485 Niaid 485 Niaid

Model Instance Name:			red & strike-through: DELETE
NIAID October 2011			underlined & italicized: RE-ORDER
MID: Existing Measure - Please fill in; New Measure - DOT will fill in			pink: ADDITION
Date:	8/31/2011		blue + -->: REWORDING
NIAID October 2011 CUSTOM QUESTION LIST
QID	Skip Logic Label	Question Text	Answer Choices (limited to 50 characters)	Skip to	Type (select from list)	Single or Multi	Required Y/N	Special Instructions	CQ Label
		How frequently do you visit this site?	First time		Radio button, one-up vertical	Single	Y		Visit Freq
			More than once a day
			Daily
			About once a week
			About once a month
			Every 6 months or less
		What is your primary purpose for visiting this site?	Find general information about NIAID		Drop down, select one	Single	Y		Reason for Visit
			Find information on diseases and conditions
			Find information on research funding
			Find information on research programs
			Find information on labs at NIAID
			Find training or employment opportunities
			Find information on research news
			Other, please specify:	A
	A	Please specify primary purpose for visiting this site today:	open		Text area, no char limit		N		Other Reason for Visit
		In what role are you visiting the NIAID website today?	Patient with a specific disease or condition	A1A, A3A	Radio button, one-up vertical	Single	Y		Role
			Family member, Friend or Acquaintance of a Patient	A1B, A3B, B1A
			Health Care Provider/Health Professional	C, D, E, C1A
			Scientist Researcher	AK, F, D1A, D1B
			General Health Consumer	AM, A1C
			NIAID employee or contractor
			Advocate	AO, A1C
			Media/Journalist
			Policy Maker
			Public Health Official
			Student	AQ, A1C
			Educator/Teacher	A1C
			Librarian or Information professional	A1C
			Other	G
	G	Please specify what best describes your role in visiting the NIAID Web site today.			Text area, no char limit		N		Other role
	A1A	Which best describes your specific role?	Patient diagnosed with a disease or condition		Radio button, one-up vertical	Single	Y		Patient role
			Patient in treatment for a disease or condition
			Person concerned about being at risk for a disease or condition
			Other	A2A
	A2A	Please specify your role as a patient:			Text area, no char limit		N		Other patient role
	A1B	Which best describes your specific role?	Person concerned about someone else		Radio button, one-up vertical	Single	Y		Family/Friend role
			Person concerned about being at risk for a disease or condition
			Other	A2B
	A2B	Please specify your role as a family member, friend or acquaintance.			Text area, no char limit		N		Other family/friend role
	B1A	Are you the caregiver for a patient?	Yes		Radio button, one-up vertical	Single	Y		Caregiver
			No
	A3A	How do you plan to use the information you find on this site today?	Give information to a family member or friend		Radio button, one-up vertical	Single	Y		Patient info usage
			Share and talk about information with my health care provider
			For my own personal use
			Didn't find what I wanted
			Not sure yet
			Other	A4A
	A4A	Please specify how you plan to use the information you find on the site today:			Text area, no char limit		N		Other Patient Info Usage
	A3B	How do you plan to use the information you find on this site today?	Give information to a family member or friend		Radio button, one-up vertical	Single	Y		Family/Friend Info Usage
			Share and talk about information with my health care provider
			For my own personal use
			Didn't find what I wanted
			Not sure yet
			Other	A4B
	A4B	Please specify how you plan to use the information you find on the site today:			Text area, no char limit				Other Fam/Friend Info Usage
	AM	Which best describes your specific role as a general health consumer?	Person with a health concern		Radio button, one-up vertical	Single			Health Consumer role
			Person interested in learning more about a disease or condition
			Other	AN
	AN	Please specify your role as a general health consumer:			Text area, no char limit				Other health consumer role
	AO	Which best describes your specific role as an advocate?	Patient advocate		Radio button, one-up vertical	Single			Advocate role
			Policy advocate
			Research advocate
			Other	AP
	AP	Please specify your role as an advocate:			Text area, no char limit				Other advocate role
	AQ	Which best describes your specific role as a student?	Elementary school		Radio button, one-up vertical	Single			Student role
			Middle school
			High school
			College/University
			Graduate school
			Post-graduate school (including medical school)
			Other	AR
	AR	Please specify your role as a student:			Text area, no char limit				Other student role
	A1C	How do you plan to use the information you find on this site today?	Give information to a family member or friend		Radio button, one-up vertical	Single			Advocate info usage
			Share and talk about information with my health care provider
			For my own personal use
			Use to do homework or class assignment
			Use as teaching material or for a class
			Didn't find what I wanted
			Not sure yet
			Other	A2C
	A2C	Please specify how you plan to use the information you find on the site today:			Text area, no char limit				Other advocate info usage
	C	Which best describes your specific role?	Physician		Radio button, one-up vertical	Single			Healthcare role
			Nurse/Nurse practitioner
			Care coordinator/Case manager/Patient navigator
			Pharmacist
			Physician assistant
			Counselor/Clinical social worker
			Dietician/Nutritionist
			Other	K
	K	Please specify your role as a health professional:							Other health prof role
	C1A	Are you involved in clinical research?	Yes		Radio button, one-up vertical	Single			Clinical research
			No
	D	Do you specialize in the care of patients with allergy or infectious diseases?	Yes		Radio button, one-up vertical	Single			Allergy/infection Disease Health Prof
			No
	E	How do you plan to use the information you find on this site today?	Keep myself up-to-date/Improve my understanding of clinical research findings		Radio button, one-up vertical	Single			Health Prof Info Usage
			Improve my understanding of basic research concepts and findings
			Plan or verify treatment
			Learn how to become a clinical trial investigator
			Provide information to a patient or family member
			Provide clinical trial information to a patient or family member
			Provide information to other health care providers
			Provide information to students
			For my personal use
			Didn’t find what I wanted
			Not sure yet
			Other	L
	L	Please specify how you plan to use the information you find on this site today:			Text area, no char limit				Other Health Prof Info Usage
	AK	Which best describes your specific role?	Post doctoral fellow		Radio button, one-up vertical	Single			Scientist Researcher Role
			Prospective researcher
			First-time researcher
			New Principal Investigator (PI)
			Long-time/Experienced researcher
			Research manager/Administrator
			Other	AL
	AL	Please specify your role as a scientist researcher:			Text area, no char limit				Other Sci Researcher Role
	D1A	Have you ever...?	Applied for funding from NIAID		Radio button, one-up vertical	Single			Scie Research Funding
			Received funding from NIAID
	D1B	Are you involved in…	Clinical research		Radio button, one-up vertical	Single			Sci Research Type
			Basic research
			Both
	F	How do you plan to use the information you find on this site today?	Learn about NIAID research priorities		Radio button, one-up vertical	Single			Sci Research Info Usage
			Improve my understanding of basic research concepts and findings
			Keep myself up-to-date/Improve my understanding of clinical research findings
			Develop a research proposal
			Provide information to other scientist/researchers
			Provide information to students
			For my personal use
			Didn’t find what I wanted
			Not sure yet
			Other	M
	M	Please specify how you plan to use the information you find on this site today:			Text area, no char limit				Other Sci Research Info Usage
		Have you found the information you were looking for on the NIAID site today?	Yes		Radio button, one-up vertical	Single	Y		Found Information
			No	A
	A	Please specify what you are unable to find on the NIAID site:	open		Text area, no char limit		N		Information Seeking
		Which of the follow ways did you primarily look for information?	Type in text box (Search Tool)	A	Radio button, one-up vertical	Single	Y		Look for Info
			Navigate by Health or Research topic/subject
			Navigate by Research Funding
			Navigate by latest News and Events
			Navigate by Labs and Scientific Resources
			More than one of the above
			No Preference/Not Sure
			Other	B
	B	Please specify how you looked for information:			Text area, no char limit		N		Other Look for Info
	A	Which of the following difficulties did you experience when typing into the text box (search tool)? (Please select all that apply)	I did not encounter any difficulties		Checkbox, one-up vertical	Single	Y		Search Difficulty
			Search results were not helpful
			Returned too many results
			Returned too few results
			Returned no results
			Returned results that were too similar/redundant
			Results were not relevant to my search
		Which of the following navigation difficulties did you experience on the site today? (Please select all that apply)	I had no difficulty navigating on this site		Checkbox, one-up vertical	Single	N		Navigation Difficulty
			Could not get back to previous information
			Would often feel lost, not know where I was
			Links did not take me where I expected	A
			Links/labels are too difficult to understand
			Too many links or navigational choices
			Had technical difficulties (e.g. broken link)
	A	Please describe in as much detail as possible the links or labels that did not take you where you expected:
		Please tell us how we can improve the NIAID site to better meet your needs:	open		Text area, no char limit	open	N		Improvements
		In the last three months, which of the following have you done? (Please select all that apply)	Signed up for email updates on NIAID.gov		Checkbox, one-up vertical	multi	y		social media
			Visited or "liked" NIAID's Facebook page
			Followed NIAID's Twitter profile
			Sent a NIAID E-card
			Shared or viewed an image on the NIAID Flickr page
			Watched a video on NIAID.gov or NIAID's YouTube page
			Listened to podcasts on NIAID.gov
			None of the above
		Please rank the top 3 factors that brought you to the website today. (Rank 1 = Most important) Rank 1	Message or recommendation from a friend on a social network		Drop down, select one	Single	Y	Rank Group	SV - Rank 1
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook, My Space, Twitter)					Randomize
			Message directly from NIAID on a social network
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with site/organization
			Email Alerts
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Internet advertising
			Link from another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		Rank 2	Message or recommendation from a friend on a social network		Drop down, select one	Single	N	Rank Group	SV - Rank 2
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook, My Space, Twitter)					Randomize
			Message directly from the company on a social network
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with site/organization
			Email Alerts
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Internet advertising
			Link from another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		Rank 3	Message or recommendation from a friend on a social network		Drop down, select one	Single	N	Rank Group	SV - Rank 3
			Video I saw on YouTube
			Internet blogs or discussion forums					Adjust Template/Style Sheet
			Advertising on social networks (Facebook, My Space, Twitter)					Randomize
			Message directly from the company on a social network
			Mobile phone text messages or alerts
			Instant Message from a friend or colleague
			Familiarity with site/organization
			Email Alerts
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Internet advertising
			Link from another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
		If you heard about this website from a social network, please specify the site (i.e. Facebook, Twitter)			Text area, no char limit		N		SV - Other Social Network