Form 1 PregSourceBeta Test Survey

PregSource Feedback Form
Welcome to the PregSource™ Beta Test Feedback Form

OMB#: 0925-0643
Exp. Date:10/2017

Thank you for taking the time to participate in the PregSource™ beta test. Your feedback is very
important to us as we get PregSource™ ready to launch.
On the following pages, we will ask you some questions about your experience using the
PregSource™ website -- what you liked about it, any problems you encountered, and your overall
impressions.
We really value your participation and interest in PregSource™.
Thank you,
Caroline Signore, MD, MPH
PregSource™ Principal Investigator
Public reporting burden for this collection of information is estimated to average 20 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925-0643). Do not return the completed form to this address.

Consent and Registration Process

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1. After reading the “Informed Consent for PregSource™ beta-testers”, did you understand the purpose of
the project?
Yes
No
Comments:

2. After reading the “Informed Consent for PregSource™ beta-testers,” did you understand how your
privacy will be protected?
Yes
No
Comments:

3. About how long did it take you to create an account, including completing the consent form?
1-5 Minutes
6-10 Minutes
11-15 Minutes
16-20 Minutes
More than 20 Minutes
Unsure

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PregSource Feedback Form
Website Feedback

4. Was it clear how to navigate or move through the website and access the different features?
Yes
No
If not, please describe what was unclear.

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5. Did you hit a programming roadblock or error?
Yes
No
If yes, please describe.

6. Did you like the look and feel of the website?
Yes
No
Please explain.

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7. Which of these PregSource™ features did you use? (Select all that apply)
Add a Pregnancy
Change My Pregnancy Info
FAQs
Messages
My Latest Update
Need Help
Personalized Article Library
Printing or saving completed questionnaires
Printing or saving of Tracker graphs
Questionnaires
Resource Library
Show Me My Data
Update My Due Date

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PregSource Feedback Form
The Questionnaires

8. How often would you like to complete questionnaires in PregSource?
As often as possible
One a day
One a week
One a month
Less than one a month
I don’t want to answer any

9. Did you complete the My Latest Update questionnaire?
Yes
No

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10. If yes, how often would you like to complete that questionnaire to track your weight, sleep, activity,
nausea, and mood?
As often as possible
Once a day
Once a week
Once a month
Less than once a month
I don’t want to answer it at all

11. Did you compare your answers to all the PregSource answers? (under the link: Show Me All
PregSource Data)
Yes
No
If so, how was this helpful or not helpful to you?

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PregSource Feedback Form
The Questionnaires (continued)

Were there any questions/answer options that you felt were unclear or problematic? If so, please
identify which ones, by telling us the name of the questionnaire, the text that was unclear (question
and/or answer), and what was unclear.
12. Issue 1 (Please provide the Questionnaire name, page, and individual question.)

13. Issue 2 (Please provide the Questionnaire name, page, and individual question.)

14. Issue 3 (Please provide the Questionnaire name, page, and individual question.)

15. Issue 4 (Please provide the Questionnaire name, page, and individual question.)

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16. Issue 5 (Please provide the Questionnaire name, page, and individual question.)

17. Issue 6 (Please provide the Questionnaire name, page, and individual question.)

18. Issue 7 (Please provide the Questionnaire name, page, and individual question.)

19. Issue 8 (Please provide the Questionnaire name, page, and individual question.)

20. Issue 9 (Please provide the Questionnaire name, page, and individual question.)

21. Issue 10 (Please provide the Questionnaire name, page, and individual question.)

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PregSource Feedback Form
Overall Impressions

22. If you were pregnant, do you think you would be interested in coming back to provide information to
PregSource™ on a regular basis? Why or why not?
Yes
No
Comments:

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23. Would you recommend PregSource ™ to a friend? Why or why not?
Yes
No
Comments

24. Once your account was created, what was the first thing you did or clicked on in PregSource?

25. How often would you personally use PregSource™, whether for tracking your pregnancy, completing
questionnaires, accessing the resource library, or other activity?
Daily
Once a week
Once a month
Once a year
Never

26. Did you notice that PregSource™ doesn’t include any advertisements?
Yes
No

27. Would this feature influence your decision to use PregSource™? Why or why not?

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28. Would this feature influence your decision to recommend PregSource™ to a friend? Why or why not?

29. Overall, please rate and review your experience with PregSource™.
I hate it.

I don't like it.

It's OK.

I like it.

I love it.

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S

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S

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30. Please provide any additional suggestions or comments you have about PregSource™ .

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