Attachment D: OADC Message and Material Feedback Surveys — Screener Questions (text)
OADC Message and Material Feedback Surveys — Screener Questions (text)
Form Approved
OMB No. 0920-1050
Welcome
Welcome to the CDC Health Material Project!
You’re being asked to participate in a survey about a health material. We are conducting this survey on behalf of the Centers for Disease Control and Prevention (CDC), Office of the Associate Director for Communication (OADC).
Screener Questions
First, we want to see if you qualify.
We have a few
simple questions to ask. At some point, the questions may end if you
don’t qualify. This has nothing to do with you. We simply are
looking for people who meet certain criteria.
Please
tell us a little bit about yourself.
What year were you born? [End survey if participant is was born after 1997]
[textbox with validation for year between 1910 and 2015]
[new survey page]
What is your sex?
Male
Female
What is your ethnicity?
Hispanic or Latino
Not
Hispanic or Latino
What is your race? (Please select all that apply.)
White
Black or African American
Asian
Native Hawaiian or Other Pacific Islander
American Indian or Alaska Native
What is the highest level of education that you’ve completed?
Grade school
Some high school
High school graduate or completed GED
Some college or technical school
Received 4-year college degree
Some post-graduate studies
Received advanced degree
Other: ________________
Which of the following categories best describes your total, annual household income?
Under $20,000/year
$20,001 - $30,000/year
$30,001 - $40,000/year
$40,001 - $50,000/year
$40,001 - $50,000/year
$50,001 - $60,000/year
$60,001 - $80,000/year
$80,000 - $100,000/year
Over $100,000/year
Prefer not to answer
Are you comfortable looking at materials on a computer in English and giving your opinion on these materials in English?
Yes
No
Do you, or does any member of your household or immediate family, work for:
A market research company
An advertising or public relations firm
The
media (TV/radio/newspapers/magazines)
Have you participated in a feedback session (e.g., focus group or other research) within the past 6 months?
Yes
No
How confident are you filling out medical forms by yourself?
None of the time
A little of the time
Some of the time
Most of the time
All of the time
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Kelsey Jordan |
File Modified | 0000-00-00 |
File Created | 2021-01-25 |