Sample Questions

OMB Generic Clearance Survey Questions.doc

Health Marketing

Sample Questions

OMB: 0920-0798

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  1. Sample Demographic and Screening Questions


Are you male or female?

  • Male

  • Female


How old are you?

  • 17 years old or younger

  • 18-24 years old

  • 25-34 years old

  • 35-49 years old

  • 50-64 years old

  • 65 years old or older


What is your highest level of education?

  • GED

  • High school diploma

  • Associates degree

  • 4-year degree

  • Bachelors

  • Masters

  • Graduate degree

  • Post-graduate degree

  • Doctoral degree

  • Other: _________


What is your country of origin?


How would you describe your race?

  • American Indian or Alaska Native

  • Asian, Native Hawaiian, or Other Pacific Islander

  • Black or African-American

  • Hispanic or Latino

  • White or Caucasian

  • Don’t Know/Prefer not to answer


What is (are) your primary language(s)?


What languages would you like to see represented on the CDC Web site?


In what country do you live?


If you are in the USA, in which city (also give state or territory) do you live?


Would you describe the area in which you live as rural or urban?

  • Rural

  • Urban

  • I don’t know


Are you a CDC employee, contractor, or fellow?


What is your profession?

  • Attorney or other Legal Professional

  • Business Owner or Operator

  • CDC Employee or Contractor

  • CDC Partner

  • Disease carrier or survivor

  • Epidemiologist

  • Farmer

  • General public

  • Health Communication

  • Health Education

  • Health  Administration

  • Healthcare provider (physician, nurse, physician’s assistant, nurse practitioner)

  • Media

  • Medical or Scientific researcher

  • Medicine

  • Mother/Primary Caregiver

  • Non-Health Care Related

  • Nurse/Advanced Practice Nurse

  • Other Health Care Professional: ________

  • Pharmacy, Physician Assistant

  • Policy maker or their staff

  • Program Grantee

  • Public Health Communication Specialist

  • Public Health Educator

  • Public Health Worker

  • Retired

  • Staff at Hospital or Clinic

  • Student (Medicine and Allied Health Professions)

  • Student (non-Medicine and non-Allied Health Professions)

  • Teacher/Educator

  • [insert health topic specific job/role]

  • [insert health topic specific job/role]

  • [insert health topic specific job/role]

  • [insert health topic specific job/role]

  • [insert health topic specific job/role]

  • Other: _____________


Who is your employer?

  • Agriculture Industry

  • Clinic

  • Community Based Organization (CBO)

  • Correctional Institution

  • Federal Agency (not military)

  • Health-Related Professional Association/Organization 

  • Homeless Shelter

  • Hospital

  • International

  • Medical or Allied Health School or Library 

  • Military

  • National Model [insert health topic] Center

  • Non-Health Related Business/Industry

  • Non-profit Organization

  • Nursing Home, Drug

  • Private Sector Health Care Provider

  • Private Sector non-Health Care Provider

  • State/Local Health Department

  • Student

  • Treatment Facility

  • Other: __________


What is your job title?


Please describe your job role:


How long have you worked in your current profession?

  • Less than one year

  • 1 year

  • 2 – 5 years

  • 6 – 10 years

  • More than 10 years


On average, how much time do you spend using a computer each day?

  • More than 4 hours a day

  • 1 – 4 hours a day

  • Less than 1 hour a day


What type of computer do you use most often?

  • PC

  • Mac

  • Other

Please describe:


Where do you use your computer most often?

  • At Home

  • At Work

  • At School

  • At friend’s/relative’s

  • At library

  • Other

Please describe:


How would you rate your computer experience?

  • Novice – I am new to computers and/or I only use one for a specific purpose

  • Low – I am somewhat new to computers and/or I am relatively comfortable with one or two software applications/programs (e.g. Microsoft Word, Excel, etc.).

  • Intermediate – I am comfortable with computers and/or I have learned and use between three and ten different software applications/programs.

  • Expert – I know my way around computers and/or I am comfortable troubleshooting most of the problems that arise with computers and/or I have used many different software applications and have some programming skills.


In general, what are the most frequent computer-related activities you do? (check all that apply)

  • Email

  • Internet/Intranet

  • Software programs/applications. Please describe:

Other: __________


Are you currently a CDC employee, full-time contractor, part-time contractor, or fellow?

Response options: ‘yes’, ‘no’

  1. Sample Knowledge, Attitude, and Behavior questions


What is your typical purpose when searching for [insert health topic] information on the Web? I am looking for…

  • Specific [insert health topic] information for myself

  • Specific [insert health topic] information for someone else (loved one, family member, patient, client, etc.)

  • Vaccination information

  • Professional training/education materials

  • Patient education materials

  • Clinical information/resources

  • Hospitals, doctors offices, or clinics located near me

  • Symptoms

  • Treatment

  • Prevention

  • Data or statistics

  • Registries and Surveillance

  • Fact Sheets

  • Partners

  • Events

  • Training

  • Outbreak information

  • Publications

  • Health Disparities

  • Legislation

  • Diagnostic tools/aids

  • Information in other languages

  • Program information

  • Research activities (intramural and extramural)

  • News

  • Funding opportunities

  • Recommendations/Guidelines

  • Meeting/Conference information

  • Caregiver resources

  • Partner/Other Organization opportunities and resources

  • Best Practices/Success Stories

  • Public Health program specific resources

  • General Health Information including prevention and/or treatment

  • Other (please specify): ______________________________


Where do you typically acquire [insert health topic] information?

  • Internet/Web

  • Radio

  • T.V.

  • Journal articles

  • Textbooks

  • Library

  • Brochures, Pamphlets

  • Healthcare provider

  • Friend

  • Family

  • Online library

  • Online journals

  • Listservs

  • Newsletters

  • Magazines

  • Newspapers

  • Don’t consult sources

  • Other: _______



If you need information about [insert health, communication, or marketing topic/challenge], where do you generally look first?

  • Overall, how satisfied are you with [insert respondent’s response] as an information source?

      • extremely satisfied

      • very satisfied

      • satisfied

      • not very satisfied

      • extremely unsatisfied

  • What do you like most about [insert respondent’s response]?

  • What do you like least about [insert respondent’s response]?

  • How useful is [insert respondent’s response] as an information source?

      • extremely useful

      • very useful

      • useful

      • not very useful

      • extremely not useful


Have you ever used [insert CDC program/product/service of interest]?


If yes…

  • What was the reason you used [insert CDC program/product/service of interest]?

  • How recently have you used [insert CDC program/product/service of interest]:

      • within the last week

      • within the last month

      • within the last six months

      • within the last year

      • over one year ago

  • How frequently do you use [insert CDC program/product/service of interest]:

      • Daily

      • Weekly

      • Monthly

      • Yearly

      • every couple of years

  • What do you like about [insert CDC program/product/service of interest]?

  • What do you not like about [insert CDC program/product/service of interest]?

  • Overall, how would you rate your experience with [insert CDC program/product/service of interest]?

      • very positive

      • positive

      • so-so

      • negative

      • very negative

  • Please tell me a little more about why your experience was [insert respondent’s rating answer]?


If no…

  • What do you think [insert CDC program/product/service in question] is?

  • Who do you think [insert CDC program/product/service in question] is for?

  • Are you planning to use [insert program/product/service in question]:

      • in the next month

      • in the next 2 to 3 months

      • in the next 4 to 6 months

      • in the next year

      • never


If any answer except ‘never’…

  • Please tell me a little more about why you plan to use [insert program/product/service in question] in the future?


  • How would you rate your knowledge about [insert description of health, communications, or marketing challenge]?

      • novice - I am new to and/or I am not comfortable with [insert description of health, communications, or marketing challenge].’

      • Intermediate – I am comfortable with and/or I generally know how to approach [insert description of health, communications, or marketing challenge].’

      • Expert – I am completely comfortable [insert description of health, communications, or marketing challenge].’


  • How would you rate your level of experience with [insert description of health, communications, or marketing challenge]?

      • novice - I am new at [insert description of health, communications, or marketing challenge].

      • low – I am somewhat new at [insert description of health, communications, or marketing challenge].’

      • intermediate – I am comfortable with [insert description of health, communications, or marketing challenge].’

      • expert – I am confident with[insert description of health, communications, or marketing challenge].’


  • Did using [insert CDC program/product/service in question] require any new skills?

      • Yes

      • No

      • If yes, please explain


  • How likely are you to use [insert CDC program/product/service in question] for [insert usage purpose reported by respondent] again in the future?

      • Extremely likely

      • Somewhat likely

      • Somewhat unlikely

      • Extremely unlikely


If any answer except ‘extremely unlikely’,


  • How soon do you anticipate using [insert CDC program/product/service in question] again?

      • in the next month

      • in the next 2 to 3 months

      • in the next 4 to 6 months

      • in the next year


  • How likely are you to use [insert CDC program/product/service in question] for some reason other than for [insert usage purpose reported by respondent] in the future?

      • Extremely likely

      • Somewhat likely

      • Somewhat unlikely

      • Extremely unlikely


If any answer except ‘extremely unlikely’,


  • How soon do you anticipate using [insert CDC program/product/service in question] for this purpose?

      • in the next month

      • in the next 2 to 3 months

      • in the next 4 to 6 months

      • in the next year



  1. Which of the following organizations are you familiar with? Please answer yes if you have heard of the organization, or no if you have not.


    • The Food and Drug Administration (FDA)

    • The Centers for Disease Control and Prevention (CDC)

    • The US Department of Agriculture (USDA)

    • The Environmental Protection Agency (EPA)

    • The Department of Homeland Security (DHS)

    • The Transportation Security Administration (TSA)

    • The National Institutes of Health (NIH)

    • National Institute for Occupational Safety and Health (NIOSH)

    • Occupational Safety and Health Administration (OSHA)

    • World Health Organization

    • The American Cancer Society

    • The American Heart Association

    • American Medical Association


  1. Please say for each if you understand what it is and does, or not. Please answer yes if you know what the organization does, no if you do not, or not sure if you are not sure.


    • The Food and Drug Administration (FDA)

    • The Centers for Disease Control and Prevention (CDC)

    • The US Department of Agriculture (USDA)

    • The Environmental Protection Agency (EPA)

    • The Department of Homeland Security (DHS)

    • The Transportation Security Administration (TSA)

    • The National Institutes of Health (NIH)

    • National Institute for Occupational Safety and Health (NIOSH)

    • Occupational Safety and Health Administration (OSHA)

    • World Health Organization

    • The American Cancer Society

    • The American Heart Association

    • American Medical Association


  1. Overall, how would you rate the job [organization] does - – excellent, pretty good, only fair or poor?


    • The Food and Drug Administration (FDA)

    • The Centers for Disease Control and Prevention (CDC)

    • The US Department of Agriculture (USDA)

    • The Environmental Protection Agency (EPA)

    • The Department of Homeland Security (DHS)

    • The Transportation Security Administration (TSA)

    • The National Institutes of Health (NIH)

    • National Institute for Occupational Safety and Health (NIOSH)

    • Occupational Safety and Health Administration (OSHA)

    • World Health Organization

    • The American Cancer Society

    • The American Heart Association

    • American Medical Association


  1. In what health areas does the Centers for Disease Control and Prevention (CDC) do research or conduct programs? Please answer yes, no, or not sure to each.


    1. Infectious diseases (like flu, AIDS/HIV, or the ebola virus)

    2. Chronic diseases (like cancer, heart disease, or diabetes)

    3. Injuries and violence (like domestic abuse, head injuries or vehicle collisions)

    4. Childhood and adult immunizations (like for the flu, measles, and hepatitis)

    5. Illnesses caused by the environment (like asthma or lead poisoning)

    6. Workplace-related illnesses (back injuries, hearing loss, or black lung disease)

    7. Tracking and monitoring diseases

    8. Training Public Health Workers


  1. Please answer (yes, no, not sure) each of the following items regarding the CDC:


    1. I have a good understanding of what CDC does.

    2. CDC protects America by fighting epidemics and disease outbreaks.

    3. CDC works only in the U.S. – not in other countries.

    4. CDC is one of the first places I would turn to for reliable health information.

    5. CDC treats patients with complicated medical problems.

    6. CDC helps make America safer.

    7. CDC usually works alone – not with local and state organizations (like the March of Dimes, schools, or health departments).

    8. One of the health information sources I trust most is the CDC.

  1. Open-Ended questions


  • When you think about [insert CDC program/product/service in question], what are the first three things that come to mind?

  • Please tell me a little more about why you say [insert respondent’s response].


  • What do you like most about [insert CDC program/product/service in question]?


  • What do you like least about [insert CDC program/product/service in question]?


  • Is [insert CDC program/product/service in question] for you? Do you think it would be better for someone else? Who? Why?


  • In your opinion, does/would [insert CDC program/product/service in question] meet your needs?

  • Please tell me a little more about why you say [insert respondent’s response].

  • Are any ways in which [insert CDC program/product/service in question] can be improved?


  • In your opinion, does/would [insert CDC program/product/service in question] prompt you to [insert description of specific behavior being encouraged]?


  • Please tell me a little more about why you say [insert respondent’s response].


  • Are any ways in which [insert CDC program/product/service in question] could be modified to be more motivational or encouraging?


  • What did you like most about your experience acquiring [insert CDC program/product/service in question]?


  • What did you like least about your experience acquiring [insert CDC program/product/service in question]?


  • Is there anything you think should be included in [insert CDC program/product/service in question] that does not currently exist?


  • Please share any suggestions you have for improving the design of [insert CDC program/product/service in question]?


  • Please share any suggestions you have for improving the usability of [insert CDC program/product/service in question]?


  • What was the main purpose of your using [insert CDC program/product/service in question]?


  • What, if anything, did you learn by using [insert CDC program/product/service in question]?


  • What surprised you the most about your overall experience using [insert CDC program/product/service in question]?


  • What surprised you the least about your experience using [insert CDC program/product/service in question]?


  • What did you expect from [insert CDC program/product/service in question] that disappointed you when you found it was unavailable?


  • What would you like to see from [insert CDC program/product/service in question] in the future?


  • How useful was [insert CDC program/product/service in question]?


  • Is the [insert CDC program/product/service in question] up to date?


  • Who do you think would find [insert CDC program/product/service in question] most useful?


  • What is the best way to inform other [user type] that [insert CDC program/product/service in question] exists?


  • In 2-3 brief sentences, please describe your experience with [insert CDC program/product/service in question]


  • What’s the biggest barrier/challenge to using [insert CDC program/product/service in question]?

  • Is there anything that might make it easier to use [insert CDC program/product/service in question]?


  • What are the three most important things CDC can do to improve the delivery of [insert CDC program/product/service in question] in the future?


  • Would you recommend [insert CDC program/product/service in question] to anyone? Who? Why?


Please describe any programs, products, or services you would like to have or like to be able to use to address [insert health, communication, or marketing topic/challenge] that are currently unavailable to you.

  • How would [insert program, product, or service identified by respondent] help you?

  • If [insert program, product, or service identified by respondent] were developed, why would it be beneficial?

  • Are there any potential problems or challenges you might foresee with [insert program, product, or service identified by respondent]? Please explain why you think these problems or challenges might arise.

  • In what aspect of your job does [insert CDC program/product/service in question] assist you the most?


I want you to think about a time when you [insert description of health, communication, or marketing topic/challenge].

  • What was good about the experience?

  • What was not so good?


I want to understand how decisions are made in your group/organization about which program, product, or service to use to address [insert health, communication, or marketing topic/challenge]. Who are the primary people you interact with? How? Why?


Explain to me the step involved in adopting a program, product, or service to address [insert health, communication, or marketing topic/challenge]. Where or from whom do you need to obtain approval?


How would you describe your role with regard to [insert health, communication, or marketing topic/challenge]?

  • Is there anything that would make it more useful?


What types of programs, products or services do you typically use to address [insert health, communication, or marketing topic/challenge]?


What types of programs, products or services do you rarely use to address [insert health, communication, or marketing topic/challenge]?


In your opinion, what makes [insert respondent’s response for program/product/service used regularly] more appealing than [insert respondent’s response for program/product/service rarely used]?


If you were going to design a program/product/service to address [insert description of health, communications, or marketing challenge], what key features would it need to have?

  • In your opinion, why are these features important to include?


Customer Service

  • How satisfied are you with the following customer service aspects of [insert CDC program/product/service in question]’s delivery?



Very

Unsatisfied

Very Satisfied

Not Applicable


- -

-

+ -

+

+ +


    • Representative/website/1-800#’s ability to resolve questions about [insert CDC program/product/service in question]

    • Representative/website/1-800#’s ability to resolve questions about accessing [insert CDC program/product/service in question]

    • Representative/website/1-800#’s ability to resolve questions about obtaining [insert CDC program/product/service in question]

    • Representative’s level of professionalism

    • Representative’s level of courtesy

    • Representative’s level of knowledge

    • Overall impression of customer service during [insert CDC program/product/service in question] acquisition process

Program/Product/Service

How would you rate the following aspects of [insert CDC program/product/service in question]’s delivery?



Very Poor



Very Good

Not Applicable


- -

-

+ -

+

+ +


    • Convenience

Was it easy/hard for you to find?

    • Accessibility

Was it easy/hard for you to obtain?

    • Timeliness

Was it delivered in the amount of time promised?

    • Overall impression of [insert CDC program/product/service in question]’s delivery




How satisfied are you with the following elements of [insert CDC program/product/service in question]’s?



Very

Unsatisfied

Very Satisfied

Not Applicable


- -

-

+ -

+

+ +


    • [insert CDC program/product/service in question] content

    • [insert CDC program/product/service in question] design

    • [insert CDC program/product/service in question] usability

    • [insert CDC program/product/service in question] quality

    • [insert CDC program/product/service in question] overall



Please rate [insert CDC program/product/service in question] on the following:



Very

Unsatisfied

Very Satisfied

Not Applicable


- -

-

+ -

+

+ +


    • Accuracy of content

    • Freshness of content

    • Quality

    • Usefulness

    • Convenience

    • Ability to help you get your job done

    • Ease of use

    • Clarity

    • Organization

    • Response time (if needed)

    • Consistency of [program/product/service] provision

    • Reliability of [program/product/service] provision

    • Overall [program/product/service] satisfaction




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File Modified2008-04-24
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