Attachment C1 -- Screen shots of the osteoporosis decision aid

Attachment C1 -- Screen shots of the osteoporosis decision aid.doc

Eisenberg Center Voluntary Customer Survey Generic Clearance for the AHRQ

Attachment C1 -- Screen shots of the osteoporosis decision aid

OMB: 0935-0128

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Screens 1-33 represent the main screens of the decision aid for osteoporosis.



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Screen 7

Note: If respondents answer “yes” they are currently taking medicines for osteoporosis, the second question will read, “Are you planning to switch medicines?”.



















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Screen 32a



















Screen 32b

Tell Us Who You Are

Please choose ONE statement that best describes you:

 I am a woman who has osteoporosis

 I am the caregiver, family member or friend of a woman with osteoporosis

 I am a health care professional who provides care to women with osteoporosis

 I am a health care administrator or policymaker

 Other Please describe yourself



Responses to this question will be used to describe the types of people who view the decision aid, as well as to identify surveys from women with osteoporosis, the group from which we are primarily interested in obtaining feedback.

Note: This screen has not been added to the test version at the time of this submission. However, it will be added before the decision aid is finalized.





Screen 33























The next four screens (Screens 34-37) contain the feedback survey that can be done after completing the decision aid.



Screen 34















Screen 35



Note: If on screen 7 respondents answered “Yes” they were taking an osteoporosis medicine, question 6 in the feedback survey will be, “After going through the decision aid, are you planning to switch medicines?”

















Screen 36





















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Screen 38

File Typeapplication/msword
Authorsharmap
Last Modified Bysandra joos
File Modified2009-03-19
File Created2009-03-19

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