HMTS Form - Sepsis R2 Testing wtih Consumers

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)

Sepsis Campaign Development: Round 2 Concept/Materials Testing with Consumers

2. Study Population: (Discuss study population and explain how they will be selected/recruited.)

Adults aged 18 years and older who are registered with an on-line panel provider and live in the following
states or district: GA, LA, MS, TN, Washington DC, NY, NJ, MO, IL or NV. Respondents will be
recruited using an on-line panel from these states.
Respondent characteristics:
Number of subject: 180

Number of males:

60

Age range: 18 and older

Number of females: 120

Racial/ethnic composition: Mix of ethnic and racial backgrounds
Special group status: (e.g., risk group, health care providers)
Type of group(s): Adults over 18 years of age
Geographic location(s): The following locations in the United States: GA, LA, MS, TN,
Washington DC, NY, NJ, MO, IL, NV.
3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

For the R2 research, we are requesting approval for incentives that will be point equivalent of $10 for all
consumers. Survey respondents will be those registered with an on-line panel provider. A token of
appreciation with a point equivalent of $10 will be given to redeem online or at a retailer (commonly
provided to survey panel respondents who complete on-line surveys). The "points" will not be sent from
CDC, but instead be provided by an on-line panel provider to respondents who complete the survey.

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no): No

Other (describe): Online (or Web-based) survey

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)

CDC requests OMB approval to collect information related to development of the sepsis awareness
building campaign. Information collected will inform revisions to draft campaign materials (developed
based on Round 1 formative research) and help ensure that the national campaign meets the needs of
intended target audiences.

6. Category of time sensitivity: (Please check one below)
Health emergency:
Time-limited audience access:
Press coverage correction:
Time-limited congressional/administrative mandate:
Trend Tracking
Ineffective existing materials due to historical event/social trends:
7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
Each year in the U.S., more than a million people are infected with sepsis and it is estimated that 28-50%
of those infected die each year from sepsis. The sepsis campaign provides information to raise knowledge
and awareness about the threat of sepsis. Because campaign launch is scheduled for fall of 2017, it is
critical to rapidly test initial campaign concepts and materials to ensure that they resonate with target
audiences prior to the campaign launch.

8. Number of burden hours requested: 24

BURDEN HOURS
Category of Respondent

No. of
Participation
Respondents Time

Burden

Consumers - Screener

180

5/60

15 hours

Consumers - Online Survey

18

30/60

9 hours

Totals
9. Are you using questions from the approved question bank?

198

24 hours

No

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)

*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation:
2. OADC confirmation of time-sensitivity:
Yes:
No:

Project Officer
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