Form 2 Survey

Evaluation of the NIAID HIV Vaccine Research Education Initiative (NHVREI)

Attachment C InfluencerSurvey_1-20-10

Key Influencer Survey Instrument - Time 2

OMB: 0925-0611

Document [doc]
Download: doc | pdf

OMB No. XXXX-XXXX
Expires XX/XX/20XX

ATTACHMENT C

KEY INFLUENCER SURVEY INSTRUMENT

National Survey on Knowledge, Attitudes, and Behaviors

Related to HIV Vaccine Research


We need your assistance to improve our understanding of attitudes related to HIV vaccine research. In appreciation for your assistance, a gift code worth $25 at Amazon.com will be provided to you at the end of this survey.


More than 1,000,000 Americans are thought to be infected with Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immune Deficiency Syndrome (AIDS). The National Institute of Allergy and Infectious Disease (NIAID) at the National Institutes of Health (NIH) is working with researchers to develop a vaccine that prevents HIV infection. Survey data will guide efforts to educate the public about clinical trials, which are a necessary part of the development of an effective vaccine.


You have been selected for participation in this survey because of your affiliation with [ORG NAME], which serves communities that are highly impacted by HIV/AIDS.


Your personal information will be protected to the fullest extent permitted by law. Your answers will be stored separate from your identifying information in a secure environment. During analysis, survey answers will be combined across all respondents and reported in the aggregate. NIAID, the NIAID HIV Vaccine Research Education Initiative and your employer will not be informed of your personal responses to survey questions.


Your participation in this survey is voluntary. Though there are no penalties for not responding to the survey, if you do not respond, the survey finding may not represent your point of view and the final results may be inaccurate.


In about a year we will ask you to fill out a similar survey in order to assess your attitudes at that time.


If you have any questions about the survey, please contact Dan Eckstein:


DEckstein@novaresearch.com

NOVA Research Company

4600 East-West Highway, Suite 700

Bethesda, MD

(301) 986-1891


Public reporting burden for this collection of information is estimated to average 20 minutes per response. This time includes the length of time allotted for the survey questions. 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN; PRA (0925-0585). Do not return the completed form to this address.


  1. What is your current position with respect to [qualifying organization]?

Board Member


Executive Officer


Program Manager/Project Director


Outreach Worker/Field Worker


Other (specify):     



  1. How long have you been associated with this organization?

More than 1 year

Less than 1 year



Now we are going to ask you some questions related to HIV/AIDS.



Awareness

  1. How recently have you heard or read about research efforts to develop a vaccine that prevents HIV infection? HIV is the virus that causes AIDS.


Less than 1 year ago


1 year or more ago


I heard about it but I don’t know when


Not sure if I ever heard about it


Never heard of it

SKIP to 4


    1. From which sources have you read of or heard about research efforts to develop a vaccine that prevents HIV? (Check all that apply).

  1. TV


ii. Radio


iii. Newspaper or Magazine



iv. Internet:



Wiki



Nonprofit Web site



Government Web site



Social Networking Web site

(e.g., Facebook, Twitter)



Blog


v. Non-work-related interpersonal contact (discussion, email)


vi. E-mail listserv


vii. Work-related duties (e.g., presentations, healthcare outreach, community work) or interests promoted at work


viii. Workshop, health fair, brochure, program, or any other activity sponsored by an agency in your community

(specify):


     

ix. Presentation at professional conference/meeting

(specify):


     

x. Other (specify):     


xi. Don’t know




  1. Have you seen “Be The Generation” materials or “Be The Generation” Web Site?

(Check all that apply).


Yes


No

SKIP TO 5



  1. Did you hear of “Be The Generation” through your work? (Check all that apply).

No, I didn’t hear of “Be The Generation” through my work

SKIP to 5

Yes, I’ve heard of “Be The Generation” through my work, but I have not used these materials

SKIP to 5

Yes, I use these materials in my work now


Yes, I’ve used these materials in the past


Other (specify):     



  1. How has your organization used “Be The Generation” materials?

(Check all that apply).

  1. Distributed link to website


  1. Distributed hard copy materials


  1. Played “Community Voices” video for constituents


  1. Other (specify):     )


  1. Don’t know



Attitudes

  1. How relevant is the topic of HIV vaccine research to you, your friends and family, and the community served by [qualifying organization]?

(Check one response in each row).


How relevant is HIV vaccine research to…


Not Relevant

At All

Slightly Relevant



Somewhat Relevant


Very Relevant

Extremely Relevant

Don’t Know

  1. You?

  1. Your family?

  1. Your friends?

  1. Co-workers?

  1. The community served by [qualifying organization]?


  1. How much do you agree or disagree with each of the following statements?

(Check one response in each row).



Strongly Disagree

Some-what Disagree

Don’t Know/ Neither Agree Nor Disagree

Agree

Strongly Agree

  1. I am confident that an effective vaccine for HIV will be developed.

  1. An HIV vaccine is being unfairly withheld as part of discrimination against certain groups.

  1. Volunteers in HIV vaccine trials may become infected with HIV acquired from the vaccine.

  1. I am confident that HIV vaccine clinical trials staff take good care of volunteer participants.

  1. I am concerned that volunteers in an HIV vaccine clinical trial may put their own good health at risk.

  1. Spreading the word about the importance of HIV vaccine research conflicts with outreach on HIV/AIDS prevention.

  1. Development of an HIV vaccine has been delayed because a vaccine would not be profitable for drug companies.

  1. Procedures established in HIV vaccine research are adequate to protect volunteers.

  1. HIV vaccine clinical trial volunteers are counseled to avoid behaviors that can result in exposure to HIV.

  1. The only way to support HIV vaccine research is to volunteer for a clinical trial.

  1. HIV vaccine clinical trials seek only volunteers who are high risk of exposure to HIV.

  1. The benefits of participating in an HIV vaccine clinical trial outweigh the burden or risks of participation to the individual.

  1. If I support HIV vaccine research, it will hurt me socially and/or professionally.

  1. I would feel comfortable initiating conversations about the importance of HIV vaccine research.



  1. How open are the people around you to supporting HIV vaccine research? How open are… (Check one response in each row).


Not at All Open

Not Very Open

Somewhat Open


Very Open

Extremely Open

Don’t Know

a. Your family?

b. Your friends?

c. Co-workers?

d. The community served by [qualifying organization]?



  1. How important is it to you to increase support for HIV vaccine research?

(Check one response in each row).




Not at All Important

Not Very Important

Somewhat Important

Very Important

Extremely Important

Don’t Know




IF you checked “Not at All” or Not Very” Important, SKIP to Question 9.


a. How confident are you that you are able to increase support for HIV vaccine research among… ?

(Check one response in each row).



Not at All Confident

Not Very Confident



Somewhat Confident


Very Confident

Extremely Confident

  1. Your family?

ii. Your friends?

iii. Your co-workers?

iv. The community served by [qualifying organization]?



  1. How much do you agree or disagree with the following statements?

(Check one response in each row).


Strongly Disagree

Somewhat Disagree

Don’t Know/

Neither Agree Nor Disagree

Somewhat Agree

Strongly Agree

a. I have the skills needed to spread the word about the importance of HIV vaccine research.

b. I have the knowledge needed to spread the word about the importance of HIV vaccine research.

c. I have the resources and materials to spread the work about the importance of HIV vaccine research.

d. I have the opportunity to speak out about the importance of HIV vaccine research.



  1. How willing would you be to…

(Check one response in each row).



Not at All Willing

Not Very Willing

Somewhat Willing


Very Willing

Extremely Willing

Don’t Know

  1. Provide emotional support for someone participating in a vaccine trial?

  1. Participate in a clinical trial for an HIV vaccine (assuming it was nearby and you were eligible)?

  1. Recommend to a friend that they volunteer for an HIV vaccine trial?

  1. Initiate a conversation with clients of [qualifying organization] about the importance of HIV vaccine trials?

  1. Encourage clients of [qualifying organization] to volunteer for an HIV vaccine trial?



Activities Supportive of HIV Vaccine Research

  1. Have top administrators of [qualifying organization] requested or received a briefing regarding the status of HIV vaccine research?

(Check one response).


Yes

No

Don’t Know



  1. Have you personally provided information on HIV vaccine research to top administrators of [qualifying organization]?


Yes

No

Don’t Know



  1. Have the staff of [qualifying organization] received in-service training related to HIV vaccine research?


Yes, on site

Yes, off site

No

Don’t Know



  1. Has [qualifying organization] raised awareness of HIV vaccine research as an important strategy for controlling the AIDS epidemic? (Check one response).


Yes How (specify):      

No

Don’t Know



  1. Does [qualifying organization] provide information about HIV Vaccine Research through…

(Check one response in each row).

Type of Media

Yes

No

Don’t Know

a. The Internet?

b. Hard copy materials?

c. Presentations/ conferences/health fairs?

d. Mass media news releases?

e. Church communities?

f. Community events/festivals?

g. Universities and colleges?

h. Word of mouth?


  1. Have you personally provided information to others about HIV vaccine research through…

(Check one response in each row).


Type of Media

Yes

No

Don’t Know

a. Distributing materials?

b. Writing articles or papers?

c. Making presentations

d. Providing interviews?



  1. Have you personally championed support for HIV vaccine research within your organization? (Check one response).

Yes, more than one year ago

Yes, within the last year

No



  1. Have you personally taken a course or attended a workshop providing training on how to improve support for HIV vaccine research? (Check one response).



Yes, more than one year ago

Yes, within the last year

No



  1. In the last three months, about how many times have you engaged in the following activities? (Check one response in each row).




Not at All

Once or Twice

3 – 5 Times


6 – 8 Times

9 or More Times

  1. Initiated a conversation about HIV vaccine research

  1. Spoken with friends about HIV vaccine research

  1. Recommended to friends that they volunteer for HIV vaccine clinical trials

  1. Spoken to clients of [qualifying organization] about HIV vaccine research

  1. Encouraged clients of [qualifying organization] to volunteer for HIV vaccine clinical trials



  1. In the past year, have you worked with or obtained information from any of the following organizations? (Check all that apply in each row).




Obtained Info

Worked With

Other Contact

No Contact

Don’t Know

  1. NIAID HIV Vaccine Research Education Initiative (NHVREI)

  1. Academy for Educational Development (AED)

  1. AIDS Alliance for Children, Youth, and Families (AACHF)

  1. National AIDS Education and Services for Minorities (NAESM)

  1. AIDS Action Foundation (AAF)

  1. National Minority AIDS Council (NMAC)

  1. National Association of State and Territorial AIDS Directors (NASTAD)


Demographics

  1. What is your age? (Check only one).

Under 21 years

21-30 years

31-40 years

41-50 years

51-60 years

61-70 years

over 70 years



  1. What is your gender?

Male

Female

Transgender



  1. What is your ethnicity? (Check only one).

Hispanic or Latino

not Hispanic or Latino



  1. What is your race? (Check all that apply).

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White



  1. Which of the following categories best describes the highest educational level you attained? (Check only one).

Less than a high school degree

High school degree or GED

Some college/technical school/associates degree

College degree

Some graduate school or more

Other (specify):     


  1. In the United States, African Americans, Hispanics/Latinos, and men who have sex with men (MSM) are populations that have been disproportionately affected by HIV/AIDS. For this reason, NIAID is particularly interested in learning about communities with these characteristics.

Thinking about your social network (your clients, coworkers, friends and family), about how many are members of the following populations?



None

Some

Many

Most

Don’t Know

People Served by [qualifying organization]






African American

Hispanic/Latino

MSM

Coworkers






African American

Hispanic/Latino

MSM

Family






African American

Hispanic/Latino

MSM

Friends






African American

Hispanic/Latino

MSM



  1. Please add any other comments regarding HIV vaccine research of which you believe NIAID should be aware:

     





  1. We would like to gather information from other staff from [organization] who have direct contact with the constituents of [organization]. Would you be willing to provide us with the names of two people whom we could contact for participation in this survey?

Name Position Email Telephone

                       


                       

THANK YOU FOR YOUR ASSISTANCE

TO OBTAIN YOUR $25 HONORARIUM, CLICK ON THE LINK BELOW TO GO TO AMAZON.COM.


Page 1 of 13

File Typeapplication/msword
File TitleTable 1
File Modified2010-01-20
File Created2010-01-20

© 2024 OMB.report | Privacy Policy