Paper and Pencil Survey

Formative Research and Tool Development

Att 2 Paper and Pencil Survey

Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC)

OMB: 0920-0840

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OMB No. 0920-0840

Expiration Date 02/29/2016



Attachment 2
Paper-and-Pencil Survey



Formative Research to Develop Social Marketing Campaigns: Prevention Is Care (PIC)






























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PIC

Paper and Pencil Questionnaire


We recognize that many physicians split their time between private practices (individual or group) and practices that are public or university based. For the following question, please provide responses for both these practice types as applicable to your own practice of medicine. Please use your best estimate.




Private Practice


Public or University

Based Practice


  1. Number of patients you see in a month.


______

______

2. Number of HIV-infected patients you see in a month.


______

______



Male

Female

3. What percent of your patients are male vs. female? (Please use your best estimate)


________

__________



4. Which medical associations do you belong to? Please select one or more of the following associations. [MARK ALL THAT APPLY]



American Academy of Family Physicians (AAFP)

American College of Physicians (ACP)

American Medical Association (AMA)

National Medical Association (NMA)

HIV Medicine Association (HIVMA)

American Academy of HIV Medicine (AAHIVM)

Infectious Diseases Society of America (IDSA)

American Congress of Obstetricians and Gynecologists (ACOG)

International AIDS Society (IAS)

American College of Physicians (ACP)

Other [Specify:_________________]

None of these


Information Needs

5. Would you be interested in receiving information about…



Topic

Yes

No

a. Reducing transmission

b. Retention in care

c. Initiating ART

d. Communicating about ART medication adherence (e.g., patient compliance)

e. Conducting STD screening

f. Partner services

g. Screening for risky sexual behaviors

h. Screening for risky alcohol and illicit drug use behaviors

i. Helping patients modify risky sexual behaviors

j. Helping patients modify alcohol and illicit drug use



Use of Electronic Media

6. How often do you do the following for professional purposes?




Daily



Weekly



Monthly

Less than once per month



Never

a. Use an app on a portable device, such as an iPod/iPad

b. Download content to a portable device, such as an iPod, cell phone, or PDA

c. Print online content such as a medical journal article

d. Access Medical blogs, such as those available through Medscape or Sermo

e. Use social media, like Twitter or Facebook

f. Listen to podcasts



Patient resources

7. Do you refer your patients to the following resources…


Yes

No

a. Your practice’s website

b. CDC’s website

c. Other websites

d. Other electronic resources (specify)_______________________

e. Printed materials

f. Other (specify)_______________________________________

Continuing Medical Education (CME)

8. How do you obtain CME credits?

a. Attending conferences

b. Through employer-provided in-service trainings

c. Dinner presentations by local chapter of a professional association

d. Attending meetings of a regional professional association

e. Journal supplement education programs

f. Other (specify) ______________________________________





9. How useful are CME programs about HIV care, treatment and prevention?

a. Never useful

b. Rarely useful

c. Somewhat useful

d. Always useful




10. Do you currently use CME courses or programs as a source of information about the following topics?

Topic

Yes

No

a. Reducing transmission

b. Retention in care

c. Initiating ART

d. Communicating about ART medication adherence (e.g., patient compliance)

e. Conducting STD screening

f. Partner services

g. Screening for risky sexual behaviors

h. Screening for risky alcohol and illicit drug use behaviors

i. Helping patients modify risky sexual behaviors

j. Helping patients modify alcohol and illicit drug use




11. Would you be interested in CME courses or programs about the following topics?



Topic

Yes

No

a. Reducing transmission

b. Retention in care

c. Initiating ART

d. Communicating about ART medication adherence (e.g., patient compliance)

e. Conducting STD screening

f. Partner services

g. Screening for risky sexual behaviors

h. Screening for risky alcohol and illicit drug use behaviors

i. Helping patients modify risky sexual behaviors

j. Helping patients modify alcohol and illicit drug use



11A. Of the CME courses or programs that you are interested in, please indicate your top three choices:


1. ______________________________________


2.______________________________________


3. _____________________________________

Communicating with Patients about Risk Behaviors

12. What challenges, if any, prevent you from having discussions regarding high-risk sexual or substance use behaviors with your HIV-infected patients? [MARK ALL THAT APPLY]

a. Lack of time

b. Cultural difference between you and your patient

c. Gender difference between you and your patient

d. Lack of trust/relationship with patient

e. Lack of skills or training in this area

f. Patients are uncomfortable discussing the subject

g. I am uncomfortable discussing the subject

h. Other (specify) ______________________________

i. There are no challenges to such discussion that I can identify


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File TitleRoutine Testing
AuthorPeyton Williams
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File Created2021-01-30

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