Att D_BAA Consumer Survey PRESEST_Screenshots

Form Approved
OMB Control No.:
0920-0572 Expiration date:
8/31/2021
Public reporting burden of this collection of information is estimated to average 20 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. An
agency may 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. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA 0920-0572

Informed Consent
Before beginning the survey, there are a few things you should know.
On behalf of the Centers for Disease Control and Prevention (CDC), the research firm ICF is
conducting an online survey with adults from the community to gather feedback on educational
materials related to antibiotic use. These materials were developed in partnership with the CDC, and
we hope to use what we learn from these survey results to improve these materials and/or how and
where we promote them to raise awareness within your community. We expect this survey to take
about 20 minutes. You will only be asked to complete this survey once.
We want to learn from you, so we encourage you to answer honestly. There are no right or wrong
answers. If you agree to participate in the survey, here are some points to know:
Rights Regarding Participation: Your participation in this survey is completely voluntary. You may
choose to leave the survey and/or not answer a question at any time for any reason. Refusal to
participate will involve no penalty or loss of benefits.
Privacy: We will take every precaution to protect your identity and ensure your privacy. We will keep
your name and answers to these survey questions private. Your name and contact information will be
kept separate from any survey responses. We will never use your name in any reports.
Benefits: Your participation in the survey will not result in any direct benefits to you. However, your
input will help us to develop and improve educational materials about sepsis for people like you.
Risks: There is no known risk to you for your participation in the survey.
Contact Information: If you have any questions about this survey or the campaign, please contact the
research director, Kristen Cincotta, PhD, at 404-320-4433.
1. Do you agree to participate in the survey?
Yes
No

Termination
Thank you for your time. Click here to exit this survey.

Screener
The results of this survey will help the Centers for Disease Control and Prevention (CDC) refine its
ongoing campaign to improve antibiotic use by helping CDC staff understand the public’s response to
the campaign and its key messages. You will be asked to complete different versions of the survey
depending on whether you have seen or heard certain messages from the CDC about antibiotic use.
2. May we ask you some questions to see if you are a good match to take this survey?
Yes
No

3. How old are you?
[ ] Years
Prefer not to answer

4. In what ZIP code do you live?

5. What is your sex?
Male
Female
Other, please specify
Prefer not to answer

6. Have you visited an urgent care clinic for a medical concern to receive care at least one time in the past 2
months for yourself (not for the care of a loved one)? Urgent care clinics are freestanding clinics that treat
patients for unscheduled or walk-in illnesses or injuries but that DO NOT include a pharmacy (like a CVS or a
Walgreens), a store, or emergency department.
Yes
No
Not sure

7. When you visited an urgent care clinic, did you do so for an illness, an injury, or both?
Illness
Injury
Both
Don't know/cannot remember

8. Do you, your spouse or partner, or any other member of your household currently or in the past work for or
as:
Yes
A. A market research company
B. An advertising agency or public
relations firm
C. The media
(TV/radio/newspapers/magazines)
D. A healthcare setting or a health
and wellness organization (e.g.,
doctor’s office, clinic, hospital,
health department, fitness center)
E. A healthcare provider (e.g.,
doctor, nurse, pharmacist,
physician assistant, medical
assistant, dietician, aid, sitter,
social worker)

No

Termination: Ineligible
Thank you for your willingness to participate and answer our questions. Unfortunately, you do not
meet the criteria to continue with the survey. If you have any questionsabout your participation and/or
any questions about this survey, please contact the research director, Kristen Cincotta, Ph.D., at (404)
321-3211 orKristen.Cincotta@icf.com. Thank you for your time.

Eligible
Thank you for answering the questions. We have determined that you are a good match for this
survey. If you have any questionsabout your participation and/or any questions about this survey,
please contact the research director, Kristen Cincotta, Ph.D., at (404) 321-3211
orKristen.Cincotta@icf.com Thank you for answering the questions. We have determined that you are
a good match for this survey. If you have any questionsabout your participation and/or any questions
about this survey, please contact the research director, Kristen Cincotta, Ph.D., at (404) 321-3211
orKristen.Cincotta@icf.com.

Exposure to Campaign
Now we would like to ask you about a CDC campaign on improving antibiotic use that you may or may
not have seen or heard about in the past 12 months.
9. Please indicate below whether you have seen or heard any of following campaign names or slogans in the
past 12 months.
Yes

No

A. Get Ahead of
Antibiotics
B. Flip the Script
C. Be Antibiotics Aware
D. Get Smart About
Antibiotics
E. Don't Mis-take
Antibiotics

10. In the past 12 months, did you see this logo or hear the slogan on it anywhere?

Yes
No
Don't know/cannot recall

Don't know/cannot recall

Frequency and Channel of Exposure (Exposed)
You indicated that you had seen or heard the campaign name, Be Antibiotics Aware, or seen the
campaign logo in the past 12 months.
11. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in PRINTED MEDIA?

1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t
know/cannot
recall

Poster
Fact Sheet
Brochure
Graphic
Newspaper/magazine
advertisement
Flyer
Other Printed Media
(please specify)
Other printed media (please specify)

12. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo on SOCIAL MEDIA?

1-2 times a day
Facebook
Instagram
Twitter
LinkedIn
YouTube
Other Social Media
(please specify)
Other social media (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t
know/cannot
recall

13. In the past 12 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in ONLINE/INTERNET MEDIA?

1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t
know/cannot
recall

Health websites
/resources
Website advertisements
Online news articles
Streaming TV/video
services (e.g., Hulu,
Netflix, [Amazon] Prime
Video)
Blogs
Advertisements on
mobile phone (including
mobile apps)
Search engines (e.g.,
Google)
Other websites (please
specify)
Other Websites (please specify)

14. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in TV AND RADIO MEDIA?
1-2 times a day
Television (cable,
satellite, or antenna)
Broadcast radio
Other TV or
Radio(please specify)
Other TV or Radio (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t know/
cannot recall

15. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in PUBLIC PLACES?
1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t know/
cannot recall

Billboards
Bus, train, or subway
stations
On buses or taxi cabs
Advertisement in a mall
Advertisement in a
grocery store
Advertisement in a store
pharmacy (e.g., CVS,
Walgreens, Walmart)
Other public locations
(please specify)
Other Public Locations (please specify)

16. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in HEALTHCARE SETTINGS?
1-2 times a day
Videos/commercials
shown at doctor’s offices
or healthcare facilities
Other healthcare
locations (please
specify)
Other Healthcare Locations (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t know/
cannot recall

17. In the past 12 months, approximately how often did you see CDC’s Be Antibiotics Aware campaign
messages, campaign name, or logo in OTHER MEDIA?
1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Don’t know/
cannot recall

Emails
Email newsletters
Webcasts or webinars
Live events
Other media (please
specify)
Other Media (please specify)

18. You indicated that you saw or heard the campaign name, Be Antibiotics Aware, or saw the campaign logo
in the past 12 months. Where did you see or hear it?

Knowledge
19. Which types of infections do antibiotics treat? (select one)
Certain infections caused by viruses.
Certain infections caused by bacteria.
Certain infections caused by bacteria and viruses.
Don’t know

Knowledge (page 2)
20. Which of the following illnesses do antibiotics treat? (select all that apply)
Common cold

Urinary tract infection (UTI)

Influenza (flu)

None of the above

Pneumonia

Don’t know

Strep throat

Knowledge (page 3)
21. When antibiotics are not needed, taking antibiotics will still help.
True
False
Don't know

Knowledge (page 4)
22. Taking antibiotics can lead to side effects that could cause harm.
True
False
Don't know

Knowledge (page 5)
23. Which of the following are common side effects of antibiotics? (select all that apply)
Rash

Yeast infections

Nausea

None of the above

Diarrhea

Don’t know

Knowledge (page 6)
24. Which of the following statement(s) are true about antibiotic resistance? (select all that apply)
Antibiotic use can lead to antibiotic resistance.
Infections caused by antibiotic resistant germs are always easy
to treat with antibiotics.
Antibiotic resistance happens when germs – not your body become resistant to antibiotics.

Antibiotic resistant infections can require antibiotic treatment
that may cause more side effects.
None of the above
Don’t know

Knowledge (page 7)
25. When taking antibiotics… (select all that apply)
I should take my antibiotics exactly as my healthcare provider
prescribed.

It is ok to share my left-over antibiotics with a family member
or friend who is not feeling well.

It is ok if I skip doses of my antibiotics.

None of the above.

I can save left over antibiotics for later.

Don’t know

Knowledge (page 8)
26. Which of the following can help you feel better when you have a cold? (select all that apply)
Drink extra water and fluids.

Use honey to relieve cough for adults and children over the
age of 1.

Avoid overeating.
None of the above.
Use a cool mist vaporizer to relieve congestion.
Don’t know
Use a saline nasal spray to relieve congestion.

Attitudes and Beliefs
Next, we are going to ask you some questions to learn more about your perspective on antibiotics.
Please give us your honest responses. There are no right or wrong answers to any of these
questions.
We’d like to provide you with a definition for a few key terms to assist you in answering the following
questions:
Antibiotic resistance occurs when bacteria have become resistant to the antibiotics designed to kill
them. It does not mean the body is becoming resistant to antibiotics.
Clostridioides difficile (also known as C. difficile or C. diff.) is a bacterium that causes colitis, or
inflammation of the colon. C. difficile infection can lead to severe colon damage, disabling diarrhea,
and sometimes death.

Attitudes and Beliefs: Perceived Susceptibility
27. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
I believe that I may have
taken antibiotics when I
didn’t need them.
I believe that I could get
an antibiotic-resistant
infection.
I believe that any time
people take antibiotics, it
contributes to antibiotic
resistance.
I believe that my
healthcare providers
may have given me
prescriptions for
antibiotics when they
were not necessary.
I believe that anyone
taking antibiotics can
experience common
side effects, such as
rash, nausea, and/or
diarrhea.
I believe that taking
antibiotics can lead to
severe, but rare, side
effects such as
Clostridioides difficile (or
C. diff) infection or lifethreatening allergic
reactions.

Disagree

Neither agree nor
disagree

Agree

Strongly agree

Attitudes and Beliefs: Perceived Severity
28. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If I got an antibioticresistant infection, it
could be very dangerous
for me.
I believe that antibiotic
resistance is a severe
problem that can
threaten the health of
myself and others.
I believe that antibiotics
can sometimes lead to
Clostridioides difficile (or
C. diff) infection, which
can cause diarrhea and
death.

Disagree

Neither agree nor
disagree

Agree

Strongly agree

Attitudes and Beliefs: Perceived Benefits
29. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
I believe that using
antibiotics only when
needed helps to
preserve their
effectiveness.
I believe that using
antibiotics only when
needed helps to keep
me safe from side
effects.
I believe that using
antibiotics only when
needed helps fight
antibiotic resistance.

Disagree

Neither agree nor
disagree

Agree

Strongly agree

Attitudes and Beliefs: Perceived Barriers to Using Antibiotics Appropriately
30. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If my healthcare provider
told me to wait one to
two weeks to see if I feel
better before prescribing
antibiotics, I would feel
inconvenienced.
If my healthcare provider
told me I didn’t need
antibiotics for an illness, I
would feel worried that I
wouldn’t feel better or
that I might get sicker.

Disagree

Neither agree nor
disagree

Agree

Strongly agree

Attitudes and Beliefs: Self-Efficacy
31. Please indicate your level of confidence for each of the following questions.
Not at all confident Somewhat confident
How confident are you
that you will get better
when you have a virus,
like a cold or the flu, if
you don’t take
antibiotics?
How confident are you in
your ability to discuss
your questions and
concerns about antibiotic
use with your healthcare
provider?
How confident are you
that you can accept your
healthcare provider’s
recommendation if
he/she says you do not
need antibiotics?

Moderately
confident

Confident

Very confident

Attitudes and Beliefs (final Q)
32. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly
disagree
When I’m sick, it’s
important to talk with my
healthcare providers
about what the best
treatment is for my
illness.
When I’m sick, but
antibiotics aren’t
needed, it is important to
talk with my healthcare
providers about other
ways to feel better.
When I’m sick and
antibiotics can help, it is
important to talk with my
healthcare providers
about the risks of taking
antibiotics (e.g., side
effects, antibiotic
resistance).
When I’m sick and
antibiotics can help, it is
important to talk with my
healthcare providers
about the benefits of
taking antibiotics.

Disagree

Neither agree
nor disagree

Agree

Strongly agree

Don't know

Behavior
33. Think about the visits you had with a healthcare provider for an illness over the past 12 months. During
these visits, how often did you speak with your healthcare providers about the following?

Never
Whether or not
antibiotics were needed
to treat my illness.
How to feel better if I
was sick and an
antibiotic was not
needed.
The risks of taking an
antibiotic (e.g., antibiotic
resistance, side effects)
when I was sick.
The benefits of taking an
antibiotic when I was
sick.

Rarely

Sometimes

Often

Always

Don't recall

Did not visit
healthcare
provider for an
illness in the
past 12
months

Behavior (page 2)
34. In the past 12 months, how often have you expected—but not outright asked—a healthcare provider to
prescribe you antibiotics?
Always

Rarely

Often

Never

Sometimes

Don’t know/cannot recall

Behavior (page 3)
35. In the past 12 months, how often have you specifically asked a healthcare provider to prescribe you
antibiotics?
Always

Rarely

Often

Never

Sometimes

Don’t know/cannot recall

Behavior (page 4)
36. In the past 12 months, did a healthcare provider prescribe you antibiotics?
Yes
No
Don't know/cannot recall

Behavior (page 5)
37. You said you got a prescription for antibiotics from a healthcare provider in the past 12 months. Which of
the following best describes how you took the antibiotics? (select all that apply)
I did not take the antibiotics at all
I did not take the antibiotics for the same number of days as
my healthcare provider said to
I did not take the antibiotics the same number of times per day
as my healthcare provider said to

I took the antibiotics exactly as my healthcare provider said to
(e.g., number of times per day and number of days)
I stopped taking the antibiotics after I felt better
Don’t know/cannot remember

Behavior (page 6)
38. In the past 12 months, did you ever take left-over antibiotics previously prescribed to you by a healthcare
provider?
Yes
No
Don’t know/cannot remember
Not applicable / I was not sick during this time

Behavior (page 7)
39. In the past 12 months, did you ever take left-over antibiotics prescribed to someone else?
Yes
No
Don’t know/cannot remember
Not applicable / I was not sick during this time

Sources of Information
40. To whom or where do you go to learn about antibiotic use? (select all that apply)
My doctor/healthcare provider’s office

Newspapers (Please specify:_______________)

Pharmacist

Television (Please specify:_______________)

Health websites/Health-related mobile apps (e.g., WebMD,
MayoClinic, etc.) (Please specify:_______________)

Radio (Please specify:_______________)

Centers for Disease Control and Prevention (CDC) website
Health magazines (e.g., Women’s Health, Men’s Health,
Prevention) (Please specify:_______________)

Social media (e.g., Facebook, Twitter, Instagram, LinkedIn,
etc.) (Please specify:_______________)
Other (Please specify:_______________)
I have not tried to learn about antibiotic use

Family members and/or friends

41. Did you know that CDC’s Be Antibiotics Aware campaign has resources you can use to learn about
antibiotic use?
Yes
No

42. How did you learn about CDC’s Be Antibiotics Aware resources? (select all that apply)
My doctor/healthcare provider’s office

Family members and/or friends

Pharmacist

Social media (e.g., Facebook, Twitter, Instagram, LinkedIn,
etc.) (Please specify:_______________)

Health websites/ Health-related mobile apps (e.g., WebMD,
Mayo Clinic, etc.) (Please specify:_______________)

Other (please specify:_______________)

Centers for Disease Control and Prevention (CDC) website

Don’t know/cannot recall

Demographic Characteristics (All)
Thank you. Now we would like to know more about you.
43. Do you have children under the age of 5 years?
Yes
No
Prefer not to answer

44. How would you describe your racial background? Select all that apply.
White

American Indian or Alaska Native

Black or African American

Other, please specify: ________________

Asian

Prefer not to answer

Native Hawaiian or Other Pacific Islander

45. Are you Hispanic or Latino?
Yes
No
Prefer not to answer

46. What language do you primarily use at home (i.e., when speaking with family and friends)?
English

Portuguese

Spanish

Vietnamese

Chinese (including Mandarin, Cantonese, and other Chinese
languages)

Other (please specify: _______________)
Prefer not to answer

French

47. What is the highest grade of school you have completed, or the highest degree you have received?
Some high school

Bachelor’s (4-year college) degree

High school graduate (or equivalent)

Master’s degree

Some college (1-4 years, no degree)

Professional or doctoral degree (MD, JD, PhD, etc.)

Associate or technical degree

Prefer not to answer

Thank you for taking the time to participate in this important survey!