Provide Services for the Dissemination of CER to Patients and Providers to Increas Adoption- Gutcheck Website Usability Survey

HHS+IDEO+IHI: Gutcheck
A CER Translation & Dissemination Innovation Project

Colon Cancer Screening

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

Appendix B: Gutcheck website usability survey

The survey that will be posted on the website is below.

Gutcheck Feedback

What do you think?

This website has been shaped and inspired by people like you. By answering 7 quick questions, you can help us make the website even better – and help more people get screened. Your answers to the survey will be kept anonymous.

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How would you rate the website in terms of VISUAL APPEAL

	1	2	3	4	5
Unattractive						Attractive

How would you rate the website in terms of UNDERSTANDABILITY

	1	2	3	4	5
Confusing						Clear

How would you rate the website in terms of HELPFULNESS

	1	2	3	4	5
Not Helpful						Very Helpful

How would you rate the website in terms of ENGAGEMENT

	1	2	3	4	5
Boring						Interesting

How did you learn about this website? (check all that apply)

• My healthcare provider

• Poster

• A friend or family member

• Folder or brochure

• Note in a bathroom

• Web search

• Other:

How does this website compare to other websites that you go to for medical information?

	1	2	3	4	5
Very Similar						Very Different

Any other feedback you want to give us about the website?

Thank you!

The goal of Gutcheck is to help people make good decisions about colon cancer screening. Understanding how well we've communicated with you helps us do a better job communicating with others.

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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 ( hours)(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 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer