Digital Ad Response Sheet (completed during focus groups

CDC and ATSDR Health Message Testing System

ATTACHMENT B5 Digital Ad Response Sheet _ 04 25_17

Skin Cancer Messages among Racial Ethnic Groups at Risk for Delayed Diagnosis, Advanced Disease and Lower Survival

OMB: 0920-0572

Document [docx]
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Form Approved

OMB No. 0920-0572

Exp. Date 03/31/2018

Response Sheet: Digital Ad

Public reporting burden of this collection of information is estimated to average 3 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: PRA (0920-0572)




After reviewing the digital ad, please check the box that most closely matches your opinions about the following statements.

  1. This ad is convincing


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad grabbed my attention


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad was easy to understand


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. I learned something new from this ad


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad is believable and trustworthy


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. I would talk to someone else about this ad


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad is annoying


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad is powerful


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad is informative


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. This ad is meaningful


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree

  1. I can identify with what the ad says


Strongly Agree


Agree


Neutral


Disagree


Strongly Disagree





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