Experimental Group Survey

Form Approved

OMB No. 0920-0840

Expiration Date 02/29/2016

“Evaluating a HIV/AIDS Focused Video Game for Young People”

Attachment 3c. Experimental Group Immediate Post Survey

Public reporting burden of this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0840)

Participant 30-day Post Follow up Survey

Study ID No. _____

1. Demographics

A1: What grade are you in at school? _______

2. Attitudes About HIV Testing

The next set of questions will ask about your attitudes and feelings about HIV testing. Please tell us how much you agree or disagree with the following statements.

B1: Do you plan to get tested for HIV in the next 3 months (90 days)?

Yes

No

Don’t know

B2: I am too scared to get an HIV test.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

B3: If I was offered a chance to get an HIV test, I would get it.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

B4: Everybody who has had unprotected sex should get an HIV test.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

B5: I know where to get an HIV test.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

3. HIV Stigma

The next set of questions will ask about your attitudes and feelings about people who are living with HIV. Please tell us how much you agree or disagree with the following statements.

C1: I would sit next to an HIV-positive person.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C2: People who are HIV-positive have gotten what they deserve.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C3: I would be afraid to live with an HIV-positive person.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C4: I would buy fruit from someone who I knew was HIV-positive

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C5: I would not eat in a restaurant if I found out that someone who was HIV-positive worked there.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C6: I would date someone who is HIV-positive.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

C7: I would live with someone who is HIV-positive.

Strongly agree

Somewhat agree

Somewhat disagree

Strongly disagree

4. HIV Knowledge

The next set of questions will be about your understanding of HIV and sexually transmitted infections (STIs). Please mark whether you think the following statements are true or false.

D1: You can always tell if someone has HIV.

True

False

D2: All people who have been infected with HIV quickly show signs of being infected.

True

False

D3: You cannot get HIV by sharing knives, forks or cups with a person who has HIV.

True

False

D4: Wearing a condom correctly will protect you from most STIs.

True

False

D5: If a woman uses birth control pills, it lowers her risk of getting HIV.

True

False

D6: Using oil based lubricants such as Vaseline or Crisco with condoms will reduce the risk of getting HIV or another STI.

True

False

D7: There is no cure for HIV.

True

False

D8: Having another STI like Gonorrhea or Herpes increases a person’s risk of becoming infected with HIV.

True

False

D9: Having sex without a condom increases a person’s risk of becoming infected with HIV.

True

False

D10: A person can get HIV by sharing a glass of water with someone who has HIV.

True

False

5. Behavioral Intentions

The next two questions will ask you about your intentions to have sex in the next 6 months please read them carefully.

E1: Do you think you will have sex sometime in the next 6 months?

Yes (if yes go to F2)

No (if no go to G1)

E2: How often do you think you will use a condom if you have sex in the next 6 months?

Never

Occasionally

About half the time

Most times

Always

6. Questions about the Game

The next set of questions will ask about the game you just played. Please answer them as complete as possible.

F1. On a scale of 1 to 5, where 1 is the worst and 5 is the best, how much did you like the game?

F2. How many times did you play the game? _____

E3. Would you share the game with your friends?

Yes No

E4. Would you recommend it to your friends if they could download it in the iTunes store or Android store?

Yes No

E5. How likely are you to play it again?

1 is highly unlikely and 5 is highly likely

E6. Do you think you learned anything from playing the game? (1-5) 1 is nothing and 5 is a lot

____

E7. What was your favorite part of the game?

E8. What was your least favorite part of the game?