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Stool blood test or FOBT 
The following questions are about the stool blood test, also known as a FOBT, a test to check for colon cancer. It is done at home using a set of three cards to determine whether the stool contains blood. You smear a sample of your fecal matter or stool on a card from three separate bowel movements and return the cards to be tested. 
Questions 
Before this test was described, had you ever heard of a fecal occult or stool blood test? 
 •Yes 
 •No 
 •Not sure/do not know 
If “yes” to “ever heard”: 
Have you ever done a stool blood test using a “home” test kit? 
 •Yes 
 •No 
 •Not sure/do not know 
If “yes” to “ever had”: 
How many home stool blood tests have you done in the last 5 years? 
 •____ (number from 1 to 5) 
 •Not sure/do not know 
When did you do your most recent home stool blood test? 
 •A year ago or less 
 •More than 1 but not more than 2 years ago 
 •More than 2 but not more than 5 years ago 
 •More than 5 years ago 
 •Not sure/do not know 
If you did your most recent test within the past year, what was the month and year? 
 Month_____/Year_____ 
Why did you do your most recent home stool blood test? 
 •Part of a routine examination or checkup 
 •Because of a symptom or health problem 
 •Follow-up of an earlier abnormal test 
 •Not sure/do not know 
Prompt for T and F surveys: “You said that your most recent test was [insert time frame]” 
When did you do the home stool blood test before your most recent one? 
 •None before the most recent 
 •A year ago or less* 
 •More than 1 but not more than 2 years before 
 •More than 2 years before 
 •Not sure/do not know 
Why did you have that home stool blood test? 
 •Part of a routine examination or checkup 
 •Because of a symptom or health problem 
 •Follow-up of an earlier abnormal test 
 •Not sure/do not know 
Stool blood test or FOBT 
The following questions are about the stool blood test, also known as a FOBT, a test to check for colon cancer. It is done at home using a set of three cards to determine whether the stool contains blood. You smear a sample of your fecal matter or stool on a card from three separate bowel movements and return the cards to be tested. 
Questions 
Before this test was described, had you ever heard of a fecal occult or stool blood test? 
 •Yes 
 •No 
 •Not sure/do not know 
If “yes” to “ever heard”: 
Have you ever done a stool blood test using a “home” test kit? 
 •Yes 
 •No 
 •Not sure/do not know 
If “yes” to “ever had”: 
How many home stool blood tests have you done in the last 5 years? 
 •____ (number from 1 to 5) 
 •Not sure/do not know 
When did you do your most recent home stool blood test? 
 •A year ago or less 
 •More than 1 but not more than 2 years ago 
 •More than 2 but not more than 5 years ago 
 •More than 5 years ago 
 •Not sure/do not know 
If you did your most recent test within the past year, what was the month and year? 
 Month_____/Year_____ 
Why did you do your most recent home stool blood test? 
 •Part of a routine examination or checkup 
 •Because of a symptom or health problem 
 •Follow-up of an earlier abnormal test 
 •Not sure/do not know 
Prompt for T and F surveys: “You said that your most recent test was [insert time frame]” 
When did you do the home stool blood test before your most recent one? 
 •None before the most recent 
 •A year ago or less* 
 •More than 1 but not more than 2 years before 
 •More than 2 years before 
 •Not sure/do not know 
Why did you have that home stool blood test? 
 •Part of a routine examination or checkup 
 •Because of a symptom or health problem 
 •Follow-up of an earlier abnormal test 
 •Not sure/do not know 
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