Form #5 Osteoporosis Decision Aid - feedback questionnaire

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

Screen 1

Screen 2

Screen 3

Screen 4

Screen 5

Screen 6

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?”.

Screen 8

Screen 9

Screen 10

Screen 11

Screen 12

Screen 13

Screen 14

Screen 15

Screen 16

Screen 17

Screen 18

Screen 19

Screen 20

Screen 21

Screen 22

Screen 23

Screen 24

Screen 25

Screen 26

Screen 27

Screen 28

Screen 29

Screen 30

Screen 31

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

Screen 37

Screen 38