Supporting Material 3

Heart Truth

Participating Practitioners/Students

Paper/Web

Assessment of The Heart Truth Professional Education Campaign

Welcome to the Assessment of The Heart Truth Professional Education Campaign. This is an important opportunity for you to share your experience with The Heart Truth professional education materials.

Please enter the Access Code sent to you in an e-mail from The Gallup Organization and click the "Begin Survey" button to continue.

<Begin Survey>

(PROGRAMMER NOTE: If incorrect Access Code, display the following error message:)

The Access Code you have entered is invalid. Please carefully re-enter your Access Code.

(PROGRAMMER NOTE: If no Access Code is entered, display the following error message:)

You must enter an Access Code to continue.

(PROGRAMMER NOTE: If completed survey found in database for this Access Code, display the following error message:)

A survey has already been completed with this Access Code. Thank you for your participation.

If you feel you have received this message in error, please contact Gallup Client Support at [email protected] or call 1-888-217-8202 for assistance.

(PROGRAMMER NOTE: Display the following at the bottom of each screen:)

If you need assistance completing this survey, please contact Gallup Client Support by sending an e-mail to [email protected] or by calling 1-888-217-8202 from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Thursday, or 8:00 a.m. to 6:00 p.m. Eastern Time on Fridays.

Do not print, store, or copy this page.

In the past three months, (your institution used materials provided by The Heart Truth Professional Education Campaign in a lecture or presentation)/(you used the Heart Truth interactive Case Based modules on Medscape site to take a course entitled “[Anna: what is the name of the course?]”.

1. Do you recall having seen The Heart Truth professional education materials?

Yes - (Continue)

No - (Skip to #5)

2. Please rate the extent to which you agree or disagree with these statements about The Heart Truth materials.

As a result of viewing The Heart Truth materials, I feel I am better equipped to provide my female patients with the most up-to-date information they need about heart disease

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

1. As a result of viewing The Heart Truth materials, I have adopted new preventative procedures into my practice for heart disease with my female patients

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

2. When it comes to talking to your female patients about heart disease risks, as a result of viewing The Heart Truth materials, are you?

5 Significantly more likely to discuss heart disease risks

4 Somewhat more likely to discuss heart disease risks

3 Neither more nor less likely to discuss heart disease risks

2 Somewhat less likely to talk about heart disease risks

1 Significantly less likely to talk about heart disease risks

3. Please rate the following statements with regard to The Heart Truth materials you saw

1. Relevance of the materials to my practice

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

2. Helpfulness of the materials in improving the way I communicate with female patients

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

3. Level of detail provided in the materials to meet my needs

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

4. Level of detail provided in the materials to meet my patient’s needs

5 Strongly Agree

4

3

2

1 Strongly Disagree

6 Don’t Know

4. As a result of viewing The Heart Truth materials, I have incorporated the following techniques into my practice. Please list up to five techniques that you have incorporated, numbering them consecutively starting with the number 1. (Allow 750 characters).

Please mark the best response to each question below.

5. Which of the following best describes your profession?

1 Physician (Skip to #5A)

2 Nurse, Nurse Midwife, Nurse Practitioner (Skip to #5B)

3 Physician’s Assistant (Skip to #5C)

4 Other (Fill in response) (Allow 50 characters) (Skip to #6)

A. Which best describes your area of practice?

1 Family physician

2 General internist

3 Obstetrician/gynecologist

4 Cardiologist

5 Other MD or DO (Fill in response) (Allow 50 characters)

(Skip all to #6)

B. Which best describes your area of practice?

1 Registered Nurse

2 Nurse-midwife

3 Nurse practitioner- general or family practice

4 Nurse practitioner- gynecologic practice

5 Other Nurse practitioner (Fill in response) (Allow 50 characters)

(Skip all to #6)

C. Which best describes your area of practice?

1 Physician assistant-general or family practice

2 Physician assistant-gynecologic practice

3 Physician assistant (Fill in response) (Allow 50 characters)

6. Which of the following best describes your current level of training?

1 Student

2 Intern, resident

3 Fellow

4 Practicing physician, physician assistant, nurse practitioner, nurse

5 Other (Fill in response) (Allow 50 characters)

7. In a typical week, how many female patients do you see?

0 No patients

1 1-25 patients

2 26-50 patients

3 51-75 patients

4 76-99 patients

5 99+ patients

6. Don’t Know

(PROGRAMMER NOTE: Right above the "Submit Survey" button, display:)

Please submit your survey to Gallup by clicking the "Submit Survey" button below. Once you close your browser, you will no longer be able to view the survey or change your responses.

<Submit Survey>

That completes the Assessment of The Heart Truth Professional Education Campaign. Your opinion counts! Thank you for your cooperation.

You may now close your browser or go to another Web site.