0920-0572 PWD Online Survey

OMB No. 0920-0572

Expiration Date 08/31/2021

Brand Concept Testing
for Diabetes Self-Management Education and Support (DSMES) Services:

Survey for People with Diabetes

[Complete screener and informed consent, then begin survey.]

Thank you for agreeing to participate.

Please provide your honest opinions to the questions.

This survey asks for your opinion on ways to describe and tell people about diabetes self-management education and support services. First you will see draft images. These images would be part of a flyer or poster from your local hospital, pharmacy, or doctor’s office. Keep in mind that these are not finished. We want to know what you do and don’t like about them so we can make them better.

When you are finished reviewing the image, click the "NEXT” button.

[CONCEPTS WILL INCLUDE AN IMAGE AND ACCOMPANYING TEXT, SUCH AS A TAG LINE]

[Each person will see two different concepts or “images”. After each concept is shown, they will be asked a series of questions. We will rotate the order in which they are shown.]

[First image shows on screen]

This is the first image.

1. If you had to give this [image/idea/visual] a grade, like in school, where “A” is the best and “F” is a failing grade, what grade would you give this [image/visual] as a choice for making you want to find out more?

A

B

C

D

F

2. Thinking about diabetes self-management education and support services, how likely do you think you are to sign up after seeing this?

1=Definitely will not sign up

2=Probably will not sign up

3=Might or might not sign up

4=Probably will sign up

5=Definitely will sign up

Please use the scale to indicate how much you agree or disagree with the following statements:

1=disagree strongly

2=somewhat disagree

3=neither agree nor disagree

4= somewhat agree

5= agree strongly

3. This was made for a person like me

4. I can do what this suggests

5. This grabbed my attention

6. This is confusing

7. This is offensive

8. This made me want to talk with my doctor about diabetes self-management education services

9. I could trust this service

10. I’ve already had diabetes services like what’s described

11. This shows what I need to help me manage my diabetes

12. This is unique

13. This is appealing to me

14. This is believable

15. This service cares about me and my diabetes

16. This service is friendly

17. This service is practical

18. This service would meet my needs

19. If I had to choose a diabetes self-management education service, I would choose this one

20. I would tell a friend about this service

21. What, if anything, is confusing, unclear, or hard to understand?

[TEXT BOX]

22. What, if anything, you would change about this?

[TEXT BOX]

Now we would like to get your feedback on a second idea.

[Show second concept – repeat questions 1-22; REPEAT for each brand concept]

23. Now that you’ve seen both [images/brands], please tell me which one you liked best?

[SHOW IMAGES 1 AND 2]

Why did you like this one best?

[TEXT BOX]

(Reviewers, see “OMB attachment with samples” for example).

DSMES Brand Concept Testing Survey with People with Diabetes 4