Survey on Sodium Awareness

Form Approved

OMB No. 0920-xxxx

Expiration date: xx/xx/xxxx

Improving the Quality and Delivery of CDC’s Heart Disease and Stroke

Prevention Programs

Information Collection #2

Web Based Survey Instrument to Assess Adoption and Use of Materials for the Sodium Reduction Awareness Toolkit

______________________________________________________________________

We would like to thank you for agreeing to complete this survey about the Sodium Reduction Awareness Toolkit. This survey will be used to assess how the Division for Heart Disease and Stroke Prevention (DHDSP) at the Centers for Disease Control and Prevention (CDC) can best support state heart disease and stroke prevention programs in using the Sodium Reduction Awareness Toolkit and future sodium reduction products or tools.

The Sodium Reduction Awareness Toolkit included the following contents.

• Fact sheet

• Point and counterpoint document

• Question and answer document

• List of internet resources

• Video

We want to ask you a few questions from the perspective of your role as a program manager.

Obtain Electronic Consent

Consent Statement – The DHDSP is conducting a web based survey as part of its effort to evaluate CDC’s initiatives to reduce and control hypertension. The purpose of this survey is to solicit feedback on the Sodium Reduction Awareness Toolkit. Information collected from this survey will be used by the DHDSP to help improve existing and future sodium reduction products. You were chosen to participate in this survey because you are a program manager funded by DHDSP or a contact from a partner organization. The survey should take no more than 20 minutes of your time. Participation in the survey is voluntary, you may choose to end the survey at any time for any reason with no penalty, and may choose not to answer any questions at any time for any reason. Your participation in the survey poses few, if any risks to you and you may choose not to participate in the survey for any reason. If you have any questions about this survey, or evaluation, please contact Mr. Christopher Thomas, Public Health Advisor, at Phone: (770) 488-4264, E-mail: [email protected].

By clicking “Next” you give your consent to participate in this survey.

1. What type of organization do you currently work at?

• Non-Profit Organization

• State Health Agency

• Tribal Health Agency

• Other (please specify____________)

2. What is your job title or role?

• Program Director

• Program Coordinator

• Epidemiologist

• Health Educator

• Other (please specify____________)

3. Have you or anyone in your organization used any materials from the Sodium Reduction Awareness Toolkit in the last three months?

• Yes

• No

If no, a skip pattern will lead the respondent to question 12 and then thank the respondent for participation in the survey and provide the respondent with contact information for Christopher Thomas at [email protected] for any additional questions.

4. How often do you or anyone in your organization use any materials from the Sodium Reduction Awareness Toolkit?

• Daily

• Weekly

• Monthly

• Never

5. Which Sodium Reduction Awareness Toolkit contents have been used? (select all that apply)

• Salt Matters video – short version

• Salt Matters video – long version

• Sodium fact sheet

• Sodium internet resources list

• Sodium point-counterpoint document

• Sodium questions and answers document

6. How have you or your organization used the Sodium Reduction Awareness Toolkit? (select all that apply)

• Presentation to

  • Public

  • Partner organizations

  • Policymakers

  • Staff in your organization

• Policy briefing for legislator

• To develop other informational materials

• Other (please specify____________)

For the following statements, please indicate whether you agree or disagree, with 1 representing complete disagreement and 5 representing complete agreement: [answers: 1) Strongly disagree, 2) Disagree, 3) Neither agree nor disagree, 4) Agree, 5) Strongly agree]

7. I am satisfied with the Sodium Reduction Awareness Toolkit.

8. The Sodium Reduction Awareness Toolkit filled a resource gap for me or my organization.

9. The Sodium Reduction Awareness Toolkit is a useful resource for disseminating sodium reduction information.

Please provide your answers to the following questions in the space below. [open ended questions]

10. What can we do to improve the Sodium Reduction Awareness Toolkit?

[open ended question]

11. What content or information would you like to see in future sodium reduction education tools?

[open ended question]

We thank you for your time, if you have questions about this survey please contact Christopher Thomas at [email protected].

12. Why have you or your organization not used materials from the Sodium Reduction Awareness Toolkit? (select all that apply)

• My agency is not currently working on sodium reduction initiatives.

• My agency is not interested in sodium reduction initiatives.

• My agency plans to use the Sodium Reduction Awareness Toolkit in future sodium reduction initiatives.

• Other (please specify____________)

We thank you for your time, if you have questions about this survey please contact Christopher Thomas at [email protected].

Public reporting burden of this collection of information is estimated to average 20 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).