Form #3 Form #3 Interview Guide for Patients

(

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment C)

OCHIN-Member Clinics

Interview Questions for Patients

1. Were you ever given a guide – and an instruction sheet inviting you to read the guide - that had information about your condition and the different choices for treating your condition?

   1. (If yes) Do you remember when the information was given to you? (During you meeting with the doctor? Just before you left the office? Later in the mail after your visit was over?)

2. Do you remember if someone talked with you about why you were being given the information and how it might help you understand what choices you have in your health care?

   1. If so, did you have the chance to ask questions about the information, or how you should use it?

3. Did you read the information that was given to you?

   1. (If yes) What do you think of the information that was given to you?

   2. Did you find the information useful in helping you to make a choice about your health care?

   3. (If no) What are the reasons that you did not read the information that was given to you? (Were you unsure why the information had been given to you? Was the information hard to understand or difficult to read because of the size of the printing or the types of words used?)

4. Is there a way in which the information that you received could be made easier for you to understand and use?

5. Are there any other ideas that you have about printed information that you were given in the clinic that you would like to tell me about?

6. Finally, do you have any suggestions for ways in which doctors and other people in the clinic could provide you with more information about the choices you have in treating your condition?

Public reporting burden for this collection of information is estimated to average 30 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.