| Model Instance Name: | ||
| NIAMS SiteFeedback | ||
| MID: | ||
| Date: | 3/5/2013 | |
| Model Instance Name: MODEL QUESTION LIST | ||
| Model questions utilize the ACSI methodology to determine scores and impacts | ||
| CUSTOMER SATISFACTION | ||
| Satisfaction questions are required. Satisfaction questions appear on all surveys. |
||
| Satisfaction (1=Poor, 10=Excellent) | ||
| 1 | What is your <b>overall satisfaction</b> with this site? | |
| 2 | How well does this site <b>meet your expectations</b>? | |
| 3 | How does this site <b>compare to your idea of an ideal website</b>? | |
| Model Instance Name: | |||||||||
| NIAMS SiteFeedback | underlined & italicized: RE-ORDER | ||||||||
| MID: | pink: ADDITION | ||||||||
| Date: | 3/6/2013 | blue + -->: REWORDING | |||||||
| NIAMS SiteFeedback 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 Labels |
| How would you best describe yourself? | Government employee | Radio button, one-up vertical | Single | Y | Role | ||||
| Healthcare provider | |||||||||
| Media professional | |||||||||
| Nonprofit/Community-Based Organization Member | |||||||||
| Patient/Family/Friend | |||||||||
| Professional Organization | |||||||||
| Student/Educator | |||||||||
| Other | |||||||||
| How did you reach the National Multicultural Initiative pages? | I received A Year of Health planner | Radio button, one-up vertical | Single | Y | Hear About | ||||
| I was referred to the website by someone else | |||||||||
| I did a search on the internet | |||||||||
| I saw information about the Initiative on a different website | |||||||||
| Other | |||||||||
| Was the information you found on these pages useful? | Yes | B | Radio button, one-up vertical | Single | Y | Skip Logic Group | Information | ||
| No | C | ||||||||
| I don't know | C | ||||||||
| C | What type of information would have been useful to you? | Text area, no char limit | N | Skip Logic Group | OE_ Information | ||||
| B | What information did you find most useful? | Access to A Year of Health planner | Radio button, one-up vertical | Single | Y | Skip Logic Group | Most Useful | ||
| Multicultural- specific health information | |||||||||
| The electronic toolkit | D, Z | ||||||||
| Topic-specific materials (e.g., bones, joints, muscles,skin, pain) | E | ||||||||
| Other | |||||||||
| D | What features of the electronic toolkit did you find the most useful?(Select all that apply) | Sample Facebook posts | Checkbox, one-up vertical | Multi-Select | Y | Skip Logic Group | Most Useful Topic | ||
| Sample Twitter posts | |||||||||
| Promotional flyer | |||||||||
| Image gallery | |||||||||
| Newsletter article | |||||||||
| Web banner | |||||||||
| Contact information label | |||||||||
| Outreach tips | |||||||||
| Other (please specify) | F | ||||||||
| F | Please specify what other features were most useful: | Text area, no char limit | N | Skip Logic Group | Other_ Most Useful | ||||
| Z | What features of the electronic toolkit did you find the least useful (Select all that apply) | Sample Facebook posts | Checkbox, one-up vertical | Multi-Select | Y | Skip Logic Group | Least Useful Topic | ||
| Sample Twitter posts | |||||||||
| Promotional flyer | |||||||||
| Image gallery | |||||||||
| Newsletter article | |||||||||
| Web banner | |||||||||
| Contact information label | |||||||||
| Outreach tips | |||||||||
| Other (please specify) | G | ||||||||
| G | Please specify what other features were least useful: | Text area, no char limit | N | Skip Logic Group | Other_Least Useful | ||||
| E | Which topic(s) are you interested in? (Select all that apply) | Bones | Checkbox, one-up vertical | Multi-Select | Y | Skip Logic Group | Topics of Interest | ||
| Joints | |||||||||
| Muscles | |||||||||
| Skin | |||||||||
| Pain | |||||||||
| Other (please specify) | H | ||||||||
| H | Please specify what other topics you are interested in: | Text area, no char limit | N | Skip Logic Group | Other_Topics | ||||
| Have you done anything differently or plan to do anything differently as a result of the information you received on these pages? | Yes | I | Radio button, two-up vertical | Single | Y | Skip Logic Group | Different Action | ||
| No | |||||||||
| I | Please describe what you did or plan to do differently: | Text area, no char limit | N | Skip Logic Group | OE_Different Action | ||||
| How likely are you to return to these pages to find more information on multicultural-specific materials? | 1=Not At All Likely | Radio button, one-up vertical | Single | Y | Return | ||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 = Very Likely | |||||||||
| Don't Know | |||||||||
| How likely are you to share the information you found on these pages? | 1=Not At All Likely | Radio button, one-up vertical | Single | Y | Share Information | ||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 = Very Likely | |||||||||
| Don't Know | |||||||||
| How likely are you to share the link to these web pages? | 1=Not At All Likely | Radio button, one-up vertical | Single | Y | Share Link | ||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 = Very Likely | |||||||||
| Don't Know | |||||||||
| Please share any additional feedback you may have. | Text area, no char limit | N | OE_Additional Feedback | ||||||
| File Type | application/vnd.ms-excel |
| File Title | Questionnaire Production Guidelines_Template |
| Author | Professional Services |
| Last Modified By | Department Of The Interior |
| File Modified | 2013-03-08 |
| File Created | 2001-08-03 |