Physician

Trends in U.S. Public's Awareness of Racial and Ethnic Heatlh Disparities (1999- 2008)

0990-Trends in the USAttachment F-2_Physician Questionnairem

Physician

OMB: 0990-0335

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Attachment F-2


National Survey of U.S. Public’s Awareness of Racial and Ethnic Health Disparities


Questionnaire, Physician Population

Attachment F-2


Form Approved OMB No. 0990-XXXX

Exp. Date XX/XX/XX11






NATIONAL SURVEY OF U.S. PUBLIC’S AWARENESS

OF RACIAL AND ETHNIC HEALTH DISPARITIES






Physician Population Edition



























According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990- . The time required to complete this information collection is estimated to average 14 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer.

DIRECTIONS


Thank you for agreeing to participate in this survey.


For each question, please choose the answer that best applies to you. If you are not able to find an answer that fits exactly, choose the one that comes closest.


These questions can be answered by simply marking the box next to the response that best fits your answer.


We appreciate you taking the time to contribute to this important study.

__________________________________________________________________


These first few questions ask about your practice and public health information.


  1. How would you describe the practice where you see most of your patients (i.e., your main practice)?


General hospital

Private practice

Teaching hospital

Local health department

Community health clinic

Campus health center

Other (Specify __________________________________________________________)


2. What percentage of your patients are (check only one percentage for each group):

Less than 10% 11- 25% 26-50% Over 50%

White

Black or African American

Hispanic/Latino

Asian American/Pacific Islander

Other (Specify_______________)

3. In the last year, have you heard or read anything about racial and ethnic disparities in health and health care in America?


Yes (If yes, briefly describe_____________________________________________)

No

________________________________________________________________________


4. Have you ever heard of any of the following public health campaigns or read any of the following publications? (Check all that apply)


The US Dept. of Health and Human Services’ Healthy People 2010

The Agency for Healthcare Research and Quality’s National Healthcare Disparities Report

The Institute of Medicine’s 2003 report, Unequal Treatment: Confronting Racial and

Ethnic Disparities in Health Care

The Office of Minority Health’s National Partnership for Action

The PBS Documentary: Unnatural Causes: Is Inequality Making Us Sick?

______________________________________________________________________


5. Does the organization where you currently practice offer the following (check all that apply):

Training for your staff using OMH’s Cultural Competency Curriculum Modules (CCCMs)

Language assistance services (i.e., bilingual staff, interpreter services)

Easily understood patient-related materials in the languages of the commonly encountered groups and/or groups represented in your service area.

Signage in the languages of the commonly encountered groups and/or groups represented in your service area.


___________________________________________________________________________



For the next few questions, please think about African Americans in our country today.


6. Do you think the average African American is better off, worse off or just as well off as the average white person in terms of:


  1. getting needed health care?


Better off

Worse off

Just as well off


  1. infant mortality?


Better off

Worse off

Just as well off


  1. life expectancy?


Better off

Worse off

Just as well off

________________________________________________________________________


7. Do you think the average African American is more likely, just as likely, or less likely to be diagnosed (or to have) with any of the following health conditions as the average white person?


  1. Auto Immune Deficiency Syndrome (AIDS) or the HIV virus


More likely

Just as likely

Less likely


  1. Cancer (including cancer of the stomach, prostate, or bladder)


More likely

Just as likely

Less likely


  1. Hypertension


More likely

Just as likely

Less likely


  1. Diabetes


More likely

Just as likely

Less likely

________________________________________________________________________


8. When going to a doctor or health clinic for health care services, do you think most

African Americans receive the same quality of health care as whites, higher quality of care or lower quality of health care as most whites?


Same quality

Higher quality

Lower quality

________________________________________________________________________


9. Do you think the average African American is better off, worse off or just as well off as

the average white person in terms of:


  1. how healthy they are?


Better off

Worse off

Just as well off


  1. getting routine medical care when they need it?


Better off

Worse off

Just as well off


  1. getting specialized treatments or surgery when they need it?


Better off

Worse off

Just as well off


  1. having health insurance?


Better off

Worse off

Just as well off

________________________________________________________________________


10. How big a problem do you think each of the following issues is for the average African American? Is it a major problem, a minor problem or not a problem at all for the average African American?


a. being able to afford the cost of health insurance and necessary medical care


Major problem

Minor problem

Not a problem at all


b. having enough doctors and other health providers near where they live


Major problem

Minor problem

Not a problem at all


c. having difficulty getting care because of their race or ethnic background


Major problem

Minor problem

Not a problem at all

________________________________________________________________________



Now, thinking about Hispanics or Latinos in our country today.


11. Do you think the average Hispanic/Latino is better off, worse off or just as well off as the

average white person in terms of:


  1. getting needed health care?


Better off

Worse off

Just as well off


  1. infant mortality?


Better off

Worse off

Just as well off


  1. life expectancy?


Better off

Worse off

Just as well off

________________________________________________________________________


12. Do you think the average Hispanic/Latino is more likely, just as likely, or less likely to be

diagnosed (or to have) any of the following health conditions as the average white person?


    1. Auto Immune Deficiency Syndrome (AIDS) or the HIV virus


More likely

Just as likely

Less likely


    1. Cancer (including cancer of the stomach and liver)


More likely

Just as likely

Less likely


    1. Hypertension


More likely

Just as likely

Less likely


    1. Diabetes


More likely

Just as likely

Less likely

________________________________________________________________________


13. When going to a doctor or health clinic for health care services, do you think most Hispanics/Latinos receive the same quality of health care as whites, higher quality of care or lower quality of health care as most whites?


Same quality

Higher quality

Lower quality

________________________________________________________________________


14. How big a problem do you think each of the following issues is for the average Hispanic/Latino? Is it a major problem, a minor problem or not a problem at all for the average Hispanic/Latino?


a. being able to afford the cost of health insurance and necessary medical care


Major problem

Minor problem

Not a problem at all


b. having enough doctors and other health providers near where they live


Major problem

Minor problem

Not a problem at all


c. having difficulty getting care because of their race or ethnic background


Major problem

Minor problem

Not a problem at all

________________________________________________________________________


15. Do you think the average Hispanic/Latino is better off, worse off or just as well off as the average white person in terms of


  1. how healthy they are?


Better off

Worse off

Just as well off


  1. getting routine medical care when they need it?


Better off

Worse off

Just as well off


  1. getting specialized treatments or surgery when they need it?


Better off

Worse off

Just as well off


  1. having health insurance?


Better off

Worse off

Just as well off

________________________________________________________________________


Now, thinking about Asian Americans/Pacific Islanders in our country today,


16. Do you think the average Asian American/ Pacific Islander is better off, worse off or just as well off as the average white person in terms of:


  1. getting needed health care?


Better off

Worse off

Just as well off


  1. infant mortality?


Better off

Worse off

Just as well off


  1. life expectancy?


Better off

Worse off

Just as well off

________________________________________________________________________


17. Do you think the average Asian American/ Pacific Islander is more likely, just as likely, or less likely to be diagnosed (or to have):


  1. Auto Immune Deficiency Disorder (AIDS) or the HIV virus


More likely

Just as likely

Less likely


  1. Cancer (including cancer of the stomach and liver)


More likely

Just as likely

Less likely


  1. Hypertension


More likely

Just as likely

Less likely


  1. Diabetes


More likely

Just as likely

Less likely

________________________________________________________________________


18. When going to the doctor or health clinic for health care services, do you think most

Asian American/ Pacific Islanders receive the same quality of health care as whites, higher quality of care or lower quality of health care as most whites?


Same quality

Higher quality

Lower quality

________________________________________________________________________


19. How big a problem do you think each of the following issues is for the average Asian American/ Pacific Islander? Is this a major problem, a minor problem or not a problem at all for the average Asian American/ Pacific Islander?


a. being able to afford the cost of health insurance and necessary medical care


Major problem

Minor problem

Not a problem at all


b. having enough doctors and other health providers near where they live


Major problem

Minor problem

Not a problem at all


c. having difficulty getting care because of their race or ethnic background


Major problem

Minor problem

Not a problem at all

________________________________________________________________________


20. Do you think the average Asian American/ Pacific Islander is better off, worse off or just as well off as the average white person in terms of:


  1. how healthy they are?


Better off

Worse off

Just as well off


  1. getting routine medical care when they need it?


Better off

Worse off

Just as well off


  1. getting specialized treatments or surgery when they need it?


Better off

Worse off

Just as well off


  1. having health insurance?


Better off

Worse off

Just as well off

________________________________________________________________________


These last questions are designed to help us better understand the doctors who participate in our survey.


21. Are you male or female?


Male

Female

________________________________________________________________________

22. What is your age?

___________

23. Are you yourself of Hispanic, Latino or Spanish origin?


Yes

No

________________________________________________________________________


24. What is your race?


White

Black or African American

Asian American/ Pacific Islander

Other (Specify __________________________________________________________)


_________________________________________________________________________

Thank you very much for completing the questionnaire. The information you have provided will be useful to policymakers. If you have anything else to add, or any questions, please call toll-free 1-877-236-8161. Again, thank you for your participation.


PLEASE RETURN THE COMPLETED QUESTIONNAIRE IN THE POSTAGE-PAID ENVELOPE, OR FAX THE SURVEY TO: secure fax-line.

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