0920-0572 HCP Online Survey

OMB No. 0920-0572

Expiration Date 08/31/2021

FHI 360 - Centers for Disease Control and Prevention

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

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

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 a 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.

[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.]

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

[First image shows on screen]

This is the first image.

1. Thinking about diabetes self-management education and support services, how likely do you think you are use these materials to promote these services to your patients with diabetes?

1=Definitely would not

2=Probably would not

3=Might or might not

4=Probably would

5=Definitely would

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

[RANDOMIZE STATEMENTS]

2. This service is made for patients like mine

3. I can do what this suggests

4. My patients can do what this suggests

5. This grabs my attention

6. This is confusing

7. This is offensive

8. This would help me talk with my patients about diabetes self-management education services

9. I could trust this service

10. My patients could trust this service

11. I already refer my patients to services like what’s described

12. This shows what my patients need to help them manage their diabetes

13. This is unique

14. This is appealing to me

15. This is believable

16. This service cares about my patients and their diabetes

17. This service is friendly

18. This service is practical

19. This service meets my needs

20. This service meets my patients’ needs

21. I would tell a colleague about this service

22. This service seems like something I would like to refer my patients to

23. This service seems like something my patients would like to try

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

[TEXT BOX]

25. 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 1-25; REPEAT for each brand concept]

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

[SHOW IMAGES 1 AND 2]

27. Why did you like this one best?

[TEXT BOX]