Campaign to Increase Postpartum Depression Symptom Reporting. Office on Women's Health, Division of Strategic Communications

Form Approved
OMB No.
0990-0459
Exp. Date
08/31/2023

REVIEWER NOTES:
• There are no question numbers as we will use a unique variable name for each of the items
to provide the ability to move the order around, add or remove items.
• Anything in orange font, all caps or within brackets will not be displayed and are notes for
reviewers/programmers.
• We will include programming that will allow respondents to skip a question if they prefer
not to answer in lieu of including a “prefer not to answer” option on the screen. If they
attempt to skip a question or item, respondents will see text or dialogue such as “Did you
skip this by accident? We value your response.”
• Do not know options have been removed except in the case of a knowledge question where
the respondent may not know an answer or conditions where they may not be able to
answer due to lack of experience. In those cases, “not sure” is a response option.
INTRODUCTION
Welcome to the New Mom’s Health & Wellness Project. We are going to have you view a video
and some materials about being a new mom. We will then ask you questions about your
reactions to the video and materials. Your experience will help to create a special health
campaign for new moms focusing on postpartum feelings. NORC and LTG Associates, Inc., are
conducting this survey on behalf of the U.S. Department of Health & Human Services Office on
Women’s Health (OWH). https://www.womenshealth.gov/.
The online survey should take about 25 minutes.
New Mom’s Health & Wellness Project
momshealth@norc.org
1-877-229-4783
INTRO, ENTER INTO SURVEY: SCREEN 1
This survey is for women ages 18-44 who had a baby in the last year. If this does not apply to
you, please exit the survey now.
INTRO FOR ALL: SCREEN 2
Welcome to the New Mom’s Health & Wellness Project. Please use the "Continue" and
"Previous" buttons to answer the survey questions and move to the next question. Do not use
your browser or phone’s BACK button.
Your answers are saved automatically. If you need to close out of the survey before you finish,
just close your browser. To return to the survey, please [INSERT PROGRAMMING
INSTRUCTIONS]. You will return to the same place in the survey.
The purpose of the survey is to get your reactions to some information about being a new mom
that will become part of videos and materials for a campaign. Some of the questions may be
personal or sensitive. You can skip any question that makes you uncomfortable. You can take a

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0990-0379. The time required to complete
this information collection is estimated to average 25 minutes per response, including the time to review instructions, search existing
data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services,
OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201 Attention: PRA Reports Clearance Officer.

New Mom’s Health & Wellness Video and Materials Testing Survey
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break or quit the survey at any time. To save your answers and come back to the survey later,
be sure to use the Quit button.
The survey should take about 25 minutes, depending on your answers. If you want to see the
questions first, go to [HERE- LINK].
Should you have any other questions, you may contact the New Mom’s Health and Wellness
Team at momshealth@norc.org or 1-877-229-4783.
Your answers will be kept separate from your name. We assign a number to your survey
answers instead of using your name. Your name will never be linked to your survey answers.
The survey uses a very secure computer system to make sure all your answers and personal
information are kept private. It is possible that someone could see or hear your answers if they
are nearby when you take the survey online. Please look around your area and change your
location or screen so others cannot view your answers. We also suggest you use a secure
network to take the online survey and avoid public WIFI.
Your name will never be linked to your answers.
If you agree to take the survey, select the “I agree” option. [GO TO START]
If you do not want to take the survey, select the “I do not agree” option.
[START]

-----------------END OF CONSENT-----------------

We will start with general questions.
[LIVEWITHBABY] Do you live with your baby most of the time?
Yes
[CONTINUE]
No
[CONTINUE, but put results aside]
[S1] What is the highest level of school you have completed?
No school
Some School, No High School Diploma
High School Diploma or the equivalent (GED)
Some college, no degree
Associates/Technical degree or professional certification or license
Bachelor’s degree
Master’s degree, Professional or Doctorate degree

2

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[S2] Are you …
Married
Widowed
Divorced
Separated
Never married
[S3] Are you of Hispanic or Latino origin?
No, not of Hispanic or Latino origin
Yes, of Hispanic or Latino origin
Not sure
Prefer not to answer
[IF YES]
Yes, Mexican, Mexican-American, Chicano
Yes, Puerto Rican
Yes, Cuban
Yes, Central American
Yes, South American
Yes, other Spanish or Hispanic or Latino origin
[S4] Which best describes your race? (Select one or more)
American Indian or Alaska Native
Asian
Black or African American
White
Native Hawaiian or other Pacific Islander
Prefer not to answer
[Source: OMB Revisions to the Standards for the Classification of Federal Data on Race and
Ethnicity. (1997). Federal Register, 62(210).
We will also ask questions about your partner. We understand that some moms may not have a
partner. A “partner” is someone you live with or have a close, romantic or personal relationship
with. You may or may not live together, but you think about yourself as a couple. You are
emotionally connected and have regular contact with each other. A partner could be any of the
following: a spouse (husband or wife), boyfriend or girlfriend, dating partner, or sexual partner.
They may or may not be the parent of your baby or any other children.
[PARTNER]
Please choose the statement that best describes your current partner and living situation.
I do not have a partner
My partner lives with me all of the time
My partner lives with me some of the time
My partner does not live with me
3

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[S5] How many people live with you? Include the people who live in your home who you share
food with. Sharing food includes buying and eating meals together. You do not need to be
related to the other people in your household. Include people of all ages, even children.
Number of people living in your household ________ [TEXT BOX WITH MAX NUMBER]
Your household’s total annual income includes income from you, your partner, or from any
dependent children. It is the amount you receive before any taxes are taken out. Income can be
pay for work or any other money coming in. Remember that the information you provide is
confidential.
[S6] Do you make less than… [SHOW 185% INCOME LIMIT CORRESPONDING TO ANSWER GIVEN
IN QUESTION ABOUT HOUSEHOLD SIZE]
[If household size = 1, show: $25,142]
[If household size = 2, show: $33,874]
[If household size = 3, show: $42,606]
[If household size = 4, show: $51,338]
[If household size = 5, show: $60,070]
[If household size = 6, show: $68,802]
[If household size = 7, show: $77,534]
[If household size = 8, show: $86,266]
1. Yes
2. No
66. None of these
77. Not sure
99. Prefer not to answer

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Next we’re going to ask you about your experiences with your mood and certain behaviors over
the last seven days.
[S7] Over the last week or 7 days, how often have you experienced the following?

1
1
1
1
1
1
1
1
1
1

More than
half the
week
2
2
2
2
2
2
2
2
2
2

Less than
half the
week
3
3
3
3
3
3
3
3
3
3

1

2

3

4

1

2

3

4

1

2

3

4

Nearly every
day
Very little interest or pleasure in doing things
Not feeling “yourself”
Feeling down, sad, depressed, or hopeless
Crying a lot
Trouble falling or staying asleep
Sleeping too much
Feeling tired or having little energy
Eating very little or eating too much
Feeling isolated from friends or family
Trouble concentrating on things such as
watching television or reading
Moving or speaking a lot more slowly than
usual
Being a lot more fidgety, restless, or moving
around a lot more than usual
Feeling unconnected to your baby, as if you
are not the baby’s mother, or you might not
love or care for the baby as you should

Never

5

Sometimes

Rarely

Never

Your friends
Social media like Facebook, online discussion
forum, message boards or email listservs
Parenting websites

Often

1. Think about who you ask or where you look for advice about parenting. How often, if at all, do
you get parenting advice from:

1

2

3

4

1

2

3

4

1

2

3

4

4
4
4
4
4
4
4
4
4
4

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2. Thinking about the social media sites you use... About how often do you visit or use Facebook?
1.
2.
3.
4.
5.

Several times a day
About once a day
A few times a week
Every few weeks
Never

3. How often do you visit YouTube to stream video content?
1.
2.
3.
4.
5.

Several times a day
About once a day
A few times a week
Every few weeks
Never

4. Since your baby was born have you had any help from WIC (the Special Supplemental Nutrition
Program for Women, Infants, and Children) for you or your baby?
1. Yes
2. No
5. Are you currently breastfeeding your baby (or pumping breastmilk for your baby)?
1. Yes
2. No

I feel happy when my baby smiles or laughs
I feel distant from my baby

1
1

2
2

Never

Rarely

Sometimes

Often

Always

Please select how often the following are true for you. We want to know how you personally feel.

3
3

4
4

5
5

6

Somewhat
Agree

Neither
Agree nor

Somewhat
Disagree

Strongly
Disagree

I think that picking up the baby every time he or she
cries will spoil the baby
I often feel overwhelmed by my baby’s crying

Strongly
Agree

6. How much do you agree or disagree with the following statements?

1

2

3

4

5

1

2

3

4

5

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7. Since your baby was born, have you talked with any of the following to get through a tough
time?

Your partner
A counselor, therapist or social worker
A medical doctor or other health care worker like a
nurse or midwife

Yes

No

1
1

2
2

1

2

I did not have a partner
during that time
3

8. Do you feel that your partner is someone who you can count on?
1. Yes
2. No
3. I do not have a partner at this time
9. These statements are about stressful things that may have happened during the year

after your baby was born. Select “Yes” if the statement is true for you or “No” if it is not.

I had problems paying the rent, mortgage,
or other bills
I argued with my partner more than usual

Yes

No

1

2

1

2

I did not have a partner
during that time

3

10. Please indicate how much you agree or disagree with the following statement: People
experiencing a mental illness are more likely than other people to be dangerous
1.
2.
3.
4.
5.

Strongly agree
Somewhat agree
Neither agree not disagree
Somewhat disagree
Strongly disagree

7

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Neither Agree
nor Disagree

Somewhat
Disagree

Strongly
Disagree

I can see how moms with postpartum depression
might choose not to talk about it
I want to be as supportive as possible to moms
experiencing postpartum depression
I would like to know more about postpartum
depression

Somewhat
Agree

Strongly Agree

11. For each of the following statements, please tell us whether you agree or disagree with each.

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

12. The following questions are about what you would do if you were going through a tough time in
your life. A tough time is a time when someone might feel anxious, stressed, unmotivated,
lonely or depressed and need extra support. The following statements are about the way you
usually handle difficult life events.
I usually bounce back quickly after hard times
I am confident in my ability to take care of my baby in difficult times

8

Yes
1
1

No
2
2

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INTRODUCTION TO VIDEO TESTING
Next, you will see a video designed to help new moms who may struggle with postpartum
depression. We want your thoughts as a new mom to help us to create the best information for
other moms. Your input today will help decide what is used to finish the videos and other
materials. The videos will be shown online, through social media and other places where moms
might see them. Before the videos are made, the creators want to get your reactions to
understand how they might make women feel. The videos are still in a draft format – your
responses will help us to decide on what they will finally look like. Your honest reactions and
input will help the creators improve the information.
VIDEO TESTING:
[RANDOM PRESENTATION OF VIDEO- EITHER NEW VIDEO OR EXISTING ROAD TO BABYVILLE]
REACTIONVID
In a few words, what do you think about the video? ______________________
[OPEN-ENDED]
FEELINGSVIDOE
What did you feel when you watched the video?
[OPEN-ENDED- UP TO THREE FIELD OPTIONS]________________
________________
________________
FEELINGSVIDRO Are there any words on the list below that describe feelings that came to mind
when you saw the video? Please select up to three.
 Joy
 Surprise
 Anger
 Annoyance
 Fear
 Confusion
 Confidence
 Urgency

 Sadness
 Informed
 Curious
 Shame
 Appreciation  Vulnerability
 Guilt
 Duty
 Faith
 Love
 Frustration  Hope
 Concern
 Comfort
 Discomfort
 Boredom  Skepticism  Pride
 Helplessness  Frustration  Empathy
 Hopelessness  Something else _______________

MAINMESSGVID
In a few words, what do you feel is the main message in the video?
[OPEN-ENDED] ______________________________________
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CTAVID
What is the video asking you to do?
[OPEN-ENDED] _____________________________________
UNDERSTAND
Is there anything difficult to understand in the video?
1 Yes [GO TO WHATDIFFCLT]
2 No [GO TO BELIEVE]
WHATDIFFCLT
[IF YES] Please describe what was difficult to understand:______________________
[OPEN-ENDED]
BELIEVE
How believable is the information presented in this video?
1 Very Believable
2 Somewhat Believable
3 Not Very Believable
4 Not at All Believable
TRUSTVIDEO
How much do you trust the characters/women presented in this video?
1 A lot [GO TO WHOFOR]
2 Some [GO TO WHOFOR]
3 Not much [GO TO UNTRUSTEDVID]
4 Not at all [GO TO UNTRUSTEDVID]
UNTRUSTEDVID
[IF NOT MUCH OR NOT AT ALL] Please describe what made you not trust the
characters/women:______________________
[OPEN-ENDED]
WHOFOR
Who do you think this video was created to reach?
[OPEN-ENDED] _____________________________________
77 Not Sure
LIKEVID
What do you like about this video?
[OPEN-ENDED] _____________________________________

10

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DISLIKEVID
Is there anything you do not like about the video?
1 Yes [GO TO DISLIKESPEC]
2 No [GO TO INTENTION]
DISLIKEVIDSPEC
What do you not like?:__________________________
[OPEN-ENDED]
OFFENDVID
Is there anything that you feel is offensive in the video?
1 Yes [GO TO WHATOFFENDVID]
2 No [GO TO TOWEBVID]
WHATOFFENDVID
[IF YES] Please describe what was offensive:______________________
[OPEN-ENDED]
SUGGESTSM1
SUGGESTSM2
What would you suggest to fix what offended you? ______________________
[OPEN-ENDED]
TOWEBVID
After seeing this video, how likely are you to visit the www.womenshealth.gov website?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely

11

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12

Very Likely

Likely

Neither
Likely nor
Unlikely

Unlikely

Talk to your partner about it [SKIP IF NO PARTNER]
Talk to a friend about it
Talk to your parents about it
Talk to a family friend or relative about it
Talk to a professional like a medical doctor or other health
care worker about it
Talk to a counselor, therapist or social worker about it
Talk to a religious or faith leader, or a counselor associated
with a specific faith tradition (such as a Christian Counselor)
about it
Talk to someone through an online community forum,
board or chat room
Look for help on a website
Look for help by using a social networking site such as
Facebook, Reddit or Other
Nothing
Something else (please specify): [TEXT BOX]

Very Unlikely

TALKVID
After seeing this video, how likely are you to do any of the following if you were going through
a tough time?

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

5
5
5
5
5

New Mom’s Health & Wellness Video and Materials Testing Survey
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ACTIONVID
Here are some different types of responses you might have after seeing this video. For each,
please mark how true the statement is for you with 1 being not at all true for you and 5 being
very true for you.

Want to do something else (please specify): [TEXT BOX]

13

Somewhat true for me

Neither true nor untrue

Somewhat untrue for me

Not at all true for me

Think about someone who might be struggling with postpartum
depression
Want to learn about postpartum depression
Want to talk with someone I have been concerned about to
discuss how they might be struggling emotionally as a new
mom
Aware to watch for signs or symptoms of postpartum
depression I might experience as a new mom
Aware to watch for other moms around me who might be
experiencing postpartum depression
Want to talk to a professional like a medical doctor or other
health care worker about postpartum depression
Want to talk to a professional like a counselor, therapist or
social worker about postpartum depression

Very true for me

The video makes me…

1

2

3

4

5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

New Mom’s Health & Wellness Video and Materials Testing Survey
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INTRODUCTION TO MATERIALS TESTING
Next, you will see some materials designed to help new moms who may struggle with
postpartum depression. Again, we want your reactions as new moms to help us to create the
best information for other moms. These materials might show up on a social media post or as a
takeaway from a clinic, social services office or health care provider. As these materials get
finalized, the creators want to get your reactions to understand how they might make other
women feel or react. Again, your honest reactions and input will help the creators improve the
information.
[RANDOMIZE THE ORDER OF THE MATERIALS PRESENTED, SM1 LINKS TO SOCIAL
POST FROM CBO, SM2 LINKS TO SOCIAL POST FROM OWH, PC LINKS TO PALM CARD]

MATERIALS TESTING: SOCIAL POST
REACTIONSM1
REACTIONSM2
In a few words, what do you think about this social media post? ______________________
[OPEN-ENDED]
HOWREACTSM1
HOWREACTSM2
How would you react to the social media post?
1 Love (heart emoji)
2 Like (thumbs up)
3 Laughter (laughing face emoji)
4 Surprise (wow face emoji)
5 Dislike (thumbs down)
6 Sad (sad face emoji)
7 Angry (angry face emoji)
8 Some other reaction (specify)______________
9 No reaction/Swipe away
TOWEBSM1
TOWEBSM2
After seeing this post, how likely are you to visit the www.womenshealth.gov website?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely

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SHARESM1
SHARESM2
After seeing this post, how likely are you to share the post with others?
1 Very Likely [GO TO COMMENTSM1/COMMENTSM2]
2 Somewhat Likely [GO TO COMMENTSM1/COMMENTSM2]
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely
COMMENTSM1
COMMENTSM2
How likely are you to add a comment when you share the post with others?
1 Very Likely [GO TO SHAREWHOSM1/SHAREWHOSM2]
2 Somewhat Likely [GO TO SHAREWHOSM1/SHAREWHOSM2]
3 Neither Likely nor Unlikely [GO TO FOLLOWSM1/FOLLOWSM2]
4 Not Likely [GO TO FOLLOWSM1/FOLLOWSM2]
5 Not At All Likely [GO TO FOLLOWSM1/FOLLOWSM2]
SHAREWHOSM1
SHAREWHOSM2
Who are you most likely are you to share the post with? (check all that apply)
1 Everyone I’m connected with through social media
2 Friends
3 Family
4 Someone directly
5 A certain group of people (specify)
6 Someone else (specify)___________
FOLLOWSM1
FOLLOWSM2
How likely would you be to follow the account that shared the post?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely
MAINMESSGSM1
MAINMESSGSM2
In a few words, what do you feel is the main message in the social media post?
[OPEN-ENDED] ______________________________________

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LIKESM1
LIKESM2
What do you like about the post?
[OPEN-ENDED] _____________________________________
DISLIKESM1
DISLIKESM2
Is there anything you do not like about the post?
1 Yes [GO TO DISLIKESM1/DISLIKESM2]
2 No [GO TO OFFENDSM1/OFFENDSM2]
DISLIKESPECSM1
DISLIKESPECSM2
What do you not like?__________________________
[OPEN-ENDED]
OFFENDSM1
OFFENDSM2
Is there anything that you feel is offensive in the post?
3 Yes [GO TO WHATOFFENDSM1 OR WHATOFFENDSM2 BASED ON POST]
4 No [GO TO TRUSTSM1 OR TRUSTSM2 BASED ON POST]
WHATOFFENDSM1
WHATOFFENDSM2
[IF YES] Please describe what was offensive:______________________
[OPEN-ENDED]
SUGGESTSM1
SUGGESTSM2
What would you suggest to fix what offended you? ______________________
[OPEN-ENDED]
TRUSTSM1
TRUSTSM2
How much do you trust the source of the post to know about postpartum depression?
1 A lot
2 Some
3 Not much
4 Not at all

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WHOTRUSTSM1
WHOTRUSTSM2
Who would you trust to send you a message about postpartum depression?
______________________
[OPEN-ENDED]
PERSONALEXSM1
PERSONALEXSM2
After seeing this post, how likely would you be to share a personal experience of being a new
mom or about an emotionally tough time you’ve been through on the social media platform
where you received the post (such as Facebook, Instagram, etc.)?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely

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18

Very Likely

Likely

Neither
Likely nor
Unlikely

Unlikely

Talk to your partner about it [SKIP IF NO PARTNER]
Talk to a friend about it
Talk to your parents about it
Talk to a family friend or relative about it
Talk to a professional like a medical doctor or other health
care worker about it
Talk to a counselor, therapist or social worker about it
Talk to a religious or faith leader, or a counselor associated
with a specific faith tradition (such as a Christian Counselor)
about it
Talk to a school counselor or teacher about it
Talk to someone through an online community forum,
board or chat room
Look for help on a website
Look for help by using a social networking site such as
Facebook, Reddit or Other
Nothing
Something else (please specify): [TEXT BOX]

Very Unlikely

TALKSM1
TALKSM2
After seeing this post, how likely are you to do any of the following if you were going through a
tough time?

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

1
1

2
2

3
3

4
4

5
5

1
1

2
2

3
3

4
4

5
5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

5
5
5
5
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New Mom’s Health & Wellness Video and Materials Testing Survey
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ACTIONSM1
ACTIONSM2
Here are some different types of responses you might have after seeing this social media post.
For each, please mark how true the statement is for you with 1 being not at all true for you and
5 being very true for you.

want to do something else (please specify): [TEXT BOX]

19

Somewhat true for me

Neither true nor untrue

Somewhat untrue for me

Not at all true for me

think about someone who might be struggling with
postpartum depression
want to learn about postpartum depression
want to talk with someone I have been concerned about to
discuss how they might be struggling emotionally as a new
mom
aware to watch for signs or symptoms of postpartum
depression I might experience as a new mom
aware to watch for other moms around me who might be
experiencing postpartum depression
want to talk to a professional like a medical doctor or other
health care worker about postpartum depression
want to talk to a professional like a counselor, therapist or
social worker about postpartum depression

Very true for me

The social media post makes me…

1

2

3

4

5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

MATERIALS TESTING: PALM CARD
REACTIONPC
In a few words, what do you think about this informational card? ______________________
[OPEN-ENDED]
TOWEBPC
After seeing this information, how likely are you to visit the www.womenshealth.gov website?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely
MAINMESSGPC
In a few words, what do you feel is the main message in this informational card?
[OPEN-ENDED] ______________________________________
CTAPC
What do you feel like this informational card asking you to do?
[OPEN-ENDED] _____________________________________
LIKEPC
What do you like about this informational card?
[OPEN-ENDED] _____________________________________
DISLIKEPC
Is there anything you do not like about this informational card?
1 Yes [GO TO DISLIKEPC]
2 No [GO TO OFFENDPC]
DISLIKESPECPC
What do you not like?__________________________
[OPEN-ENDED]
OFFENDPC
Is there anything you feel is offensive in the informational card?
1 Yes [GO TO WHATOFFENDPC]
2 No [GO TO TRUSTPC OR TRUSTPC BASED ON POST]
WHATOFFENDPC
[IF YES] Please describe what is offensive:______________________
[OPEN-ENDED]
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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

SUGGESTPC
What would you suggest to fix what offended you? ______________________
[OPEN-ENDED]
SHAREPC
After seeing this informational card, how likely are you to share it with others?
1 Very Likely
2 Somewhat Likely
3 Neither Likely nor Unlikely
4 Not Likely
5 Not At All Likely
TRUSTPC
How much do you trust the source of the information to know about postpartum depression?
1 A lot
2 Some
3 Not much
4 Not at all

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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

22

Very Likely

Likely

Neither
Likely nor
Unlikely

Unlikely

Talk to your partner about it [SKIP IF NO PARTNER]
Talk to a friend about it
Talk to your parents about it
Talk to a family friend or relative about it
Talk to a professional like a medical doctor or other health
care worker about it
Talk to a counselor, therapist or social worker about it
Talk to a religious or faith leader, or a counselor associated
with a specific faith tradition (such as a Christian Counselor)
about it
Talk to someone through an online community forum,
board or chat room
Look for help on a website
Look for help by using a social networking site such as
Facebook, Reddit or Other
Do nothing
Something else (please specify): [TEXT BOX]

Very Unlikely

TALKPC
After seeing this informational card, how likely are you to do any of the following if you were
going through a tough time?

1
1
1
1
1

2
2
2
2
2

3
3
3
3
3

4
4
4
4
4

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

5
5
5
5
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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

ACTIONPC
Here are some different types of responses you might have after seeing this informational card.
For each, please mark how true the statement is for you with 1 being not at all true for you and
5 being very true for you.

Want to do something else (please specify): [TEXT BOX]

23

Somewhat true for me

Neither true nor untrue

Somewhat untrue for me

Not at all true for me

Think about someone who might be struggling with postpartum
depression
Want to learn about postpartum depression
Want to talk with someone I have been concerned about to
discuss how they might be struggling emotionally as a new
mom
Aware to watch for signs or symptoms of postpartum
depression I might experience as a new mom
Aware to watch for other moms around me who might be
experiencing postpartum depression
Want to talk to a professional like a medical doctor or other
health care worker about postpartum depression
Want to talk to a professional like a counselor, therapist or
social worker about postpartum depression

Very true for me

The informational card makes me…

1

2

3

4

5

1
1

2
2

3
3

4
4

5
5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

RESPONDENT CHARACTERISTICS/RISK FACTORS
The next questions are about you…
MH
Please read the statements below and check all that apply to you:
I have a mental illness, or had a mental illness in
Yes □ No □ Prefer not to answer □
the past
A member of my family has mental illness
Yes □ No □ Prefer not to answer □
I have a friend who has mental illness
Yes □ No □ Prefer not to answer □
I do not know anyone who has mental illness
Yes □ No □ Prefer not to answer □
I know someone who has attempted or died by
Yes □ No □ Prefer not to answer □
suicide

About
once a
day

A few
times a
week

Every
few
weeks
or less
often

Never

Twitter
Instagram
Pinterest
Facebook
TikTok
LinkedIn

Several
times a
day

SMDOSE
Thinking about the social media sites you use... About how often do you visit or use the
following sites?

1
1
1
1
1
1

2
2
2
2
2
2

3
3
3
3
3
3

4
4
4
4
4
4

5
5
5
5
5
5

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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

A few
times a
week

Every few
weeks or
less often

Never

About
once a
day

Several
times a
day

FORUMDOSE
Thinking about the online community network, boards or forums you use... About how often do
you visit or use the following sites?

3
3
3
3

4
4
4
4

5
5
5
5

3
3

4
4

5
5

What to Expect
1
2
Peanut
1
2
Tinyhood Circle
1
2
Mama Meetups by 1
2
MOPS
Mocha Moms
1
2
Lucie’s List
1
2
Somewhere else: Please specify

More
than 20
hours

11-20
hours

5-10
hours

4 hours
or less

Never/D
o not

MEDIADOSE
In a typical week, about how many hours do you do the following?

1
1
1

2
2
2

3
3
3

4
4
4

5
5
5

Listen to the radio (AM/FM/streaming)
Use the internet
Watch TV (regular, cable, online, streaming,
etc.)

About
once a
day

A few
times a
week

Every few
weeks or
less often

Never

Hulu
YouTube
Vudu
Vimeo
Crackle
Twitch
Netflix
Amazon
Disney Plus

Several
times a
day

VIDEODOSE
How often do you stream video content from these sources: ?

1
1
1
1
1
1
1
1
1

2
2
2
2
2
2
2
2
2

3
3
3
3
3
3
3
3
3

4
4
4
4
4
4
4
4
4

5
5
5
5
5
5
5
5
5

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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

PRE_EMPLOY
Before your baby was born, did you work (for pay or not) outside of the home?
Part-time job
Full-time job
I did not work outside of the home
POST_EMPLOY
Which statement best describes your current employment status? If you are on maternity leave
from a job, mark the one you were doing before maternity leave.
Working-as a paid employee
Working-self employed
Not working for pay-home maker
Not working-on temporary layoff from a job
Not working-looking for work
Not working-retired
Not working-disabled
Not working-other
INSHURD
Do you currently have medical/health insurance?
Yes
No
[IF YES]CIS_SOURCE Is your current health insurance through…
Your employer or union
Your family member’s employer or union
Directly with a health insurance company or health insurance marketplace
Medicare, the insurance program for Americans aged 65 plus and people with
certain health problems
Medicaid, CHIP or some other type of government assistance program for those
with low incomes or a disability
TRICARE or other military health care, including VA health care
Indian Health Service
Another source, please specify: [TEXT BOX]
Not sure
Prefer not to answer
URBAN
How would you best characterize the place where you live?
Rural (far away from the city, in the country)
Suburban (homes near a city)
Urban (in the city)
Not sure
Prefer not to answer
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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

ZIP
What is your current zip code? ________________
SO
Which of the following best represents how you think of yourself?
Lesbian or gay
Straight, that is, not lesbian or gay
Bisexual
Something else: _____________________ [TEXT BOX]
I do not know the answer
Prefer not to answer

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New Mom’s Health & Wellness Video and Materials Testing Survey
JUNE 30, 2022

SURVEY COMPLETION
On behalf of the Office on Women’s Health and our survey team, we want to thank you for your
participation in this survey. Your information will help us to design a strong PPD campaign that
will reach new moms across the country and help them understand and address the symptoms
of PPD. If you would like to learn more about postpartum depression or resources for mental
health, go to https://www.womenshealth.gov/mental-health/mental-healthconditions/postpartum-depression
People often do not get the mental health services they need because they do not know where
to start. Talk to your primary care doctor or another health professional about mental health
problems. Ask them to connect you with the right mental health services. If you do not have a
health professional who is able to assist you, use these free and confidential resources to find
help for yourself, your friends, your family, or your community.
https://www.mentalhealth.gov/get-help/immediate-help
If you need to talk to someone about:
• Feelings of depression, including
• Sadness or crying most of the time
• Feeling unconnected to your baby
• Not being able to take care of yourself,
including sleeping, eating, or bathing
• Getting help with a mental health condition
• Getting help with drug or alcohol use

Call or text:
• Postpartum Support International
1-800-944-4PPD (4773) and leave a
message. A volunteer will call back
as soon as possible
•

•

Any type of crisis

•

If you are experiencing serious mental concerns •
including thoughts of self-harm or harm to
other yourself
•

•

28

Substance Abuse and Mental
Health Services Administration's
national helpline
1-800-662-HELP (4357)
Text HOME to 741741
from anywhere in the USA
National Suicide Prevention Lifeline
1-800-273-TALK (8255)
911