693 2013 693 CDC Questionnaire 3.29.2012

---

Overview

English Equiv Model Qsts
EE Current Custom Qsts

---

Sheet 1: English Equiv Model Qsts

Model Instance Name:
CDC (Jan 2011-present)
MID:	Y9h8gZZ0ghx0VYtM1w8I8A==
Date:	1/1/2011
\
Model questions utilize the ACSI methodology to determine scores and impacts
	ELEMENTS (drivers of satisfaction)		CUSTOMER SATISFACTION		FUTURE BEHAVIORS
	Content (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Likelihood to Return (1=Very Unlikely, 10=Very Likely)
	Please rate the accuracy of information on this site.		What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)		How likely are you to return to this site?
	Please rate the quality of information on this site.		How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Very Unlikely, 10=Very Likely)
	Please rate the freshness of content on this site.		How does this site 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?
	Functionality (1=Poor, 10=Excellent, Don't Know)				Future Participation (1=Very Unlikely, 10=Very Likely)
	Please rate the usefulness of the features provided on this site.				How likely are you to express your thoughts or ideas to this agency in the next 90 days?
	Please rate the convenience of the features on this site.				Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
	Please rate the variety of features on this site.				Please rate your level of trust in this agency.
	Look and Feel (1=Poor, 10=Excellent, Don't Know)
	Please rate the visual appeal of this site.
	Please rate the balance of graphics and text on this site.
	Please rate the readability of the pages on this site.
	Navigation (1=Poor, 10=Excellent, Don't Know)
	Please rate how well the site is organized.
	Please rate the options available for navigating this site.
	Please rate how well the site layout helps you find what you are looking for.
	Please rate the number of clicks to get where you want on this site.
	Site Performance (1=Poor, 10=Excellent, Don't Know)
	Please rate how quickly pages load on this site.
	Please rate the consistency of speed from page to page on this site.
	Please rate the ability to load pages without getting error messages on this site.
	Search (1=Poor, 10=Excellent, Don't Know)
	Please rate the relevance of search results on this site.
	Please rate the organization of search results on this site.
	Please rate how well the search results help you decide what to select.
	Please rate how well the search feature helps you to narrow the results to find what you want.
	Online Transparency (1=Poor, 10=Excellent, Don't Know)
	Please rate how thoroughly this Web site discloses information about what this agency is doing.
	Please rate how quickly agency information is made available on this Web site.
	Please rate how well information about what this agency is doing can be accessed by the public on this Web site

---

Sheet 2: EE Current Custom Qsts

Model Instance Name:			red & strike-through: DELETE
CDC (Jan 2011-present)			underlined & italicized: RE-ORDER
MID:	Y9h8gZZ0ghx0VYtM1w8I8A==		pink: ADDITION
Date:	3/1/2008		blue + -->: REWORDING
CDC (Jan 2011-present) 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
CWS06063		Which category best describes the health topic you were looking for?	Diseases and Conditions (ADHD, birth defects, cancer, diabetes, fetal alcohol syndrome, flu, hepatitis, HIV/AIDS, STDs…)	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	1. Health topic looking for
			Healthy Living (food safety, bone health, physical activity, immunizations, genetics, sexual health, smoking prevention…)	B
			Emergency Preparedness & Response (bioterrorism, chemical & radiation emergencies, severe weather…)	D
			Injury, Violence & Safety (motor vehicle safety, traumatic brain injury and concussion, falls, child abuse, prescription drug abuse, suicide, injury data…)	E
			Environmental Health (air pollution, biomonitoring, carbon monoxide, toxic lead, toxic substances, mold…)	F
			Workplace Health (asbestos, chemical safety, construction, mining, office environments, respirators…)	G
			Global Health (Global AIDS, malaria, disease detection, polio, influenza…)	I
			Traveler's Health (destinations, outbreaks, travel vaccinations, Yellow Book…)	C
			Life Stages & Populations (infant & child, disabilities, men, minorities, pregnancy, seniors, women...)	H
			State, Tribal, Local & Territorial (The Public Health Workplace, program planning, professional development, tribal support…)	J
			Outbreaks (International outbreaks, outbreaks in the United States, food-related outbreaks ...)	W
			Other, please specify:	K
CWS06064	K	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1Oth Health Topic
CWS06065	A	More specifically, what topic were you looking for?	ADHD		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.1Diseases&Conditions
			Arthritis
			Asthma
			Autism
			Birth defects
			Cancer
			Diabetes
			Epilepsy
			Fetal alcohol syndrome
			Flu (influenza)
			Hand, foot and mouth disease
			Heart disease
			Hepatitis
			HIV/AIDS
			HPV
			Meningitis
			MRSA (Methicillin Resistant Staphylococcus Aureus)
			Obesity
			Salmonella
			Sexually transmitted diseases (HPV, chlamydia, gonorrhea, etc.)
			Shingles
			Stroke
			Tuberculosis
			Water-related diseases
			Other, please specify:	L
CWS06066	L	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.1Oth Disease&Conditions
CWS06067	B	More specifically, what topic were you looking for?	Aging		Radio button, one-up vertical	Single	Y		1.2 Healthy Living
			Birth defects
			BMI (Body Mass Index)
			Bone health
			Breastfeeding
			Child development
			Excessive alcohol use
			Food safety
			Genetics and genomics
			Mental health
			Nutrition
			Physical activity and exercise
			Reproductive health
			Sexual health
			Sleep and sleep disorders
			Smoking and tobacco use
			Vaccines and immunizations
			Other, please specify:	M
CWS06068	M	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.2 Oth HealthyLiving
CWS06069	C	More specifically, what topic were you looking for?	Yellow Book (CDC Health Information for International Travel)		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.3 Travelers Health
			Destinations
			Diseases related to travel (including malaria and yellow fever)
			Illness & injury abroad (what to do if you become sick while traveling)
			Preparing for your trip
			Staying healthy & safe (insect protection, safe food & water, survival guide)
			Vaccinations
			Other, please specify:	N
CWS06070	N	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.3Oth Travelers Health
CWS06071	D	More specifically, what topic were you looking for?	Bioterrorism (anthrax, plague, smallpox)		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.4 Emergency
			Chemical emergencies (ricin, chlorine, nerve agents)
			Coping with a disaster
			Mass casualties (explosions, blasts, injuries)
			Natural disasters & severe weather (earthquakes, hurricanes, volcanoes, winter weather)
			Preparation & planning for hazards
			Radiation emergencies (dirty bombs, nuclear blasts)
			Recent outbreaks & incidents (salmonella, melamine)
			Surveillance
			Other, please specify:	O
CWS06072	O	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.4Oth Emergency
CWS06073	E	More specifically, what topic were you looking for?	Acute care (injury response)		Radio button, one-up vertical	Single	Y		1.5 Injury
			Adolescent injuries
			Child abuse / maltreatment
			Choking
			Concussion / brain injuries
			Dog bites
			Drowning
			Elder maltreatment
			Explosion and blast injuries
			Falls among older adults
			Fire-related injuries
			Fireworks
			Intimate partner violence
			Mass casualties
			Motor vehicle injuries
			Poisoning
			Preventing injury & violence
			Sexual violence
			Suicide
			Violence
			Other, please specify:	P
CWS06074	P	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.5Oth Injury
CWS06075	F	More specifically, what topic were you looking for?	Air quality		Radio button, one-up vertical	Single	Y		1.6 Environmental
			Asbestos
			Asthma
			Biomonitoring
			Carbon monoxide poisoning
			Childhood lead poisoning prevention
			Climate change
			Cruise ship health
			Extreme weather conditions
			Mold
			Natural disasters
			Protect yourself from the sun
			Radiation studies
			Rodent control
			Smoking and tobacco use
			Water
			Other, please specify:	Q
CWS06076	Q	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.6Oth Enviro
CWS06077	G	More specifically, what topic were you looking for?	Asbestos		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.7 Workplace
			Blood borne Infectious Diseases
			Chemical safety
			Construction
			Electrical safety
			Emergency preparedness & Response
			Ergonomics and Musculoskeletal Disorders
			Eye safety
			Falls
			Heat Stress/Cold Stress
			Machine safety
			Mining
			Noise/Hearing Loss
			Office environments
			Protective clothing
			Respirators
			Stress
			Violence
			Workplace safety & prevention
			Other, please specify:	R
CWS06078	R	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.7Oth Workplace
CWS06079	H	More specifically, what topic were you looking for?	Adolescents & teens		Radio button, one-up vertical	Single	Y		1.8 Lifestages
			Children
			People with disabilities
			Family
			Infants & toddlers
			Men
			Older adults & seniors
			Parents
			Pregnancy
			Women
			Young adults
			Other, please specify:	H
CWS06080	S	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.8Oth Lifestages
CWS06081	I	More specifically, what topic were you looking for?	Field Epidemiologist Training Program		Radio button, one-up vertical	Single	Y		1.9 Global
			Global disease detection
			Global health initiatives
			Global HIV/AIDS
			Global immunizations
			Haiti
			International emergency and refugee health
			Parasites
			Other, please specify:	T
CWS06082	T	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.9Oth Global
CWS06083	J	More specifically, what topic were you looking for?	Best practices		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.10 State Tribal
			Cooperative agreements
			Funding and grants
			Policy
			Strategy and planning
			Training
			Other, please specify:	U
CWS06084	U	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.10Oth State Tribal
ACQWro0010097	W	More specifically, what topic were you looking for?	Travel-related outbreaks		Radio button, one-up vertical	Single	Y	Skip Logic Group	1.11 Outbreaks
			International outbreaks
			United States outbreaks
			Food-related outbreaks
			Other, please specify:	V
ACQWro0010098	V	Please list the other topic you were looking for:			Text area, no char limit			Skip Logic Group	1.11Oth Outbreaks
CWS06085		Which of the following best describes the type of information you were looking for?	General information about the health topic selected		Radio button, one-up vertical	Single	Y	OPS Group	2. Type of Info Looking For
			General information about symptoms, causes, risk factors, tests, or treatment
			Data and statistics
			Scientific research, articles, publications, and journals
			Guidelines and recommendations for healthcare providers
			Professional training for healthcare providers, researchers, public health professionals, etc.
			Educational materials
			Campaigns and initiatives
			Grants and funding opportunities
			Tools, software applications, systems, and other resources
			Print materials (fact sheets, brochures, posters, etc.)
			Multimedia products (podcasts, videos, widgets, etc.)
			Jobs and careers
			Other, please specify:	A
CWS06086	A	Please list the other type of information you were looking for:			Text area, no char limit			OPS Group	2.Oth Type of Info
CWS06087		Were you able to find what you were looking for?	Yes		Radio button, one-up vertical		Y	Skip Logic Group	3. Able to Find
			Partially	A
			No, I'm still looking	A
CWS06088	A	What were you looking for?			Text area, no char limit			Skip Logic Group	3Oth. Unable to Find
ACQOsl0003358		I'm planning to use the information I found today:	For my own health or my family's health	A	Radio button, one-up vertical	Single	Y	Skip Logic Group	4. How will use
			For my friend or family member (not living in my household)
			For a physician's office/hospital
			For a patient or client
			For a public health agency
			For a research institution
			For a business / workplace
			For an educational institution or teaching purposes
			For a school / class project
			Other, please specify:	B
ACQWro0010091	A	Based on the information I found, I am planning to make changes to my lifestyle or my family's lifestyle:	Strongly agree		Radio button, one-up vertical	Single	Y	Skip Logic Group	4.1 Behavior Change
			Agree
			Disagree	C
			Strongly disagree	C
			Not applicable
ACQWro0010092	C	Why are you unlikely to make a change to improve your health?			Text area, no char limit	Single		Skip Logic Group	4.2Unlikely Change
ACQOsl0003359	B	Please specify how you will use the information you are looking for today:			Text area, no char limit			Skip Logic Group	4.Oth How will use
ACQOsl0004055		Would you access information from CDC through other electronic channels or devices? (Please select all that apply):	Facebook		Checkbox, one-up vertical	Multi	Y	OPS Group	6. Electronic Channels (3.14.2011)
			Google+
			LinkedIn
			Twitter
			Mobile websites
			Mobile applications or "apps"
			Text messages
			Online Videos
			Podcasts
			Blogs
			eCards
			Widgets (i.e. module or application you can add to a website or personalized web page like iGoogle or MyYahoo!)
			E-mail updates
			RSS Feeds
			Pinterest
			None of the above
			Other, please specify:
CWS06098		How frequently do you use the CDC.gov Web site?	Daily		Radio button, one-up vertical	Single	Y		9. Frequency
			Weekly
			Monthly
			A couple times a year
			About once a year
			This is my first time
CWS06099		Which best describes the primary role that brought you to the CDC.gov Web site today?	Individual interested in health		Radio button, one-up vertical	Single	Y	Skip Logic Group	10. Role
			Traveler
			Healthcare provider (physician, nurse, physician’s assistant, nurse practitioner, pharmacist, or other healthcare provider)	B, C
			Public health agency employee or public health professional	D, E
			Scientist or researcher
			Educator, teacher or trainer
			Student
			Safety advisor
			Business manager
			Journalist or member of the media
			Emergency responder
			Law enforcement
			Policymaker, legislator, or staff
			Grantee
			CDC Employee, staff, or contractor
			Other, please specify:	A
CWS06100	A	Please list your role:			Text area, no char limit		N	Skip Logic Group	10.Oth Role
CWS06101	B	Which of the following best describes you?	Physician, actively seeing patients at least 2 days a week		Radio button, one-up vertical	Single	Y		10.1 HCP Role
			Physician, primarily conducting research projects
			Nurse or nurse practitioner
			Physician’s assistant
			Pharmacist or pharmaceutical assistant
			Other type of healthcare provider, please specify:	F
CWS06102	F	Please list your role:			Text area, no char limit		N	Skip Logic Group	10.1Oth HCP Role
CWS06103	C	Which of the following best describes where you work?	Hospital		Radio button, one-up vertical	Single	Y		10.2 HCP Location
			Large medical practice
			Small medical practice
			Not-for-profit
			Research institution
			Other, please specify:	G
CWS06104	G	Please list where you work:			Text area, no char limit		N	Skip Logic Group	10.2Oth HCP Location
CWS06105	D	Which of the following best describes you?	Public health advocate		Radio button, one-up vertical	Single	Y		10.3 PHP Role
			Health educator
			Health communicator
			Management
			Epidemiologist
			Research scientist
			Administrative staff
			Other, please specify:	H
CWS06106	H	Please list your role:			Text area, no char limit		N	Skip Logic Group	10.3Oth PHP Role
CWS06107	E	Which of the following best describes where you work?	Public or commercial sector		Radio button, one-up vertical	Single	Y		10.4 PHP Location
			Not-for-profit
			Federal public health agency
			State public health agency
			Local public health agency
			Territorial public health agency
			Tribal public health agency
			Other, please specify:	I
CWS06108	I	Please list where you work:			Text area, no char limit		N	Skip Logic Group	10.4Oth PHP Location
CWS06109		Which of the following sources drove you to visit the site today? (Please rank the top 3, with number 1 being the most important) Rank 1 (Required)	Message directly from CDC on Facebook or Twitter		Drop down, select one	Single	Y	Rank Group	SV - Rank 1
			Message or recommendation from a friend on Facebook or Twitter
			Video I saw on CDC's YouTube Page
			Advertisement on Facebook, or Twitter					Randomize
			CDC's mobile site
			Mobile phone text messages or alerts
			Mobile application or "app"
			Scanned a QR code
			Instant message from someone
			Familiarity with site/agency
			Email updates from the agency
			Website is bookmarked
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Advertisement on another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
CWS06110		Rank 2 (Optional)	Message directly from CDC on Facebook or Twitter		Drop down, select one	Single	N	Rank Group	SV - Rank 2
			Message or recommendation from a friend on Facebook or Twitter
			Video I saw on CDC's YouTube Page					Adjust Template/Style Sheet
			Advertisement on Facebook, or Twitter
			CDC's mobile site
			Mobile phone text messages or alerts
			Mobile application or "app"
			Scanned a QR code
			Instant message from someone
			Familiarity with site/agency
			Email updates from the agency
			Website is bookmarked
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Advertisement on another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
CWS06111		Rank 3 (Optional)	Message directly from CDC on Facebook or Twitter		Drop down, select one	Single	N	Rank Group	SV - Rank 3
			Message or recommendation from a friend on Facebook or Twitter
			Video I saw on CDC's YouTube Page					Adjust Template/Style Sheet
			Advertisement on Facebook, or Twitter
			CDC's mobile site
			Mobile phone text messages or alerts
			Mobile application or "app"
			Scanned a QR code
			Instant message from someone
			Familiarity with site/agency
			Email updates from the agency
			Website is bookmarked
			Search engine results
			Word of mouth recommendation from someone I know
			TV, radio, newspaper, or magazine advertising
			Advertisement on another website
			Don't know					Anchor Answer Choice
			Other					Anchor Answer Choice
CWS06112		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
CWS06113		How old are you?	19 or under		Radio button, one-up vertical	Single	Y		11. Age
			20-34 years old
			35-49 years old
			50-64 years old
			65 or older
			Prefer not to answer
CWS06114		How would you describe yourself?	White		Checkbox, one-up vertical	Multi	Y		12. Ethnicity
			Hispanic or Latino
			Asian
			Black or African American
			American Indian or Alaska Native
			Native Hawaiian or other Pacific Islander
			Prefer not to answer
CWS06115		What is the highest level of education you have completed?	High school or less		Radio button, one-up vertical	Single	Y		13. Education
			Some college
			College degree
			Advanced degree
			Prefer not to answer
CWS06116		What is your gender?	Female		Radio button, one-up vertical	Single	Y		14. Gender
			Male
			Transgender
			Prefer not to answer
CWS06117		What is your country of residence?	USA				Y		15. Country
			Afghanistan
			Albania
			Algeria
			American Samoa
			Andorra
			Angola
			Anguilla
			Antarctica
			Antigua and Barbuda
			Argentina
			Armenia
			Aruba
			Australia
			Austria
			Azerbaijan
			Bahamas
			Bahrain
			Bangladesh
			Barbados
			Belarus
			Belgium
			Belize
			Benin
			Bermuda
			Bhutan
			Bolivia
			Bosnia/Herzegovina
			Botswana
			Bouvet Island
			Brazil
			British Indian Ocean
			Brunei Darussalam
			Bulgaria
			Burkina Faso
			Burundi
			Cambodia
			Cameroon
			Canada
			Cape Verde
			Cayman Islands
			Central African Rep.
			Chad
			Chile
			China
			Christmas Island
			Cocos Islands
			Colombia
			Comoros
			Congo
			Congo, Democratic Rep.
			Cook Islands
			Costa Rica
			Côte D'Ivoire
			Croatia
			Cuba
			Cyprus
			Czech Republic
			Denmark
			Djibouti
			Dominica
			Dominican Republic
			East Timor
			Ecuador
			Egypt
			El Salvador
			Equatorial Guinea
			Eritrea
			Estonia
			Ethiopia
			Falkland Islands
			Faroe Islands
			Fiji
			Finland
			France
			French Guiana
			French Polynesia
			French Southern Terr.
			Gabon
			Gambia
			Georgia
			Germany
			Ghana
			Gibraltar
			Greece
			Greenland
			Grenada
			Guadeloupe
			Guam
			Guatemala
			Guinea
			Guinea& Bissau
			Guyana
			Haiti
			Heard/McDonald Isls.
			Holy See/Vatican
			Honduras
			Hong Kong
			Hungary
			Iceland
			India
			Indonesia
			Iran
			Iraq
			Ireland
			Israel
			Italy
			Jamaica
			Japan
			Jordan
			Kazakhstan
			Kenya
			Kiribati
			Korea, North
			Korea, South
			Kuwait
			Kyrgyzstan
			Laos
			Latvia
			Lebanon
			Lesotho
			Liberia
			Libya
			Liechtenstein
			Lithuania
			Luxembourg
			Macao
			Macedonia
			Madagascar
			Malawi
			Malaysia
			Maldives
			Mali
			Malta
			Marshall Islands
			Martinique
			Mauritania
			Mauritius
			Mayotte
			Mexico
			Micronesia
			Moldova
			Monaco
			Mongolia
			Montserrat
			Morocco
			Mozambique
			Myanmar
			Namibia
			Nauru
			Nepal
			Netherlands
			Netherlands Antilles
			New Caledonia
			New Zealand
			Nicaragua
			Niger
			Nigeria
			Niue
			Norfolk Island
			Northern Mariana Isls
			Norway
			Oman
			Pakistan
			Palau
			Palestinian Territory
			Panama
			Papua New Guinea
			Paraguay
			Peru
			Philippines
			Pitcairn
			Poland
			Portugal
			Puerto Rico
			Qatar
			Réunion
			Romania
			Russian Federation
			Rwanda
			Saint Helena
			Saint Kitts/Nevis
			Saint Lucia
			Saint Pierre/Miquelon
			Saint Vincent/Grenadines
			Samoa
			San Marino
			Sao Tome/Principe
			Saudi Arabia
			Senegal
			Seychelles
			Sierra Leone
			Singapore
			Slovakia
			Slovenia
			Solomon Islands
			Somalia
			South Africa
			S. Georgia/S. Sand. Isls
			Spain
			Sri Lanka
			Sudan
			Suriname
			Svalbard/Jan Mayen
			Swaziland
			Sweden
			Switzerland
			Syria
			Taiwan
			Tajikistan
			Tanzania
			Thailand
			Togo
			Tokelau
			Tonga
			Trinidad and Tobago
			Tunisia
			Turkey
			Turkmenistan
			Turks and Caicos Isls
			Tuvalu
			Uganda
			Ukraine
			United Arab Emirates
			United Kingdom
			US Minor Outlying Isls
			Uruguay
			Uzbekistan
			Vanuatu
			Venezuela
			Viet Nam
			Virgin Islands, British
			Virgin Islands, U.S.
			Wallis and Futuna
			Western Sahara
			Yemen
			Yugoslavia
			Zambia
			Zimbabwe
CWS06118		If you could suggest one change to improve the CDC Web site, what recommendation would you make?			Text area, no char limit		N		16. One Improvement