Main Instrument- General Population, Adult Women, 25+

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

Draft Questions for OWH Campaign

February 10 2012

V6

BASE: ALL RESPONDENTS

Q1. (AHA 2009 Question): Based on what you know, what warning signs do you associate with having a heart attack? [Accept multiple responses]

For phone respondents the list the interviewer has available (they do not read it) includes:

Chest pain

Fatigue

Nausea

Pain that spreads to the shoulders, neck or arms

Shortness of breath

Tightness of the chest

Other (specify_______)

Don’t know (vol.)

Refused (vol.)

BASE: ALL RESPONDENTS

Q2. (AHA 2009 Question): If you thought you were experiencing signs of a heart attack, what is the first thing you would do? [Single response]

For phone respondents the list the interviewer has available (they do not read it) includes:

Take an aspirin

Call your doctor

Call a family member

Call 911

Go to the hospital

Other (specify___________)

Don’t know (vol.)

Refused (vol.)

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-xxxx . The time required to complete this information collection is estimated to average 4 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

BASE: ALL RESPONDENTS

Q3. (New OWH Question): I am going to read you a list of possible symptoms that may or may not be associated with a heart attack for a woman. Based on what you know, is (READ ITEM) a symptom of a heart attack for a woman?

1. Yes

2. No

3. Don’t know (vol.)

4. Refused (vol.)

RANDOMIZE

1. Having a fever

2. Chest pain or discomfort

3. Unusual upper body discomfort

4. Shortness of Breath

5. Ringing in your ear

6. Breaking out in a cold sweat

7. Unusual or unexplained fatigue or tiredness

8. Breaking out in hives

9. Lightheadedness or sudden dizziness

10. Nausea or feeling sick to your stomach

BASE: DID NOT SELECT 911 AS FIRST ACTION TO TAKE IN Q2

Q4. (New Question): Now, I would like to read you some reasons other women have told us why they would not call 911 as the first action they would take if they thought they were experiencing symptoms of a heart attack. As I read each one, please tell me how much you agree or disagree that it is a reason you would not call 911 if you thought you were experiencing symptoms of a heart attack. (READ ITEM) – Do you agree strongly, agree somewhat, neither agree nor disagree, disagree somewhat or disagree strongly?

1. Agree strongly

2. Agree somewhat

3. Neither agree or disagree

4. Disagree somewhat

5. Disagree strongly

6. Don’t know (vol.)

7. Refused (vol.)

RANDOMIZE

1. I have responsibility for other people or things

2. I don’t want to be a burden to my friends or family

3. I would worry about the appearance of myself or my home

4. I am uncomfortable asking for help

5. I would worry that doctors and nurses would not take my concerns seriously

6. I believe that I should call my doctor first before calling 911

7. I believe that I should take an aspirin first before calling 911

8. I feel like I should call a family member or a friend first

9. I believe there is a better way for me to get to the hospital

10. I would be embarrassed about what my neighbors might think

11. I would be embarrassed if it wasn’t really a heart attack

12. I would be worried about the costs that I would have to pay because of calling 911

BASE: DID NOT SELECT 911 AS FIRST ACTION TO TAKE IN Q2

Q4a. Are there any other reasons why calling 911 might not be the first action you would take if you thought you were experiencing symptoms of a heart attack? (4 REs)

[TEXT BOX]

BASE: ALL RESPONDENTS

Q3b How likely would you be to call 911 in the following situations?

1. Definitely would

2. Probably would

3. Might or might not

4. Probably would not

5. Definitely would not

6. Don’t know (vol.)

7. Refused (vol.)

1. If you were experiencing more than one potential symptom of a heart attack

2. If you never felt this way before

3. If you were alone

4. If you were not able to get in touch with your doctor

5. If you were not able to get in touch with a family member or friend

OWH Campaign Awareness Questions

(To be asked at the end of entire survey to reduce risk of bias)

ROTATE ORDER OF 5A, 5B AND 5C

BASE: ALL RESPONDENTS

Q5a. In the past year, have you seen an advertisement on TV that shows the 7 symptoms of a heart attack in women and encourages women to call 9-1-1?

1. Yes

2. No

3. Don’t know (vol.)

4. Refused (vol.)

BASE: ALL RESPONDENTS

Q5B In the past year, have you heard an advertisement on the radio that features a woman singing a song about the 7 symptoms of a heart attack in women and encourages women to call 9-1-1?

1. Yes

2. No

3. Don’t know (vol.)

4. Refused (vol.)

BASE: ALL RESPONDENTS

Q5C In the past year, have you seen an advertisement on billboards, bus shelters, or posters showing the 7 symptoms of a heart attack in women and encourages women to call 9-1-1? 

1. Yes

2. No

3. Don’t know (vol.)

4. Refused (vol.)

BASE: SAW, READ, HEARD ADVERTISEMENT

Q6. Based on what you saw, read or heard in the advertisement about women and heart attack, how likely are you to (INSERT ITEM) – would you definitely do this, probably do this, you might or might not, you probably would not or you definitely would not?

1. Definitely would

2. Probably would

3. Might or might not

4. Probably would not

5. Definitely would not

6. Don’t know (vol.)

7. Refused (vol.)

RANDOMIZE

1. Call 911 right away if you thought you were having any one of these symptoms of a heart attack

2. Talk to family or friends to educate them about symptoms of a heart attack

3. Encourage family or friends to call 911 if they think they or someone else is experiencing symptoms of a heart attack

4. Take your symptoms more seriously

5. Educate yourself about the symptoms of a heart attack

6. Take more preventive steps to keep your heart healthy, for example, by watching your cholesterol, blood pressure, and weight

7. Call your doctor

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