Evaluation of Travelers' Health Zika Prevention Communication Campaign for HispanicsLatinos Visiting Friends and Family Word of Mouth Survey (Pre/Post Test)

Form approved

OMB No. 0920-0932

Expiration Date 07/31/2018

Attachment C

WORD OF MOUTH SURVEY

Introduction

Thank you for agreeing to participate in this brief survey. The purpose of this survey is to explore what the public knows about Zika and the precautions you can take to reduce the chance of getting Zika when traveling. Please answer each question to the best of your ability; there are no right or wrong answers. The survey should take about 10 minutes.

Screener Questions:

1. Are you 18 years of age or older?

1. Yes

2. No (end survey)

2. Do you consider yourself to be of Hispanic or Latino origin?

1. Yes, I am Hispanic/Latino.

2. No, I am not Hispanic/Latino (end survey)

3. Were you or someone in your immediate family born in Latin America or the Caribbean? Select all that apply.

1. Myself

2. My parent(s), aunt(s), and/or uncle(s)

3. My grandparent(s)

4. None of the above (end survey)

4. Have you done any of the following? Select all that apply.

1. Traveled to your family’s country of origin in the past 5 years

2. Made or are making plans to travel to your family’s country of origin in the next 12 months

3. None of the above (end survey)

Survey Questions:

1. Gender:

1. Male

2. Female

3. Other

2. Were you or any of your family members born in one of the following countries or territories? Select all that apply.

1. Dominican Republic

2. Puerto Rico

3. Mexico

4. Other (please specify): _____________________

3. Do any of the following descriptions apply to you? Select all that apply.

1. Currently pregnant

2. Planning to get pregnant within the next year

3. The male partner of a woman who is pregnant or planning to get pregnant

4. The mother, aunt, or other female relative of a woman who is pregnant or planning to get pregnant

5. None of the above

4. If you traveled to your family’s country of origin within the past 5 years, think about your most recent trip. How long did you stay?

1. Less than two weeks

2. Two weeks or longer

5. If you are planning a trip to your family’s country of origin, how long do you intend to stay?

a. Less than two weeks

b. Two weeks or longer

6. Imagine you are preparing for a trip to your family’s country of origin. Select the items you would pack. Select all that apply.

1. Sunscreen

2. Insect repellent

3. Swimsuit

4. Permethrin spray

5. Long pants

6. Bed net

7. Ear plugs

8. Diarrhea medicine

9. Condoms

10. Long-sleeved shirts

11. Other (please specify): _____________________

7. Which of the following ways can Zika be spread from one person to another? Select all that apply.

1. By having unprotected sex with a person who has Zika but doesn’t have symptoms

2. Through kissing

3. Through mosquito bites

4. Through contact with urine

5. Through coughing or sneezing

6. From a pregnant woman to her unborn baby

7. By having unprotected sex with a person who has Zika while they have symptoms

8. Through touching

8. Which of the following are symptoms of Zika? Select all that apply.

1. Fever

2. Rash

3. Diarrhea

4. Headache

5. Joint/muscle pain

6. Pain in the lower back

7. Eye infection/red eyes

8. Coughing and sneezing

9. Which of the following statements are true? Select all that apply.

1. Zika symptoms usually last a few weeks.

2. Zika infection can lead to pneumonia.

3. Zika does not always show symptoms.

4. Zika infection during pregnancy can cause birth defects.

10. Which of the following precautions to prevent Zika should you take during your trip? Select all that apply.

1. Use insect repellent at all times.

2. Wear a face mask when going outdoors.

3. Wear both long pants and long-sleeved shirts when outdoors when possible.

4. Use condoms every time you have sex with all partners during and after travel.

5. Drink bottled water.

6. Bring and use a bed net.

7. Wash your hands frequently with soap and water.

11. When returning from a trip to an area with a risk of Zika, how long should you continue to wear insect repellent?

1. A few days

2. One week

3. Three weeks

4. I only need to use insect repellent during the trip, not after

12. For women returning from a trip to an area with a risk of Zika, how long should they use a condom after the trip?

    1. Two months

    2. Six weeks

    3. Two weeks

    4. Women do not have to use condoms during sex

13. For men returning from a trip to an area with a risk of Zika, how long should they use a condom after the trip?

1. Six months

2. Nine months

3. Two months

4. Men do not have to use condoms during sex

14. Do you get health information before you take a trip to your family’s country of origin? If yes, where do you go for information? Select all that apply.

1. TripAdvisor

2. Centers for Disease Control and Prevention (CDC) website

3. Passport Health USA

4. Lonely Planet

5. I do not look for health information before a trip to my family’s country of origin

12. Other (please specify): _____________________

15. From the list below, circle your top three sources for health information when planning a trip to your family’s country of origin. [Alternative instruction for online survey: “click on your top three sources”]

1. Friends and family

2. Google or another internet search engine

3. A physician

4. A pharmacist

5. A community health worker

6. The CDC website

7. Twitter, Facebook, or other social media channels

8. The WebMD website

16. Is it safe for pregnant women to travel to areas with risk of Zika?

    1. Yes

    2. No

    3. I don’t know

Conclusion

Thank you for taking the time to complete this survey. We value the information you have given us.

Public reporting burden of this collection of information is estimated to average 10 minutes per focus 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 (0920-0932).