H1_Variables collected

PATIENT, PROVIDER AND CLINIC SURVEY MEASURES

Examples of Patient Survey Questions and Constructs

Measures	Survey Items
Patient Characteristics	Date of birth (age) Hispanic or Latina origin Race Marital status Highest level of schooling Type of health insurance Birth country and year moved to US if foreign-born Language normally spoken at home
Experience with this Clinic	How often visited this clinic for own health care in the past year This is the clinic used most of the time when need to see a doctor Number of times had a Pap test at this clinic Whether visited other clinics in the past year for your health care
Care at this Clinic – Attitude Scale	Rate how you feel about the health care that you have received from this clinic: Good – Bad Comforted – Worried Safe – Unsafe Satisfied – Dissatisfied
Pap History	Number of times had a Pap test over lifetime How often get Pap tests Ever had Pap test that was not normal. If yes, most recent abnormal Pap. After last Pap test, when told to come back for next Pap test
Pap Knowledge Scale	Do you agree or disagree that the Pap test is used to check for: Pregnancy HIV/AIDS Gonorrhea Chlamydia Human Papillomavirus (HPV) Cervical cancer Vaginal cancer Yeast Infections Vaginal Infections
High Risk Behaviors	Age at first vaginal sex Number of partners had vaginal sex with in your entire life, and last 12 months Ever have a sexually transmitted infection or STD Ever have genital warts Cigarette smoking
Ever heard of HPV & information sources	Ever heard of HPV If yes, whether learned about HPV from a list of 18 possible sources.
HPV Knowledge Scale	Opinions about HPV: There are many types of HPV HPV causes HIV/AIDS Antibiotics can cure HPV You can always tell when someone else has HPV HPV can cause abnormal Pap tests Only women get HPV HPV causes herpes HPV affects your ability to get pregnant HPV is a virus Once you get HPV, you always have it There are types of HPV that cause genital warts HPV can be cured HPV is spread on toilet seats HPV is a sexually transmitted infection There are types of HPV that cause cervical cancer HPV may go away by itself You can get HPV through poor personal hygiene Even if you do not see a wart, you can still give HPV to someone else Using a condom will decrease the chance of giving HPV to someone else Lots of people have HPV You can have HPV for a long time without knowing it You can have more than one type of HPV
Previous HPV Test Use	Had HPV test with last Pap test. If yes, HPV test result. Ever told had HPV infection
Previous HPV Test - Attitude Scale	How did you feel after getting the result of your HPV test: Good – Bad Worried – Relieved Happy - Unhappy
HPV Testing Today - Attitude Scale	Getting an HPV test the next time you have a Pap would be: Good – Bad Useless – Useful Comforting – Worrying Wise – Foolish
HPV Testing Today - Beliefs Scale	Getting an HPV test the next time you have a Pap: Would give you peace of mind Would tell you whether you need to worry if your Pap is abnormal Would be an unnecessary extra cost Is something your doctor thinks you should have Would give you the best care available
Screening interval - Intention	If your health care provider recommends that you have your next Pap test in 3 years, how likely are you to wait that long?
Screening interval - Attitude Scale	How do you feel about the idea of waiting to have your next Pap test in 3 years if that is what your health care provider recommends that you do? Good – Bad Useless – Useful Comforting – Worrying Wise – Foolish
Screening interval - Beliefs Scale	Do you think that waiting 3 years for your next Pap test: Would save you money Would cause you to worry about getting cervical cancer Would give you peace of mind Is something your doctor thinks you should do Would mean you would not get other health care that you need Would increase your chance of getting cervical cancer Would save you time
Indirect/direct cost to patient for clinic visit	Time cost: Clinic wait; travel time; employment status; Wage; Travel cost: Transportation mode and costs Child care cost: Amount paid when go to clinic Direct payment of patient to clinic for visit
Items added at follow-up surveys to measure Pap History & Screening Interval
Pap History & Screening Interval	When told to come back for next Pap at baseline study contact Number of Paps since baseline Most recent Pap was at baseline clinic Months since most recent Pap Abnormal Pap result since baseline. If yes, number of months since abnormal. After baseline, when did you expect to get next Pap.

Table 2: Examples of Provider Questions and Constructs

Measures	Survey Items
Provider Characteristics	Age; Gender; Ethnicity; Race; Type of clinician; Primary and Secondary clinical specialties; Number of years providing clinical care; Number of primary care outpatient settings where currently practice; Hours spent in direct patient care; Percent of professional time spent the following: primary care, subspecialty care, research, teaching, administration or other.
Clinic Practice / Patient Characteristics	Years in practice at this clinic; Hours per week spent on outpatient care at this clinic; Number of patients seen at this clinic in a typical week; Percentage of these patients that are female; Percentage of these female patients by age group; Number of adult female patients seen for routine or well-woman exams in typical week
Cervical Cancer Screening Practices	Number of screening Paps personally perform in typical month. Percent with abnormal or borderline cervical cytology? Follow-up care for ASC-US Cervical colposcopy performed at this clinic, by this provider Cytology methods used: conventional Pap, liquid-based Pap test, other Factors considered in to use of conventional versus a liquid-based Pap: List of 9 items
Importance of Annual Exam Scale	Indicate the extent to which you agree or disagree with the following: An annual exam is necessary An annual exam improves detection of subclinical illness An annual exam improves patient-physician relationships An annual exam is expected by most patients An annual exam is covered by many insurance plans An annual exam is of little or no proven value An annual exam is recommended by national organizations An annual exam provides a valuable time to counsel on preventive health behaviors
Content of Routine Exams	Examinations and lab tests routinely performed or recommended during health maintenance exams. List of 9 examinations and 7 lab tests.
Risk Assessment Approaches	How often you take each approach during an exam: I rely on cues I rely primarily on the patient’s Pap test history I pursue a discussion of risks for all patients in certain demographic groups I ask specific questions to see if the patient engages in risky behaviors I ask questions about sexual and behavioral risk I depend on my professional intuition or judgment I depend on my knowledge of each patient
STD exposure	Number female patients you see with any STD (including HIV) in a typical month
HPV Experience	Among patients who are over age 30, how often use HPV DNA testing: With the Pap test for routine cervical cancer screening As a follow-up test for an ASC-US Pap test? Among patients who are under age 30, how often use HPV DNA testing: With the Pap test for routine cervical cancer screening As a follow-up test for an ASC-US Pap test? In last month, number of patients who asked if they could or should be tested for HPV.
HPV Testing - Attitude Scale	Conducting HPV testing along with Pap testing for screening in women over age 30 is: Good – Bad Difficult – Easy Beneficial – Harmful
HPV Testing - Belief Scale	Conducting HPV testing along with Pap testing for screening in women over age 30: Is not needed because my patients have access to colposcopy Helps me determine appropriate screening intervals Is not needed because most of my patients have 3+ prior normal Pap tests Would necessitate a difficult discussion with the patient Helps me determine a plan for follow-up Is costly to patients Takes too much of my time Does not provide any more useful information Helps me explain cervical cancer risk to patients Gives me understanding of a patient’s risk for disease Is the best way to screen for cervical cancer Is only needed for high risk patients Is a test my patients would not want Would be an extra burden for my office staff
HPV Testing - Social Support Scale	Please indicate the extent to which you feel that the following individuals or entities encourage or discourage you to conduct HPV testing along with Pap testing for routine screening in women over age 30: Your patients Your colleagues Your professional organization National/local health organizations Professional journals Administration in your practice
Discussion with Patients who are HPV Positive and Pap Normal - Belief Scale	Discussing with patients the results of a positive HPV test and a normal Pap test would: Make many patients feel uncomfortable Reduce the willingness of patients to seek care Increase the likelihood that patients will return Distract attention from cervical cancer prevention Raise patients’ concerns about confidentiality Raise patients’ concerns about partner fidelity Make me feel uncomfortable Take too much time Assure patients they are getting the best standard of care Be too complex for most of patients to understand Encourage patients to talk openly about sexual health with their partners
Discussion with Patients who are HPV Positive and Pap Abnormal - Beliefs Scale	Discussing with patients the results of a positive HPV DNA test and an abnormal Pap test would: Same options as above.
Educate Patient about HPV Scale	When you order an HPV DNA test along with a Pap test, how often do you: Tell the patient that you are ordering an HPV DNA test? Explain the purpose of an HPV DNA test in relation to the Pap test? Explain that the HPV DNA test detects an STI? Discuss how HPV DNA test results may affect future Pap tests?
Screening Interval with 3 Normal Paps – Attitude Scale	Deciding to extend the cervical cancer screening interval to 3 or more years because a woman over age 30 had received 3 normal Pap results the last 5 years would be: Good – Bad Difficult – Easy Beneficial – Harmful
Screening Interval with Negative HPV and Normal Pap – Attitude Scale	Deciding to extend the cervical cancer screening interval to 3 or more years because a woman over age 30 had received a normal Pap result and negative HPV test would be: Same options as above.
Screening Interval with 3 Normal Paps – Belief Scale	Extending the screening interval to 3 or more years between tests for a 30 year old with 3 normal Pap results the past 5 years would: Result in the patient not visiting annually for other tests Put me at risk for liability if the patient’s next result is abnormal Put the patient at increased risk for cervical cancer Help reduce health care costs Increase patient concerns about missing cervical cancer Take too much of my time to explain to the patient Reduce patient worries about acquiring cervical cancer Result in higher cervical cancer rates Cause patients to lose contact with the medical care system Decrease care provided to the patient
Screening Interval with Negative HPV and Normal Pap – Belief Scale	Extending the screening interval to 3 or more years between tests for a 30 year old with a normal Pap result and a negative HPV test. Same options as above.
Screening Interval with 3 Normal Paps – Social Support	Please indicate the extent to which you feel that the following individuals or entities encourage or discourage you to extend the screening interval to 3 or more years between tests for a 30 year old with 3 normal Pap results the past 5 years. Your patients Your colleagues Your professional organization National/local health organizations Professional journals Administration in your practice
Screening Interval with Negative HPV and Normal Pap – Social Support	Please indicate the extent to which you feel that the following individuals or entities encourage or discourage you to extend the screening interval to 3 or more years between tests for a 30 year old with a normal Pap result and a negative HPV test. Same options as above.
Screening Interval – Decision Making	List of 19 factors the provider might consider in deciding whether or not to extend the cervical cancer screening interval to greater than one year for a woman over age 30?
HPV Vaccine	Whether provider currently recommends vaccine; To what age groups; Plan to recommend vaccine; Reasons do not recommend; Plan to change cervical cancer screening and management based on vaccination status; How determine when to start routine screening for vaccinated; How often screen vaccinated women; Use HPV test to manage abnormal Pap results for vaccinated; Patients asking about vaccination; Vaccinating females will lead to the following: (a) fewer numbers of abnormal Paps, (b) fewer referrals, fewer CIN results.
Education & Guidelines	Personally follow published guidelines for cervical cancer screening and management. Which guidelines. Clinic has implemented guidelines for cervical cancer screening and management. Which guidelines. Able to access these practice guidelines in an electronic format. Whether learned about HPV through a list of 10 sources. Currently provide patients educational materials regarding cervical cancer screening. Have an individual affiliation with a medical school. Last time participated in a CME on cervical cancer screening.

Table 3: Examples of Clinic Survey Questions and Constructs

Measures	Survey Items
Clinic Characteristics	Number of patients seen; Number that are females age 18 and older; Number of these females that are seen for routine or well-woman exams; Distribution of insurance payments; Age distribution of female patients; Ethnic and racial composition of female patients; Type of reminder system for routine Pap screening
Cost of Training	Number of staff and number of hours spent by provider type
Cost of Patient Testing	Number of staff and number of hours spent by provider type
Cost of Evaluation Activities	Number of staff and number of hours spent by provider type

Attachment H1. Variables collected 7