Sample Follow-up Questions

Attachment 9: Follow-Up Questions

 Follow-Up Questions

Form Approved

OMB No. 0920-0572

Expiration Date: xx-xx-xxxx

F. Follow-Up Questions

(Questions can be used for Central Location Intercept Interviews, Telephone Interviews, Individual In-depth Interviews [Cognitive Interviews], Focus Group Screeners, and Focus Groups.)

1. Does this message make you want to do anything?

• Does this motivate you to take action?

• Would this make you interested in finding out about [INSERT health topic or behavior] in your community?

2. Would it make you think more about the importance of [INSERT health topic or behavior]?

3. Would it make you concerned about increasing [INSERT health topic or behavior]?

4. Would it make you want to [INSERT health topic or behavior]?

5. Would it make you likely to do something about increasing [INSERT health topic or behavior]?

• What about the message makes you more or less likely to [INSERT health topic or behavior]?

6. Would you change anything about your current routine after seeing this?

7. Do you plan to [INSERT health topic or behavior]?

8. Doctors are interested in what they can say to motivate patients (or other parents) to [INSERT health topic or behavior]. What is your advice to them? That is, what should doctors tell people if they want them to [INSERT health topic or behavior]?

9. Were there any tips on here that you would not follow or comply with? Explain.

10. Is there anything that could be changed to make it more likely you would be motivated to [INSERT health topic or behavior]?

11. If you saw a [INSERT health topic or behavior] story (on television, in newspapers, or on the Internet], how likely would you be to pay close attention to it?

12. How likely would you be to talk about [INSERT health topic or behavior] with your family in the next week or so?

13. How likely would you be to talk about [INSERT health topic or behavior] with your friends in the next week of so?

14. Will you bring up the issue of [INSERT health topic or behavior] the next time you visit your healthcare provider?

Behavioral Intentions

15. Are you seriously considering [INSERT health behavior] within the next 6 months? SINGLE RESPONSE.

• Yes

• No

16. Are you planning to [INSERT health behavior] within the next 30 days? SINGLE RESPONSE.

• Yes

• No

17. Overall on a scale from 1 to 10 where 1 is not at all interested and 10 is extremely interested, how interested are you in [INSERT health behavior]? SINGLE RESPONSE.

1. Not at all interested

10. Extremely interested

18. Overall, on a scale from 0 to 10, where 0 is not at all confident and 10 is extremely confident, how confident are you right now that you can [INSERT health behavior]? SINGLE RESPONSE.

0 Not at all confident

10. Extremely confident

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
I intend to do something about [INSERT health topic or behavior]. I plan on looking into [INSERT health topic or behavior]. I mean to research [INSERT health topic or behavior]. I have thought about taking action to/for [INSERT health topic or behavior]. I have considered doing something about [INSERT health topic or behavior]. I will do something about [INSERT health topic or behavior]. I am taking action to/for [INSERT health topic or behavior] right now.	1 1 1 1 1 1 1	2 2 2 2 2 2 2	3 3 3 3 3 3 3	4 4 4 4 4 4 4	5 5 5 5 5 5 5

26. If a score of 3 or less is entered for Statements 19f – 25f:

Please indicate why you disagree with the earlier statement, [INSERT statement from 19f – 25f]. (Check all the reasons that apply)

• I don’t think it’s important

• I don’t have time

• I don’t have a way to pay for it

• I’m afraid [of/to INSERT action]

• I don’t have a health care provider

• I would be embarrassed

• I don’t trust [INSERT item]

• I don’t want anyone to suspect I’m [INSERT action]

• I wouldn’t know where to go [INSERT action]

• I don’t know how to [INSERT action]

• I don’t want my partner to find out

• I’m not at risk for [INSERT DISEASE] (if this response is selected, provide “because” options)

• Because I’m in a monogamous relationship

• Because I’m not currently sexually active

• Because I use protection

• Because I’m careful about my partners

• Other: ____________________

27. After watching these ads, how likely are you to talk about [INSERT health topic or behavior] with your family in the next week or so?

28. After watching these ads, how likely are you to talk about [INSERT health topic or behavior] with your friends in the next week or so?

29. After watching these ads, will you bring up [INSERT health topic or behavior] the next time you visit your healthcare provider?

• Yes

• No

30. Thinking about the next 6 months, on a scale from 1 to 10, where 1 is not at all likely and 10 is extremely likely, how likely are you to…………?

	Not at All Likely 1	2	3	4	5	6	7	8	9	Extremely Likely 10	DK 88	RF 99
Look for more information on [INSERT health topic or behavior].
Talk to a friend about ways to [INSERT health topic or behavior].
Contact a local official about [INSERT health topic or behavior].
Contact a school official about [INSERT health topic or behavior].

Involvement

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
The outcome of [INSERT health topic or behavior] directly affects my life. Whether or not people do something about [INSERT health topic or behavior] is important to my life. The outcome of [INSERT health topic or behavior] is relevant to my life. Whether or not others care about [INSERT health topic or behavior] is important to me. The problem of [INSERT health topic or behavior] is against my personal values. People who support [INSERT health topic or behavior] are against all I stand for. If I thought [INSERT health topic or behavior] was not a big deal, my friends would think poorly of me. I am fearful that my circle of friends would think I was dumb for caring about [INSERT health topic or behavior]. Whether I do something to improve [INSERT health topic or behavior] is central to how I view myself. How I handle [INSERT health topic or behavior] is central to my self-image. Handling [INSERT health topic or behavior] actively is an important part of how I see myself.	1 1 1 1 1 1 1 1 1 1 1	2 2 2 2 2 2 2 2 2 2 2	3 3 3 3 3 3 3 3 3 3 3	4 4 4 4 4 4 4 4 4 4 4	5 5 5 5 5 5 5 5 5 5 5

Self-efficacy scale

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
I feel as though I can make a difference regarding [INSERT health topic or behavior]. The suggestions for dealing with [INSERT health topic or behavior] made in the message are doable. I personally could do the suggested [INSERT health topic or behavior] in the message. Helping improve [INSERT health topic or behavior] is a goal within my reach. I am confident that I can protect myself from [INSERT health topic or behavior].	1 1 1 1 1	2 2 2 2 2	3 3 3 3 3	4 4 4 4 4	5 5 5 5 5

Attitudes

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
I think that [INSERT health condition/behavior/disease/syndrome/injury/disability] is a critical issue. People should make a strong effort to do something about [INSERT health condition/behavior/disease/syndrome/injury/disability]. People that do not do something about [INSERT health condition/behavior/disease/syndrome/injury/disability] are inconsiderate. People who do not care about [INSERT health condition/disease/syndrome/injury/disability] are dumb.	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4	5 5 5 5

51. I’m going to read you a list of statements. For each one let me know if you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree.

	Strongly Disagree 1	Somewhat disagree 2	Neither agree or disagree 3	Somewhat Agree 4	Strongly Agree 5	DK 88	RF 99
[INSERT health topic or behavior] is a problem in my community.
It is important for my community to [INSERT action].
My community should do more to [INSERT action].

Response efficacy scale

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
Visiting the Web site/calling the number listed in the message is a good start to improving [INSERT health condition/disease/syndrome/injury/disability]. By doing the behaviors suggested by the message, the [INSERT health condition/disease/syndrome/injury/disability] can be improved. Generally speaking, it is possible to improve [INSERT health condition/disease/syndrome/injury/disability]. There are many things I can do to protect myself from [INSERT health condition/disease/syndrome/injury/disability].	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4		5 5 5 5

Self-protection motivation

On a scale from 1 to 5, where 1 indicates that you strongly disagree, and 5 indicates that you strongly agree, please tell me the number which indicates how much you agree or disagree with each statement.

	Strongly Disagree				Strongly Agree
I want to combat [INSERT health condition/disease/syndrome/injury/disability]. I want to have the ability to fight [INSERT health condition/disease/syndrome/injury/disability]. I want to prevent [INSERT health condition/disease/syndrome/injury/disability]. I really don’t care about [INSERT health condition/disease/syndrome/injury/disability].	1 1 1 1	2 2 2 2	3 3 3 3	4 4 4 4	5 5 5 5

60. Before being contacted for this study, had you ever heard of CDC or the Centers for Disease Control and Prevention?

• Yes

• No

61. Before being contacted for this study, had you ever heard of the Department of Health and Human Services?

• Yes

• No

62. Before being contacted for this study, had you ever heard of the [INSERT organization name]?

• Yes

• No

63. Below is a list of environment and health topics covered on [INSERT website or resource]. Are there additional environmental hazards or health conditions you would like to see covered on the [INSERT website or resource] that aren’t today? If so, what are they?