2 Consumer Survey

OMB Control Number: 0990-0281

ODPHP Generic Information Collection Request: Prevention Communication and Formative Research

Audience Research to Inform Physical Activity Guidelines Strategic Communication

Attachment C:

Consumer Survey

(Research Instrument)

March 28, 2019

Submitted to:

Sherrette Funn

Office of the Chief Information Officer

U.S. Department of Health and Human Services

Submitted by:

Frances Bevington

Strategic Communication and Public Affairs Advisor

Office of Disease Prevention and Health Promotion

U.S. Department of Health and Human Services

Consumer Survey

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0281. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

For Questions 1 – 20 (screening questions), see Attachment B.

Q21 [QUALITY CONTROL QUESTION] We care about the quality of our survey data and hope to receive the most accurate measures of your opinions, so it is important to us that you thoughtfully provide your best answer to each question in this survey.

• I will provide my best answers (1)

• I will not provide my best answers (2)

• I can't promise either way (3)

Q22 Have you seen, heard, or read anything about government physical activity guidelines? [Awareness of PAG]

• Yes (1)

• No (2)

Q23 Have you seen, heard, or read anything about the Move Your Way campaign? [Exposure to campaign]

• Yes (1)

• No (2)  Skip to Q25

Q24 Where have you seen, heard, or read anything about the Move Your Way campaign? (Check all that apply.)

[Location(s) of exposure to campaign]

• My workplace (1)

• My child’s school (2)

• Community health center (3)

• Doctor’s office (4)

• Facebook (5)

• Instagram (6)

• YouTube (7)

• Twitter (8)

• Website (please name: _____) (9)

• TV (10)

• Newspaper (11)

• From a friend or family member (12)

• Other (please name: _______) (13)

Q25 What best describes what typically happens during moderate-intensity physical activity? [Knowledge]

• Your heart beats about the same as usual, and you can sing while doing the activity. (1)

• Your heart beats somewhat faster than usual, and you can talk while doing the activity. (2)

• Your heart beats much faster than usual, and you can’t say more than a few words without pausing for a breath. (3)

Q26 Choose the activity below that is typically considered moderate intensity. [Knowledge]

• Jogging (1)

• Brisk walking (2)

• Fast swimming (3)

• Playing competitive basketball (4)

Q27 What best describes what typically happens during vigorous-intensity physical activity? [Knowledge]

• Your heart beats about the same as usual, and you can sing while doing the activity. (1)

• Your heart beats somewhat faster than usual, and you can talk while doing the activity. (2)

• Your heart beats much faster than usual, and you can’t say more than a few words without pausing for a breath. (3)

Q28 Choose the activity below that is typically considered vigorous intensity. [Knowledge]

• Running (1)

• Walking the dog (2)

• Gardening (3)

• Washing the dishes (4)

Q29 What is the minimum amount of moderate-intensity physical activity the government recommends for adults to get big health benefits? [Knowledge]

• 20 minutes a day, 3 or more days a week (1)

• 100 minutes spread out over a week (2)

• 30 minutes a day, 5 or more days a week (3)

• 60 minutes a day, 7 days a week (4)

• 150 minutes spread out over a week (5)

• Don't know / Not sure (6)

Q30 How many days a week of muscle-strengthening activity does the government recommend for adults to get big health benefits? [Knowledge]

• At least 1 day a week (1)

• At least 2 days a week (2)

• At least 3 days a week (3)

• At least 4 days a week (4)

• Don't know / Not sure (5)

Q31 How confident are you right now that you could be physically active often enough to stay healthy if:

[Self-efficacy]

[Include scale for each item: 1 (not confident) to 10 (very confident)]

• The weather was bothering you

• You were bored by the program or activity

• You felt pain when being physically active

• You had to be physically active alone

• You did not enjoy it

• You were too busy with other activities

• You felt tired

• You felt stressed

• You felt depressed

Q32 Thank you for sharing your feedback with us. Please click on the arrows below to submit your response.