ToxFAQs Before and After Testing Survey - Text

Attachment D: ToxFAQs Before and After Testing Survey (text)

ToxFAQs Before and After Testing Survey (text)

Form Approved

OMB No. 0923-0047

Exp. Date 05/31/2016

Welcome

Welcome to the ToxFAQ Survey!

You’re being asked to participate in a survey about a carbon monoxide ToxFAQ. We are conducting this survey on behalf of the Agency for Toxic Substances and Disease Registry (ATSDR), part of the U.S. Department of Health and Human Services (HHS).

Public reporting burden of 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 CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0047).

Consent

Who is working on this project?
This project is being coordinated by CommunicateHealth, a health communication consulting firm, on behalf of ATSDR, which is part of HHS.
 
What is the goal of this project? 
We are working to make sure that the fact sheet developed for ATSDR is helpful and easy to use.
 
How can I help?
We are interested in getting your feedback and opinions. Your feedback on this survey will help us create better fact sheets. 
 
Do I have to participate in this project?
No. It is your choice whether to participate or not. You can stop at any time, and you don’t have to answer any questions you don’t want to answer. If you don’t want to participate or decide to stop, that’s okay.

We are offering 50 Reward Points as a token of appreciation for taking part in this survey. Panel participants can accumulate points by taking additional surveys (unrelated to this study) through Qualtrics, and eventually redeem for items such as gift cards and subscriptions (e.g., magazines).
 
How will you protect my privacy?
We will not collect or store your identity or any personal information. Also, your responses will not be linked with your name.
 
How long will this take? 
This survey should take about 20 minutes. 
 
For more information:
If you have questions about the project, contact Health Communication Manager, Katrina Lanahan, MPH, at [email protected] or (240) 428-1189.

 

1. I have read the above information and agree to participate. By clicking Yes, you consent that you are willing to answer the questions in this survey.

• Yes

• No [If No, end survey]

[Note: All questions are required.]

Demographics

Please tell us a little bit about yourself.

1. What year were you born? [End survey if participant is was born after 1997]

• [textbox with validation for year between 1910 and 2015]

2. What is your sex?

• Male

• Female

3. What is your ethnicity?

• Hispanic or Latino

• Not Hispanic or Latino

4. What is your race? (Please select all that apply.)

• White

• Black or African American

• Asian

• Native Hawaiian or Other Pacific Islander

• American Indian or Alaska Native

5. What is the highest level of education that you’ve completed?

• Grade school

• Some high school

• High school graduate or completed GED

• Some college or technical school

• Received 4-year college degree

• Some post-graduate studies

• Received advanced degree

• Other: ________________

6. Which of the following categories best describes your total, annual household income?

• Under $20,000/year

• $20,001 - $30,000/year

• $30,001 - $40,000/year

• $40,001 - $50,000/year

• $40,001 - $50,000/year

• $50,001 - $60,000/year

• $60,001 - $80,000/year

• $80,000 - $100,000/year

• Over $100,000/year

• Prefer not to answer

7. How confident are you filling out medical forms by yourself?

• None of the time

• A little of the time

• Some of the time

• Most of the time

• All of the time

8. In the past 12 months, how many times have you seen a medical provider?

• 0

• 1

• 2

• 3

• 4

• 5

• 6

• 7

• 8

• 9

• 10 or more

9. How often do you look for health information?

• Never

• Sometimes

• Often

• Always

Review Fact Sheet

Control Group:

The next questions are about this fact sheet on carbon monoxide. Please take a few minutes to read it entirely. After 90 seconds you’ll be able to continue to the next page (you may stay on this page as long as you like). [Participants will review the 2-page fact sheet — See Attachment C for the original ToxFAQ fact sheet.]

One quick question before you get started: Do you see an image above this question on your screen?

• Yes

• No [End survey]

[After 90 seconds, Continue button will allow participant to proceed]

Intervention Group:

The following questions are about this fact sheet on carbon monoxide. Please take a few minutes to read it entirely. After 90 seconds you’ll be able to continue to the next page (you may stay on this page as long as you like). [Participants will review the 2-page fact sheet — See Attachment C for the revised ToxFAQ fact sheet.]

[After 90 seconds, Continue button will allow participant to proceed]

One quick question before you get started: Do you see an image above this question on your screen?

• Yes

• No [End survey]

Knowledge Questions

First, we would like to ask you a few questions about the information you read in the fact sheet on carbon monoxide. You'll see that the fact sheet appears again below. You can use it to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

All participants:

1. Can you smell carbon monoxide in the air?

• Yes

• No

• Sometimes

• I’m not sure

2. Why might someone get carbon monoxide from a gas-fueled appliance?

• It’s not set up (installed) correctly

• It’s not cleaned properly

• It’s not used properly

• All of the above

• None of the above

3. What can you do to prevent contact with carbon monoxide? [open-ended response, in data cleaning, re-code as correct or incorrect]
   [Answering any one of the bullets below will be coded as correct]

If you have any appliances that burn fuel (like gas, kerosene, or wood):

• Make sure they are set up correctly — that includes being vented to the outside.

• Always read the instruction manual so you know how to use them safely.

• Find out if you need to do anything to keep your appliances working like they’re supposed to. For example, you may need to have a professional clean your appliance once each year.

• Check the vents regularly to make sure they aren’t blocked.

• Never use generators, charcoal grills, or gas-powered tools indoors.

• Never use portable camping stoves in a camper or tent.

And always follow these tips to protect your family:

• Never leave your car running in the garage — even if the garage door is open.

• Keep your home and car tobacco smoke-free.

• Get carbon monoxide and smoke detectors for your home.

Modified Consumer Information Rating Form (CIRF)

Now, we would like to ask you what you thought about this fact sheet. Remember, you can use the fact sheet below to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

[Control group: Survey displays before version of ToxFAQ]

[Intervention group: Survey displays after version of ToxFAQ]

For each of the following questions, please select the answer that most closely reflects your opinion.

1. Overall, how easy or hard would you say this information is to…

	Very easy (1)	Pretty easy (2)	In between (3)	Pretty hard (4)	Very hard (5)
Read
understand
remember
locate important information
keep for future reference

2. If you came info contact with this substance for the first time and received this information, how likely is it that you would…

	Very likely (1)	Somewhat likely (2)	Unsure (3)	Somewhat unlikely (4)	Very likely (5)
read the fact sheet
use the information
keep the fact sheet

Remember, you can use the fact sheet below to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

[Control group: Survey displays before version of ToxFAQ]

[Intervention group: Survey displays after version of ToxFAQ]

All participants:

3. Below is a list of topics. Please indicate your opinion about how much information was provided on each topic.

	Too much	About right	Too little
Carbon monoxide and its dangers
The impact of the carbon monoxide on the environment
How you can come into contact with carbon monoxide
Health effects related to coming into contact with carbon monoxide
How you can limit coming into contact with carbon monoxide
What to do if you have come into contact with carbon monoxide

Remember, you can use the fact sheet below to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

[Control group: Survey displays before version of ToxFAQ]

[Intervention group: Survey displays after version of ToxFAQ]

All participants:

4. Please indicate your opinion about how useful you think this information would be if you came into contact with this substance for the first time.

	Very useful	Somewhat useful	Not useful
Carbon monoxide and its dangers
The impact of carbon monoxide on the environment
How you can come into contact with carbon monoxide
Health effects related to coming into contact with carbon monoxide
How you can limit coming into contact carbon monoxide
What to do if you have come into contact with carbon monoxide

Control group:

Remember, you can use the fact sheet below to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

Intervention group:

Remember, you can use the fact sheet below to answer the questions — you don't need to answer from memory. (Use your mouse to scroll through the fact sheet.)

[Control group: Survey displays before version of ToxFAQ]

[Intervention group: Survey displays after version of ToxFAQ]

All participants:

Next, we would like to ask you about the design, layout and tone of the fact sheet. Please select the choice that best describes your opinion.

5. Organization

1 – Poorly organized

2

3

4

5 – Well organized

6. Attractiveness

1 – Unattractive

2

3

4

5 – Attractive

7. Print Size

1 – Poor

2

3

4

5 – Excellent

8. Tone

1 – Alarming

2

3

4

5 – Comforting

9. Helpfulness

1 – Unhelpful

2

3

4

5 – Helpful

10. Bias

1 – Biased

2

3

4

5 – Unbiased

11. Spacing between lines

1 – Poor

2

3

4

5 – Excellent

Side-by-Side Comparisons Questions

Finally, we would like for you to select which of the following parts of the fact sheets you find more useful, easy to understand, informative, and better designed.

[Note: Answer order will be random for questions below.]

1. Select the design you like better:

   1. [Screenshot of front side of before version]

   2. [Screenshot of front side of after version]
      
      

2. Select the option you think is more useful:

   1. How can families reduce the risk of exposure to carbon monoxide?

• Make sure appliances that burn natural gasoline, kerosene, or other fuels are properly installed and vented.

• Have appliances routinely maintained.

• Always follow the manufacturer’s recommendations on installing and using these devices.

• Do not use portable propane heaters in enclosed indoor settings such as campers and tents.

• Do not let your car run idle for a long period of time in your garage.

• Carbon monoxide is a component of tobacco smoke. Avoid smoking in enclosed spaces like inside the home or car in order to limit exposure to children and other family members.

• Have carbon monoxide and smoke detectors installed in your home.

2. What steps can I take to protect my family?

The good news is there’s a lot you can do to prevent carbon monoxide poisoning.

If you have any appliances that burn fuel (like gas, kerosene, or wood):

• Make sure they are set up correctly — that includes being vented to the outside.

• Always read the instruction manual so you know how to use them safely.

• Find out if you need to do anything to keep your appliances working like they’re supposed to. For example, you may need to have a professional clean your appliance once each year.

• Check the vents regularly to make sure they aren’t blocked.

• Never use generators, charcoal grills, or gas-powered tools indoors.

• Never use portable camping stoves in a camper or tent.

And always follow these tips to protect your family:

• Never leave your car running in the garage — even if the garage door is open.

• Keep your home and car tobacco smoke-free.

• Get carbon monoxide and smoke detectors for your home.

3. Select the option you think is easier to understand:

   1. What is carbon monoxide?

Carbon monoxide is a poisonous gas that you can’t see, smell, or taste. It’s made when carbon fuel isn’t burned down completely. Carbon monoxide exists naturally in the environment, but human activity can also create it — for example, there’s carbon monoxide in fumes produced by driving cars or burning fireplace wood.

Carbon monoxide is most dangerous when it builds up indoors.

2. What is carbon monoxide?

Carbon monoxide is a colorless, nonirritating, odorless, tasteless gas that is found in both indoor and outdoor air. It is made when carbon fuel is not burned completely and is produced from both human-made and natural sources. The most important human-made source is from exhaust of automobiles.

Carbon monoxide levels in indoor air vary depending on the presence of appliances such as kerosene and gas space heaters, furnaces, wood stoves, generators and other gasoline-powered equipment. Tobacco smoke also contributes to indoor air levels.

Industry uses carbon monoxide to manufacture compounds such as acetic anhydride, polycarbonates, acetic acid and polyketone.

4. Select the option you think is more informative:

   1. How can carbon monoxide affect my health?

Exposure to high levels of carbon monoxide can be life-threatening. Carbon monoxide poisoning is the leading cause of death due to poisoning in the United States.

Headache, nausea, vomiting, dizziness, blurred vision, confusion, chest pain, weakness, heart failure, difficulty breathing, seizures and coma have been reported in people inhaling carbon monoxide. People who have heart or lung disease are more vulnerable to the toxic effects of carbon monoxide.

2. How can carbon monoxide affect my health?

Breathing in too much carbon monoxide causes carbon monoxide poisoning. People poisoned by carbon monoxide can pass out or even die. It’s also important to know that people who are sleeping can die of carbon monoxide poisoning without waking up.

Symptoms of carbon monoxide poisoning may include:

• Headache

• Stomach problems

• Feeling dizzy or confused

• Blurred vision

• Chest pain

• Weakness

• Trouble breathing

Less serious cases of carbon monoxide poisoning can cause flu-like symptoms.

5. Select the design you like better:

   1. [Screenshot of back side of before version]

   2. [Screenshot of back side of after version]

End of Survey

Thank you for sharing your opinions with us. Your input will help us create better fact sheets about toxic chemicals.