Attachment C -- Oral meds for Type 2 diabetes consumer guide _ feedback survey for people with type 2 diabetes

Form Approved OMB No. 0935-0128 Exp. Date XX/XX/20XX

Thank you for taking the time to tell us what you think about the Pills for Type 2 Diabetes: a Guide for Adults consumer summary guide. The information you provide will help us to improve current and future guides. You may choose not to answer any question, and your responses are completely anonymous. No information that could be used to identify you will be collected. The average time required to complete this survey is 5 minutes.

0. Please choose ONE statement that best describes you:
	I am a health care professional who provides care to people with Type 2 diabetes
	I am a health care administrator or policymaker
X	I have Type 2 diabetes
	I am the caregiver, family member or friend of someone with Type 2 diabetes
	Other ---> Please describe yourself
1. Did you trust the information in the Pills for Type 2 Diabetes: A Guide for Adults guide?
	Yes
	No ---> Why not?
2. Did you learn anything new about the benefits of the different pills for Type 2 diabetes?
	Yes, a lot
	Yes, some
	No
3. Did you learn anything new about the risks or side effects of the different pills for Type 2 diabetes?
	Yes, a lot
	Yes, some
	No
4. How useful was the cost information?
	Very useful
	Somewhat useful
	Not very useful ---> Why not?

Public reporting burden for this collection of information is estimated to average 5 minutes per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0128) AHRQ, 540 Gaither Road, Room #5036, Rockville, MD 20850.

5. Would the guide help you to talk with a doctor or nurse about pills for Type 2 diabetes?
	Yes
	No ---> Why not?
6. Would the guide help you to make a decision about choosing or changing pills for Type 2 diabetes?
	Yes
	No ---> Why not?
7. Overall, how useful to you was the information in this guide?
	Very useful
	Somewhat useful
	Not very useful ---> Why not?
8. Would you recommend this guide to others?
	Yes, definitely
	Not sure ---> Why not?
	No ---> Why not?
9. Would you like to give us any other comments or thoughts about the guide?
10. How did you find this guide about pills for Type 2 diabetes?
	Internet search
	Link from another website ---> Which website?
	Clinic or doctor's office
	Friend/family
	Magazine, journal, or newsletter ---> Please describe
	Other ---> Please describe
11. Are you:
	Male
	Female
12. What is your age?
	Younger than 18
	18-29
	30-39
	40-49
	50-59
	60-69
	70-79
	80 or older
13. What is the highest level of education you have completed?
	Some high school
	Graduated high school or GED
	Some college, no degree
	Associate's degree
	Bachelor's degree
	Master's, professional, or doctoral degree
14. How would you rate your current health status?
	Very Poor
	Poor
	Fair
	Good
	Very Good
	Excellent
15. Do you have health insurance that covers all or part of the costs for pills to treat Type 2 diabetes?
	Yes
	No
16. Are you Hispanic or Latino/Latina?
	No
	Yes
17. What is your race? Please select one or more.
	American Indian or Alaska Native
	Asian
	Native Hawaiian or other Pacific Islander
	Black or African American
	White