Form 1024 2017 1024 Medicaid.gov first draft questionnaire 6.5.17

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Overview

How to read this file
Welcome and Thank You Text
Model Questions
Custom Questions

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Sheet 1: How to read this file

Welcome and Thank You Text
The text you see here will appear at the top and bottom of your survey. Default text is included and you may modify this text as needed.
Model Questions
As discussed during the kick-off call, the model questions are part of the ForeSee methodology. For consistency within the model, these questions are standardized and have been tested and validated. Standardization of model questions allows benchmarking across companies/industries, and these questions are used in calculating scores and impacts.
Focus on the future behaviors; I’ve started with some that I believe are a good fit but we can certainly make adjustments. These are desired customer outcomes that are impacted by customer satisfaction.
Custom Questions
When reviewing the custom questions tab, keep in mind these questions are used for segmentation analysis of the model data. It is suggested that you add, delete or change custom questions over time, as your needs or business objectives change.
Focus Area #1: Achieving Actionable Data - Know what changes are being made based on the intelligence - Change Custom Questions so that stakeholders see a clear “must do”
Focus Area #2: Aligning Data to Business Strategies - Update your Custom Questions as business cycles change - Integrate Executive Level questions to evaluate initiatives
Focus Area #3: Strategic and Tactical Value - Influence Board Room Decisions - Change Operational Approaches - Mature Your Research

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Sheet 2: Welcome and Thank You Text

	The text you see here will appear at the top and bottom of your survey, examples below.
	Default text is included and you may modify this text as needed.
	Welcome and Thank You Text
		Welcome Text		Welcome Text - Tablet / Phone
		Thank you for visiting medicaid.gov. You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.		Thank you for visiting medicaid.gov. You've been selected to participate in a brief survey to let us know how we can improve your experience. Please take a minute to share your opinions.
		Thank You Text		Thank You Text - Tablet / Phone
		Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.		Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
		Example Desktop		Example Mobile

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Sheet 3: Model Questions

Model Name		Medicaid.gov Browse 2017					Red & Strike-Through: Delete
Model ID							Underlined & Italicized: Re-order
Partitioned		Yes - 2MQ					Pink: Addition
Date							Blue: Reword
Model Version		17.2.G
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Return (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this site.	19	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	23	Return	How likely are you to return to medicaid.gov in the future?
2	Look and Feel - Balance	Please rate the balance of graphics and text on this site.	20	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend (1=Very Unlikely, 10=Very Likely)
3	Look and Feel - Readability	Please rate the readability of the pages on this site.	21	Satisfaction - Ideal	How does this site compare to an ideal website? (1=Not Very Close, 10=Very Close)	24	Recommend	How likely are you to recommend Medicaid.gov to someone else?
		Site Performance (1=Poor, 10=Excellent, Don't Know)						Primary Resource (1=Very Unlikely, 10=Very Likely)
4	Site Performance - Loading	Please rate how quickly pages load on this site.				21	Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicaid?
5	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
6	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Organized	Please rate how well this site is organized.
8	Navigation - Options	Please rate the options available for navigating this site.
9	Navigation - Layout	Please rate how well the site layout helps you find what you need.
		Information Browsing (1=Poor, 10=Excellent, Don't Know)
10	Information Browsing - Sort	Please rate the ability to sort information by criteria that are important to you on this site.
11	Information Browsing - Narrow	Please rate the ability to narrow choices to find the information you are looking for on this site.
12	Information Browsing - Features	Please rate how well the features on the site help you find the information you need.
		Site Information (1=Poor, 10=Excellent, Don't Know)
13	Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
14	Site Information - Understandable	Please rate how understandable this site’s information is.
15	Site Information - Answers	Please rate how well the site’s information provides answers to your questions.

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Sheet 4: Custom Questions

Model Name		Medicaid.gov Browse 2017				Red & Strike-Through: Delete
Model ID		0				Underlined & Italicized: Re-order
Partitioned		Yes - 2MQ				Pink: Addition
Date		6/6/2017				Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
	Primary Reason		What was your primary reason for visiting the website?	Federal policy or program information for Medicaid or CHIP		Y	Radio button, one-up vertical	Skip Logic Group*	Primary Reason
				State-specific policy or program information for Medicaid or CHIP
				Federal Medicaid or CHIP guidance (regulation, SHO and SMD policy letters, etc.)
				Medicaid or CHIP data
				Section 1115 demonstration or other waiver information
				Other (Please specify).	A
		A	Please explain your primary reason for visiting the website. (Please refrain from entering personal information.)			N	Text field, <100 char	Skip Logic Group*	Primary Reason - Other
	Role		Which of these best describes you?	Federal employee		Y	Radio button, one-up vertical		Role
				State government employee
				Local government employee
				Elected official
				Academic researcher
				Media
				Healthcare policy analyst
				Intergovernmental liaison
				Professional healthcare provider (doctor, physician assistant, nurse, etc.)
				Individual looking for Medicaid coverage information for myself or another person.
			What best describes your organization?	Research institute or association		Y	Radio button, one-up vertical		Organization
				Law firm
				National state government association (Executive Branch)
				National state government association (Legislative Branch)
				National local government association (county)
				National local government association (city/municipal)
				National healthcare policy association
				Other
			How did you look for information or navigate the site today? (Please select all that apply.)	Top navigation bar		Y	Checkbox, one-up vertical	Skip Logic Group*	Navigation Method
				Middle navigation bar
				Search feature	Y,X,Z
				Clicked on links on the page
				Page bookmark or favorite link
				Site map
				Google or other search engine
				Other (Please specify).	A
				Don't recall				Mutually Exclusive
		A	Please tell us how else you looked for information. (Please refrain from entering any personal information.)			N	Text field, <100 char	Skip Logic Group*	Navigation Method - Other
		Y	Please tell us about your experience with the site's search feature today. (Please select all that apply.)	Results were not relevant/not what I wanted		Y	Checkbox, one-up vertical	Randomize	Search Experience
				Too many results/I needed to refine my search
				Not enough results				Skip Logic Group*
				Returned NO results
				Received error message(s)
				Search speed was too slow
				I experienced a different search issue:	C			Anchor Answer Choice
				I had no difficulty with search/results were helpful				Mutually Exclusive
		C	Please specify the search issue you experienced. (Please refrain from entering any personal information.)			N	Text area, no char limit	Skip Logic Group*	Search Issue - Other
		X	Did you try using the site's navigational links before using the search feature today?	Yes, I navigated first		Y	Radio button, one-up vertical	Skip Logic Group*	Search or Nav First
				No, I went straight to the search feature
				Don't recall
		Z	Did the search feature help you to locate what you were looking for today?	Yes	B	Y	Radio button, one-up vertical	Skip Logic Group*	Search Help Locate
				Partially	B
				No	B
		B	Please describe in detail what you were primarily searching for. (Please refrain from entering any personal information.)			N	Text area, no char limit	Skip Logic Group*	Search Detail OE
			How would you describe your browsing experience on the site today? (Please select all that apply.)	Links often did not take me where I expected	L	Y	Checkbox, one-up vertical	Skip Logic Group*	Navigation Experience
				I had difficulty finding relevant information
				Links and labels were difficult to understand	U
				There were too many links or navigation options to choose from				Randomize
				I had technical difficulties (error messages, broken links, etc.)	T
				I could not navigate back to previous information
				I had a different navigation difficulty	A			Anchor Answer Choice
				I had no difficulty navigating the site				Mutually Exclusive
		A	Please specify your navigation difficulty. (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Navigation Experience - Other
		L	Please describe any specific navigation links or paths that did not take you where they should have. (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Navigation Not Expected OE
		U	What specific links or labels were difficult to understand? (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Nav Links and Labels OE
		T	Please describe the technical difficulty you encountered (include as much detail as possible). (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Navigation Technical Issue OE
			Which of the following issues, if any, did you experience while reviewing information? (Please select all that apply.)	Information was not up to date		Y	Checkbox, one-up vertical	Skip Logic Group*	Information Issues
				Information did not answer my questions	B
				Information was not presented in a concise format
				Wording was not clear
				Text was difficult to read
				Other (please specify)	A
				I did not experience any issues while reviewing information				Mutually Exclusive
		A	Please describe the issue you experienced reviewing information. (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Other Information Issues
		B	What information were you looking for that you could not find? (Please refrain from entering personal information.)			N	Text area, no char limit	Skip Logic Group*	Information Looking For
			In which state/territory do you live?	Alabama		Y	Drop down, select one		State
				Alaska
				American Samoa
				Arizona
				Arkansas
				California
				Colorado
				Connecticut
				Delaware
				District of Columbia
				Florida
				Georgia
				Guam
				Hawaii
				Idaho
				Illinois
				Indiana
				Iowa
				Kansas
				Kentucky
				Louisiana
				Maine
				Maryland
				Massachusetts
				Michigan
				Minnesota
				Mississippi
				Missouri
				Montana
				Nebraska
				Nevada
				New Hampshire
				New Jersey
				New Mexico
				New York
				North Carolina
				North Dakota
				Northern Mariana Islands
				Ohio
				Oklahoma
				Oregon
				Pennsylvania
				Puerto Rico
				Rhode Island
				South Carolina
				South Dakota
				Tennessee
				Texas
				U.S. Virgin Islands
				Utah
				Vermont
				Virginia
				Washington
				West Virginia
				Wisconsin
				Wyoming
				I live outside of the United States
				Prefer not to respond
	Visit Frequency		How often do you visit our site using a mobile device?	Every 6 months or less		Y	Drop down, select one		Visit Frequency
				About once a month
				About once a week
				Daily
				More than once a day
				I have never accessed the site using a mobile device
			Are you affiliated with an American Indian/Alaskan Native Tribe?	Yes		Y	Drop down, select one		Native Tribe Affiliation
				No
				Prefer not to respond
	OE_Improve Experience		What else would you like to share with us to help improve your online experience with the medicaid.gov site? (Please refrain from entering any personal information.)			Y	Text area, no char limit		Improve