Attachment A: Live Phone Follow-up Survey (English)
Live Phone Follow-up Survey
Introduction
Hello! A few weeks ago someone in your household agreed to take part in a 15 minute survey. Are you that person?
If the person answering the telephone is not the person who agreed to participate in the survey, reply:
When would be a good time to
reach the other adult in your household?
If the person answering the telephone says they are the person who agreed to participate in the survey, reply:
[
In
order to verify your identity, we gave you a code for you to
remember. What is that code word?
[The
code word is CDC-INFO. If can’t recall] Do
you remember the name if the organization that asked you
to participate in a survey?
[If
not handy]
Are you able to get it? We can only proceed with the survey if we
can
verify
your identity with the code word.
[If
not available] I’m
sorry, but you need to have the code word to participate. Thank
you for your interest in the survey. Goodbye.
[If
yes]
Great! You can skip any question you don’t want to answer or
stop at any time. If you’re ready, let’s begin.
[If
not available now] When is a good time for me to call you back?
Remember, we are definitely not selling anything.
Your responses will be strictly confidential and will not be identified with you in any way.
T
Public
reporting burden of this collection of information is estimated to
average of 7 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)
[
CDC-INFO
is a single phone number for the public to freely access
information on a variety of health topics, including diseases,
environmental hazards, inoculations, congenital conditions,
emergency response, and so on. Previously, this was available
through separate tool-free numbers. They are being combined to
provide one face to the public, with one access number. If you have
any questions about the survey, you may contact the study director,
Dr. Elizabeth Harris at (800) 368-0056 (800-EMT-0056)
If
you’d like, we can send you a summary if the survey results.
QUESTIONS
Familiarity with CDC-INFO
1. Was that the first time you contacted CDC-INFO?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
2. How did you find out about CDC-INFO? [Check all that apply]
1. Advertisement on TV or Radio |
|
2. |
TV ad |
3. |
Radio ad |
4. Advertisement NOT on TV or Radio |
|
5. |
Billboard |
6. |
Bus ad (outside or inside) |
7. |
Flyer |
8. School |
|
9. |
Preschool |
10. |
Elementary School |
11. |
Middle School |
12. |
High School |
13. |
College |
14. Health care provider |
|
15. |
Hospital |
16. |
Doctor/other health care professional |
17. |
Other health care hotline |
18. |
Social Worker |
19. Media |
|
20. |
Phone book or Information line (411) |
21. |
Internet search |
22. |
Other web site |
23. |
CDC-INFO Website |
24. |
Newspaper story |
25. |
Radio announcement or news story |
26. |
TV announcement or news story |
27. |
Friend/family member |
28. |
Other: ____________________ |
29. |
Don’t recall |
30. |
Refused to answer |
Usefulness of CDC-INFO
3. Was it easy to actually reach a representative?
1. |
Yes |
3. |
No |
3. |
Refused to answer |
[If the respondent does not answer question 3 as “Yes,” probe]
4. I would appreciate it if you could tell me more about the difficulties you experienced in reaching a representative.
1. |
Confused about what selection to choose |
2. |
Took too long to get through automated system |
3. |
Put on hold for a long time |
4. |
Other (specify)__________________ |
5. |
Refused to answer |
Knowledge Change
5. What did you learn from your call to CDC-INFO that you did not know before?
1. |
Nothing [skip to Q9] |
2. |
Where to get additional information |
3. |
The need for testing |
4. |
Where to go for testing |
5. |
Need to seek medical attention |
6. |
Symptoms of disease |
7. |
Risk reduction/ Prevention strategies |
8. |
Immunization schedule |
9. |
Other (specify) _________________ |
10. |
Refused to answer |
Attitude Change
6. Did what you learn make you want to change any behaviors?
1. |
Yes |
2. |
No [skip to Q9] |
3. |
Not sure |
4. |
N/A [what caller learned was not related to behavior] |
5. |
Refused to answer |
7. [If “yes” or “not sure” to above] I would appreciate it if you would tell me more about what changes you are thinking about. Would you feel comfortable sharing that with me? If not, we can go to the next question. [Mark all that apply]
1. |
Increase exercise, sports or physical activity |
2. |
Lose weight |
3. |
Change diet or eating habits |
4. |
Quit smoking / reduce amount smoked or reduce tobacco use (smokeless tobacco) |
5. |
Exercise better hygiene |
6. |
Get counseling |
7. |
Start taking medications |
8. |
Plan to see a doctor |
9. |
Reduce risky sexual behaviors |
10. |
Get tested |
11. |
Change eating habits |
12. |
Get immunized |
13. |
Other: (specify)________________________ |
14. |
Refused to answer |
Behavior Change
8. Have you actually changed any behaviors?
1. |
Yes |
2. |
No |
3. |
Not yet, but planning to |
4. |
Refused to answer |
Comfort with the CSR/HSR
[Note to interviewer: If the respondent talked with more than one representative and is unsure which one to comment on, tell the respondent: “Please choose the representative you want to talk about the most.”]
9. Thinking about the person you spoke with at CDC-INFO, how polite was the Representative? [Read options to respondent]
1. |
Very polite |
2. |
Somewhat polite |
3. |
Not very polite |
4. |
Not at all polite |
5. |
Refused to answer |
10. How satisfied are with the way he or she interacted with you during the call? [Read options to respondent]
1. |
Very satisfied |
2. |
Somewhat satisfied |
3. |
Somewhat dissatisfied |
4. |
Very dissatisfied |
5. |
Refused to answer |
Trust in CDC-INFO
11. How knowledgeable was the person you spoke with? [Read options to respondent]
1. |
Very knowledgeable |
2. |
Somewhat knowledgeable |
3. |
Not sure |
4. |
Not very knowledgeable |
5. |
Not knowledgeable at all |
6. |
Refused to answer |
12. How helpful was the person you spoke with at CDC-INFO? [Read options to respondent]
1. |
Very helpful |
2. |
Somewhat helpful |
3. |
Not sure |
4. |
Not very helpful |
5. |
Not at all helpful |
6. |
Refused to answer |
13. Overall, how satisfied are you with the quality of the health care information provided by CDC-INFO? [Read options to respondent]
1. |
Very satisfied |
2. |
Somewhat satisfied |
3. |
Neither |
4. |
Somewhat dissatisfied |
5. |
Very dissatisfied |
6. |
Refused to answer |
14. Do you consider CDC-INFO to be a reliable source of information? [Read options to respondent]
1. |
Definitely yes |
2. |
Probably yes |
3. |
Don’t know/not sure |
4. |
Probably not |
5. |
Definitely not |
6. |
Refused to answer |
Overall Satisfaction with CDC-INFO
15. Thinking about your entire call experience, how satisfied are you with CDC-INFO? Are you: [Read options to respondent]
1. |
Very satisfied |
2. |
Somewhat satisfied |
3. |
Neither |
4. |
Somewhat dissatisfied |
5. |
Very dissatisfied |
6. |
Refused to answer |
16. [If less that “very satisfied” to above] I would appreciate it if you would tell me about the reason you are not completely satisfied. [Mark all that apply]
System Issues |
|
Publication Issues |
||
|
Hard to reach a live operator |
|
21. |
No publication available |
|
On hold too long |
|
22. |
CSR would not take publication order |
|
No one spoke language |
|
Other |
|
|
Poor telephone connection |
|
34. |
Doesn’t want to report satisfaction until services are received |
CSR Issues |
|
35. |
Lost information from CDC-INFO |
|
|
Call took too long |
|
36. |
Other (specify): |
|
CSR couldn’t find answer to question |
|
37. |
Refused to answer |
|
CSR wouldn’t answer question |
|
|
|
|
CSR didn’t understand what I needed |
|
|
|
|
CSR referred respondent to another hotline |
|
|
|
|
CSR hard to understand (didn’t speak clearly) |
|
|
|
|
CSR was disrespectful/rude |
|
|
|
|
CSR was impatient |
|
|
|
|
Not enough information provided (partial answer to question) |
|
|
|
|
Unclear information provided |
|
|
|
|
Too much information provided |
|
|
|
|
Information was too technical to understand |
|
|
|
|
Information not relevant to question |
|
|
|
|
Information not current/most recent |
|
|
|
|
Sent to website |
|
|
|
|
Could’ve looked up same information on website |
|
|
|
17. Judging from your experience with CDC-INFO, would you call again?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
18. Would you recommend CDC-INFO to a friend?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
19. Have you recommended CDC-INFO?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
Who would you have called if CDC-INFO was not available? [Check all that apply]
1. |
Doctor’s office |
2. |
Don’t Know |
3. |
Community health center |
4. |
Walk-in clinic |
5. |
Hospital emergency room |
6. |
Telephone health line (specify)___________________ |
7. |
Other: (specify) |
8. |
Other hospital service |
9. |
Refused to answer |
Thank you very much! Do you have any questions for me in regard to this survey?
CDC-INFO can be reached at 1-888-CDC-INFO, 1-888-232-4636. Thanks again!
[Note to Interviewer: If the respondent would like a copy of the survey results, write his or her email or address down on a piece of paper and submit it to Dr. Harris. Do not record the respondent’s contact information in the Access database] |
* [Note to Interviewer: Please write any general comments that are NOT improvement related. Include positive comments here.]
Attachment B: Live Phone Follow-up Survey (Spanish)
Live Phone Follow-up Survey
Introduction
Hola! Hace unas semanas alguien en su hogar estuvo de acuerdo en participar en un cuestionario de 7 minutos de duración. Es Ud. esa persona?
If the person answering the telephone is not the person who agreed to participate in the survey, reply:
Cual sería la mejor hora para encontrar a la persona que estuvo de acuerdo en participar en el questionario?
If the person answering the telephone says they are the person who agreed to participate in the survey, reply:
Con el fin de verificar su identidad se le dió una clave la cual se le pidió recordar. Podría darme la clave?
[The code word is CDC-INFO. If can’t recall] Se acuerda del nombre de la organización que le pidió participar en el cuestionario?
[If not handy] Sería mucha molestia pedirle que buscara la clave? Solo podemos proceder con el questionario después de que su identidad haya sido verificada con la clave.
[If not available] Lo siento, pero necesita tener la clave par poder participar. De todas maneras gracias por su interés en el cuestionario. Adiós.
[If yes] Magnífico! Ud. puede omitir cualquier pregunta que no desee responder o terminar este questionario en cualquier momento. Si esta listo, empecemos!.
[If not available now] Cuando sería el mejor momento para volverlo a llamar?
|
De
acuerdo a gravámenes en informes públicos el
promedio para recaudar ésta información es de 7
minutos por respuesta,
lo
cual incluye el tiempo utilizado para revisar instrucciones,
buscar fuentes de datos ya existentes, recaudar y conservar
datos necesarios, y completar y analizar la recaudación
de la información. Una recaudación de información
no debe llevarse a cabo o ser auspiciada por una agencia al
menos que dicha recaudación lleve consigo un número
actual de control OMB válido. De igual modo una persona
no debe responder una recaudación de información
si dicha recaudación no presenta un número actual
de control OMB válido. Por favor sírvase enviar
comentarios con respecto al estimado de este gravamen o de
cualquier otro aspecto de ésta recaudación de
información, también se pueden incluir sugerencias
en cómo reducir este gravamen a CDC/ATSDR Reports
Clearance Officer, 1600 Clifton Road NE, MS D-74 Atlanta,
Georgia 30333. ATTN: PRA (0920-XXXX)
De acuerdo a gravámenes en informes públicos el promedio para recaudar ésta información es de 7 minutos por respuesta, lo cual incluye el tiempo utilizado para revisar instrucciones, buscar fuentes de datos ya existentes, recaudar y conservar datos necesarios, y completar y analizar la recaudación de la información. Una recaudación de información no debe llevarse a cabo o ser auspiciada por una agencia al menos que dicha recaudación lleve consigo un número actual de control OMB válido. De igual modo una persona no debe responder una recaudación de información si dicha recaudación no presenta un número actual de control OMB válido. Por favor sírvase enviar comentarios con respecto al estimado de este gravamen o de cualquier otro aspecto de ésta recaudación de información, también se pueden incluir sugerencias en cómo reducir este gravamen a CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333. ATTN: PRA (0920-XXXX)
|
[If yes]
Dejeme recordarle que definitivamente no le estamos vendiendo nada.
Sus respuestas seran estrictamente confidenciales y no seran relacionadas con usted de ninguna manera.
Este cuestionario esta siendo conducido por E.M.T. Associates, Inc. Una agencia independiente de investigaciones. Nosotros hemos sido contratados por CDC-INFO para llevar a cabo este cuestionario.
[Note: If the respondent asks for more information about CDC-INFO, reply]
CDC-INFO es un número telefónico individual para uso del público y brinda acceso a información sobre diversos temas de salud. CDC-INFO es financiado por el Centro para el control y prevención de enfermedades. Si tiene alguna pregunta acerca del cuestionario. Ud puede comunicarse con la directora de este estudio, Doctora Elizabeth Harris al (800) 368-0056 (800-EMT-0056).
|
Familiarity CDC-INFO
Fue la primera vez que llamó a CDC-INFO?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
Cómo se enteró de CDC-INFO? [Check all that apply]
1. Advertisement on TV or Radio |
|
2. |
TV ad |
3. |
Radio ad |
4. Advertisement NOT on TV or Radio |
|
5. |
Billboard |
6. |
Bus ad (outside or inside) |
7. |
Flyer |
8. School |
|
9. |
Preschool |
10. |
Elementary School |
11. |
Middle School |
12. |
High School |
13. |
College |
14. Health care provider |
|
15. |
Hospital |
16. |
Doctor/other health care professional |
17. |
Other health care hotline |
18. |
Social Worker |
19. Media |
|
20. |
Phone book or Information line (411) |
21. |
Internet search |
22. |
Other web site |
23. |
CDC-INFO Website |
24. |
Newspaper story |
25. |
Radio announcement or news story |
26. |
TV announcement or news story |
27. |
Friend/family member |
28. |
Other: ____________________ |
29. |
Don’t recall |
30. |
Refused to answer |
Usefulness of CDC- INFO
Fue fácil lograr hablar con un representante?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
[If the respondent does not answer question 3 as “Yes”, probe]
Apreciaría mucho si me dijera las dificultades que experimentó al tratar de hablar con un representante.
1. |
Confused about what selection to choose |
2. |
Took too long to get through automated system |
3. |
Put on hold for a long time |
4. |
Other (specify) _________________ |
5. |
Refused to answer |
Knowledge Change
Aprendio algo nuevo como resultado de su llamada a CDC-INFO?
1. |
Nothing [skip to Q9] |
2. |
Where to get additional information |
3. |
The need for testing |
4. |
Where to go for testing |
5. |
Need to seek medical attention |
6. |
Symptoms of disease |
7. |
Risk reduction/prevention strategies |
8. |
Immunization schedule |
9. |
Other (specify) _________________ |
10. |
Refused to answer |
Attitude Change
Cambio algo en su conducta/comportamiento como resultado de esta nueva información?
La nueva información hizo que cambiara algo en su comportamiento/conducta?
1. |
Yes |
2. |
No [skip to Q9] |
3. |
Not sure |
4. |
N/A [what caller learned was not related to behavior] |
5. |
Refused to answer |
[If “yes” or “not sure” to above] Apreciaría mucho si me dijera que cambios esta pensando hacer. Pero si no se siente cómodo compartiendo esta información con nosotros, podemos continuar con la siguiente pregunta. [Mark all that apply]
1. |
Increase physical activity |
2. |
Lose weight |
3. |
Change diet or eating habits |
4. |
Quit smoking / reduce amount smoked or reduce tobacco use (smokeless tobacco) |
5. |
Exercise better hygiene |
6. |
Get counseling |
7. |
Start taking medications |
8. |
Plan to see a doctor |
9. |
Reduce risky sexual behaviors |
10. |
Get tested |
11. |
Change eating habits |
12. |
Get immunized |
13. |
Other: (specify)________________________ |
14. |
Refused to answer |
Behavior change
Ya hizo algun cambiado en su comportamiento/conducta?
1. |
Yes |
2. |
No |
3. |
Not yet, but planning to |
4. |
Refused to answer |
Comfort with the CSR/HSR
[Note to interviewer: If the respondent talked with more than one representative and is unsure which one to comment on, tell the respondent: “Por favor escoga el representante del cual quiere hablar más.”]
Por favor piense en la persona con la que habló en su llamada a CDC-INFO, Que tan cortez fue el representante? [Read options to respondent] Diria usted:
1. |
Muy cortez |
2. |
Algo cortez |
3. |
No fue muy cortez |
4. |
Descortez |
5. |
Rehuso a contestar |
Que tan satisfecho esta con la manera que el representante interactuó con usted durante la llamada? [Probe: Esta usted satisfecho con la manera en que usted fue tratado] [Read options to respondent] Diria usted:
1. |
Muy satisfecho |
2. |
Algo satisfecho |
3. |
Algo insatisfecho |
4. |
Muy insatisfecho |
5. |
Rehuso a contestar |
Trust in CDC-INFO
Tuvo la persona con quien habló un buen conocimiento sobre la informacion que usted pidió? ? [Probe: Diria que la persona mostro familiariad con la información. Hablaba la persona con seguridad?]
Que tan instruida o experta era la persona con quien habló [Read options to respondent] Diria que la persona fue:
1. |
Muy instruida |
2. |
Algo instruida |
3. |
No se |
4. |
No muy instruida |
5. |
Inculta |
6. |
Rehuso a contestar |
Que tan servicial fue la persona con quien habló en CDC-INFO? [Read options to respondent] Diria que la persona fue:
1. |
Muy servicial |
2. |
Algo servicial |
3. |
No muy servicial |
4. |
Desagradable |
5. |
Rehuso a contestar |
En general, que tan satisfecho esta con la calidad de la información sobre salud que CDC-INFO le brindó? [Read options to respondent] Diria que la persona fue:
1. |
Muy satisfecho |
2. |
Algo satisfecho |
3. |
Ninguno |
4. |
Algo insatisfecho |
5. |
Muy insatisfecho |
6. |
Rehuso a contestar |
Considera usted a CDC-INFO como un recurso de información en el cual puede confiar? [Read options to respondent] Diria usted:
1. |
Definitivamente si |
2. |
Probablemente si |
3. |
No se/No estoy seguro |
4. |
Probablemente no |
5. |
Definitivamente no |
6. |
Rehuso a contestar |
Overall Satisfaction with CDC-INFO
15. Por favor piense en su llamada en general. Que tan satisfecho esta con CDC-INFO? [Read options to respondent] Diria usted:
1. |
Muy satisfecho |
2. |
Algo satisfecho |
3. |
Ninguno |
4. |
Algo insatisfecho |
5. |
Muy insatisfecho |
6. |
Rehuso a contestar |
16. [If less than “very satisfied” to above] Apreciaría mucho si me dijera la razón de su insatisfacción. [Mark all that apply]
System Issues |
|
Publication Issues |
||
|
Hard to reach a live operator |
|
21. |
No publication available |
|
On hold too long |
|
22. |
CSR would not take publication order |
|
No one spoke language |
|
Other |
|
|
Poor telephone connection |
|
34. |
Doesn’t want to report satisfaction until services are received |
CSR Issues |
|
35. |
Lost information from CDC-INFO |
|
|
Call took too long |
|
36. |
Other (specify): |
|
CSR couldn’t find answer to question |
|
37. |
Refused to answer |
|
CSR wouldn’t answer question |
|
|
|
|
CSR didn’t understand what I needed |
|
|
|
|
CSR referred respondent to another hotline |
|
|
|
|
CSR hard to understand (didn’t speak clearly) |
|
|
|
|
CSR was disrespectful/rude |
|
|
|
|
CSR was impatient |
|
|
|
|
Not enough information provided (partial answer to question) |
|
|
|
|
Unclear information provided |
|
|
|
|
Too much information provided |
|
|
|
|
Information was too technical to understand |
|
|
|
|
Information not relevant to question |
|
|
|
|
Information not current/most recent |
|
|
|
|
Sent to website |
|
|
|
|
Could’ve looked up same information on website |
|
|
|
A juzgar por su experiencia con CDC-INFO, llamaría otra vez?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
Recomendaria CDC-INFO?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
Ya ha recomendado a CDC-INFO?
1. |
Yes |
2. |
No |
3. |
Refused to answer |
A quién hubiese llamado si CDC-INFO no estuviera disponible? [Check all that apply]
1. |
Doctor’s office |
2. |
Don’t know |
3. |
Community health center |
4. |
Walk-in clinic |
5. |
Telephone health line (specify)___________________ |
6. |
Hospital emergency room |
7. |
Other hospital service |
8. |
Other: (specify) ___________________ |
9. |
Refused to answer |
Muchas gracias! Tiene usted alguna pregunta con respecto a este cuestionario?
Para comunicarse con CDC-INFO llame al 1-800-CDC-INFO, 1-800-232-4636. Nuevamente, muchas gracias!
|
* [Note to Interviewer: Please write any general comments that are NOT improvement related. Include positive comments here.]
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | imn1 |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |