Attachment H -- Osteoporosis decision aid feedback questionnaire

Tell Us Who You Are

Please choose ONE statement that best describes you:

 I am a woman who has osteoporosis

 I am the caregiver, family member or friend of a woman with osteoporosis

 I am a health care professional who provides care to women with osteoporosis

 I am a health care administrator or policymaker

 Other  Please describe yourself

(Responses to this question will be used to describe the types of people who view the decision aid, as well as to identify surveys from women with osteoporosis, the group from which we are primarily interested in obtaining feedback.

Note: This screen has not been added to the test version at the time of this submission. However, it will be added before the decision aid is finalized.)

The next four screens contain the feedback survey that can be done after completing the decision aid.

Screen 34

Note: If respondents answered previously, “Yes” they were taking an osteoporosis medicine, question 6 in the feedback survey will be, “After going through the decision aid, are you planning to switch medicines?”