Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12

Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12.docx

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Supp 1_Brochure_Feedback_Alcohol and Pregnancy Message Testing_01-23-12

OMB: 0920-0919

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What You Think About This Brochure

Focus Group: ____________________________

Location: ______________ Time: ______________


Please Do Not Start Filling This Out Until The Moderator Says So.


Using a scale from 1 to 5 where a 1 means “Definitely No” and a 5 means “Definitely yes”, how would you rate this brochure on the following aspects? (Circle the number for your answer)

Definitely Definitely

NO YES

  1. This brochure is easy to read 1 2 3 4 5

  2. I like how this brochure looks 1 2 3 4 5

  3. This brochure is easy to understand 1 2 3 4 5

  4. Information is easy to find in this brochure 1 2 3 4 5

  5. This brochure helps me understand the risks of drinking 1 2 3 4 5

alcohol while pregnant or trying to become pregnant and the health of my baby


These words or sentences in the brochure are hard for me to understand:

____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________


What do you like the most about this brochure?

____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________


What do you like the least about this brochure?

____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleWhat You Think About This Booklet
AuthorElizabeth Frentzel
File Modified0000-00-00
File Created2021-01-31

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