579 NIH SR Health Questionnaire 9-26-12

---

Overview

Guidelines
Welcome and Thank You Text
Current Model Qsts
Current CQs

---

Sheet 1: Guidelines

Questionnaire Management Guidelines

Goals:

�

One consolidated document to track all model and CQ changes throughout the life of the project

�

Questionnaire always matches the live survey

�

Easy and error-free way to submit CQ changes

�

All changes tracked and reflected in one document (DOT will help)

Questionnaire Resources:

1

Questionnaire Design and Approval Process

2

Question Grouping Rules

3

OPS vs. Skip Logic Decision for "Other, Please Specify"

4

Foreign Language Survey Instructions

---

Sheet 2: Welcome and Thank You Text

Model Instance Name:
#REF!
MID:	#REF!
Date:	Fill In Date
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 and Thank you text shown in the boxes below. Please read comments before using any of the text.
					Examples
					Welcome Text Example
	Welcome Text
	bharati.hulbanni: if STORES MEASURE: do NOT use any welcome text. Thank you for visiting our site. 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
	DEFAULT Thank You Text
	bharati.hulbanni: TY text can be used for all measure types (call center, web, stores, mobile etc.) “Thank you for taking our survey - and for helping us serve you better. We appreciate your input!”
	ALTERNATE WEB Thank You Text
	bharati.hulbanni: Use this TY text ONLY for WEB 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.

---

Sheet 3: Current Model Qsts

Model Instance Name:
NIH Senior Health
MID:		Existing Measure - Please fill in; New Measure - DOT will fill in
Partitioned (Y/N)? YES
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:		9/28/2012
#REF!
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
		Content (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
1	Content - Accuracy	Please rate the accuracy of information on this site.	20	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	23	Return	How likely are you to return to this site?
2	Content - Quality	Please rate the quality of information on this site.	21	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
3	Content - Freshness	Please rate the freshness of content on this site.	22	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	24	Recommend	How likely are you to recommend this site to someone else?
		Functionality (1=Poor, 10=Excellent, Don't Know)						Primary Resource (1=Very Unlikely, 10=Very Likely)
4	Functionality - Usefulness	Please rate the usefulness of the features provided on this site.				25	Primary Resource	How likely are you to use this site as your primary resource for obtaining senior health information?
5	Functionality - Convenient	Please rate the convenience of the features on this site.
6	Functionality - Variety	Please rate the variety of features on this site.
		Look and Feel (1=Poor, 10=Excellent, Don't Know)
7	Look and Feel - Appeal	Please rate the visual appeal of this site.
8	Look and Feel - Balance	Please rate the balance of graphics and text on this site.
9	Look and Feel - Readability	Please rate the readability of the pages on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
10	Navigation - Organized	Please rate how well the site is organized.
11	Navigation - Options	Please rate the options available for navigating this site.
12	Navigation - Layout	Please rate how well the site layout helps you find what you are looking for.
13	Navigation - Clicks	Please rate the number of clicks to get where you want on this site.
		Privacy (1=Poor, 10=Excellent, Don't Know)
14	Privacy - Limit Sharing	Please rate the ability to limit sharing of your personal information on this site.
15	Privacy - Amt Personal Info	Please rate the amount of personal information you are asked to submit on this site.
16	Privacy - Protect	Please rate the site's commitment to protecting your personal information.
		Site Performance (1=Poor, 10=Excellent, Don't Know)
17	Site Performance - Loading	Please rate how quickly pages load on this site.
18	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
19	Site Performance - Errors	Please rate the ability to load pages without getting error messages on this site.

---

Sheet 4: Current CQs

Model Instance Name:

red & strike-through: DELETE

NIH Senior Health

underlined & italicized: RE-ORDER

#REF!

pink: ADDITION

Date:

9/28/2012

blue + -->: REWORDING

NIH Senior Health CUSTOM QUESTION LIST

bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. QID

bharati.hulbanni: there should be NO MORE THAN ONE LETTER IN HERE (Skip Logic Label) Skip Logic Label

Question Text

bharati.hulbanni: Hide (DO NOT DELETE) this column before sending to a client. AnswerIDs (DOT)

Answer Choices (limited to 50 characters)

Skip to

Type (select from list)

Single or Multi

Required Y/N

bharati.hulbanni: Can not have more than one CQ GroupType (denoted by an *) within one colored group in 'Special Instructions' . Special Instructions

CQ Label

How frequently do you visit this site?

First time

Radio button, one-up vertical

Single

Y

Frequency of Visit

More than once a day

Daily

About once a week

About once a month

Every 6 months or less often

How did you learn of the NIHSeniorHealth site?

Internet search engine

Radio button, one-up vertical

S

Y

Skip Logic Group*

Awareness of Site

Healthcare provider

Senior Center

Friend

I already know about the site

I have the site bookmarked

Other (please specify)

A

A

What other way did you learn of the site?

Text area, no char limit

N

Skip Logic Group*

Other Awareness of Site

What best describes your primary purpose in visiting NIHSeniorHealth today?

Just browsing

Radio button, one-up vertical

S

Y

Skip Logic Group*

Reason for Visit

Find health information for seniors

Find general health and wellness info

Find info on a specific disease, condition, diagnosis, or treatment

Find info on medicines or prescription drugs

Find info on alternative treatments, herbals, or vitamins

Interested in a Web site that lets me do things like change the size of the text on the screen and other senior-friendly features.

For a project or presentation

Other, please specify:

A

A

What other reason do you have for visiting the site today?

Text area, no char limit

N

Skip Logic Group*

Other Reason for Visit

How do you plan to use the information you find on this site today?

For yourself

Radio button, one-up vertical

S

Y

Skip Logic Group*

How Use the Information

For others

For both

Other, please specify

A

A

How else do you plan on using the information?

Text area, no char limit

N

Skip Logic Group*

Other Use Information

What best describes your role in visiting NIHSeniorHealth during this session?

Educator

Radio button, one-up vertical

S

Y

Skip Logic Group*

Role

Student

Researcher/Scientist

Health Care Provider (e.g., Physician, Dentist, Nurse)

A

Patient with a specific disease or condition

Family or friend of patient

General health information seeker

NLM Staff

Other, please specify

B

B

What other way would you describe yourself?

Text area, no char limit

N

Skip Logic Group*

Other Role

A

What type of health care provider are you?

Allied health professional

Radio button, one-up vertical

S

N

Skip Logic Group*

Health Care Provider

Dentist

Nurse (RN/LPN)

Pharmacist

Physician Assistant/Nurse Practitioner

Physician, primary care

Physician, specialist

Psychologist

Social Worker

Other health professional, please specify

C

C

What other type of health care professional are you?

Text area, no char limit

N

Skip Logic Group*

Other Health Care Provider

What features of the site did you use today? (please select all that apply)

Videos

Checkbox, one-up vertical

M

Y

Skip Logic Group*

Features Used

Email updates

Search box

FAQ’s

Quizzes

Share button

Printing

Change text size

Change contrast

Other (please specify)

A

A

What other features did you use?

Text area, no char limit

N

Skip Logic Group*

Other Features Used

In the last three months, have you done any of the following: (please select all that apply)

Watch videos on a website

Checkbox, one-up vertical

M

Y

Skip Logic Group*

Social Media Interaction

Browse websites using my mobile phone/device

B, D, E

Receive/send text messages using my mobile phone/device

Sign up for email updates from a website

Participate in Facebook

Participate in Twitter

Use personalized web pages (such as iGoogle or My Yahoo!)

Listen to podcasts or audio on a website

Bookmark or tag websites (using social bookmarking sites such as Digg or Del.icio.us)

Other, please specify

A

None of these

Mutually Exclusive

A

What other social media interactions have you done in the last three months?

Text area, no char limit

N

Skip Logic Group*

Other Social Media Interaction

B

What device were you using? (select all that apply)

Blackberry

Checkbox, one-up vertical

M

N

Skip Logic Group*

Device Used

Android

iPad

iPhone

iPod Touch

Kindle Fire

Other, please specify:

C

C

What other device were you using?

Text area, no char limit

N

Skip Logic Group*

Other Device Used

D

If NIHSeniorHealth were to offer mobile content, which would you prefer?

Mobile site (example - m.sitename.gov)

Radio button, one-up vertical

S

Y

Skip Logic Group*

Mobile Content

Downloadable Application (example - iPhone app, Android app, Blackberry app)

Not sure

I am not interested in mobile content

Mutually Exclusive

E

What information already available from NIHSeniorHealth would you find most useful to have on your mobile device?

Text area, no char limit

N

Skip Logic Group*

Other Device Used

What other places do you go to for consumer health information?

Text area, no char limit

N

Other Places for Consumer Health

Do you have any suggestions for improving NIHSeniorHealth?

Text area, no char limit

N

Improvements

Please select the category that includes your age.

24 and under

Drop down, select one

S

N

Age

25 - 34

35 - 44

45 - 54

55 - 59

55 - 64

60 - 64

65 - 69

65 - 74

70 - 74

75 - 84

85 - 94

95 or over