0920-0572 Health Care Providers Survey

OMB No. 0920-0572

Expiration Date 3/31/2021

MESSAGE TESTING CARD SORT SURVEY FOR HEALTHCARE PROVIDERS (HCP)

September 19, 2019

To be included on the first page: Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0572). 

FOR HEALTHCARE PROVIDERS (PHYSICIANS, PHYSICIAN ASSISTANTS, NURSE PRACTICIONERS, AND ADVANCED PRACTIVE NURSES):

Introduction: Thank you for agreeing to participate. We are interested in your thoughts about services available to help people manage their diabetes.

This survey asks you about diabetes self-management education and support services to which you refer your patients with diabetes. [INSERT PLAIN LANGAUGE DESCRIPTION HERE].

1. From the list of words below, please select up to 5 qualities that best describe what you would consider to be ideal diabetes self-management education and support services for your patients (services you would give a grade of A+). (SELECT NO MORE THAN 5)

[INSERT LIST OF POSITIVE WORDS; RANDOMIZE OPTIONS] 

2. Why did you choose each of these five qualities instead of the others? What’s important about them? [SHOW THE WORDS SELECTED IN Q1] [OPEN ENDED TEXT BOX]

3. Thinking about these five qualities of ideal diabetes self-management education and support services, please rank them in order of importance to you, with 1 being the most important, 2 being the second most important, and so on.

(SHOW LIST THAT THEY CHOSE IN Q1 IN RANDOM ORDER; HAVE THEM RANK THE WORDS 1 TO 5) 

4. Now I’d like you to think of the diabetes self-management education and support services available for you to refer your patients. Which of the following words or phrases do you think describe the actual diabetes self-management education and support services available to refer your patients? (SELECT UP TO 5) 

[INSERT LIST OF POSITIVE WORDS; RANDOMIZE OPTIONS] 

5. Now, please think about your patients with diabetes. Which of the following words or phrases do you think patients would use to describe the diabetes self-management education and support services to which you refer them? (SELECT UP TO 5)

[INSERT LIST OF NEGATIVE WORDS; RANDOMIZE OPTIONS; INCLUDE AN “OTHER/SPECIFY”]

6. Now I want to show you another list of words or phrases. Which of the following words or phrases do you think patients would use to describe the diabetes self-management education and support services to which you refer them? [SELECT UP TO 10] 

[INSERT LIST OF POSITIVE WORDS; RANDOMIZE OPTIONS; INCLUDE AN “OTHER/SPECIFY”]