Primary Pre and Post Campaign Survey

APPENDIX D2

Baseline and Immediate Post Intervention

Telephone Interview Questionnaire

Form Approved

OMB No. 0920-XXXX

Expiration Date XX/XX/XXXX

Centers for Disease Control and Prevention ARTHRITIS PROGRAM

Evaluation of the Spanish language campaign

“Good Morning Arthritis. Today you will not defeat us.”

Pre- and Post Campaign Data Collection Survey

Public Reporting Burden Statement

Public reporting burden of this collection of information is an estimated average of 13 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: OMB 0920-XXXX

[RESPONDENT MUST HAVE QUALIFIED THROUGH THE SCREENING QUESTIONNAIRE PRIOR TO CONTINUING]

5. Thinking about your arthritis or joint symptoms, which of the following best describes you TODAY? [READ LIST.]

I can hardly do anything I would like to do	1
I can do some things I would like to do	2
I can do most things I would like to do	3
I can do everything I would like to do	4
Don’t know	77
Refused	88

MEASUREMENT OF EXERCISE

[PLEASE READ] For the next several questions we will be asking you about exercise. Exercise includes any physical activity that causes some increase in your breathing or heart rate.

10. Now, thinking about the exercise you do when you are not working, do you exercise for at least 10 minutes at a time, such as brisk walking, bicycling, vacuuming, gardening, or anything else that causes some increase in breathing or heart rate?

Yes	1	[SKIP TO Q.12]
No	2	[CONTINUE]
Don’t know	77
Refused	88

Within the next month, how likely, if at all, are you to start exercising? Are you…[READ LIST.]

Very Unlikely	1	[SKIP TO Q.15]
Somewhat Unlikely	2
Somewhat Likely	3
Very Likely	4
Don’t know	77
Refused	88

11. How many days per week do you exercise for at least 10 minutes at a time?

__________ days a week [CODE 0-7]
Don’t know	77
Refused	88

11. On days when you do exercise for at least 10 minutes at a time, how much total time per day do you spend doing these activities?

Total time in minutes per day: _________ [IF GIVEN IN HOURS, CONVERT TO MINUTES]
Don’t know	77
Refused	88

11. Within the next month, how likely, if at all, are you to increase your participation in exercise? [READ LIST.]

Very Unlikely	1
Somewhat unlikely	2
Somewhat Likely	3
Very Likely	4
Don’t know	77
Refused	88

11. Now thinking back to your schedule three months ago, how many days per week did you exercise for at least 10 minutes at a time?

____________ days a week [CODE 0-7]
Don’t know	77
Refused	88

GENERAL KNOWLEDGE OF ARTHRITIS AND EXERCISE

11. I’d like to talk to you about some of your impressions of arthritis and physical activity. Please tell me whether the following statements are true or false. [READ AND ROTATE LIST.]

	True	False	DK
Moderate exercise can help you beat arthritis	1	2	77
Moderate exercise can be helpful for people with arthritis even if done for 10 minutes at a time	1	2	77
To be beneficial exercise should be done for at least three days a week	1	2	77
It is possible to reduce arthritis pain without medication	1	2	77
Any exercise that causes pain or discomfort should be stopped	1	2	77

11. For the following statements, please tell me whether you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree. How strongly do you agree or disagree that… [READ AND ROTATE LIST. RECORD RESPONSE.]

	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree	DK
I can reduce my arthritis or joint pain by exercising regularly	1	2	3	4	5	77
I feel confident about my ability to engage in regular exercise	1	2	3	4	5	77
It’s easy for me to engage in regular exercise	1	2	3	4	5	77
Since I have arthritis, it is important for me to exercise regularly	1	2	3	4	5	77
I can do more regular exercise than I currently am	1	2	3	4	5	77
I know how to exercise without aggravating my arthritis	1	2	3	4	5	77

MEASUREMENT OF SHORT-TERM/INTERMEDIATE OUTCOMES

Campaign Awareness/Breakthrough Measures

11. In the last month, not counting this survey, have you seen, heard or read something about…

[READ & ROTATE OPTIONS 1-6. ACCEPT MULTIPLE RESPONSES.]

Arthritis	1	[CONTINUE]
Diabetes	2
Cancer	3
Heart disease	4
Nutrition	5
Physical activity/exercise	6
None	7

[IF CODE 1 NOT MENTIONED ABOVE, SKIP TO Q.31, OTHERWISE CONTINUE]

11. [UNAIDED] What organization sponsored or created the information you recently saw, heard, or read on arthritis? [DO NOT READ LIST. SEE CODE LIST IN Q.20]

11. [AIDED] I’m going to read a list of organizations that might have sponsored or created information you recently saw, heard, or read on arthritis. I’d like you to tell me if you recall recently hearing or seeing any information on arthritis from... [READ & ROTATE OPTIONS 1-7. ACCEPT MULTIPLES.]

[NOTE: IF ANY OPTION MENTIONED IN Q.19, SKIP IN Q.20]

	Q.20	Q.21
The American Medical Association or AMA?	1	1
The Centers for Disease Control and Prevention or CDC?	2	2
The Arthritis Foundation?	3	3
The National Institutes of Health or NIH?	4	4
Department of Health and Human Services or DHHS?	5	5
State and Local Health Department [SPECIFY]?	6	6
A drug company?	7	7
The Food and Drug Administration or FDA?	8	8
Other: [SPECIFY. DO NOT READ] _____________________	9	9

11. Have you recently seen, heard, or read arthritis information on how to beat arthritis through the use of…[READ LIST.]

	Yes	No
a) Prescription drugs, like Vioxx or Celebrex?	1	2
b) Over the counter or non-prescription drugs, like Tylenol or Bengay?	1	2
c) Exercise or Physical activity?	1	2

[IF RESPONDENT INDICATES “YES” (CODE 1) TO OPTION c IN Q.21, ASK Q.22 IMMEDIATELY. IF RESPONDENT INDICATES “NO” (CODE 2) TO OPTION c IN Q.21, SKIP TO Q.24.]

11. And where do you recall seeing, hearing or reading that arthritis information? Specifically, did you see, hear, or read about it…[READ & ROTATE LIST. ACCEPT MULTIPLES.]

In a brochure?	1	AFTER ASKING ALL STATEMENTS, IF CODE 1 MENTIONED, PROCEED TO Q.23. OTHERWISE, SKIP TO Q.24
In a magazine?	2
In a newspaper?	3
On the radio?	4
On a billboard?	5
On the Internet or World Wide Web?	6
On a poster or flyer?	7
On television?	8
By word-of-mouth? (e.g. friends, family)	9
On a display in the doctor’s office	10
Other [SPECIFY. DO NOT READ]:_________	11
None	12

11. You mentioned seeing or reading arthritis information in a brochure. Did you… [READ & ROTATE LIST.]

	Yes	No
Take the brochure home?	1	2
Take extra copies of the brochure?	1	2
Read the brochure?	1	2
Give the brochure to a friend or family member?	1	2
Talk about the brochure with a friend or family member?	1	2

11. Now I’m going to read some phrases that might have been featured in the arthritis information you recently saw, read, or heard. Do you recall seeing or hearing the phrase… [READ & ROTATE LIST.]

	Yes	No
a) “More Life, Less Limits”	1	2
b) “Good morning arthritis, today you will not defeat us”	1	2
c) “Take Control. We Can Help”	1	2
d) “Celebrate”	1	2
e) “For everyday victories”	1	2
f) “Take it for pain. Take it for life”	1	2
g) “Exercise is good for arthritis”	1	2
h) “When Arthritis is Your Enemy” [DISGUISE]	1	2

[IF RESPONDENT INDICATES “YES” OR CODE 1 TO OPTION “b” ON Q.24, CONTINUE. OTHERWISE, SKIP TO Q.29.]

[IF RESPONDENT INDICATES “YES” OR CODE 1 TO OPTION “b” on Q.24, INSERT “Good morning arthritis, today you will not defeat us”

“PROBABLE EXPOSED VIEWERS” DEFINED AS:

• RESPONDENTS WHO ANSWER Q.24b WITH CODE 1 “Yes”

“POSSIBLE EXPOSED VIEWERS” DEFINED AS:

• RESPONDENTS WHO ANSWER CODE 1 “YES” TO Q.21c

11. In the last month, approximately how many times did you see, hear or read the phrase “Good morning arthritis, today you will not defeat us”?

____________ times
Don’t know	77
Refused	88

Campaign Communication Effectiveness

11. Do you recall where you saw, heard, or read the phrase “Good morning Arthritis, today you will not defeat us”? Was it…[READ & ROTATE LIST. RECORD RESPONSE. ACCEPT MULTIPLE RESPONSE.]

On television?	1
In a magazine?	2
In a newspaper?	3
On the radio?	4
On a billboard?	5
On the Internet or World Wide Web?	6
On a poster or flyer?	7
In a brochure?	8
By word-of-mouth? (e.g. friends, family)	9
On a display in the doctor’s office	10
Other [SPECIFY. DO NOT READ]:______________________
Don’t know	77

11. What does the phrase “Good morning Arthritis, today you will not defeat us” mean to you? [RECORD VERBATIM RESPONSE] Anything else?

11. What type and amount of exercise is needed to reduce arthritis pain? [PROBE TYPE, FREQUENCY, AMOUNT. RECORD VERBATIM RESPONSE.]

Response to the Campaign’s Call-to-Action

11. Have you done any of the following things as a result of what you recently saw, heard or read on arthritis? Specifically, have you… [READ & ROTATE STATEMENTS.]

	Yes	No
Thought about exercising more?	1	2
Talked to a physician about exercise?	1	2
Talked to a friend or family member about exercise?	1	2
Gone online to get more information on exercise?	1	2
Tried to begin moderate exercise	1	2
Increased your exercise?	1	2
Participated in moderate exercise for three or more days per week?	1	2
Called a toll-free 800 number to get more information on arthritis and/or exercise?	1	2

[IF RESPONDENT INDICATES “NO” (CODE 2) TO ANY OF THE a-h OPTIONS SHOWN IN Q.29, ASK Q.30 FOR EACH OPTION. IF RESPONDENT INDICATES “YES” (CODE 1) TO ALL OF THE a-h OPTIONS SHOWN IN Q.29, SKIP TO Q.31.]

Intent to Respond to the Campaign’s Call-to-Action

11. For these final few questions, please tell me if you are very unlikely, somewhat unlikely, neither likely nor unlikely, somewhat likely, or very likely, to do any of the following within the next month based on what you recently saw, heard, or read about arthritis. How likely, if at all, are you to…[READ AND ROTATE LIST.]

Think about exercising more?	1	2	3	4	5
Talk to a physician about exercise?	1	2	3	4	5
Talk to a friend or family member about exercise?	1	2	3	4	5
Go online to get more information on arthritis and/or exercise?	1	2	3	4	5
Try to begin moderate exercise?	1	2	3	4	5
Increase your exercise?	1	2	3	4	5
Participate in moderate exercise for three or more days per week?	1	2	3	4	5
Call a toll-free 800 number to get more information on arthritis and/or exercise?	1	2	3	4	4

Self Management of Arthritis or Joint Pain

11. Are you currently doing anything to manage your own arthritis or joint pain?

Yes	1	[SKIP TO Q. 33]
No	2	[CONTINUE]

11. Why not? [DO NOT READ LIST; RECORD RESPONSE IN APPROPRIATE CATEGORY BELOW; ACCEPT MULTIPLE RESPONSES.]

Arthritis cannot be treated	1
Can’t afford treatment	2
Don’t know how to treat it	4
Don’t like to take drugs/medication	5
It’s not a problem for me right now	6
Medication interferes with other medication I am on	7
Medication upsets my stomach/causes ulcers	8
My symptoms/arthritis are not that serious right now	9
Too painful to exercise	10
Nothing I do helps	11
Other [SPECIFY___________________________	12

Media Usage

11. Do you listen to Spanish language radio?

Yes	1
No	2	[SKIP TO Q.35]
Don’t know	77
Refused	88

11. When do you typically listen to the radio? [READ LIST. ACCEPT MULTIPLE RESPONSE.]

Weekday Mornings	1
Weekday Afternoons	2
Weekday Evenings	3
Weekends	4
Don’t know	77
Refused	88

11. How many days per week do you read the local Spanish-language newspaper?

__________ days a week [CODE 0-7]
Don’t know	77
Refused	88

11. Do you currently use the Internet at home or at work?

Yes	1
No	2
Don’t know	77
Refused	88

11. In the past month, have you gone to… [READ LIST.]

	Yes	No	Don’t know	Refused
a) A pharmacy?	1	2	77	88
b) A community center?	1	2	77	88
c) A doctor’s office or clinic?	1	2	77	88

11. What was the last grade of school or level of education you completed? [READ LIST.]

Grade school (grades 1-8)	1
Some high school (grades 9-11)	2
Completed High school or GED (grade 12)	3
Some college or technical school	4
College/technical school graduate or more	5
Refused	88

Those are all of the questions I have for you today. I would like to thank you for participating in our study.