Survey

Form Approved

OMB Approval No. 0920-1050

Expiration Date: 02/18/2018

StopAnthrax™ Jurisdictional Pilot Test

Participant Pilot Test Survey

Note: The following participant survey will be contained within an online form.

Please complete the following questions. All answers are anonymous and voluntary.

1. Did you have any difficulty enrolling in the pilot test?

• Yes

• No

If yes, what was difficult?

2. Did you have any difficulty participating in the pilot test? For example, did you have difficulty understanding how to participate or respond, or did you have limits on the number of text messages you could receive with your data plan?

• Yes

• No

If yes, what was difficult?

3. Did you text "END" to opt-out of the pilot test before completing the 10-day program?

• Yes

• No

If yes, why did you opt-out?

Public reporting burden of this collection of information is estimated to average 60 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 (0920-1050).

 

4. Did you have any issues with the way the program functioned? For example, did you receive messages that appeared to be out of order, or did the program fail to recognize your responses?

• Yes

• No

If yes, what issues did you have?

5. What did you think about the overall length of the individual text messages?

• Too long

• Too short

• The right length

• Other: (please describe)

6. What did you think about the total number of text messages you received?

• Too many messages

• Not enough messages

• The right number of messages

• Other: (please describe)

7. How helpful do you think the education text messages would be in an anthrax incident?

• Very helpful

• Somewhat helpful

• Neutral

• Somewhat unhelpful

• Not helpful

8. How helpful do you think the adverse event reporting text messages would be in an anthrax incident?

• Very helpful

• Somewhat helpful

• Neutral

• Somewhat unhelpful

• Not helpful

9. How helpful do you think the adverse event feedback text messages would be in an anthrax incident?

• Very helpful

• Somewhat helpful

• Neutral

• Somewhat unhelpful

• Not helpful

10. How helpful do you think the medication reminder text messages would be in an anthrax incident?

• Very helpful

• Somewhat helpful

• Neutral

• Somewhat unhelpful

• Not helpful

11. How easy were the messages to understand?

• Very easy to understand

• Somewhat easy to understand

• Neutral

• Somewhat confusing

• Very confusing

12. Was the program what you expected based on the posters, enrollment cards, and FAQ sheets?

• Yes

• No

• Did not see posters, enrollment cards, and FAQ sheets

If no, what did you expect, and what was different?

13. What do you think of the StopAnthrax™ program?

14. Based on your experience in the pilot test, do you think people would benefit from enrolling in the StopAnthrax™ program during an anthrax incident?

• Yes

• No

If no, why not?

Participant Pilot Test Survey 5