Survey #4 Provider Survey #4 Provider View of Decision Aid

OMB No. 0930-0197
Expiration Date: XX/XX/XXXX

USER SATISFACTION SURVEY
on
DECISION AID ON ANTIPSYCHOTIC MEDICATIONS
for Mental Health Services Providers
Thank you for taking the time to answer this survey about your experience with use of
the computer-based Decision Aid on Antipsychotic Medications. We are interested in
your experiences with mental health services consumers who used the Decision Aid.
The results from this survey will be used to determine whether the Decision Aid is useful
for helping people make important decisions about antipsychotic medications and
alternative and complementary approaches, and whether it supports shared decisionmaking in mental health services.
Your participation is VOLUNTARY. You may choose to answer this survey or not.
The information you provide is kept PRIVATE. Your name will not be associated
with this survey. Other information that would let someone identify you will be kept
private. AHP will not share your personal answers with anyone. Reports that explain
the findings of this survey will reflect a collection of information from many participants.
This survey will be destroyed after data collection is completed.

Public Burden Statement: 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. The OMB control number for
this project is 0930-0197. Public reporting burden for this collection of information is estimated to average 10
minutes per respondent per year, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to SAMHSA Reports Clearance Office, 1 Choke Cherry Road, Room 71044, Rockville, Maryland, 20857.

For Office
Use Only

Date:

Site:

OMB No. 0930-0197
Expiration Date: XX/XX/XXXX

Survey Instructions
You may be asked to skip over some questions in this survey. When this
happens you will see an arrow with a note that tells you what question to answer
next, like this:

Yes → If Yes, go to #1 on page 1
No

Questions
Your Training and Role
1. What is your education or training
background?
Psychiatrist
Other M.D. _______________
Nurse
Physician’s Assistant
Psychologist
Social Worker
Other Counseling or Related
Peer Support Training
Other_____________________
2. What is your primary role with
consumers?
Medication Prescriber
Therapist or Counselor
Case Manager
Peer Support Staff
Other______________________

Consumers You Met With
Think about the meetings you had with
consumers who used the Decision Aid and
answer the following questions. Estimate
numbers as necessary.
3. How many consumers did you meet with
who used the Decision Aid?
Number of consumers: _________
4. With how many of the consumers you met
with did you discuss a shared decision between
you and the consumer (a decision involving your
expertise and recommendation)?
Number of consumers: _________
5. How many of the consumers you met
with shared a written report they prepared
using the Decision Aid?
Number of consumers: _________
6. With how many of the consumers you
met with were you able to review the written
report?
Number of consumers
Before the meeting:

_________

During the meeting:

_________

Please continue on next page

OMB No. 0930-0197
Expiration Date: XX/XX/XXXX

7. Think about all of the meetings you had with consumers who used the Decision
Aid and answer the following questions.
a. Do you believe that any of the consumers you met with benefitted
from using the Decision Aid?

Yes

If yes, how many?

No

_______________

b. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their confidence about making a
decision about mental health treatment or services?

Yes

If yes, how many?

No

_______________

c. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their confidence about talking to you
or another provider about mental health treatment or services?

Yes

If yes, how many?

No

_______________

d. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their knowledge about antipsychotic
medications including benefits and side effects?

Yes

If yes, how many?

No

_______________

e. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their knowledge about alternatives to
antipsychotic medications?

Yes

If yes, how many?

No

_______________

f. Do you believe that, for any of the consumers you met with, use of
the Decision Aid increased their satisfaction with the decision they
made?

Yes

If yes, how many?

No

_______________

g. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their knowledge about complementary
approaches to antipsychotic medications?

Yes

If yes, how many?

No

_______________

h. Do you believe that, for any of the consumers you met with, use
of the Decision Aid increased their knowledge about health and
wellness?

Yes

If yes, how many?

No

_______________

i. Do you believe that, for any of the consumers you met with, use of
the Decision Aid increased their knowledge about recovery
activities?

Yes

If yes, how many?

No

_______________

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OMB No. 0930-0197
Expiration Date: XX/XX/XXXX

Think about all of the meetings you had with consumers who used the Decision
Aid and answer the following questions.
j. Do you believe that, for any of the consumers you met with, use of
the Decision Aid resulted in improved communication between you
and the consumer?

Yes

If yes, how many?

No

_______________

k. Do you believe that, for any of the consumers you met with, use
of the Decision Aid resulted in your better understanding their
previous experiences with antipsychotic medications?

Yes

If yes, how many?

No

_______________

l. Do you believe that, for any of the consumers you met with, use of
the Decision Aid resulted in your better understanding their goals?

Yes

If yes, how many?

No

_______________

m. Do you believe that, for any of the consumers you met with, use
of the Decision Aid resulted in your better understanding their
priorities?

Yes

If yes, how many?

No

_______________

n. Do you believe that, for any of the consumers you met with, use
of the Decision Aid resulted in your better understanding their
values or beliefs?

Yes

If yes, how many?

No

_______________

o. Did use of the Decision Aid result in increasing the amount of
time you spent with any consumers?

Yes

If yes, how many?

No

_______________

Yes

If yes, how many?

No

_______________

Yes

If yes, how many?

No

_______________

Yes

If yes, how many?

No

_______________

p. Was this increase in time beneficial for any consumers?

q. Did use of the Decision Aid result in decreasing the amount of
time you spent with any consumers?

r. Was this decrease in time beneficial for any consumers?

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OMB No. 0930-0197
Expiration Date: XX/XX/XXXX

14. What information have you read or been
presented with on Shared Decision-Making
in mental health services in the past 6
months?

Your Thoughts
8. Did you review the Decision Aid
yourself?

Presentation
Brochure
Video
Internet
Journal or Newspaper Article
Other_____________________
I have not seen any information
on Shared Decision-Making

Yes
No → If No, go to #14 on this page
9. Would you recommend the Decision Aid
to consumers?
Yes
No

15. Is there anything else you think we
should know about the Decision Aid or your
experience with Shared Decision-Making?

10. Do you think the Decision Aid supports
shared decision-making in mental health?
Yes
No

__________________________________
__________________________________

11. Do you think the Decision Aid provides
enough information to consumers?

__________________________________

Yes
No

__________________________________
__________________________________

12. Do you think the Decision Aid gives
consumers misleading information about
antipsychotic medications?

__________________________________

Yes
No

You have completed the survey.
Thank you for your participation!

13. Do you think the Decision Aid provides
sufficient information on alternatives to
antipsychotic medications?
Yes
No

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