880 2014 880 SAMSHA Store

American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

2014 880 SAMHSA Store.xlsx

2014 874 NCI Team Science Toolkit - 2014 881 Weather.gov

OMB: 1090-0008

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Overview

Model Qsts
Current Custom Qsts


Sheet 1: Model Qsts

Model Instance Name:

red & strike-through: DELETE

SAMHSA Store V2

underlined & italicized: RE-ORDER

MID: AlJRpZ1w1xJYE9MMtg8JdA==

pink: ADDITION

Date: 7/16/2013 blue + -->: REWORDING

SAMHSA Store V2
Model questions utilize the ACSI methodology to determine scores and impacts

ELEMENTS (drivers of satisfaction)
CUSTOMER SATISFACTION
FUTURE BEHAVIORS

Navigation (1=Poor, 10=Excellent, Don't Know)
Satisfaction
Return (1=Very Unlikely, 10=Very Likely)
1 Please rate how well the site is organized. 16 What is your overall satisfaction with this site?
(1=Very Dissatisfied, 10=Very Satisfied)
19 How likely are you to return to this site?
2 Please rate the options available for navigating this site. 17 How well does this site meet your expectations?
(1=Falls Short, 10=Exceeds)

Recommend (1=Very Unlikely, 10=Very Likely)
3 Please rate how well the site layout helps you find what you are looking for. 18 How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) 20 How likely are you to recommend this site to someone else?

Site Performance (1=Poor, 10=Excellent, Don't Know)


Primary Resource (1=Very Unlikely, 10=Very Likely)
4 Please rate how quickly pages load on this site.

21 How likely are you to use this site as your primary resource for obtaining information and ordering publications from this agency?
5 Please rate the consistency of speed from page to page on this site.



6 Please rate the ability to load pages without getting error messages on this site.




Site Information (1=Poor, 10=Excellent, Don't Know)


7 Please rate the thoroughness of information provided on this site.
8 Please rate how understandable this site’s information is.
9 Please rate how well the site’s information provides answers to your questions.


Look and Feel (1=Poor, 10=Excellent, Don't Know)



10 Please rate the visual appeal of this site.



11 Please rate the balance of graphics and text on this site.



12 Please rate the readability of the pages on this site.




Information Browsing (1=Poor, 10=Excellent, Don't Know)



13 Please rate the ability to sort information by criteria that are important to you on this site.



14 Please rate the ability to narrow choices to find the information you are looking for on this site.



15 Please rate how well the features on the site help you find the information you are looking for.




Sheet 2: Current Custom Qsts

Model Instance Name: red & strike-through: DELETE





SAMHSA Store V2 underlined & italicized: RE-ORDER





MID: AlJRpZ1w1xJYE9MMtg8JdA== pink: ADDITION





Date: 7/11/2013 blue + -->: REWORDING













SAMHSA Store V2 CUSTOM QUESTION LIST
QID
(Group ID)
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 the SAMHSA Store? First time
Drop down, select one S Y
Frequency of visits


Daily






Weekly






Monthly






Every few months or less often






What is your primary interest in substance abuse and mental health topics? Personal A1-A8 Drop down, select one S Y Skip Logic Group Primary interest


Professional B1-B10





A1 For whom are you looking up information and resources? Yourself
Radio button, one-up vertical S Y
Personal info for


Family member







Friend






A2 What is the age of the person for whom you are seeking resources? 12 and under
Radio button, one-up vertical S Y
Personal age


13 to 17







18 to 24







25 to 34







35 to 44







45 to 54







55 to 64







65 and older






A3 Are you primarily looking for information on any of the following topics? Treatment and recovery A4 Radio button, one-up vertical S Y
Personal info topic


Preventing substance abuse problems A5






Preventing mental illness/promoting mental wellness A6






Helping someone cope with and recover from a traumatic event A7






Other, please specify A8





A4 Please specify the topic of interest for treatment and recovery. (Check all that apply) Options for paying for treatment
Checkbox, one-up vertical M Y
Personal treatment


Understanding different types of treatment







Identifying a treatment professional or facility







Recovery support services (e.g., support groups)







Information about specific substances of abuse







Information about specific mental illnesses






A5 Please specify the topic of interest for substance abuse prevention. (Check all that apply) Alcohol
Checkbox, one-up vertical M Y
Personal SA prevention


Illegal substances (e.g., marijuana, cocaine)







Prescription drugs







Tobacco






A6 Please specify the topic of interest for preventing mental illness and promoting mental wellness. (Check all that apply) Anger management
Checkbox, one-up vertical M Y
Personal MH illness


Anxiety or depression







Bullying prevention







Eating disorders







PTSD







Schizophrenia







Stress management







Suicide prevention






A7 Please specify the topic of interest for trauma recovery. (Check all that apply) Death of a loved one
Checkbox, one-up vertical M Y
Personal trauma


Physical or sexual abuse







Natural disaster







Mass violence







Post-military deployment






A8 Please specify other information looking for.

Text area, no char limit
N
Personal other info

B1 What best describes your organization type? Behavioral health treatment facility
Radio button, one-up vertical S Y
Organization type

Other health care facility (e.g., primary care)





Government office





Nonprofit/community-based organization/coalition





School/university





Military/veterans group





Criminal justice/courts





Health insurer





Human resources/employee assistance program





Other





B2 For whom are you primarily looking for information and resources? Professional education for self/colleagues
Radio button, one-up vertical S Y
Professional info for


Use with patients/clients







Use within classroom/youth setting







Public awareness campaign/event







Other






B3 Which of the following best describes the age of your patients, clients, or students? 12 and under
Radio button, one-up vertical S Y
Professional age


13 to 17







18 to 24







25 to 34







35 to 44







45 to 54







55 to 64







65 and older






B4 Were you primarily looking for information on any of the following topics? Affordable Care Act (e.g., health reform, parity) B5 Radio button, one-up vertical S Y
Professional info topic


Treatment and recovery B6






Substance abuse prevention B7






Preventing mental illness/promoting mental wellness B8






Trauma B9






Other, please specify B10





B5 Please specify the topic of interest for Affordable Care Act. (Check all that apply) Reimbursement for behavioral health services
Checkbox, one-up vertical M Y
Professional ACA


Enrolling patients/clients in health insurance exchanges or Medicaid/Medicare







Other






B6 Please specify the topic of interest for treatment and recovery. (Check all that apply) Patient/client educational materials
Checkbox, one-up vertical M Y
Professional treatment


Evidence based practices







Information for working with specific populations







Information about specific substances of abuse







Information about specific mental illnesses






B7 Please specify the topic of interest for substance abuse prevention. (Check all that apply) Alcohol
Checkbox, one-up vertical M Y
Professional SA prevention


Illegal substances (e.g., marijuana, cocaine)







Prescription drugs







Tobacco







Parenting/family resources






B8 Please specify the topic of interest for preventing mental illness and promoting mental wellness. (Check all that apply) Anger management
Checkbox, one-up vertical M Y
Professional MH illness


Bullying prevention







Eating disorders







Mood disorders







PTSD







Schizophrenia







Stress management







Suicide prevention







Parenting/family resources






B9 Please specify the topic of interest for trauma. (Check all that apply) Grief
Checkbox, one-up vertical M Y
Professional trauma


Physical or sexual abuse







Natural disaster







Mass violence







Post-military deployment






B10 Please specify other information looking for.

Text area, no char limit
N
Professional other info


Did you find what you were looking for? Yes
Drop down, select one S Y
Find info

No





Partially





Still looking






How satisfied were you with the content available? Very satisfied
Drop down, select one S Y Skip Logic Group Content satisfaction



Somewhat satisfied








No opinion








Somewhat dissatisfied A







Very dissatisfied A





A Please tell us how our products and resources could be improved.

Text area, no char limit
N
Improve products


What services could this agency provide to better serve you?

Text area, no char limit
N
Other services wanted


Please specify the types of electronic devices you use. (Check all that apply) Desktop or laptop computer
Checkbox, one-up vertical M Y
Device type


Tablet or e-reader (e.g., iPad, Kindle, Nook)







Smartphone (e.g., iPhone or similar devices with web access)







Cell phone





The following demographics questions are entirely optional and will be used for statistical purpose only.


What is your gender? Female
Drop down, select one S N
Gender


Male






Prefer not to respond






Please select the category that includes your age. 17 and under
Drop down, select one S N
Age


18 - 24






25 - 34






35 - 44






45 - 54






55 - 64






65 and over






Prefer not to respond






Which of the following best describes the highest level of education you have completed? Current middle or high school student
Drop down, select one S N
Education


Did not complete high school






High school graduate






Some college/vocational school






College graduate






Some postgraduate school






Graduate/professional degree






MD/PhD






Prefer not to respond






What state do you live in? Alabama
Drop down, select one S N
State


Alaska






Arizona






Arkansas






California






Colorado






Connecticut






Delaware






Florida






Georgia






Hawaii






Idaho






Illinois






Indiana






Iowa






Kansas






Kentucky






Louisiana






Maine






Maryland






Massachusetts






Michigan






Minnesota






Mississippi






Missouri






Montana






Nebraska






Nevada






New Hampshire






New Jersey






New Mexico






New York






North Carolina






North Dakota






Ohio






Oklahoma






Oregon






Pennsylvania






Rhode Island






South Carolina






South Dakota






Tennessee






Texas






Utah






Vermont






Virginia






Washington






Washington D.C.






West Virginia






Wisconsin






Wyoming






Prefer not to respond






Are you living in a: Urban area
Drop down, select one S N
Living area


Rural area






Don't know






How do you describe your ethnicity? Hispanic
Drop down, select one S N
Ethnicity


Non-Hispanic






Prefer not to respond






How do you describe your race? American Indian or Alaska Native
Drop down, select one S N
Race


Asian or Pacific Islander






African American or Black






White






Other






Prefer not to respond




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