CDC Digital Health Tools Survey - word
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Attachment B-CDC Digital Health Tools Survey Questions-2
CDC Digital Health Tools Evaluation
OMB: 0920-0956
Attachment B
*TEXT IN RED, CAPS AND ITALICS ADDED FOR CLARIFICATION, BUT NOT TO BE INCLUDED IN ACTUAL SURVEY.
PRE-TEST QUESTIONS BEGIN, QUESTIONS ASKED
OF ALL PARTICIPANTS
Q1.2
Form approved
OMB Control No. 0920-0956
Expiration Date: March 31, 2016
Thank you for agreeing to help the Centers for Disease Control and Prevention (CDC) evaluate tobacco prevention and control digital products. Your feedback is extremely important. We anticipate that it will take approximately 25 minutes to complete these questions. All information is used for evaluation purposes only and CDC does not plan to share the data with anyone outside of CDC.
To begin the survey, please click "Next".
Public reporting burden of this collection of information is estimated to average 25 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0956).
Q2.1 How old are you?
18-25 (1)
26-34 (2)
35-54 (3)
55-64 (4)
65 or over (5) ____________________
Q2.2 What is your ethnicity?
Hispanic or Latino (1)
Not Hispanic or Latino (2)
Q2.3 What is your race (select one or more)?
American Indian or Alaska Native (1)
Asian (2)
Black or African American (3)
White (5)
Q2.4 What is your sex?
Male (1)
Female (2)
Q2.5 What is the highest level of education you have completed?
Less than High School (1)
High School / GED (2)
Some College (3)
2-year College Degree (4)
4-year College Degree (5)
Masters Degree (6)
Doctoral Degree (7)
Professional Degree (JD, MD) (8)
Q2.6 Please select the state in which you currently reside.
Q2.7 For how many children under the age of 18 do you provide direct care, either as a parent or caregiver?
0 (1)
1 (2)
2 (3)
3 (4)
4 (5)
5+ (6)
Q2.8 What is your combined annual household income?
Less than 30,000 (1)
30,000 – 39,999 (2)
40,000 – 49,999 (3)
50,000 – 59,999 (4)
60,000 – 69,999 (5)
70,000 – 79,999 (6)
80,000 – 89,999 (7)
90,000 – 99,999 (8)
100,000 or more (9)
Q3.1 Tobacco includes both smoked and smokeless tobacco. Examples of tobacco products include cigarettes, pipes, cigars, snus and chewing tobacco. Have you ever used tobacco more than 100 times in your entire life?
Yes (1)
No (2)
Q3.2 Have you used any type of tobacco product in the past 30 days?
Yes (1)
No (2)
Q3.3 Have you ever used an electronic vapor nicotine product, such as an e-cigarette?
Yes (1)
No (2)
PRE-TEST QUESTIONS END
EXPOSURE TO DIGITAL TOOLS AND ALTERNATES BEGINS.
ALL PARTICIPANTS EXPOSED TO ONE (1) OF FOUR (4) SITES.
EXPOSURE TO THE MICROSITE TOOL, GROUP 1
Q4.1 You will now be shown a new type of health site that displays a collection of tobacco prevention and control resources. This site is updated frequently by automatically displaying resources from many different health agencies, such as the Centers for Disease Control and Prevention. The purpose of this site is to create a central location that compiles the most up-to-date and relevant tobacco prevention and control resources in one place. Please feel free to review the resources provided on this site and feel free to open links that may interest you.
Q4.2 Timing
First Click (1)
Last Click (2)
Page Submit (3)
Click Count (4)
EXPOSURE TO THE ALTERNATE TO THE MICROSITE
SITE, GROUP 2
Q5.1 You will now be shown a health site that displays tobacco prevention and control resources. This site contains resources from many different health agencies including the Centers for Disease Control and Prevention. Please review the resources provided on this site and feel free to open links that may interest you.
Q5.2 Timing
First Click (1)
Last Click (2)
Page Submit (3)
Click Count (4)
EXPOSURE TO THE DATA WIDGET TOOL, GROUP 3
Q6.1 You will now be shown a digital health visualization that displays tobacco information, including the levels of tobacco use for each state in an interactive format. Youth cigarette smoking levels are provided by the Centers for Disease Control and Prevention for those states with available data. The purpose of this site is to provide people with tobacco prevention and control resources that are most relevant to their needs and interests. Feel free to look at data from your state or others that may interest you.
Q6.2 Timing
First Click (1)
Last Click (2)
Page Submit (3)
Click Count (4)
EXPOSURE TO THE ALTERNATE TO THE DATA
WIDGET SITE, GROUP 4
Q7.1 You will now be shown a health site that displays smoking and tobacco use information, including the levels of youth cigarette smoking for each state in a table format. Smoking and tobacco use levels are provided by the Centers for Disease Control and Prevention for those states with available data. Feel free to look at data from your state or others that may interest you.
Q7.2 Timing
First Click (1)
Last Click (2)
Page Submit (3)
Click Count (4)
POST-TEST QUESTIONS BEGIN
ONLY PARTICIPANTS IN GROUPS 1 AND 2 ANSWER
THESE QUESTIONS
Q8.1 For approximately how many minutes did you use the site?
______ Minutes (1)
Q8.2 Approximately how many links did you click while on the site (select one)?
0 (1)
1 (2)
2-5 (3)
6-10 (13)
11+ (12)
Q8.3 Approximately how many videos did you watch while on the site (select one)?
0 (1)
1 (2)
2-5 (3)
6-10 (102)
11+ (103)
Q9.1 Self-efficacy
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I feel confident that I could ask teens and adults around me not to smoke or use tobacco (1) |
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I feel confident that I could prevent teens and adults from experimenting with tobacco (2) |
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I feel confident that I could help teens and adults quit using tobacco (3) |
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Q9.2 Knowledge
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
Using tobacco is harmful to health (1) |
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It is safe for a teen or adult to use tobacco for only a year or two as long as they quit after that (2) |
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Q9.3 Motivation
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I feel motivated to ask teens and adults around me not to use tobacco (1) |
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I feel motivated to prevent teens and adults from experimenting with tobacco (2) |
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I feel motivated to help teens and adults quit using tobacco (3) |
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Q9.4 Attitudes
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I am in favor of banning tobacco use in outdoor public places, such as parks, beaches, and playgrounds. (3) |
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Teens and adults that use tobacco look less healthy (5) |
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Q9.5 Intentions
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I intend to ask teens and adults around me not to use tobacco (1) |
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I intend to prevent teens and adults from using tobacco (2) |
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I intend to help teens and adults quit using tobacco (3) |
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I intend to support clean air policies (4) |
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Q10.1 General site information
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
The site was easy to use (1) |
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I would use the site again for tobacco use information (3) |
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I feel motivated to share the site with others (4) |
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I was able to easily identify the source of the tobacco use information on the site (5) |
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I feel motivated to use the social media sharing options to share the videos, images and stories (6) |
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Q10.2 Like
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I liked the layout of the site (1) |
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I liked the images on the site (2) |
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I liked the videos on the site (3) |
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I liked this site more than other health sites I visit (4) |
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I liked the social media sharing options (5) |
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Q10.3 Learn
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I learned a lot from the site about how to help teens and adults quit using tobacco (1) |
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I learned a lot from the site about the dangers of smoking and tobacco use (2) |
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The site presented useful and relevant smoking and tobacco use related information for me (4) |
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The site presented useful and relevant smoking and tobacco use information for people in the area where I live (5) |
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Q10.4 Trust
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I trust the smoking and tobacco use information on the site (1) |
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The tobacco use information on the site came from trustworthy sources (2) |
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The tobacco use information on the site was believable (3) |
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Q10.5 Elaboration, vividness, and message sensitivity
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Strongly Disagree (15) |
Disagree (16) |
Somewhat Disagree (17) |
Neither Agree nor Disagree (18) |
Somewhat Agree (19) |
Agree (20) |
Strongly Agree (21) |
I had many thoughts in response to the site (1) |
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The site was vivid (5) |
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The site was interesting (2) |
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I paid attention to the messages on the site (3) |
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I put thought into the site's messages (6) |
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ONLY PARTICIPANTS IN GROUPS 3 AND 4 ANSWER
THESE QUESTIONS
Q11.1 For approximately how many minutes did you use the site?
______ Minutes (1)
Q11.2 Did you look up the levels of cigarette smoking for your state?
Yes (1)
No (2)
Q11.3 Did you compare your state's level of cigarette smoking with another state?
Yes (1)
No (2)
Q11.4 Approximately how many links did you click while on the site (select one)?
0 (1)
1 (2)
2-5 (3)
6-10 (6)
11+ (7)
Q12.1 Self-efficacy
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I feel confident that I could ask teens and adults around me not to smoke cigarettes (1) |
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I feel confident that I could prevent teens and adults from experimenting with cigarette smoking (2) |
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I feel confident that I could help teens and adults quit cigarette smoking (3) |
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Q12.2 Knowledge
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
Cigarette smoking is harmful to health (1) |
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It is safe for a teen or adult to smoke cigarettes for only a year or two as long as they quit after that (2) |
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Q12.3 Motivation
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I feel motivated to ask teens and adults around me not to smoke cigarettes (1) |
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I feel motivated to prevent teens and adults from experimenting with cigarette smoking (2) |
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I feel motivated to help teens and adults quit cigarette smoking (3) |
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Q12.4 Attitudes
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I am in favor of clean air policies, such as banning tobacco use in outdoor public places, such as parks, beaches, and playgrounds. (3) |
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Teens and adults that smoke cigarettes look less healthy (5) |
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Q12.5 Intentions
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I intend to ask teens and adults around me not to smoke cigarettes (1) |
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I intend to prevent teens and adults from smoking cigarettes (2) |
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I intend to help teens and adults quit smoking cigarettes (3) |
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I intend to support clean air policies (4) |
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Q13.1 General site information
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
The site was easy to use (1) |
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I would use the site again for cigarette smoking information (3) |
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I feel motivated to share the site with others (4) |
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I was able to easily identify the source of the cigarette smoking information on the site (5) |
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Q13.2 Like
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I liked the layout of the site (1) |
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I liked the level of interactivity available on the site (2) |
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I liked the way in which the levels of cigarette smoking were displayed on the site (5) |
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Q13.3 Learn
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I learned a lot from the site about how to help teens and adults quit cigarette smoking (1) |
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I learned a lot from the site about the dangers of cigarette smoking (2) |
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The site presented useful and relevant cigarette smoking related information for me (4) |
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The site presented useful and relevant cigarette smoking information for people in the area where I live (5) |
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Q13.4 Trust
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Strongly Disagree (1) |
Disagree (2) |
Somewhat Disagree (3) |
Neither Agree nor Disagree (4) |
Somewhat Agree (5) |
Agree (6) |
Strongly Agree (7) |
I trust the cigarette smoking information on the site (1) |
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The cigarette smoking information on the site came from trustworthy sources (2) |
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The cigarette smoking information on the site was believable (3) |
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Q13.5 Elaboration, vividness, and message sensitivity
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Strongly Disagree (15) |
Disagree (16) |
Somewhat Disagree (17) |
Neither Agree nor Disagree (18) |
Somewhat Agree (19) |
Agree (20) |
Strongly Agree (21) |
I had many thoughts in response to the site (1) |
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The site was vivid (5) |
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The site was interesting (2) |
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I paid attention to the messages on the site (3) |
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I put thought into the site's messages (6) |
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | MIcrosite and Data Widget Pre and Post All Combined |
| Author | Qualtrics |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |
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