2 instrument

OMB # 0925-0486-1301-05
Exp. 07/31/2010

NIDDK NKDEP’s Family Reunion Initiative Web site User Satisfaction Survey (User Track)

Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0486). Do not return the completed form to this address.

Thank you for choosing to take part in NKDEP’s survey about the Family Reunion Initiative and Family Reunion Health Guide. This survey will take less than 5 minutes to complete. Please be assured your identity and answers will be kept confidential and not shared with anyone outside the study. Once again, thank you for your time.

1. How did you view or receive the Family Reunion Health Guide (select all that apply).

 I downloaded part or all of Guide from the NKDEP Website.

 I ordered a printed copy.

 Someone gave one to me.

 Other: Please specify: _______________________________________________

2. What did you do with the Guide? (Select all that apply.)

 I read or skimmed through it.

 I used it to plan an activity at a family event.

 I gave it to a family member so she/he could plan an activity.

 I encouraged friends to check out the Guide.

 I promoted the Guide to people I work with, or people who are members of an organization I belong to.

 I distributed the Guide to 50 or more people.

Other: Please specify ___________________________________________________

I don’t know.

3. How did you learn about the Guide?

 Through a search engine (e.g., Yahoo!, Google, etc.)

 NKDEP Website or eNewsletter

 Another organization’s Website, newsletter, or email (If you select this response, please tell us the organization if you can remember it: ________________________________)

 A friend, family member, or colleague

 Church or other place of worship

 An event (e.g., National Urban League conference)

 A community worker

 I don’t know

 Other: Please specify: _____________________________________________________

4. Did you personally use the Guide to help you plan an activity at your family reunion or other family gathering?

A)  Yes

i) If yes, will you use it again?

 Yes. Please briefly explain. _______________________

 No. Please briefly explain__________________

ii ) If yes, have you or will you encourage others to use the Guide with their families?

 Yes. Why? ______________________________________

 No. Why not? _____________________________________

B) No

i) If no, why not? Please mark all that apply.

 I gave it to another family member to plan an activity.

 I didn’t learn about it and/or receive the Guide in time for the event

 No time yet, but I plan to use it in the future

 I didn’t feel I could do it well

 It was too complicated

 I don’t know

 I felt my family wouldn’t like it

 Diabetes and high blood pressure don’t affect many of my family members

 It’s not my job to talk about health with family members

 It didn’t feel appropriate to do at a family reunion or gathering

 I’d rather not say

 Other: Please specify: _________________________________

ii) What, if anything, would make you more likely to use the Guide in the future? For example, how should it be changed? ________________

C)  I don’t know

D)  Other: Please briefly explain: _______________________________________

5. How do you rate the Guide in terms of the following factors?

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree	Don't Know
It is easy to read						
It is useful						
It is easy to use.						
It is attractive.						
It has all the information I need.						
It includes language I can relate to						
It includes images I can relate to.						

If you would like, please use this space to explain your reasoning for any of the ratings ________

6. You may remember that the Guide offered three approaches for sharing information with family members. Which approach or combination of approaches did you use? Select all that apply.

 Note to Family Members

 Individual One-on-one Discussion (Talking One-on-One)

 15-minute “Make the Kidney Connection” Health Discussion

 I used a combination of activities.
(If you can remember, please tell us what you did: ________________________________)

I created my own approach
(If you can remember, please tell us what you did:_____________________)

I don’t know

Other: Please specify ________________________________

7. Which family gathering did you use to share information with your family members?

 Family reunion

 A holiday (Which one? _____________________)

 An anniversary party

 A birthday party

 Other: Please specify: ______________________________

8. Approximately how many family members did you reach with information? _____________________________

9. How useful did your family find the information useful?

Very useful

Somewhat useful

Not very useful

Not at all useful

10. During or at the end of your family event, did anyone tell you that he/she was planning to get tested for CKD as a result of the information you provided?

Yes

No

I don’t know/Not sure

 Other: Please specify: _______________________________________________

11. Do you know if anyone was tested for CKD as a result of your presentation, letter, discussion, etc.?

 Yes

 No

 I don’t know/Not sure

 Other: Please specify: _______________________________________________

12. What giveaways would you have liked to be able to distribute during your reunion had they been available? ______________________________________________________

13. When you completed the survey, you said you learned about the Guide through _____________. Can you tell me other ways that NKDEP might consider promoting the Guide?
    ________________

14. Would you recommend the Guide to your friends who are planning family gatherings?

 Yes. Why? ________________________________________________________

 No. Why not? ____________________________________________________

Once again, thank you for taking this survey!

ATTACH 1 – Guide user survey