Follow-up Questions

Attachment 9: Follow-Up Questions

Revised June 21, 2010

This version includes:

• Minor modifications to existing questions, and

• Proposed new questions

Attachment 9: Follow-Up Questions

Form Approved

OMB No. 0920-0572

Expiration Date: 06-30-2011

Follow-Up Questions

(Questions can be used in intercept interviews, telephone interviews, individual in-depth interviews [cognitive interview], online research, and focus group discussion guides.)

1. Does this message make you want to do anything?

• Does this motivate you to take action?

2. Would it make you think more about the importance of [INSERT health topic or behavior]?

3. Would it make you concerned about increasing [INSERT health topic or behavior]?

4. Would it make you want to [INSERT health topic or behavior]?

5. Would it make you likely to do something about increasing [INSERT health topic or behavior]?

• What about the message makes you more or less likely to [INSERT health topic or behavior]?

6. Would you change anything about your current routine after seeing this?

7. Do you plan to [INSERT health topic or behavior]?

8. Doctors are interested in what they can say to motivate patients (or other parents) to [INSERT health topic or behavior]. What is your advice to them? That is, what should doctors tell people if they want them to [INSERT health topic or behavior]?

9. Where there any tips on here that you would not follow or comply with? Explain.

10. Is there anything that could be changed to make it more likely you would be motivated to [INSERT health topic or behavior]?

11. If you saw a [INSERT health topic or behavior] story (on television, in newspapers, or on the Internet], how likely would you be to pay close attention to it:

• Talk about [INSERT health topic or behavior] with your family in the next week or so

• Talk about [INSERT health topic or behavior]with your friends in the next week of so

• Bring up the issue of [INSERT health topic or behavior] the next time you visit your healthcare provider

Behavioral Intentions

[NEW QUESTIONS]

1. Are you seriously considering quitting smoking within the next 6 months? SINGLE RESPONSE.

1. Yes

2. No

2. Are you planning to quit within the next 30 days? SINGLE RESPONSE.

1. Yes

2. No

3. Overall on a scale from 1 to 10 where 1 is not at all interested and 10 is extremely interested, how interested are you in quitting smoking? SINGLE RESPONSE.

1. Not at all interested

10. Extremely interested

4. Overall, on a scale from 0 to 10, where 0 is not at all confident and 10 is extremely confident, how confident are you right now that you can quit smoking? SINGLE RESPONSE.

0 Not at all confident

10. Extremely confident

	Strongly Disagree				Strongly Agree
I intend to do something about [INSERT health topic or behavior]. I plan on looking into [INSERT health topic or behavior]. I mean to research [INSERT health topic or behavior]. I have thought about taking action to/for [INSERT health topic or behavior]. I have considered doing something about [INSERT health topic or behavior]. I will do something about [INSERT health topic or behavior]. I am taking action to/for [INSERT health topic or behavior] right now. Variants: After watching these ads, how likely are you to talk about [INSERT health topic or behavior] with your family in the next week or so? After watching these ads, how likely are you to talk about [INSERT health topic or behavior] with your friends in the next week or so? After watching these ads, will you bring up [INSERT health topic or behavior] the next time you visit your healthcare provider? Yes No	1 1 1 1 1 1 1	2 2 2 2 2 2 2	3 3 3 3 3 3 3	4 4 4 4 4 4 4	5 5 5 5 5 5 5

Involvement

	Strongly Disagree				Strongly Agree
The outcome of [INSERT health topic or behavior] directly affects my life. Whether or not people do something about [INSERT health topic or behavior] is important to my life. The outcome of [INSERT health topic or behavior] is relevant to my life. Whether or not others care about [INSERT health topic or behavior] is important to me. The problem of [INSERT health topic or behavior] is against my personal values. People who support [INSERT health topic or behavior] are against all I stand for. If I thought [INSERT health topic or behavior] was not a big deal, my friends would think poorly of me. I am fearful that my circle of friends would think I was dumb for caring about [INSERT health topic or behavior]. Whether I do something to improve [INSERT health topic or behavior] is central to how I view myself. How I handle [INSERT health topic or behavior] is central to my self-image. Handing the [INSERT health topic or behavior] actively is an important part of how I see myself.	1 1 1 1 1 1 1 1 1 1 1	2 2 2 2 2 2 2 2 2 2 2	3 3 3 3 3 3 3 3 3 3 3	4 4 4 4 4 4 4 4 4 4 4	5 5 5 5 5 5 5 5 5 5 5

Self-efficacy scale

	Strongly Disagree				Strongly Agree
I feel as though I can make a difference regarding [INSERT health topic or behavior]. The suggestions for dealing with [INSERT health topic or behavior] made in the message are doable. I personally could do the suggested [INSERT health topic or behavior] in the message. Helping improve [INSERT health topic or behavior] is a goal within my reach. I am confident that I can protect myself from [INSERT health topic or behavior].	1 1 1 1 1	2 2 2 2 2	3 3 3 3 3	4 4 4 4 4	5 5 5 5 5

Attitudes

The following questions ask about your opinion on [INSERT health condition/behavior/disease/syndrome/injury/disability]].

	Strongly Disagree				Strongly Agree
I think that [INSERT health condition/behavior/disease/syndrome/injury/disability] is a critical issue. People should make a strong effort to do something about [INSERT health condition/behavior/disease/syndrome/injury/disability]. People that do not do something about [INSERT health condition/behavior/disease/syndrome/injury/disability] are inconsiderate. People who do not care about [INSERT health condition/disease/syndrome/injury/disability] are being dumb.	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4	5 5 5 5

Response efficacy scale

	Strongly Disagree				Strongly Agree
Visiting the Web site/calling the number listed in the message is a good start to improving [INSERT health condition/disease/syndrome/injury/disability]. By doing the behaviors suggested by the message, the [INSERT health condition/disease/syndrome/injury/disability] can be improved. Generally speaking, it is possible to improve [INSERT health condition/disease/syndrome/injury/disability]. There are many things I can do to protect myself from [INSERT health condition/disease/syndrome/injury/disability].	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4	5 5 5 5

Self-protection motivation

	Strongly Disagree				Strongly Agree
I want to combat [INSERT health condition/disease/syndrome/injury/disability]. I want to have the ability to fight [INSERT health condition/disease/syndrome/injury/disability]. I want to prevent [INSERT health condition/disease/syndrome/injury/disability]. I really don’t care about [INSERT health condition/disease/syndrome/injury/disability].	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4	5 5 5 5

1. [Before being contacted for this study, had you ever heard of…] CDC or the Centers for Disease Control and Prevention?

• Yes

• No

2. [Before being contacted for this study, had you ever heard of…] the Department of Health and Human Services?

• Yes

• No

3. Before being contacted for this study, had you ever heard of the [INSERT organization name]?

• Yes

• No