Attachment E: Web Site Visitors Survey
Pharmacy Health Literacy Website Visitors Survey
Form
Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX
WELCOME!
Thank you for volunteering your time to respond to this brief survey!
Your responses to this survey
will help the Agency for Healthcare Research and Quality (AHRQ)
better understand the health literacy tools for pharmacy that they
have developed, as well as improve future quality improvement tools
for pharmacists and other pharmacy stakeholders.
This survey is confidential.
Your participation in this
survey is voluntary.
Your name or other identifying information will not be requested in the survey.
It should take you no
more than 12
minutes to complete the survey
Your
answers to the questions will remain confidential and will be
grouped together with those of others who complete the survey.
We do not foresee any risks
to you from participating in this survey. However, there is a
minimal risk that your confidentiality might not be preserved,
despite our best efforts.
If you have questions about the survey, or if you have questions regarding this study, contact Sarah J. Shoemaker, PhD, PharmD, the Project Director at Abt Associates at [email protected], or the AHRQ Project Officer, Dina Moss, at [email protected].
Public
reporting burden for this collection of information is estimated to
average 12 minutes per response, the estimated time required to
complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA,
Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room
#5036, Rockville, MD 20850.
Awareness of Tools
Prior to visiting this website, from which of the following source(s) did you learn about the availability of AHRQ’s Health Literacy Tools for Pharmacy? Please check all that apply.
National Association of Chain Drug Stores (NACDS) Practice Memo [Dec. 2008]
[insert distribution mechanism #1]
[insert distribution mechanism #2]
[insert distribution mechanism #3]
Direct mailing from Abt Associates
Agency for Healthcare Research & Quality (AHRQ) website
Directly from this Pharmacy Health Literacy Center website
Other [please specify]
Respondent’s attitude about health literacy
For each of the following statements, please rate on a scale from 1 to 5 the extent to which you agree or disagree (1=strongly agree, 5=strongly disagree).
Prior
to learning about AHRQ’s health literacy tools for pharmacy…
I
was aware of the high prevalence of limited or low health literacy
skills
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
I
believed at least some of my patients or customers had limited or
low health literacy skills
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
I
was actively learning or seeking to learn more about health
literacy
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
I
was actively trying to improve my health literacy practices
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
I was committed to addressing other health disparities (e.g., racial & ethnic disparities)
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Prior to learning about AHRQ’s health literacy tools for pharmacy, which of the following was true or false for you?
I was aware of the high prevalence of limited or low health literacy skills |
True |
False |
I believed at least some of my patients or customers had limited or low health literacy skills |
|
|
I was actively learning or seeking to learn more about health literacy |
|
|
I was actively trying to improve my health literacy practices |
|
|
I was committed to addressing other health disparities (e.g., racial & ethnic disparities) |
|
|
Other [please specify] |
|
|
Respondent’s
perceived need to address health literacy
For
each of the following statements, please rate on a scale from 1 to 5
the extent to which you agree or disagree (1= strongly agree; 5 =
strongly disagree –
may not need this instruction on web).
Understanding health literacy needs of patients is an important part of a pharmacist’s role. Knowing how to care for patients or customers with low health literacy is an important part of the pharmacist’s role.
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Many of my patients may have limited health literacy skills
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Improving
health literacy practices is an important quality improvement
effort for pharmacies
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Improving
my health literacy practices will improve patient satisfaction
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Improving
my health literacy practices will improve patient care
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
Improving
my health literacy practices will increase prescription sales
Strongly Agree |
Agree |
Neither Agree Nor Disagree |
Disagree |
Strongly Disagree |
General Tool Use / Non-Use
Which of the following AHRQ health literacy tools for pharmacy did you download or read? Please check all that apply.
Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment
Tool – User’s Guide
Strategies to Improve Communication between Staff and Patients: Pill Card tool for
Pharmacy Staff
Telephone Reminders: A Tool to Help Refill Medications on Time
None
of the above
Tool 1: Assessment Tool
Tool-specific Use / Non-Use
Have you had a chance to begin using “Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment Tool – User’s Guide”? (Assessment Tool)
Yes
No [skip to question 7]
Factors that led to decision to use tool
Why did you decide to use “Is Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health Literacy Assessment Tool – User’s Guide”? Please check all that apply.
The Assessment Tool can help me to improve my pharmacy practice
The resources needed to use the Assessment Tool are reasonable
The Assessment Tool can help put me ahead of my peers or competition
The Assessment Tool is compatible with what I think my pharmacy or I should do
The Assessment Tool is consistent with my professional aims or my pharmacy’s mission
The Assessment Tool seems simple to use
The Assessment Tool seems to offer an advantage over tools I currently have
I can try out the Assessment Tool before I use it
I can see the potential benefits of the Assessment Tool
The Assessment Tool may be helpful in my teaching/class
The Assessment Tool may be helpful for pharmacy benefit management
Other [please specify]
Did the [insert tool name] live up to your expectations?
Yes
No
I
have not had a chance to use the tool to be able to answer this
question. [skip pattern to next question on why/why not]
Why or why not? [open-ended]
SKIP
to Q12
Reasons for tool non-use
What
were your reason(s) for not using the tool, Is
Our Pharmacy Meeting Patients’ Needs? A Pharmacy Health
Literacy Assessment Tool User’s Guide?
Please check all that apply.
I have not had a chance to consider using the Assessment Tool
I plan to use the Assessment Tool, but I haven’t had a chance to do so
I do not see the value of the Assessment Tool
The Assessment Tool seems too difficult to use
The Assessment Tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Assessment Tool
Our pharmacy is too busy to use the Assessment Tool
We do not have sufficient staff or staff availability to use the Assessment Tool
Other
[please specify]
Likelihood of tool use
The Assessment Tool is a user’s guide for pharmacists to measure how well their pharmacy is serving patients with limited health literacy in order to i) raise staff awareness, ii) detect literacy barriers to understanding health information, and iii) identify opportunities for improvement.
How likely is it that you will use the Assessment Tool in the next 12 months?
Very Likely [skip to Q9] |
Somewhat Likely [skip to Q9] |
Not sure
[Skip to Q10] |
Somewhat Unlikely [skip to Q11] |
Very Unlikely [skip to Q11] |
Reasons for likelihood of tool use
What are the reasons you are likely or very likely to use the Assessment Tool in the next 12 months? Please check all that apply.
The Assessment Tool can help me to improve my current practice
The resources needed to use the Assessment Tool are reasonable
The Assessment Tool that puts me ahead of my peers or competition
The Assessment Tool is compatible with my pharmacy or practice approach
The Assessment Tool is consistent with my mission or aim
The Assessment Tool is simple enough to use
I can test or pilot the Assessment Tool before I use it
The potential results of the Assessment Tool are clear
The Assessment Tool may be helpful in my teaching/class
The Assessment Tool may be helpful for pharmacy benefit management
Other (please specify)
Is there something about the Assessment Tool that makes you uncertain whether or not you will use it in the next 12 months?
Yes
Please specify____________
No
What are the reasons you are unlikely or very unlikely to use the Assessment Tool in the next 12 months? Please check all that apply.
I do not see the value of the Assessment Tool
The Assessment Tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Assessment Tool
Our pharmacy is too busy to use the Assessment Tool
We do not have sufficient staff or staff availability to use the Assessment Tool
Other
[please specify]
Tool 2: Training Program
Tool-specific Use / Non-Use
Have you had a chance to begin using Strategies to Improve Communication between Staff and Patients: Training Program for Pharmacy Staff (Training Program), to train staff or students?
Yes
No [skip to Question 13]
Factors that led to decision to use tool
Why did you decide to use Strategies to Improve Communication between Staff and Patients: Training Program for Pharmacy Staff? Please check all that apply.
The Training Program can help me to improve my pharmacy practice
The resources needed to use the Training Program are reasonable
The Training Program can help put me ahead of my peers or competition
The Training Program is compatible with what I think my pharmacy or I should do
The Training Program is consistent with my professional aims or my pharmacy’s mission
The Training Program seems simple to use
The Training Program seems to offer an advantage over tools I currently have
I can try out the Training Program before I use it
I can see the potential benefits of the Training Program
The Training Program may be helpful in my teaching/class
The Training Program may be helpful for pharmacy benefit management
Other [please specify]
SKIP to
Q19
Reasons for tool non-use
Which of the following describes your reason(s) for not using the tool, Strategies to Improve Communication between Staff and Patients: Training Program for Pharmacy Staff? Please check all that apply.
I have not had a chance to consider using the Training Program
I plan to use the Training Program, but I haven’t had a chance to do so
The Training Program seems to difficult to use
I do not see the value of the Training Program
The Training Program does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Training Program
Our pharmacy is too busy to use the Training Program
We do not have sufficient staff or staff availability to use the Training Program
Other [please specify]
Likelihood of tool use
The Training Program consists of PowerPoint slides and handouts for pharmacists to introduce pharmacy staff or students to the problem of low health literacy in patient populations and to explain techniques that pharmacy staff members can use to improve communication with patients who may have limited health literacy skills.
What is the likelihood that you will use the Training Program in the next 12 months?
Very Likely [skip to Q16] |
Likely
[skip to Q16] |
Not sure
[skip to Q17] |
Unlikely
[skip to Q18] |
Very Unlikely [skip to Q18] |
Reasons for likelihood of tool use
What are the reasons you are likely or very likely to use the Training Program in the next 12 months?
The Training Program can help me to improve my current practice
The resources needed to use the Training Program are reasonable
The Training Program puts me ahead of my peers or competition
The Training Program is compatible with my pharmacy or practice approach
The Training Program is consistent with my mission or aim
The Training Program is simple enough to use
I can test or pilot the Training Program before I use it
The potential results of the Training Program are clear
The Training Program may be helpful in my teaching/class
The Training Program may be helpful for pharmacy benefit management
Other [please specify]
Is there something about the Training Program that makes you uncertain whether or not you will use it in the next 12 months?
Yes
Please specify____________
No
What are the reasons you are unlikely or very unlikely to use the Training Program in the next 12 months?
I do not see the value of the Training Program
The Training Program does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Training Program
Our pharmacy is too busy to use the Training Program
We do not have sufficient staff or staff availability to use the Training Program
Other [please specify]
Tool 3: Pill Card
Tool-specific Use / Non-Use
Have you had a chance to begin using How to Create a Pill Card (Pill Card tool), to create a pill card for a patient?
Yes
No [skip to Question 19]
Factors that led to decision to use tool
Why did you decide to use How to Create a Pill Card? Please check all that apply.
The Pill Card tool can help me to improve my pharmacy practice
The resources needed to use the Pill Card tool are reasonable
The Pill Card tool can help put me ahead of my peers or competition
The Pill Card tool is compatible with what I think my pharmacy or I should do
The Pill Card tool is consistent with my professional aims or my pharmacy’s mission
The Pill Card tool seems simple to use
The Pill Card tool seems to offer an advantage over tools I currently have
I can try out the Pill Card tool before I use it
I can see the potential benefits of the Pill Card tool
The Pill Card tool may be helpful in my teaching/class
The Pill Card tool may be helpful for pharmacy benefit management
Other [please specify]
SKIP
to Q26
Reasons for tool non-use
Which of the following describes your reason(s) for not using the tool, How to Create a Pill Card? Please check all that apply.
I have not had a chance to consider using the Pill Card tool
I plan to use the Pill Card tool, but I haven’t had a chance to do so
I do not see the value of the Pill Card tool
The Pill Card Tool seems to difficult to use
The Pill Card tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Pill Card tool
Our pharmacy is too busy to use the Pill Card tool
We do not have sufficient staff or staff availability to use the Pill Card tool
Other [please specify]
Likelihood of tool use
The Pill Card tool is a user’s guide on how to create an easy-to-use “pill card” for your patients who have a hard time keeping track of their medicines.
What is the likelihood that you will use the Pill Card tool in the next 12 months?
Very Likely [skip to Q23] |
Likely
[skip to Q23] |
Not sure
[skip to Q24] |
Unlikely
[skip to Q25] |
Very Unlikely [skip to Q25] |
Reasons for likelihood of tool use
What are the reasons you are likely or very likely to use the Pill Card tool in the next 12 months?
The Pill Card tool can help me to improve my current practice
The resources needed to use the Pill Card tool are reasonable
The Pill Card tool puts me ahead of my peers or competition
The Pill Card tool is compatible with my pharmacy or practice approach
The Pill Card tool is consistent with my mission or aim
The Pill Card tool is simple enough to use
I can test or pilot the Pill Card tool before I use it
The potential results of the Pill Card tool are clear
The Pill Card tool may be helpful in my teaching/class
The Pill Card tool may be helpful for pharmacy benefit management
Other (please specify)
Is there something about the Pill Card tool that makes you uncertain whether or not you will use it in the next 12 months?
Yes
Please specify____________
No
What are the reasons you are unlikely or very unlikely to use the Pill Card tool in the next 12 months?
I do not see the value of the Pill Card tool
The Pill Card tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Pill Card tool
Our pharmacy is too busy to use the Pill Card tool
We do not have sufficient staff or staff availability to use the Pill Card tool
Other [please specify]
Tool 4: Telephone Reminder
Tool-specific Use / Non-Use
Have you had a chance to begin using Telephone Reminders: A Tool to Help Refill Medications on Time (Telephone Reminder tool), for your reminder system?
Yes
No [skip to Question 25]
Factors that led to decision to use tool
Why did you decide to use Telephone Reminders: A Tool to Help Refill Medications on Time? Please check all that apply.
The Telephone Reminder tool can help me to improve my pharmacy practice
The resources needed to use the Telephone Reminder tool are reasonable
The Telephone Reminder tool can help put me ahead of my peers or competition
The Telephone Reminder tool is compatible with what I think my pharmacy or I should do
The Telephone Reminder tool is consistent with my professional aims or my pharmacy’s mission
The Telephone Reminder tool seems simple to use
The Telephone Reminder tool seems to offer an advantage over tools I currently have
I can try out the Telephone Reminder tool before I use it
I can see the potential benefits of the Telephone Reminder tool
The Telephone Reminder tool may be helpful in my teaching/class
The Telephone Reminder tool may be helpful for pharmacy benefit management
Other [please specify]
SKIP to
Q33
Reasons for tool non-use
Which
of the following describes your reason(s) for not using the tool,
Telephone
Reminders: A Tool to Help Refill Medications on Time?
Please check all that apply.
I have not had a chance to consider using the Telephone Reminder tool
I plan to use the Telephone Reminder tool, but I haven’t had a chance to do so
I did not see the value of the Telephone Reminder tool
The Telephone Reminder tool seems to difficult to use
The Telephone Reminder tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Telephone Reminder tool
Our pharmacy is too busy to use the Telephone Reminder tool
We do not have sufficient staff or staff availability to use the Telephone Reminder tool
Other [please specify]
Likelihood of tool use
The Telephone Reminder tool is to help a pharmacy create a telephone reminder system working with a software vendor to remind patients to refill their prescriptions.
What is the likelihood that you will use the Telephone Reminder tool in the next 12 months?
Very Likely [skip to Q30] |
Likely
[skip to Q30] |
Not sure
[skip to Q31] |
Unlikely
[skip to Q32] |
Very Unlikely [skip to Q32] |
Reasons for likelihood of tool use
What are the reasons you are likely or very likely to use the Telephone Reminder tool in the next 12 months?
The Telephone Reminder tool can help me to improve my current practice
The resources needed to use the Telephone Reminder tool are reasonable
The Telephone Reminder tool that puts me ahead of my peers or competition
The Telephone Reminder tool is compatible with my pharmacy or practice approach
The Telephone Reminder tool is consistent with my mission or aim
The Telephone Reminder tool is simple enough to use
I can test or pilot the Telephone Reminder tool before I use it
The potential results of the Telephone Reminder tool are clear
The Telephone Reminder tool may be helpful in my teaching/class
The Telephone Reminder tool may be helpful for pharmacy benefit management
Is there something about the Telephone Reminder tool that makes you uncertain whether or not you will use it in the next 12 months?
Yes
Please specify____________
No
What are the reasons you are unlikely or very unlikely to use the Telephone Reminder tool in the next 12 months?
I do not see the value of the Telephone Reminder tool
The Telephone Reminder tool does not seem to offer an advantage over tools I currently have
I do not have the resources to use the Telephone Reminder tool
Our pharmacy is too busy to use the Telephone Reminder tool
We do not have sufficient staff or staff availability to use the Telephone Reminder tool
Other [please specify]
Open-ended question
Is there anything else you would like to add about how AHRQ can help pharmacists with their work on low health literacy or other quality improvement activities?
Pharmacy setting characteristics
Which best describes your pharmacy setting?
Retail or chain pharmacy
Grocery or mass merchant pharmacy
Independent pharmacy
340B pharmacy
Ambulatory clinic
Hospital: in-patient
Hospital: out-patient
Academia
Managed care pharmacy
Other
On average, how many prescriptions per day does your pharmacy fill?
0 – 100
101 – 200
201 – 300
301 – 400
400 or more
Not
applicable
In
the past year, has your pharmacy: Please check all that apply.
Been reimbursed for providing medication therapy management (MTM) to patients
Served as a rotation/experiential site for pharmacy students
Served as a site for a pharmacy resident
Participated in a research project or study
Been involved with a patient safety project
Been involved with a medication error project
Conducted a quality improvement project or activity [ please specify]
In what state is your pharmacy or practice located?
[ ] drop down menu for states
Respondent characteristics
Which one of these best describes your role or title?
Pharmacy owner
Pharmacy manager
Staff pharmacist
Pharmacy student or intern
Resident
Pharmacy technician
Pharmacy clerk
Pharmacy faculty
Other [please specify]
What is the highest level of school you completed?
Some high school
High school graduate or GED
Some college or technical school
College graduate (not pharmacy)
Pharmacy school – Bachelors
Pharmacy school – PharmD
Some graduate school
Graduate school (Masters or PhD)
Other [please specify
If you are a pharmacist, what year did you graduate from pharmacy school?
[ ] insert 4-digit year
Are you Hispanic or Latino/Latina?
Yes
No
What is your race? Please select one or more.
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
Black or African-American
White
Are you:
Male
Female
File Type | application/msword |
File Title | Website Survey: Survey Domains, Survey Item & Response Categories |
Author | Sarah J. Shoemaker |
Last Modified By | ShoemakerS |
File Modified | 2009-08-06 |
File Created | 2009-08-06 |