Request for Approval

Health Message Testing System Expedited Review Form
1. Title of Study: (Please append screener and questionnaire)

Message and material testing for the Get Ahead of Sepsis (GAOS) campaign for healthcare professionals
(HCPs). The other GAO package is distinctly aimed at testing material for consumers.
2. Study Population: (Discuss study population and explain how they will be selected/recruited.)

1) Emergency Medical Services (EMS) personnel, 2) long-term care (LTC) medical technicians and
sitters, and 3) LTC nurses. Professional recruitment firms will contact individuals and use screeners to
determine eligibility, availability, and interest. See attachment A for more detail.
Respondent characteristics:
Number of subject: 27

Number of males:

12-15

Age range: 18-64

Number of females: 12-15

Racial/ethnic composition: N/A; recruitment firm will attempt a mix of race/ethnicity
Special group status: (e.g., risk group, health care providers)
Type of group(s): Healthcare professionals
Geographic location(s): Illinois; Louisiana; Mississippi; New Jersey; New York; Ohio;
Pennsylvania; Tennessee; West Virginia
3. Incentives: (State what incentive will be offered and justify proposed incentives to be used in study.)

EMS personnel and LTC medical technicians and sitters will receive a $55 gift card (or cash), and LTC
nurses will receive a $75 gift card (or cash), in appreciation for their time. The incentive is based on their
participation in a 60-minute online interview. In addition, participants will be asked to review/sign the
informed consent form prior to participation. This token will help offset any costs that the individual may
incur in order to participate in the online interview. See Attachment B for more detail.

4. Study method: (Please check one below)
Central location intercept interview:
Online Interview:
Telephone interview:
Other (describe):

Focus group:
Individual in-depth interview (cognitive interview):

(CATI used: yes or no):

5. Purpose of the overall communication effort into which this health message(s) will fit:
(Please provide 2-3 sentences below.)

The GAOS educational effort seeks to prevent and reduce infections that can lead to sepsis and sepsis and
optimize healthcare quality and patient safety by raising awareness and knowledge and motivating
behavior change related to sepsis prevention, early recognition, and immediate and appropriate treatment
among healthcare professional (HCP) and consumer target audiences.

6. Category of time sensitivity: (Please check one below)
Health emergency:
Time-limited audience access:
Press coverage correction:
Time-limited congressional/administrative mandate:
Trend Tracking
Ineffective existing materials due to historical event/social trends:
7. Describe nature of time sensitivity: (Please provide 2-3 sentences below.)
Sepsis is the body's extreme response to an infection, and can lead to tissue damage, organ failure, and
death. More than 1.7 million adults in America develop sepsis, and nearly 270,000 die as a result each
year. HCP education is needed to increase awareness and knowledge related to sepsis prevention, early
recognition, and immediate and appropriate treatment of sepsis.

8. Number of burden hours requested: 38.25 hr

BURDEN HOURS
No. of
Participation
Respondents Time

Category of Respondent

Burden

Potential respondents (estimate)

135

5 min

11.25 hr

Interview participants

27

60 min

27 hr

Totals

162

9. Are you using questions from the approved question bank?

38.25 hr

Yes

If yes, please list the item number(s) for questions used from the question bank separated by a comma.
(e.g., 1a, 3c, 130d)
6d, 29d, 16e, 43e

*** Items below to be completed by Office of Associate Director for Communication (OADC)***
1. Number of burden hours remaining in current year's allocation: 6433
2. OADC confirmation of time-sensitivity:
Yes:
No:

Dawn B. Griffin
Project Officer
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