Attachment 9: Follow-Up Questions
Follow-Up Questions
Form Approved
OMB No. 0920-0572
Expiration Date: xx-xx-xxxx
(Questions can be used for Central Location Intercept Interviews, Telephone Interviews, Individual In-depth Interviews [Cognitive Interviews], Focus Group Screeners, and Focus Groups.)
Does this message make you want to do anything?
Does this motivate you to take action?
Would this make you interested in finding out about [INSERT health topic or behavior] in your community?
Would it make you think more about the importance of [INSERT health topic or behavior]?
Would it make you concerned about increasing [INSERT health topic or behavior]?
Would it make you want to [INSERT health topic or behavior]?
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]?
Would you change anything about your current routine after seeing this?
Do you plan to [INSERT health topic or behavior]?
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]?
Were there any tips on here that you would not follow or comply with? Explain.
Is there anything that could be changed to make it more likely you would be motivated to [INSERT health topic or behavior]?
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?
How likely would you be to talk about [INSERT health topic or behavior] with your family in the next week or so?
How likely would you be to talk about [INSERT health topic or behavior] with your friends in the next week of so?
Will you bring up the issue of [INSERT health topic or behavior] the next time you visit your healthcare provider?
Are you seriously considering [INSERT health behavior] within the next 6 months? SINGLE RESPONSE.
Yes
No
Are you planning to [INSERT health behavior] within the next 30 days? SINGLE RESPONSE.
Yes
No
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 [INSERT health behavior]? SINGLE RESPONSE.
Not at all interested
Extremely interested
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 [INSERT health behavior]? SINGLE RESPONSE.
0 Not at all confident
Extremely confident
On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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1
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If a score of 3 or less is entered for Statements 19f – 25f:
Please indicate why you disagree with the earlier statement, [INSERT statement from 19f – 25f]. (Check all the reasons that apply)
I don’t think it’s important
I don’t have time
I don’t have a way to pay for it
I’m afraid [of/to INSERT action]
I don’t have a health care provider
I would be embarrassed
I don’t trust [INSERT item]
I don’t want anyone to suspect I’m [INSERT action]
I wouldn’t know where to go [INSERT action]
I don’t know how to [INSERT action]
I don’t want my partner to find out
I’m not at risk for [INSERT DISEASE] (if this response is selected, provide “because” options)
Because I’m in a monogamous relationship
Because I’m not currently sexually active
Because I use protection
Because I’m careful about my partners
Other: ____________________
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
Thinking about the next 6 months, on a scale from 1 to 10, where 1 is not at all likely and 10 is extremely likely, how likely are you to…………?
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Not at All Likely 1 |
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5 |
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8 |
9 |
Extremely Likely 10 |
DK 88 |
RF 99 |
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On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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1
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On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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I’m going to read you a list of statements. For each one let me know if you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree.
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Strongly Disagree 1 |
Somewhat disagree 2 |
Neither agree or disagree 3 |
Somewhat Agree 4 |
Strongly Agree 5 |
DK 88 |
RF 99 |
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On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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1
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On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.
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Strongly Disagree |
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Strongly Agree |
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Before being contacted for this study, had you ever heard of CDC or the Centers for Disease Control and Prevention?
Yes
No
Before being contacted for this study, had you ever heard of the Department of Health and Human Services?
Yes
No
Before being contacted for this study, had you ever heard of the [INSERT organization name]?
Yes
No
Below is a list of environment and health topics covered on [INSERT website or resource]. Are there additional environmental hazards or health conditions you would like to see covered on the [INSERT website or resource] that aren’t today? If so, what are they?
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Demographic |
Author | Angela Ryan |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |