Attachment 3F Web Survey_Factsheet Testing (rev08272012)

ATTACHMENT 3F

Web Survey: Factsheet Testing

CMV Web Survey: Factsheet Testing

DRAFT

4/23/12

INTRODUCTION

Thank you for agreeing to participate in the survey. This survey is being conducted on behalf of the Centers for Disease Control and Prevention (CDC) to learn more about parents’ interactions with young children, views about childhood health conditions, and reactions to information materials CDC is creating for parents. Your answers will help guide future CDC materials and messages to parents.

Please answer questions as honestly as possible. There is no right or wrong answer and all your responses will be kept secure to the extent provided by law. This is a voluntary study and you can stop at any time. The survey will take about 15 minutes and if you’re ready to begin, please click select the forward arrow at the bottom of your screen.

1. Baseline Awareness/Knowledge of CMV

1. When your youngest child was in diapers, how often did you wash your hands or use hand sanitizer after each of the following (where 1=never and 5=always)?

[RANDOMIZE]

	Never	Rarely	Some of the time	Most of the time	Always
After changing your child’s dirty (poopy) diaper	1	2	3	4	5
After changing your child’s wet (urine only) diaper	1	2	3	4	5
After feeding your child	1	2	3	4	5
After handling household cleaning products	1	2	3	4	5
After shaking hands with a co-worker	1	2	3	4	5
After wiping your child’s nose	1	2	3	4	5
After handling your child’s toys	1	2	3	4	5

2. When your youngest child was in diapers, how often did you do each of the following (where 1=never and 5=every day)?

[RANDOMIZE]

	Never	Rarely	1-2 days a week	3-5 days a week	Every day
Share food with your child (take bites from the same food)	1	2	3	4	5
Share the same cup with your child	1	2	3	4	5
Share eating utensils (knife, fork, or spoon) with your child	1	2	3	4	5
Take vitamins, including folic acid supplements	1	2	3	4	5
Kiss your child on their lips	1	2	3	4	5
Share towels or washcloths with your child	1	2	3	4	5
Share a toothbrush with your child	1	2	3	4	5
Put a pacifier in your mouth after it has been in your child’s mouth	1	2	3	4	5
Clean toys that come in contact with your child’s mouth	1	2	3	4	5

3. Please indicate how familiar you are with each of the following health conditions (where 1=very familiar and 4=not at all familiar).

[RANDOMIZE]

	Very familiar	Somewhat familiar	Not very familiar	Not at all familiar
Congenital rubella syndrome	1	2	3	4
Beta strep (Group B strep)	1	2	3	4
HIV/AIDS	1	2	3	4
Congenital cytomegalovirus (CMV)	1	2	3	4
Down syndrome	1	2	3	4
Sudden infant death syndrome (SIDS)	1	2	3	4
Fetal alcohol syndrome	1	2	3	4
Autism	1	2	3	4
Spina bifida	1	2	3	4
Congenital toxoplasmosis (toxo)	1	2	3	4
Parvovirus B19 (Fifth disease)	1	2	3	4

The following questions will focus on a specific birth defect, congenital cytomegalovirus commonly referred to as CMV.

Programming Note:

IF 3D=4, SKIP TO SECTION II

ELSE, GO TO Q4

4. Please rank in order how likely it is for a pregnant woman to catch CMV from each of the following (where 1=most likely and 3=least likely).

[RANDOMIZE]

1. |_| Toddler

2. |_| Partner or spouse

3. |_| Child who is in elementary school

5. Please indicate how much you agree or disagree with each of the following statements (where 1=strongly agree and 4=strongly disagree).

[RANDOMIZE]

	Strongly Agree	Agree	Disagree	Strongly Disagree
CMV can cause serious disabilities in an unborn child	1	2	3	4
CMV can cause serious disabilities to a woman who is pregnant	1	2	3	4
CMV can spread through urine	1	2	3	4
CMV can spread through saliva	1	2	3	4
CMV can cause heart defects	1	2	3	4
CMV can spread by casual contact with someone	1	2	3	4
CMV can cause hearing loss	1	2	3	4
CMV is about as common as Down Syndrome	1	2	3	4
CMV can spread through feces (poop)	1	2	3	4
If I were pregnant I would be worried about CMV	1	2	3	4
CMV is preventable	1	2	3	4
CMV can spread through hugging or cuddling	1	2	3	4

II. CMV Material: Message Appeal and Understanding

1. CMV Material: [EMBED FACTSHEET]

Please take a few minutes to read the factsheet and then click the forward arrow to continue.

6. Were you able to view the factsheet?

YES
NO

7. Please rank in order how likely it is for a pregnant woman to catch CMV from each of the following (where 1=most likely and 3=least likely).

[RANDOMIZE]

1. |_| Toddler

2. |_| Partner or spouse

3. |_| Child who is in elementary school

8. Thinking about the factsheet you just read, please indicate how much you agree or disagree with each of the following statements (where 1=strongly agree and 4=strongly disagree).

[RANDOMIZE]

	Strongly Agree	Agree	Disagree	Strongly Disagree
I thought the factsheet was difficult to understand.	1	2	3	4
The information in the factsheet doesn’t apply to me	1	2	3	4
If I were pregnant I would definitely make some changes as a result of viewing this factsheet	1	2	3	4
CMV can cause serious disabilities in an unborn child	1	2	3	4
CMV can cause serious disabilities to a woman who is pregnant	1	2	3	4
CMV can spread through urine	1	2	3	4
CMV can spread through saliva	1	2	3	4
CMV can cause heart defects	1	2	3	4

CMV can spread by casual contact with someone	1	2	3	4
CMV can cause hearing loss	1	2	3	4
CMV is about as common as Down Syndrome	1	2	3	4
If I were pregnant I would be worried about CMV	1	2	3	4
CMV is preventable	1	2	3	4
CMV can spread through hugging or cuddling	1	2	3	4
CMV can spread through feces (poop)	1	2	3	4

9. Based on what you have just read about CMV in the factsheet, how often do you think you would wash your hands or use hand sanitizer after each of the following in the future (where 1=never and 5=always)?

[RANDOMIZE]

	Never	Rarely	Some of the time	Most of the time	Always
After wiping your child’s nose	1	2	3	4	5
After handling your child’s toys	1	2	3	4	5
After changing your child’s wet (urine only) diaper	1	2	3	4	5
After shaking hands with a co-worker	1	2	3	4	5

10. Thinking about what you have just read about CMV in the factsheet, how often do you think you would do each of the following in the future (where 1=never and 5=every day)?

[RANDOMIZE]

	Never	Rarely	1-2 days a week	3-5 days a week	Every day
Share food with your child (take bites from the same food)	1	2	3	4	5
Share the same cup with your child	1	2	3	4	5
Share eating utensils (knife, fork, or spoon) with your child	1	2	3	4	5
Hug or cuddle your child	1	2	3	4	5
Kiss your child on their lips	1	2	3	4	5

IV. CMV Information Sources/Channels

The following questions ask about where you might expect to get information about CMV.

11. What do you think might be the best way or most effective channel for educating mothers about CMV?  Please rate how effective each of following channels would be in getting CMV information to mothers like you.

Would you say they are very effective, somewhat effective, not too effective, or not at all effective…

	Very effective	Somewhat effective	Not too effective	Not at all effective
Pre-school/child care facility	1	2	3	4
Family/friends	1	2	3	4
Coworkers/neighbors	1	2	3	4
Doctor: OB-GYN
Doctor: Pediatrician	1	2	3	4
Doctor: Primary Care Physician	1	2	3	4
Online: Health information portals (like WebMD)	1	2	3	4
Online: Search engines (like Google, Yahoo)	1	2	3	4
Online: Media sites (like BabyCenter.com, ParentsPlace.com)	1	2	3	4
Online: Social media sites (like Facebook, Twitter, YouTube)	1	2	3	4
Online: Blogs (like Mommy Blogs)	1	2	3	4
Parenting magazines	1	2	3	4
Word-of-mouth recommendations from other mothers	1	2	3	4
Government agencies (like CDC)	1	2	3	4
Other (Specify):_____________	1	2	3	4

IF Q18o=3 OR 4, GO TO Q18a. ELSE, GO TO THANK.

18a. In the previous question you marked some “Other” was as effective. What other channel do you consider effective in getting CMV information to mothers like you?

WRITE IN YOUR RESPONSE___________________________________

THANK: Thank you for taking the time to answer these questions. Have a nice day.