by deadline to PIRE for SEOW review and approval before
or by February 16, 2021. Respond to revision requests from SEOW, and initiate data collection only upon
SEOW approval no earlier than March 1, 2021.
▪ Develop visual media and online advertising for the survey; submit all drafts to PIRE for SEOW approval and
review with your protocol.
▪ Complete and submit budget form to OSAP for approval by February 19; and submit any subsequent budget
revisions to OSAP for approval.
▪ Work to reach goal # and desired demographic representation. Consider tracking gender or age or other
demographics periodically during data collection to monitor progress towards representative sample or desired
over-sampling goal/s.
▪ Maintain contact with PIRE evaluators and program managers as to the progress, obstacles, etc. of the data
collection process.
▪ Take the initiative to communicate with PIRE about shifting approaches if goals are not being reached.
COMMUNICATE WITH PIRE ABOUT ANY NEW RECRUITMENT IDEAS PRIOR TO COLLECTION.
▪ Analyze data for community/program needs once PIRE has returned cleaned data.
▪ Submit findings sheets to OSAP at EOY reporting.
Additionally, if planning any in-person/App/paper and pencil administration,
▪ Print surveys and the (personalized to your community) take-home information in English and Spanish.
▪ Contact relevant supervisors, managers, and/or administrators to get permission to recruit and/or provide paper
surveys at those locations and determining dates and times for this to occur. If an IRB review of the protocol is
required (especially for campus or Tribal based data collection), you are responsible for following their required
process.
▪ If using the internet version for the survey, assure that internet access is available for your program tablet, mobile
device, or laptop.
▪ Print your site ID on your paper surveys before copying (if possible). Assure that site ID, surveyor name or ID,
date and survey number are recorded on each survey. This includes the app and online browser versions for the
survey.
▪ Provide a box for collection of paper surveys with a lid to protect anonymity of responses and respondents.
▪ Consider a small “up front” incentive to those completing the paper survey and the off-line version of the survey
using the Qualtrics app. Use extra tracking form for any cash incentives.
▪ In areas where Spanish is required, provide sufficient Spanish language materials and an individual who can
collect surveys who is able to communicate fluently in Spanish. (Same for any other languages such as Navajo,
etc.)
▪ Attend survey data entry webinar training (if applicable).
▪ Enter data and submit clean data in spreadsheet template provided.
▪ If an outside IRB (e.g., Tribal, University) requires changes to an already PIRE IRB-approved protocol, program
staff must report these changes immediately, before changes are implemented, to PIRE staff, who are then
required to inform the PIRE IRB about these changes.
▪ Safely store all collected surveys paper or electronic data for 5 years following data collection as mandated by
Federal law.
▪ Ensure compliance with pandemic standards concerning all interactions.
3General Background Information on the NMCS
The New Mexico Community Survey is sponsored by the NM Office of Substance Abuse Prevention (OSAP).
In fiscal year 2021, three methodologies will be used to collect data: 1) on-line recruitment through links that
you provide to the community, b) online recruitment at the state-level provided by PIRE, and possibly 3) in
person recruitment. As in the past, you want to aim to collect a reasonably representative sample of your
county’s population. Based on the reach of your coalition, you may also want to oversample sample populations
of interest such as young adults, Spanish speakers, or those living on tribal lands. There is a place to note this on
the protocol form that you submit to PIRE.
Selecting Modules
The NMCS contains a Core module that everyone must implement. Your community may select optional
modules based on what prevention strategies your community is addressing and/or what data your stakeholders
would like to collect. You and your evaluator will decide on the modules you will include as well as any
additional questions you may want to ask, but not already included in the modules. If a module is selected, the
community must use all of the measures contained in that module. All modules will be available in English and
in Spanish. Most communities select no more than 2 additional modules to the Core.
These are the FY21 modules:
1- Core Module- Includes all demographic, perception of ATOD within the community, alcohol
consumption & access, and prescription painkiller use & access. This module is required by all
programs to implement. (38 questions)
2- Adverse Childhood Experiences (ACEs) Module – Includes questions about adverse childhood events
that may have occurred during the adult respondent’s youth. (12 questions)
3- College Community Module- Includes questions about community concern and awareness of alcohol
problems in the community related to the college/university/students and how they should be addressed.
Other communities with college campuses can also implement the college community module, and we
are happy to discuss with you and your local evaluator(s) how this might work best. We recommend
colleges use every other year. (1 question)
4- Community Alcohol-Related Harms Module (formerly the “Community Module”)- Includes
questions about community concern and awareness of alcohol problems in the community and how they
should be addressed. For those of you working on Social Host Ordinances, or the alcohol tax, this
module will be required to measure outcomes. This survey parallels the College Community module, so
you will likely do one or the other in your community. We recommend using every other year. (10
questions)
5- Gambling Module - Includes questions about involvement in various gambling activities and a 3-item
gambling severity screening tool. (5 questions)
6- Marijuana Module-New questions related to access and use. (15 questions)
7- Mental Health Module- Includes current mental and behavioral health status and access to services
questions (12 questions)
8- Methamphetamine Module -Includes questions related to access and use. This module will be standard
for all online submissions that are not community-administered using a program site ID (7 questions)
9- Additional Opioid Questions Module (formerly the “Opioid Module”) - Includes additional
questions about Rx opioid and heroin use among family and friends. (9 questions)
10- Poly-Substance Use Module-(ONLINE ADMINISTRATION ONLY) (6 questions). All six items are
required of PFS-20 communities. The two items concerning 30-day methamphetamine and
4polysubstance use are required for all other counties and these counties may elect to add the other four
items as well.
11- Tobacco Module- Includes tobacco and vapor product questions (7 questions)
Like last year, we will still allow each community to add specific questions that are not included in these
modules assuming we have the time and person power to get it programmed into Qualtrics. Please be aware of
overall survey length when putting together content of your final survey. The longer the survey, the less likely
respondents are to complete it.
Adding Questions
In previous years, some communities have added additional questions at the end of the survey that are unique to
the community. These questions MUST be approved by the SEOW prior to inclusion so they should be included
in your submitted protocol. Typically, these have been questions related to alcohol tax increases or issues very
specific to your community that might not be relevant to other communities and therefore, are not included on
the general survey. You may again include some additional questions on the survey at the end of the survey
(after core module and other selected/approved modules). You need to identify these as questions as well as an
appropriate introduction to them in your protocol submission to PIRE. For example, you may preface with the
questions with a statement like:
“The last five questions are asked by the X County Partnership and are specific to your county. Your
answers help us plan and improve services.”
Timeline
Please put these dates on your calendar so you can plan accordingly.
• February 16 - First draft of data collection protocol due to PIRE (ASimons-Rudolph@PIRE.org)
• February 19- Budget (and copy of protocol FYI) due to OSAP (Heather.Burnham@state.nm.us)
• February 17-22- PIRE internal review of data collection protocols. PIRE will work with sites
individually to prepare protocol for SEOW review
• February 19-25 - SEOW reviews
• February 26 - PIRE works with communities to finalize protocols
• March 1 - Data collection may begin with approved protocol and online survey goes live
• Mid-March TBD - Data Entry Training (if communities plan to collect paper/pencil data)
• April 30 – Data Collection Ends!
• May 7 - Data files (for paper surveys) are due
• June 1-15 - PIRE returns aggregated data files to LEs
• Late June - PIRE returns R-reports (if resources available)
• July 15 - All EOY reporting documents submitted to OSAP
5Data Collection Methodology/Protocol Overview
Most FY21 data will be
collected through coalition-
led, online recruiting
***Please note that we anticipate that most of FY21 data will be collected online.
We also assume that most prior coalition data collection efforts directed towards in-
person data collection will be redirected towards online data collection!
6If you do choose to collect data in person (or via Qualtrics App or paper/pencil), you have an approved protocol
to do so, you have three ways to collect that data in person.
1) Through a Qualtrics app installed on an iPad, tablet, or another relevant IOS or Android device. This
allows you to collect data while you are offline and connect later to upload the data. PIRE recommends
using the Qualtrics app offline if you have a weak internet connection. If you have a strong internet
connection, we recommend collecting data online using the Qualtrics URL rather than through the
Qualtrics app.
2) Through a browser to access the survey while you are online, from any internet connected device via
https://tinyurl.com/NMCS2021 or QR Code
3) Using paper surveys. Contact PIRE for a paper survey that includes each of the modules that your
community has chosen.
When collecting data, all three methods require that you track the locations, dates & times and number of
surveys collected in order to use for next year’s data collection planning.
You may locate the NM Community Survey and corresponding
documents here: http://www.nmprevention.org/NM-Community-
Survey.html.
Please make sure you have the 2021 documents. Note that the
tiny url and QR code change each year!
7Collecting Data Online
To help you with this process, below is a list of possible recruitment activities to consider (thank you to those of
you who helped us with this list of suggestions). Please note this is not an exhaustive list, only some ideas that
have been shared with us:
Visual Media
Identify new/relevant places to put up posters-ex: QR Code and tiny url in places where covid testing/vaccine
provision is happening, and/or laundromats, city offices, gas station tents
Direct Mail
USPS Direct Mail
Val-Pak
Social Media
Using any email or social media communication lists that you or your partners in the community have to
distribute recruitment information.
Facebook
Facebook Meets
Facebook Watch parties
Facebook groups like church groups, civic groups, etc.
Next Door
Create online facebook survey that is easily shared (Survey for Pages)
Reach college ages through Instagram and/or Tik Tok
Identify and pay social influencers to share on social media
Partnerships with Private Delivery Companies
Santa Fe: https://www.dashingdelivery.com/restaurants
ABQ: https://selflane.com/
Selflane in NM and beyond: Albuquerque, Rio Rancho, Santa, Fe, Las Cruces, Los Lunas, Los Alamo, Las
Vegas, Edgewood, Los Ranchos, Bernalillo, Corrales
Local fast food drive-thrus
Work with Municipalities and Local Systems
Connect with local municipalities (subject to PIRE/Karen’s approval)
Notes in school lunches
Work with local school systems to connect through parents-emails to parents
Email listservs for county employees
At COVID testing sites while people are waiting for their results
Will Any Aspects of FY21 NMCS be “In-Person” this Year?
The safest mode of data collection in a global pandemic is online. PIRE is explicitly encouraging communities
to collect as much data as possible online. Related, PIRE is expecting that the level of past effort to
recruit/collect data in person will be shifted towards active and creative ways to engage participants in the
online version of the survey.
8However……
Communities have told us that online engagement is difficult/impossible in some locations and with some
populations. At the time of this protocol writing (2/2/21), some socially distanced recruiting/data collection may
be possible. This is subject to change based on the most current guidelines set forth by the State of New Mexico
and the U.S. Centers for Disease Control, and any relevant city, community, municipality, and/or tribal
guidelines. In the case that the advice differs between these governing bodies, you must follow the advice which
is most restrictive of face-to-face interactions.
For any in-person recruitment/data collection, you MUST ALSO maintain these basic standards:
1) all people engaged in any face-to-face interaction must be wearing masks;
2) these people must be at least 6 feet apart while interacting; AND
3) any interactions in closed spaces (e.g., indoors) must not be longer than 10 minutes.
4) In-person activities may only be conducted by adults (18+) who willingly volunteer.
WE WANT EVERYONE INVOLVED WITH DATA COLLECTION TO BE SAFE AND IN NO WAY
CONTRIBUTE TO THE FURTHER SPREAD OF DISEASE.
Recruiting Participants in Person
It is possible to recruit participants in person without conducting the data collection in person. From a public
safety perspective, this is usually safer than both recruiting and administering the survey in person. Only adults
(18+) who willingly volunteer may recruit in person. This process must be fully explained in your protocol and
must be approved by PIRE and the SEOW. In some cases, in-person recruitment or data collection will need
additional approval which could take time.
Some examples of in-person recruitment are:
-handing out fliers to people waiting in line for COVID immunizations/test encouraging them to take the survey
at home
-giving people a card with the project-related tiny url and QR code while exiting a food bank to take the survey
later
-engaging folks in a socially distanced conversation and then directing them to a poster with tiny url and QR
code so that they may take the survey on their own device
-Etc.
Collecting Data In-Person Via Paper/Pencil or Via App
In some communities and with some populations, collecting data in-person is permissible. Similar to in years’
past, please remember that:
• Only adult (over 18) trained community partners, volunteers and program staff can survey community
members.
• You will provide pencils or pens, clip boards, and a box for collecting completed surveys anonymously.
• Personal or prevention program devices (like an Ipad) can also be used to access the survey via an
internet-connected web browser (not required).
• The app can also be installed on your personal iOS/Apple or Android device. This can be handy if you
wish to have more devices with which to collect data when offline.
9• During data collection, you will explain to every person the purpose of the survey, about the content,
that participating in the survey is voluntary, and why the survey is being conducted (located on the front
consent page).
• In addition, you must give everyone who completes the questionnaire the “take home information”
about whom to call if they have further questions about the survey or want to talk with a mental health,
substance abuse professional, gambling, or other problem.
The following locations are possible recruitment sites. The selection of each site depends upon where you
will be most likely to gather data from a representative sample of your community, or subpopulation.
• The MVD
• Outside a local library
• In a common area on the campus of a community college, university
• Outside hardware stores
• Laundromats and other places where people are already spending time
• Outside of Target, markets, coffee shops, Wal-Mart, restaurants and other local businesses that give you
permission
Areas where you generally are not allowed to gather data include healthcare settings, local programs for high-
risk populations, treatment facilities, AA, or substance use-related clinics. You cannot collect data in or outside
of bars or public events where participants can be inebriated. You are also generally not allowed to collect data
from incarcerated or homeless populations. Exceptions to this must be approved by the SEOW and you must
provide justification in your protocol form.
If you need data on specific subpopulations, or if you have another site in mind that is very specific to your
program’s experience, or your community’s specific culture, geography and economy, please list this in your
protocol with PIRE to determine feasibility of including this site in order to ease data collection protocol review
process. Always provide a justification or explanation in your protocol for any “questionable” data collection
locations. If an additional site comes to mind once you are already collecting data, immediately communicate
this additional information to PIRE before collecting data at a new site. This is a requirement as per PIRE’s
Institutional Review Board approval of this data collection methodology. Violations of one’s approved protocol
could have consequences for everyone collecting data.
Each program must decide what will work in your community. We ask that you carefully consider if a location
may bias the responses you are getting, and if you are able to gather the data in a COVID-safe way.
“Paper and Pencil” versus “iPad App” versus “Online Browser” versions of the survey
The community-level data collection can entail any combination of the paper and pencil, iPad or online browser
versions of the survey, as long as it is through an approved data collection venue.
• The advantage of using the app or online version is that you do not have to enter data yourself. Some
participants may prefer the ‘quicker’ version of the app, while others will feel reticent to commit
personal responses to the internet. Therefore, always be prepared to administer the paper version as well.
• All versions of the survey are available in Spanish and English.
• When administering any version of the survey, the administrator should enter the site ID prior to the
respondent completing the survey. In this way, PIRE can quickly tally surveys collected from your site.
• If you use either the app while you are on-line or browser version on-line, participants will be eligible
for the online cash gift drawing. If you are not connected to the internet you will be unable to access the
gift drawing website. NOTE: PIRE recommends using the Qualtrics app offline and using the URL
10https://tinyurl.com/NMCS2021 or QR link to the survey if you have a strong internet
connection.
• A QR code for the survey is available above. This can be posted on a sign at recruiting locations so that
people with Smartphones may take the survey at their leisure. Please note if you will do this in your
protocol and at which locations you will use this.
Key issues for implementing the survey on-line using the URL or QR code
• Please note that PIRE recommends completing the survey on-line using the tinyURL or QR code rather
than the Qualtrics app because no upload is required. If you have strong and consistent internet access
(not intermittent) we strongly recommend that you use the URL and/or QR code to link respondents to
the survey.
• When administering the survey in person, you will select for the respondent that you are “administering
the survey to someone else”. You will then go to the next screen, where you will input the site ID, an
abbreviation for the location of data collection, and the data collector’s initials. After entering all the
preparatory information into Qualtrics, you will give the tablet or laptop to the participant to complete
and submit the questionnaire.
• Explain to participants that nobody can go back into the survey once the final screen is reached, and
even though you cannot go back, instruct participants to close this final screen when they are done with
survey, so they feel secure that their data will not be shared.
• Upon completion of the survey, the person completing the survey reaches an ‘end’ screen and the survey
will be immediately uploaded to PIRE’s database. If a participant decides to stop taking the survey
before reaching the end, the surveyor should instruct the participant to simply click ‘next’ until the app
reaches the ‘end’ screen. If the participant decides that s/he wishes to withdraw participation altogether,
then they can choose to close the survey (“X” in the upper right corner).
• If participating on the survey while online, participants will be able to go to a separate website to enter
their contact information to enter a lottery for a $100 or $500 check when they have completed the
survey. Participant contact information for entering the raffle/lottery is NOT associated with survey
data.
Key issues for implementing the survey using the Qualtrics app
• Please note that PIRE recommends using the Qualtrics app offline when your internet connection is
problematic or non-existent. If you have a strong and consistent internet connection, consider using the
URL and QR for the survey instead.
• If participants complete the survey using the Qualtrics app offline, they will not be able to enter
the gift-card drawing. Please let them know this upfront and consider providing a different
incentive.
• Fully charge your device and test the app before beginning data collection. Also, store the password
“PIRE2021!” and login information separately from the device; if the device is stolen, the data will be
protected.
• When administering the survey in person, you will select for the respondent that you are “administering
the survey to someone else.” You will then go to the next screen, where you will input the site ID, an
abbreviation for the location of data collection, and the data collector’s initials. After entering all the
preparatory information into Qualtrics, you will give the iPad or other device to the participant to
complete and submit the questionnaire.
11• Explain to participants that nobody can go back into the survey once the final screen is reached, and
even though you cannot go back, instruct participants to close this final screen when they are done with
survey, so they feel secure that their data will not be shared.
• Upon completion of the survey, the person completing the survey reaches an ‘end’ screen and the survey
will be sent to the app’s database. If a participant decides to stop taking the survey before reaching the
end, the surveyor should instruct the participant to simply click ‘next’ until the app reaches the ‘end’
screen. If the participant decides that s/he wishes to withdraw participation altogether, then they can
choose to close the survey (“X” in the upper right corner).
• Please upload survey data at the end of each data collection day or event.
• If you wish to install the app on your own iOS or Android device, follow directions above and contact
PIRE if you have any questions or problems.
• If experiencing problems with the app, contact PIRE.
• If any device with the app installed is lost or stolen, inform PIRE immediately.
Qualtrics App Download
If installing the app on your own device, follow these steps:
• Find “Qualtrics” app on your iOS or Android device. Check for app updates and update the app before
downloading the 2021 NMCS surveys.
• Download app and to upload survey, when it enters, you will be told to enter a
Username: nmcs@pire.org and password is PIRE2021!
• In the set-up, do not allow for geo-tracking and do not remove the ‘close’ button.
• Download the survey.
• When survey requires updating, you will be informed to “refresh”
• You will need your site ID for ALL data collection.
• Please test the survey by taking the survey before beginning data collection; BUT You must let us know so
that we can delete any test data from the data file.
• Be ready for alerts from PIRE about need to refresh survey.
• Let PIRE know if issues arise immediately.
Incentives for Face-to-Face Administration
The most typical incentives are a small snack (candy bar, snack bar, or fruit), bottled water, or small amounts of
cash that demonstrate novelty like Sacajawea $1 coin. We have found that $1 bills are good incentives for
younger adults. (Be aware that using cash incentives will require additional tracking, but PIRE can help you
with this). Please also be aware that as of December 2019, using OSAP funds for cash incentives over $1
and gift card amounts over $2.50 is no longer allowed by OSAP. Obtain something that is culturally
appropriate and won’t get you into trouble as a public health promoter. Some have used a random incentive,
where every 10th or 20th participant receives a larger prize such as a gift card. For example, you can place a
Post-it on every 10th paper survey that says the participant is a winner. Others have used coupons from local
businesses as incentives. This works nicely if you are collecting data in that venue. If an incentive has worked
well for you in the past, use it and let PIRE know so we can share your success.
DO NOT use public lotteries or other methods that that will reveal participants’ identities.
The state-level NMCS incentive is available only to those who participate in the online survey. Those using the
app when it is not online cannot participate in the on-line lottery. These participants can only receive an
incentive from you.
12Protecting Human Subjects
It is of utmost importance that you protect the anonymity of the respondents’ data. You should provide a
collection system that will allow people to provide their completed surveys to you without you, your
coalition/agency or anyone else being able to identify it. Online data collection provides a certain level of
privacy. Face-to-face administration of data collection can be trickier. If you only have a few completed surveys
at a given location, then you might be able to identify the respondents, particularly in small communities. In that
case, you must explain this technique in detail in your protocol so that reviewers will understand the process
you are putting in place to protect the anonymity of respondents.
When using the online or app versions of the NMCS, make sure that the app and the web page are closed at the
end of each survey, which is best done by the participant her or himself. Please ask the respondent to close the
app and webpage at the end of the survey. If the respondent needs assistance, you may help them close it. This
adds another level of security and protection to the respondent’s data.
Collecting data with a mobile device may require greater vigilance to protect against theft. Make sure that the
person using the device is being observed by someone on your data collection team, but at a safe distance so
they do not feel that their privacy is compromised.
A Note about Budgets
EACH COMMUNITY MUST SUBMIT BUDGET TO OSAP FOR REVIEW & APPROVAL
You are not required to turn your budget in with your protocol to PIRE, but OSAP requires submission and
approval before data collection can begin in your community.
Heather sends out the necessary forms annually and PIRE posts them to the NM Prevention Website here:
http://www.nmprevention.org/NM-Community-Survey.html
For FY21, Budgets are due to Heather no later than 2/19/2021 at heather.burnham@state.nm.us
Community Data Collection Protocol
COMMUNITY DATA COLLECTION PROTOCOL
Please submit this protocol revision form to Ashley (ASimons-Rudolph@PIRE.org) by no later
than February 16, 2021 for review
Program Name:
Date:
Original or Resubmission:
13Name of program representative(s) who attended online data collection training:
Given the ongoing public health threat of COVID-19, we anticipate that most data collection will take place
online. However, there may be certain populations and situations which would require face-to-face
recruitment and/or administration, and you may then elect to include face-to-face interactions in your
protocol. In these cases, you MUST follow the most current guidelines set forth by the State of New Mexico
and the U.S. Centers for Disease Control, and any relevant city, community, municipality, and/or tribal
guidelines. In the case that the advice differs, you must follow the advice which is most restrictive of face-
to-face interactions. In these cases you MUST ALSO maintain these basic standards: 1) all people engaged
in any face-to-face interaction must be wearing masks; 2) these people must be at least 6 feet apart while
interacting; AND 3) any interactions in closed spaces (e.g., indoors) must not be longer than 10 minutes.
WE WANT EVERYONE INVOLVED WITH DATA COLLECTION TO BE SAFE AND IN NO WAY
CONTRIBUTE TO THE FURTHER SPREAD OF DISEASE. The first part of this form will be completed
by ALL communities. If your community intends to collect data using paper/pencil, ipad, and/or face to
face, you must complete Part 2 as well.
Part 1. For all Communities
1a. Please provide a general description of your data collection plans.
1b. Are there sub-populations (examples: young adults age 18-25, Latinx, elders, LGBTQ) for whom you plan
to collect data? Who are they and what is your plan?
2a. Please describe the accessibility of the internet within your target area.
2b. Any unique barriers to collecting online data (e.g. limited entry into tribal areas?)
3a. How many completed surveys are needed for your program? You should aim for between 300 & 400 in
most cases. If less than 300, please explain.
3b. How does this compare to your recruitment last year? (i.e. how many surveys did you get last year
compared to your expectation this year)
4a. Please list all those who will be involved in the online data recruiting process. Start with the primary contact
person for data collection.
Role (e.g.
Name of Staff 18 years
supervisor,
old or
Person or Email Address Phone # trainer, data
over?
collector, data
Volunteer entry, etc.)
Y/N
144b. Who will train those responsible for recruiting about the data collection protocol and approaches? When
will training take place?
4c. As in FY 20, PIRE will offer a drawing of 3 $100 weekly winners and one $500 winner at the end of data
collection for respondents who choose to enter themselves after completing the survey. You have the option to
additionally incentivize local participation and PIRE can randomly draw those names for you. Do you plan to
provider or seek additional donations for incentives from local businesses? If so, please elaborate on who, what,
where you will seek donations?
5a. How do you plan to advertise or promote the survey?
5b. Through social media? When? How often? Attach copies of advertising for review. For human subjects’
protection, no advertising can be used without SEOW approval.
5c. Through email listservs? Please describe the purpose of listserv and approximate number of people
reached.
5d. Through visual media-related advertising such as posters in places where people are spending time outside
their homes (e.g. laundromats, local stores, waiting in line for the food bank or COVID tests)? Please describe.
5e. Do you need for PIRE to print and mail copies of fliers, posters, etc? What and how many?
5f. Other ways? Please describe.
6. Would you like for PIRE to provide additional assistance and/or training about recruitment for your program
prior to data collection?
7. You are required to include all the core survey questions as they currently exist, but you may add additional
questions at the end if you choose. In the interest of length, most communities choose no more than 2 additional
modules. Everyone will collect the CORE module (38 questions). Please select/check the additional modules
you would like to use:
❑ adverse childhood experiences (ACEs) (12 questions)
❑ college community (1 question)
❑ community alcohol-related harms (formerly called “community module”) (10 questions)
❑ gambling (5 questions)
❑ marijuana (15 questions)
15❑ mental health (12 questions)
❑ methamphetamine (7 questions)
❑ additional opioid questions (formerly called “opioid module”) (9 questions)
❑ poly-substance use (ONLINE ADMINISTRATION ONLY; all six items are required of PFS-20
communities, the two items concerning 30-day methamphetamine and polysubstance use are required for all
other counties and these counties may elect to add the other four items as well)
❑ tobacco (7 questions)
❑ Community-specific questions (please provide a list of those questions and responses and the introductory
statement to be used).
8. Is there anything else the SEOW should know when reviewing this protocol?
9. We have worked hard to design a protocol that is as protective as possible for the research volunteers and,
consistent with Federal regulations, we have received the approval of PIRE's Institutional Review Board (IRB)
for this protocol (and possibly other IRBs). We are relying on you to ensure that you adhere to this protocol. If
any deviations from the IRB-approved protocol occur, we require that you notify us immediately so that we can
notify our IRB (or the involved IRBs) as required by the regulations.
Please assent that you have read and understand this statement. ______________.
10) I have sent my budget to OSAP for approval. I acknowledge that PIRE will send OSAP a copy of my final
protocol. ______________. (initial here).
DATA COLLECTION ONLY CAN BEGIN AFTER PROTOCOL IS APPROVED
DATA COLLECTION DATES ARE MARCH 1, 2021-APRIL 30, 2021.
IF YOU ARE PLANNING TO RECRUIT PARTICIPANTS AND/OR COLLECT ANY DATA FACE TO
FACE, YOU MUST COMPLETE THE NEXT PAGES
Part 2: If you are recruiting participants and/or collecting data face-
to-face and/or via paper and pencil or ipad:
Please answer these additional questions only if you are planning face-to-face and/or paper/pencil or ipad
recruitment and/or data collection. Note that it is possible to recruit in-person without actually administering
the data collection in person (e.g. holding a poster, engaging people in a socially distanced conversation and
asking them to click on the QR code, etc).
1a. Do you plan to recruit participants in person?
___Yes
___No
161b. Please describe where, when, and how you plan to recruit participants.
1c. Do you plan to collect data using a paper form?
____Yes
____No
1d. Do you plan to collect data using ipads where the participant will take the survey online? Due to COVID,
the OSAP ipads are not available in 2021, but you may use any ipads owned by the community. Please see
“COMMUNITY PROCEDURES FOR USE OF THE NMCS DATA COLLECTION QUALTRICS APP” below.
___Yes
___No
1e. Do you plan to collect data using ipads where the participant will take the survey offline and you will upload
the data later that same day? Due to COVID, the OSAP ipads are not available in 2021, but you may use any
ipads owned by the community. Please see “COMMUNITY PROCEDURES FOR USE OF THE NMCS DATA
COLLECTION QUALTRICS APP” below.
___Yes
___No
2a. Please list all those who will be involved in the data collection/recruiting process. Start with the primary
contact person for data collection. Any in-person data collection/recruitment must be completed by individuals
18 years or older.
18 years
Role (e.g. supervisor,
Name of Staff Person or old or
Email Address trainer, data collector,
over?
Volunteer data entry, etc.)
Y/N
2b. Do you need to have data collectors/recruiters that can communicate in languages other than English?
What is your plan for approaching these populations?
2c. Who will train those responsible for collecting surveys about the data collection protocol and approved data
collection sites and approaches? When will training take place?
172d. Please explain how you intend to adequately protect respondent’s confidentiality while taking the survey
and returning the completed survey. (e.g. giving participant a manilla envelope to put completed survey and
then having a large collection box with a lock)
2e. If you plan to provide and collect paper surveys without any face-to-face contact, please explain how you
intend to adequately protect respondent’s anonymity/confidentiality while taking the survey and returning the
completed survey. If you plan to provide and collect paper surveys without any face-to-face contact, are there
any issues to address to protect anonymity and/or health and safety?
2f. Please describe how you intend to maintain COVID-safety and little/no person-to-person contact during
recruitment and/or data collection, particularly in enclosed spaces. (e.g. creating packets of the survey, pencil,
and envelope or wiping down ipads after each use)?
2g. How will paper surveys be stored following data collection and in preparation for data entry? Describe a
secure process of transport and storage.
3a. If you are planning face to face data collection, do you plan to offer any incentives?
3b. If yes, please tell us about the small incentives (e.g., type of pre-packaged food, amount of money.)
Remember the OSAP guidance regarding maximum allowable incentives (valued at $2.50 from OSAP funds;
cannot give cash). Please see budget form for additional details.
3c. Do you plan to seek additional donations for incentives from local businesses? If so, please elaborate on
who, what, where, etc., you will seek donations?
4a. If you are collecting paper and pencil surveys, who will be leading the data entry for the paper and pencil
surveys. Does anyone need to attend data entry training? Who? Who will keep the completed surveys locked
and safe for 5 years?
18COMMUNITY PROCEDURES FOR USE OF THE NMCS DATA COLLECTION QUALTRICS APP
Keep these two pages with you while collecting data with the NMCS data collection app.
OSAP iPads ARE UNAVAILABLE FOR 2021
Using the NMCS app on a private device
If you wish to install the NMCS app on your own device, contact PIRE so we can provide you the most up to
date information. Even if using a private device, you must follow the procedures for the Qualtrics app
described below.
19NMCS App Protocol
KEEP WITH YOU AT ALL TIMES AND REVIEW PRIOR TO COLLECTING DATA USING THE APP
When possible, always collect data while connected to the internet using a browser rather than the Qualtrics
app. When connected to the internet (and using a laptop or computer or tablet that is accessing the survey via
the website location), the participants’ data can be immediately submitted, and participants can opt to
participate in the online incentive, which means the provider may not need to provide an incentive. This is the
most secure way to collect the data.
When collecting data using the app, data are stored on the tablet itself. Please note the data will need to be
uploaded when you complete your data collection for the day as soon as you are able to connect to the internet.
Once the data are uploaded, they will continue to be stored on the tablet until you “log out” from the app (please
see detailed instructions). We recommend logging out immediately after uploading your data. When using the
tablet to collect data off-line, your program may want to provide a small upfront incentive since participants
will not be eligible for the on-line drawing.
When using the app to collect data:
• Instruct the respondent on how to navigate the survey instrument and how to close the survey at the end.
Upon completion of the survey in both the online and app version, the survey participant will be sent to
an ‘end’ screen and the survey will be sent to the app’s database. Explain to participants that nobody can
go back into the survey once this final screen is reached, and even through you cannot go back, instruct
participants to close this final screen when they are done, so they feel secure that their data will not be
shared.
• If a participant decides to stop taking the survey before reaching the end, the surveyor should instruct the
participant to simply click ‘next’ until the app reaches the ‘end’ screen. If the participant wishes to
withdraw their participation altogether, the ‘close’ button will allow them to withdraw.
• Keep an eye on the individual using the device (at a respectful distance to maintain privacy) to deter
theft. You may let them know that you will be nearby to make sure they are safe and to answer any
questions they may have but will be respecting their privacy.
• When your data collection is completed for the day and you have wireless access to the internet,
immediately upload the surveys from inside the app. You may do this at home or at the office. But do
not leave the data on the tablet for long.
• After uploading data, you should see the number of pending responses reduce and the number of
uploaded responses increase. Please note that these numbers may be different than the total number of
surveys you believe have been completed/collected.
• From the main app screen after uploading survey responses, go to the settings icon in top right corner of
screen. Select “Log Out”. If you have already uploaded all the completed surveys, ignore the warning
that says that logging out will delete all responses and proceed. You want survey responses to be
deleted from your device after they are uploaded.
• All devices using the app will be set to log out within 3 minutes of inactivity. Do not share the
passwords for devices except with those trained to use them for data collection.
• If theft occurs, do not put yourself at risk in order to retrieve it. Report to authorities and Dave Currey @
PIRE immediately.
• Use the device only in locations where you can maintain control over the interactions and environment
and feel safe allowing people to use them.
20• Do not leave devices unattended at any time.
Here write your own procedures for use of the app, answering the following questions:
• How many IOS (Apple) or Android devices will have the app installed? ___
• Who will be in charge of tracking the use and storage of the devices? _______
• Who will be trained to use the devices and who will do the training? _______
• How will devices be securely stored when not in use? _______
• Will any data be collected using the app offline? ___
o Based on your data collection protocol, where are the locations this likely to take place?
o Where will data collectors go to upload the data collected offline?
21By PIRE for OSAP FY 2021
For SEOW USE only:
Date of review (include this text in subsequent reviews):
SEOW REVIEW CHECKLIST
Question Yes/No Comments
1 Does the provider have a good understanding of
their data recruitment/data collection plan?
2 Based upon your knowledge of the program, are
there any subpopulations the provider should
consider but is not?
3 Based on your knowledge of the program, are
there any barriers to data collection that the
provider should consider but is not?
4 Is the recruitment/data collection plan
appropriate given the internet access within the
community?
5 What other ways would you recommend the
provider reach out and recruit participants?
6 Do these changes require resubmission?
7 Any additional comments or concerns?
If provider intends to recruit participants and/or collect data face to face…
8 If the provider plans to recruit participants and/or
collect data in-person, are the plans to maintain
participant confidentiality sufficient?
9 If the provider plans to recruit participants and/or
collect data in-person, are the plans to maintain
social distancing (> 6 feet apart and less than 10
minutes if inside) sufficient?
24By PIRE for OSAP FY 2021
PIRE Contact Information
Dave Currey 919-265-2622
dcurrey@PIRE.org
Ashley Simons-Rudolph - 919-265-2620
asimons-rudolph@pire.org
Marissa Elias – 575-202-2232
MElias@PIRE.org
Kim Zamarin 505-907-0801
KZamarin@PIRE.org
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