Form Approved
OMB No: 0920-0956
Public reporting burden (completion time) for this collection of information is estimated to average 20 minutes per session. This includes the time it takes to review instructions, and gather and maintain the data needed. An agency can 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. Please send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta Georgia 30333; ATTN : PRA (0920-0956)
Exp. Date: March 13, 2016
The Centers for Disease Control and Prevention (CDC) is interested in getting your feedback on its public information that will be presented to you during the survey. Your participation in this survey is voluntary. You can choose to end your participation at any time.
Please tell us about yourself.
Screener.
In which of the following categories does your age fall?
under 18 years of age (TERMINATE)
18-24 years of age (CONTINUE)
_25-34 years of age (CONTINUE)
_35-44 years of age (CONTINUE)
_45-54 years of age (CONTINUE)
_55-64 years of age (CONTINUE)
_65-74 years of age (CONTINUE)
_75 years of age or older (CONTINUE)
Gender
Male
Female
Programming note: 50/50 male/female split
a. What is your ethnicity?
Hispanic or Latino
Black or African American
b. What is your race? Mark all that apply.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Which of the following most closely describes your field of work?
Physician
Nurse
Health policy
Public health department
Other public health professional
None of the above [Terminate]
Quotas: Physician = 56, nurse = 56, Health Policy = 20, public health department = 20, Other public health professional = 20
What is your area of specialty?
ASK if Q4 = Physician
Programming
note: Insert drop down menu
Allergy and
Immunology
Anesthesiology/Pain medicine
Cardiology
Colon
and Rectal Surgery
Dermatology
Emergency Medicine
Family
Medicine
Gastroenterology
General Practice
Geriatric
Medicine
Gynecology
Gynecologic
Oncology
Hematology
Infectious Diseases
Internal
Medicine
Genetics
Neurology
Nephrology
Neonatology
Nuclear
Medicine
Obstetrics and Gynecology
Oncology (all
subspecialties)
Ophthalmology
Orthopedic
Surgery
Otolaryngology
Pathology-
Pediatrics
Physical
Medicine and Rehabilitation
Plastic Surgery
Radiation
Oncology
Radiology, Nuclear
Rheumatology
Occupational
Medicine
Surgery (all subspecialties)
Public Health and
General Preventive Medicine
Psychiatry
Neurology
Diagnostic
Radiology
Medical Physics
Urology
Other – Terminate
What type of nurse are you?
ASK if Q4 = Nurse
What is your job title?
[ASK if Q4 = Health policy, public health department, other public health professional]:
How many years have you worked in your field?
Less than 4 years
5 – 10 years
11- 20 years
Over 20 years
Do you agree to participate in the study?
Yes
No (Terminate)
Please read this page on [insert material topic] and answer the next set of questions. The links on the page do not work because we want your feedback on this page only.
Who do you think this document is written for?
What is the main message in [insert material description]? Please type in your answer below.
Does this page use any words or phrases that would be confusing or unclear to your colleagues, or others like you?
Yes If yes, please highlight these words on the page
No
Does this page use any numbers that would be confusing or unclear to your colleagues, or others like you?
Yes If yes, please highlight these numbers on the page
No
How difficult or easy is it to find information on these pages that is most important to you?
1 |
2 |
3 |
4 |
5 |
Very difficult |
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Very easy |
Please highlight the information that is most useful to you.
In your opinion, how useful is this information for learning about [the issue]?
1 |
2 |
3 |
4 |
5 |
Not at all useful
|
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Very useful |
How difficult or easy is it to understand this information?
1 |
2 |
3 |
4 |
5 |
Very difficult
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Very easy |
Would you recommend this information to others who need information about [the problem].
Yes
No -- If no, why not?
What do you think of the length of the material you just reviewed?
1 |
2 |
3 |
4 |
5 |
Too long
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Too short |
What do you think about the amount of material you just reviewed?
1 |
2 |
3 |
4 |
5 |
Too much
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Too little |
After someone reads this document, what does CDC want them to know or do?
In your opinion, what would have made this information easier to understand?
How frequently do you use CDC’s web site?
Daily
Weekly
Monthly
A couple of times a year
About once a year
I've never visited the CDC web site [ If “f”, survey ends here.]
I would rate the readability of the pages on CDC’s website as:
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
Poor |
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Excellent |
I can find information easily on CDC’s web site.
Strongly agree
Agree
Disagree
Strongly disagree
I usually spend too much time looking for information I need on CDC’s web site.
Strongly agree
Agree
Disagree
Strongly disagree
You have completed the survey. Thank you for participating!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Deliya Banda |
File Modified | 0000-00-00 |
File Created | 2021-01-28 |