Questionnaire Bank

Attachment 6: Introductory Questions

Attachment 6: Introductory Questions

Form Approved

OMB No. 0920-0572

Expiration Date: 06-30-2011

Introductory Questions

(Questions can be used in intercept interviews, telephone surveys, online surveys, and focus group discussion guides.)

1. Have you ever looked for health information from any source?

• Yes

• No

2. When you look for health information, where did you go?

• Books

• Brochures, pamphlets, etc.

• Organization

• Family

• Friend/Co-Worker

• Health care provider

• Internet

• Library

• Magazines

• Telephone information number (1-800-Number)

• Complementary or alternative practitioner

• Other: _________________________

• Do not look or go anywhere

3. The most recent time you looked for information was it for

• Yourself

• Someone else you care for or take care of , such as a spouse/partner, child, parent, relative, or friend

• Both?

4. In general, how much would you trust information about health or medical topics from a doctor or health care professional? Would you say a lot, some, a little, or not at all?

• A lot

• Some

• A little

• Not at all

5. In general, how much would you trust information about health or medical topics? Would you say a lot, some, a little, or not at all?

• How about from family and friends?

• How about in newspapers or magazines?

• How about on the radio?

• How about on the Internet?

• How about on television?

• How about from charitable organizations?

• How about religious organizations and leaders?

• How about from government health agencies?

[IF NEEDED: Government health agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, and state and local health departments.]

6. Think about the most recent time you looked up information on [INSERT health topic or behavior] from any source. About how long ago was that?

• Days ago

• Weeks ago

• Months ago

• Years ago

7. What type of information were you looking for in your most recent search?

• Organizations that focus on the [INSERT health condition/disease/syndrome/injury/disability]

• Causes for health condition/disease/risk factors for [INSERT health condition/disease/syndrome/injury/disability]

• Coping with health condition/disease/syndrome/dealing with [INSERT health condition/disease/syndrome/injury/disability]

• Diagnosis of [INSERT health condition/disease/syndrome/injury/disability]

• Information on [INSERT health condition/disease/syndrome/injury/disability]

• Paying for medical care/insurance

• Prognosis/recovery from [INSERT health condition/disease/syndrome/injury/disability]

• Screening/testing/early detection of [INSERT health condition/disease/syndrome/injury/disability]

• Symptoms of [INSERT health condition/disease/syndrome/injury/disability]

• Treatment/cures for [INSERT health condition/disease/syndrome/injury/disability]

• Where to get medical care for [INSERT health condition/disease/syndrome//injury/disability]

• Information on complementary alternative or unconventional treatments for [INSERT health condition/disease/syndrome/injury/disability]

• Other: __________________________

8. The next few questions are about various ways you might get health information.

Some newspapers or general magazines publish a special section that focuses on health. In the past 12 months, have you read health sections of the newspaper or of a general magazine?

• Yes

• No

9. Some local television and radio news programs include special segments of the newscasts that focus on health issues. In the past 12 months, have you watched or listened to health segments on the local news?

• Yes

• No

10. Some people notice information about health on the Internet, even when they are not trying to find out about a health concern they have or someone in the family may have. Have you read such health information on the Internet in the past 12 months?

• Yes

• No

11. Here are some ways people use the Internet. Some people have done these things, but other people have not. In the past 12 months, have you done the following things while using the Internet?

• Bought medicine or vitamins on-line?

• Participated in an on-line support group for people with a similar health or medical issue?

• Used Email or the Internet to communicate with a doctor or a doctor’s office?

• Used a Web site to help you with your diet, weight, or physical activity?

• Looked for a healthcare provider?

• Downloaded a portable device, such as an iPod, cell phone, or PDA?

• Visited a “social networking” site, such as “My Space” or “Second Life”?

• Wrote in an online diary or “blog” (i.e., Web log)?

• Kept track of personal health information, such as care received, test results, or upcoming medical appointments?

12. About how often do you use the Internet from

• Several times a day

• About once a day

• 3-5 days a week

• 1-2 days a week

• Every few weeks

• Less often

• Never

• Don’t know/refused

13. As I read the following list of items, please tell me if you, personally, happen to have each one, or not.

• A desktop computer

• A laptop computer

• A cell phone

• A personal digital device, like a Sidekick, Palm Pilot or Blackberry

• An iPod or other MP3 player