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The National Immunization Survey Evaluation Study Special Sworn Status Procedures: Focus Group Results

Theresa DeMaio and Jennifer Beck

KEY WORDS: confidentiality; National Immunization Survey, Special Sworn Status, focus groups


At the request of Demographic Surveys Division and the Centers for Disease Control and Prevention, staff from the Center for Survey Methods Research in the Statistical Research Division conducted focus groups to evaluate the Special Sworn Status procedures for health care providers who participate in the National Immunization Survey (NIS) Evaluation Study. This is necessitated by the use of the American Community Survey address file as the frame for the study. An additional mailing will be sent to health care providers of children in the survey whose parents have given permission for the providers to complete an NIS questionnaire. The mailing will contain an advance letter describing the study and the need to obtain Special Sworn Status, forms that must be completed to obtain Special Sworn Status, and instructions for completing the form and for protecting the confidentiality of the identity of patients in the NIS. In April and May 2009, we conducted four focus groups: two in Baltimore, MD, with health care providers from public health clinics, and two in Miami, FL, with health care providers from private practices. At each site, one of the groups was comprised of physicians, and the other was comprised of nurses and other office staff (e.g., office managers). The focus groups showed that: 1) participants believed the cover letter was too long, the type was too small, and the look was generally off-putting; 2) participants were well-versed with HIPAA requirements, and thought the immunization information was what needed to be kept confidential; 3) participants did not understand that Special Sworn Status protects the fact that a specific patient was in the NIS, and. because of this misunderstanding, they felt that Special Sworn Status and the associated fines for violating confidentiality were both severe and intimidating; and 4) there was some concern about how many people in the office would have to sign a form.

CITATION: DeMaio, Theresa and Jennifer Beck. (2009). The National Immunization Survey Evaluation Study Special Sworn Status Procedures: Focus Group Results. Statistical Research Division Study Series (Survey Methodology #2009-13). U.S. Census Bureau. Available online at <>.

Source: U.S. Census Bureau, Statistical Research Division

Published online: August 4, 2009
Last revised: July 24, 2009

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Source: U.S. Census Bureau | Statistical Research Division | (301) 763-3215 (or |   Last Revised: October 08, 2010