Form 541 Alzheimers Questionaire

Model Instance Name:
http://www.alzheimers.gov/
MID:	QFY5chZENEA1k8Z1RAVdNg==
Date:	7/30/2012
Welcome and Thank You Text
Welcome and Thank You Text

	Directions:
	This welcome text is shown at the top of the questionnaire window and the thank you text at the bottom. This is a good place to mention the site/company/agency name so the visitor knows whom they are taking the survey for. Feel free to modify the standard Welcome text shown in the box below.
			Examples
			Welcome Text Example




	Welcome Text
	Welcome Text
	Thank you for visiting our site.Please help us improve alzheimers.gov. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.


















		Thank You Text Example

	Thank You Text
	Thank You Text
	Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.









			B

Sheet 3: Proposed Model Qsts

Model Instance Name:
http://www.alzheimers.gov/
MID:		QFY5chZENEA1k8Z1RAVdNg==
Partitioned (Y/N)? Yes		NO
NOTE: All non-partitioned surveys will NOT be imputed and the elements will be rotated as a default unless otherwise specified and approved by Research.
Date:		4/18/2012
http://www.alzheimers.gov/
Model questions utilize the ACSI methodology to determine scores and impacts
		ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	MQ Label		MQ Label		MQ Label
		Alzheimer's Information (1=Poor, 10=Excellent, Don't Know)		Satisfaction	Return	Return (1=Very Unlikely, 10=Very Likely)
	Thoroughness	Please rate the thoroughness of information you viewed on this site today.	Satisfaction - Overall	What is your overall satisfaction with Alzheimers.gov? (1=Very Dissatisfied, 10=Very Satisfied)		How likely are you to return to this site?
	understandable	Please rate how understandable the information you viewed today was.	Satisfaction - Expectations	How well does Alzheimers.gov meet your expectations? (1=Falls Short, 10=Exceeds)	Recommend	Recommend (1=Very Unlikely, 10=Very Likely)
	Provided Answers	Please rate how well the information viewed today provided answers to your questions.	Satisfaction - Ideal	How does Alzheimers.gov compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		How likely are you to recommend this site to someone else?
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Share Information	Share Information (1=Very Unlikely, 10=Very Likely)
	Look and Feel - Appeal	Please rate the visual appeal of this site.				How likely are you to share information from this site with a family member, friend or health care professional?
	Look and Feel - Balance	Please rate the balance of graphics and text on this site.
	Look and Feel - Readability	Please rate the readability of the pages on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
	Navigation - Organized	Please rate how well the site is organized.
	Navigation - Options	Please rate the options available for navigating this site.
	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
		Plain Language (1=Poor, 10=Excellent, Don't Know)
	Plain Language - Clear	Please rate the clarity of the wording on this site.
	Plain Language - Understandable	Please rate how well you understand the wording on this site.
	Plain Language - Concise	Please rate this site on its use of short, clear sentences.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
	Site Performance - Loading	Please rate how quickly pages load on this site.
	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
	Site Performance - Errors	Please rate the ability to load pages without getting error messages on this site.




















				B

Sheet 4: Proposed Current CQs

#REF!			~~red & strike-through: DELETE~~
http://www.alzheimers.gov/			underlined & italicized: RE-ORDER
MID: QFY5chZENEA1k8Z1RAVdNg==			pink: ADDITION
Date:	4/18/2012		blue + -->: REWORDING

http://www.alzheimers.gov/ CUSTOM QUESTION LIST
QID	bharati.hulbanni: there should be NO MORE THAN ONE LETTER IN HERE 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
LNH0059		How frequently do you visit this site?	This is my first visit		Drop down, select one	Single	Y		Frequency
			Every few months or less often
			Monthly
			Weekly
			Several times a week
			Daily/more than once a day
LNH0060		What is your role in visiting the site today?	I am caring for someone with Alzheimer's disease		Radio button, one-up vertical	Single	Y	OPS Group*	Role
			I am caring for someone without Alzheimer's disease
			I am a friend or family member of someone with Alzheimer's disease
			I am a heath care professional
			I am an advocate for patients diagnosed with Alzheimer's disease
			I suspect I or someone I know has Alzheimer's disease
			Other	A
LNH0061	A	My role in visiting today was as a:					N		OE_Role
LNH0062		What is your primary reason for visiting this site today?	Obtain general information on Alzheimer's disease		Radio button, one-up vertical	Single	Y	OPS Group*	Primary Reason
			Find out about treatments or clinical trial for persons with Alzheimer's disease
			Find out how to be diagnosed for Alzheimer's disease
			Find Alzheimer's paid providers in my area
			Find Alzheimer's support programs or services for families/friends/caregivers
			Just browsing
			Other	A
LNH0063	A	The reason I visited the site today was:					N		OE_Reason
LNH0064		What sections of the site did you visit today? (Please select all that apply.)	Alzheimer's is…		Checkbox One Up Vertical	Multi	Y	OPS Group*	Section Visited
			Treatment Options
			How to Pay & Plan
			Caring for someone
			Help with Alzheimer's
			Fighting Alzheimer's
			A section not listed here (please specify):	A
LNH0065	A	What other sections did you visit today?					N		OE_Section
LNH0066		Did you find what you were looking for on the site today?	Yes		Radio button, one-up vertical	Single			Ability to Find
			No
LNH0067		How did you find out about this site?	A friend or family member		Checkbox One Up Vertical	Multi	Y	OPS Group*	Learn about Site
			A health care professional
			A general web search (e.g., Google, Bing, etc)
			A TV commercial
			A newspaper or magazine article
			An online ad
			A newspaper or magazine ad
			A news broadcast
			Other (please specify):	A
LNH0068	A	How did you learn about the Alzheimers.gov site?			Text area, no char limit		N		OE_Learn about Site
LNH0069		Did you watch any of the videos featured on the Alzheimers.gov site?	Yes	A	Radio button, one-up vertical	Single	Y	skip logic group	Watch Videos
			No	B
LNH0070	A	What did you think of the online videos you viewed on the Alzheimers.gov site?			Text area, no char limit		N		OE_Videos Yes
LNH0071	B	Why didn’t you watch any of the online videos featured on the Alzheimers.gov site?			Text area, no char limit		N		OE_Videos No
LNH0073		What additional information would you like to have available on this site?			Text area, no char limit		N		OE_Additonal Info
LNH0074		If you could make one improvement to the site what would it be?			Text area, no char limit		N		OE_Improvement

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