Form approved
OMB # 0920-####
Exp. date MM/DD/YYYY
ATTACHMENT 8g
Usability Survey:
Paper, English
Thank you for participating in this study, where we hope to learn whether different types of decision aid tools can help men make more informed decisions about prostate cancer screening. In order to learn more about whether participants find the Talk to Nathan decision aid useful and understandable, we ask that you answer the following questions. Your completion of this form is completely voluntary, and your responses are confidential. By completing the form you are giving your consent to participate in this assessment.
Section 1: Nathan Dosage
How much time did you spend reviewing the Talk to Nathan decision aid?
Less than 5 minutes
5 to 10 minutes
10 to 15 minutes
15 to 25 minutes
25 or more
None (end survey)
Did you complete the Nathan decision aid? Completing Nathan means that you reached the “Come back any time!” screen.
Yes
No
Section 2: Help Needed to Review Nathan
Did anyone else review the Talk to Nathan decision aid with you?
Yes
No
Did you ask someone to help you in reviewing the Talk to Nathan decision aid?
Yes
No (skip to Acceptability of Nathan)
How much help did you need?
A lot of help
Some help
A little help
No help
What kind of help did you need? Check all that apply:
Help to use the computer/internet
Help to find/access the Talk to Nathan decision aid
Help to use the Talk to Nathan decision aid
Help to read the information in Talk to Nathan
Help to understand the information in Talk to Nathan
Other (specify)
Section 3: Acceptability of Nathan - Ottawa Acceptability Measure (Brehaut et al., 2010)
For this next set of questions, we would like to know what you think about the Talk to Nathan decision aid.
Please rate each section, by checking ‘poor’, ‘fair’, ‘good’, or ‘excellent’ to show what you think about the way the information was presented on:
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Poor |
Fair |
Good |
Excellent |
Prostate health |
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Risks for prostate cancer |
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Screening options |
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Talking to your provider |
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The length of decision aid was (check one)
Too long
Too short
Just right
The amount of information included was (check one)
Too much information
Too little information
Just right
Would you find this decision aid useful when you are making your decision about getting screened for prostate cancer?
Yes
No, Comments:
Do you think the decision aid included enough information to help you decide whether to get screened for prostate cancer?
Yes
No, Comments:
Section 4: Perceived Fit of Nathan - Intervention Appropriateness Measure (Weiner et al., 2017)
Next, please let us know whether you agree with each of the following statements about the Talk to Nation decision aid. Please note the order of the response options for each statement: completely disagree, disagree, neither agree nor disagree, agree, or completely agree.
Question |
Completely disagree |
Disagree |
Neither agree nor disagree |
Agree |
Completely agree |
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Section 5: Usability of Nathan - System Usability Scale (Brooke, 1996)
For this next set of statements about the Talk to Nation decision aid, tell us how usable the decision aid was for you. Please note the order of the response options for each statement: strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree.
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Strongly Disagree |
Disagree |
Neither agree nor disagree |
Agree |
Strongly Agree |
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Section 6: Technology Acceptance - Technology Acceptance Model (Venkatesh & Davis, 2000 and Klaic et al., 2022)
For this next set of statements about the Talk to Nation decision aid, tell us how helpful the decision aid was for you, indicating either strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.
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Strongly Agree |
Agree |
Neither Agree or Disagree |
Disagree |
Strongly Disagree |
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Section 7: COVID-19 Impact and Telemedicine
Did the COVID-19 pandemic affect your ability to have a discussion with your provider about prostate cancer screening?
Yes
No
Would the Talk to Nathan decision aid have been useful to you during the COVID-19 pandemic?
Yes
No
How likely are you to have primary care visits through telemedicine?
Not likely
Somewhat likely
Very likely
If you were to have a telemedicine visit with your provider, would the Talk to Nathan decision aid be helpful to you?
Yes
No
Don’t Know
Section 8: Recommendations for Nathan Improvements
Finally, please provide any recommendations you have for improving the Talk to Nathan decision aid. (open ended question)
Section 9: Gift Code
Thank you for completing this survey. Your $25 Amazon gift code is <GIFT_CODE>.
The code is a unique number you can use to purchase items online at Amazon.com. You may enter the code online when you are ready to make a purchase at Amazon.com. There is no expiration date.
Would you like this gift code emailed to you as well with instructions about how to use it?
01 Yes, please email it (note email address)
02 No need to email it
Section 10: Closing
Thank you for completing this survey. We may also contact you to request your participation in a 60-minute discussion about your experience in using Talk to Nathan.
Also, within one week after your visit with your health care provider on [DATE], you will receive an email with a weblink to the final survey for this study.
If you have any questions, please contact the project manager, Danielle Nielsen at Danielle.Nielsen@icf.com.
Public reporting burden of this collection of information is estimated to average 18 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-####).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Thomas, Cheryll C. (CDC/DDNID/NCCDPHP/DCPC) |
File Modified | 0000-00-00 |
File Created | 2024-09-05 |