Form 593 2012 593 AHRQ USPSTF Q'naire 11-20-12

---

Overview

Welcome and Thank You Text
Current Model Qsts
Current Custom Qsts

---

Sheet 1: Welcome and Thank You Text

Model Instance Name:
AHRQ-ePSS
MID:	#REF!
5/17/2011
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
	Thank you for visiting the Agency for Healthcare Research and Quality (AHRQ) website. ForeSee Results is conducting the survey on behalf of AHRQ. Please take a few minutes to give us your input. The questions in this survey refer only to the USPSTF website. Your response will be used to help guide future improvements to the site. We are seeking comments about the way the content is presented, not feedback on the content of USPSTF recommendations or on the process used to develop them. Your input will be kept strictly confidential
					Thank You Text Example
	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 web site.

---

Sheet 2: Current Model Qsts

Model Instance Name:
AHRQ USPSTF
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:		11/19/2012
AHRQ USPSTF
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)
	Content - Accuracy	Please rate your perception of the accuracy of information on this site.		Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		Return	How likely are you to return to this site?
	Content - Quality	Please rate the quality of information on this site.		Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
	Content - Freshness	Please rate the freshness of content on this site.		Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)		Recommend	How likely are you to recommend this site to someone else?
		Functionality (1=Poor, 10=Excellent, Don't Know)
	Functionality - Usefulness	Please rate the usefulness of the website tools provided on this site.
	Functionality - Convenient	Please rate the convenient placement of the website tools on this site.
	Functionality - Variety	Please rate the variety of website tools on this site.
		Look and Feel (1=Poor, 10=Excellent, Don't Know)
	Look and Feel - Appeal	Please rate the visual appeal of this site.
	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.
	Navigation - Clicks	Please rate the number of clicks to get where you want on this site.
		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.

---

Sheet 3: Current Custom Qsts

Model Instance Name:

red & strike-through: DELETE

#REF!

underlined & italicized: RE-ORDER

MID:

pink: ADDITION

Date:

11/19/2012

blue + -->: REWORDING

#REF!

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?

This is my first visit

Radio button, one-up vertical

Single

Y

Frequency

Every few months or less often

Once a month

Once a week

Several times a week

Daily/more than once a day

Which of the following best describes your position or situation?

Physician

Radio button, one-up vertical

Single

Y

OPS Group

Role

Physician Assistant

Nurse

Nurse Practitioner

Medical Student

Other clinician

Medical assistant/ Medical office staff

Patient or consumer

Educator

Policy maker

Researcher

Other (please specify)

A

A

What is your position or situation?

Text field, <100 char

OPS Group

Other Role

What is the primary goal of your visit to this site today?

Find a recommendation for myself

Radio button, one-up vertical

Single

Y

Skip Logic Group

Primary Task

Find a recommendation for a patient

Find a recommendation for a friend/family member

Other, please specify

A

A

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

Text area, no char limit

N

Skip Logic Group

Other Reason for Visit

Were you able to accomplish your primary task?

Yes

Radio button, one-up vertical

Single

Y

Skip Logic Group

Accomplish

No

A

Partially

A

A

Please tell us what you were trying to accomplish.

Text area, no char limit

Single

N

Skip Logic Group

Information Seeking

How did you look or information today? (please select all that apply)

Search feature

Checkbox, one-up vertical

Multi

Y

Search Method

Browsed/clicked on links and buttons

Both

What areas of the site did you visit today? (Please select all that apply)

Methods and Processes

Checkbox, one-up vertical

Multi

Y

Skip Logic Group

Areas of the Site

Recommendations

Opportunities for Public Comment

Nominate a Recommendation Statement Topic

Special Populations

Tools for Primary Care Practice

Newsroom

Other, please specify

What other areas of the site did you visit today?

Text area, no char limit

N

Skip Logic Group

Other Areas of Site

On a scale from 1 to 10, with 1 being not at all useful and 10 extremely useful, indicate how useful the following information is?

How to explain the risks and benefits of a particular USPSTF recommendation to a patient.

1-Not at all useful

Radio button, scale, has don't know

Single

Y

Risks Benefits

2

3

4

5

6

7

8

9

10- Extremely useful

I don't know/not sure

How to explain potential harms from various screenings or tests.

1- Not at all useful

Radio button, scale, has don't know

Single

Y

Potential Harms

2

3

4

5

6

7

8

9

10- Extremely useful

I don't know/not sure

How to explain recommendations where the supporting evidence is complex or insufficient.

1- Not at all useful

Radio button, scale, has don't know

Single

Y

Explain wo evidence

2

3

4

5

6

7

8

9

10- Extremely useful

I don't know/not sure

How to rephrase recommendations into consumer-friendly or “plain” language

1- Not at all useful

Radio button, scale, has don't know

Single

Y

Plain Lang

2

3

4

5

6

7

8

9

10- Extremely useful

I don't know/not sure

How to better engage in shared decision making with patients when discussing decisions related to preventive services.

1- Not at all useful

Radio button, scale, has don't know

Single

Y

Shared Decisions

2

3

4

5

6

7

8

9

10- Extremely useful

I don't know/not sure

If there is other information that would be helpful if added to USPSTF, please describe:

Text area, no char limit

N

Other Info Helpful

What other suggestions do you have for improving the USPSTF site?

Text area, no char limit

N

Improvement