Form 1 OCS Screener for Public

Attachment 1. Screener for OCS Members of the Public

Four (4) individuals are needed to participate in a usability test to assess the OCS website. The general description of those to be recruited is as follows:

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  OMB No.: 0925-0642

  Expiration Date: 9/30/2014

  PRIVACY ACT NOTIFICATION STATEMENT

  Collection of this information is authorized by The Public Health Service Act, Section 412 (42 USC 285 a-1). Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private under the Privacy Act. Names and other identifiers will be separated from information provided and will not appear in any report of the study. Information provided will be combined for all study participants and report as statistical summaries. You are being contacted by phone to complete this instrument so that we can eventually evaluate the website.

  
  

  NOTIFICATION TO RESPONDENT OF ESTIMATED BURDEN

  Public reporting burden for this collection of information is estimated to average 15 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0642). Do not return the completed form to this address.

  
  

  
  

  our (4) participants will be new to the OCS website or be novice users of the site.

Hello, my name is _________________, calling for User-Centered Design, under contract with the National Cancer Institute. We are recruiting members of the general public who have an interest in cancer information. We would like to ask you a few questions to find out if you qualify for the brief study and would like to participate. This will only take a few minutes of your time and no one will attempt to sell you anything. This is strictly for research purposes. If you are interested and qualify for the web site usability assessment, you will be offered monetary compensation to participate. Can I ask you a few questions?

1. Are you an employee of the U.S. Federal Government?

Yes (DISMISS)

No

2. Are you or anyone in your household

A computer programmer, developer, professional web designer, or usability tester?

Employed in advertising, marketing, market research, public relations, public health or health promotion?

An employee or volunteer in the medical field?

An employee of the U.S. Department of Health and Human Services or any of its divisions?

(DISMISS if any are Yes)

3. Do you work for the American Cancer Society, National Cancer Institute or a similar organization that focuses on cancer, or does your work involve people with cancer or their families?

Yes (DISMISS)

No

4. Have you participated in a market research study, such as a focus group or an in-person interview

Within the last 6 months? (DISMISS)

Over 6 months?

Never?

5. We are looking for individuals who are interested in seeking information about cancer. Which of the following cancer topics are of interest to you? Tell us all that are appropriate.

Treatment, including Clinical Trials

Detection/Diagnosis

Prevention

Statistics and Risk

Survivorship/Post Treatment

(If clarification is needed for what cancer survivorship is, define as “the health and life of a person beyond cancer diagnosis and treatment.”)

DISMISS if they do not select the Survivorship option

6. Have you ever gone to the National Cancer Institute’s website, cancer.gov, for survivorship information?

Yes

No

Don’t Know

7. The National Cancer Institute has a specific web site and office that focuses on cancer survivorship – the Office of Cancer Survivorship. How familiar are you with it? (Recruit a mix, preferably two “Not at all familiar” and either two “Somewhat familiar” or one “Somewhat familiar” and one “Very familiar.”)

Not at all familiar

Somewhat familiar

Very familiar

Not sure

8. How many hours per week do you use the Internet for business or personal use, excluding checking your e-mail?

Less than 2 hours a week (DISMISS)

Between 2-5 hours a week

Between 6-15 hours a week

Over 15 hours a week

9. How would you rate your Internet experience? Where 5 is Advanced, 3 is Intermediate, and 1 is Novice.

_______________________________
(DISMISS anyone who rates themselves less than 2, and try for more 3 and above)

10. Which of the following activities have you done on the Internet? (Check all that apply)

Made a purchase online

Paid bills online

Are active on a social networking account

Downloaded music or videos

Looked for information about a hobby or interest

Looked at information from a local, state or government web site

Looked for current news, sports, or weather

DISMISS if respondent has not done at least two of the activities above.

11. We would like to collect some demographic information for our records. Is your age group

20 or less? (DISMISS)

Between 21 and 75?

76 or older? (DISMISS)

12. Please describe the highest level of education you completed.

Less than high school (DISMISS)

High school degree (DISMISS)

Completed a technical or vocational school

Some College

College degree

Some graduate school

Completed graduate school

Graduate degree (MD, PhD.)

13. [Do not ask but] Record gender:

Male

Female

Thank you for taking the time to answer my questions. We will speak with the National Cancer Institute to see if you meet the eligibility requirements and can be invited to participate in a web site usability assessment. For the test, you will be working one on one with a computer and you will work with the website of interest to our client. This will take about 1 hour. The sessions will be held on [day], [date] at [time] at the lab at Rockville, MD. We will email you a confirmation & directions, and we will call you the day before to confirm your attendance. For your participation, you will receive $40 as a token of appreciation for your time and travel.

Respondent's name ______________________________________

Respondent's availability ______________________________________

Respondent’s email address _______________________________

Telephone number _______________________________________

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