Expedited Review Supplement

Message Testing for Diabetes Self-Management Education and Support (DSMES) Marketing Support: Card Sort Activity

Supplement to the HMTS Expedited Review Form

	Page Number
Project Summary	1
Background	1
Methodology	2
Modes for Testing	2
Overview of Data Collection	3
Incentives	3
Duration of Survey and Focus Groups	4
Burden	4

Appendices

Appendix A: Messages to be Tested

Attachments: Materials for Online Survey

1. Survey Screeners

   1. For Diabetes Educators

   2. For People with Diabetes

   3. For Health Care Providers

2. Consent Language for People with Diabetes, Diabetes Educators and Health Care Providers

3. Online Surveys

   1. For Diabetes Educators

   2. For People with Diabetes who have not received DSMES services

   3. For People with Diabetes who have received DSMES services

   4. For Health Care Providers

4. Screenshots of Screener and Survey Questions/Messages to be Shown on Screen (as will be seen on the online survey platform by participants)

Project Summary

Goal: To conduct message testing to help inform communication efforts for identified audiences around key diabetes self-management education and support (DSMES)-related topics.

How Information Will Be Used: Findings from this message testing effort will be used by the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation (DDT) to inform how best to communicate with key audiences about DSMES services. Specifically, information about which attributes of DSMES services are most important to each audience will be identified and will serve as the basis for messages developed to promote DSMES services. This work will help increase the likelihood that messages will resonate and be understood as intended.

Methods: Messages will be tested via 400 online surveys. The panel survey will be conducted remotely through an online survey platform.

Respondent Population: The target audiences are people with diabetes, and health care professionals (certified diabetes educators, physicians, nurse practitioners, advanced practice nurses, and physician assistants) who refer to or offer DSMES services. These audiences are segmented as follows:

• People with diabetes, recruited to include a mix by age, gender, type of diabetes (type 1 or type 2), how long they have had diabetes, and race/ethnicity

  • Received DSMES services

  • Have not received DSMES services

• Health care providers, recruited to include a mix by age, age, gender, and race/ethnicity

  • Diabetes educators offering DSMES

  • Physicians who refer to DSMES

  • Specialists who refer to DSMES

  • Nurse practitioners and advanced practice nurses who refer to DSMES

  • Physician assistants who refer to DSMES

Analysis Techniques: Survey responses will be analyzed with a quantitative software program (e.g., SPSS) to identify the percentage of participants within each segment that chose each attribute. Open ended responses will be analyzed using qualitative data techniques to understand the reasons why the set of attributes were chosen. We will examine which attributes were common across each segment and which attributes were different across each segment.

Background

DDT is conducting audience research to better understand how to most effectively communicate with key stakeholders to increase enrollment in DSMES services. This data collection effort will help inform the DSMES communication efforts with identified audiences around key DSMES-related topics. Specifically, it will examine which qualities of DSMES services are most salient for health care providers, diabetes educators and people with diabetes.

See Appendix A for the messages to be tested.

Methodology

Data will be collected from people with diabetes, diabetes educators, and health care providers through an online survey that will be conducted with a national sample of 400 respondents. People with diabetes, diabetes educators, and health care providers have been identified as key audiences for message testing because DDT’s efforts ultimately seek to benefit people with diabetes; people with diabetes require a referral from a health care provider to receive services; and diabetes educators ultimately provide these services. Message testing with these audiences will provide valuable insight regarding how people with diabetes, diabetes educators and health care providers understand and react to the message.

For the people with diabetes audience, the online survey will be segmented by those who have received DSMES services and those who have not. For the health care provider audience, the survey will be segmented by profession of health care providers who refer their patients with diabetes to DSMES services and those who offer DSMES services. Segmenting this way will allow for exploring the potential similarities and differences in reactions to DSMES messages between these groups and whether distinct messages may be needed to influence intended attitudes and behaviors.

Modes for Testing

DDT is proposing data collection using an online survey. The online survey will be conducted remotely through an online survey platform. Standard procedures will be used by the online survey company to contact likely eligible online panel participants to confirm they meet the study criteria. Potentially eligible participants will complete an online screening questionnaire to confirm their eligibility prior to taking the survey. Once confirmed, participants will continue to the survey questions. Before taking the survey, the first screen will include consent language. Proceeding to take the survey will be confirmation that they have read the consent language and agree to participate. See Attachments for instruments and other documentation for the online survey— including the eligibility screener, informed consent, online survey, and screenshots of how the survey and messages will be viewed online by participants.

Overview of Data Collection

Audience	Data Collection Methodology	Participants	Type of Location	Totals
PEOPLE WITH DIABETES	Online Survey	People with type 1 diabetes	At least 30 urban and 30 rural. At least 100 will also have had DSMES services.	200
		People with type 2 diabetes
Health care providers	Online Survey	Medical doctors (general practice)	A mix of urban and rural participants will be selected.	40
		Endocrinologists		40
		Nurse practitioners or advance practice nurses		40
		Diabetes educators		40
		Physician assistants		40
Total				400 Surveys

Incentives

Appropriate incentives are key to the success of research efforts and to preventing over-burdening the public. In other words, even when individuals agree to participate, an incentive that is perceived as “insufficient” (e.g., too little money) may result in a greater likelihood of people who qualify opting not to participate.

People with diabetes who participate in the online survey will receive $5 or points equivalent to $5 from the survey company. Participants will be recruited in one of two ways. First, people with diabetes who have had DSMES services will be recruited from existing lists from CDC’s partners who offer accredited or recognized programs (e.g., American Association of Diabetes Educators; American Diabetes Association). People with diabetes who have not had DSMES services will be recruited from an online panel of potential participants who have agreed to receive $5 or points equivalent to $5 for completing surveys which they can accumulate and exchange for rewards.

Diabetes educators will be recruited through the American Diabetes Association and American Association of Diabetes Educators’ membership lists. Physicians, advanced practice nurses, physician assistants, and nurse practitioners will be recruited through online panels. Health care providers who participate in the online survey will receive $35 for primary care physicians, advanced practice nurses, physician assistants, and nurse practitioners and $45 for specialists (e.g., endocrinologists). These incentive amounts are used in market research for these audiences and FHI 360 is using these amounts in another CDC project.

Duration of Survey and Focus Groups

• The screener for the online survey will take approximately 5 minutes to complete

• The online survey will take approximately 10 minutes to complete.

Burden

Type of Respondents	Form Name	Number of Respondents	Number of Responses per Respondent	Burden per Response (in hr)	Total Burden (in hr)
People with diabetes and Health care providers	Eligibility Screener for Online Survey	1,000	1	5/60	83
	Online Survey	400	1	10/60	67
Total: 150 HOURS

Appendix A

Messages to be tested

Plain Language Description of DSMS

Diabetes self-management education and support (DSMES) services empower people to live well with diabetes throughout their life. DSMES is provided by a diabetes educator. Educators help people with diabetes eat healthy, be active, track blood sugar, take medicines correctly, and reduce risk of illness and complications. They answer questions, share resources, and help people with diabetes learn coping skills, solve problems, and set goals to help them now and in the future.

DSMES is specific to a person’s needs. The diabetes educator and person with diabetes will review and update an action plan at each visit. People may get the services long term or as needed; by themselves, with a group of other people with diabetes, or online.

Positive

1. Accessible

2. Affordable

3. Collaborative

4. Convenient

5. Creative

6. Culturally-relevant

7. Customizable

8. Effective

9. Empowering

10. Enjoyable

11. Essential

12. Expert

13. Flexible

14. Helpful

15. Hopeful

16. Inspiring

17. Informative

18. Interesting

19. Knowledgeable

20. Manageable

21. Meaningful

22. Motivating

23. Personalized

24. Professional

25. Relevant

26. Skill-building

27. Supportive

28. Sustainable

29. Understandable

30. Useful

31. Valuable

Negative

32. Boring

33. Complicated

34. Confusing

35. Depressing

36. Difficult

37. Embarrassing

38. Expensive

39. Frustrating

40. Hopeless

41. Intimidating

42. Judgmental

43. Low-quality

44. Low-priority

45. Overwhelming

46. Patronizing

47. Pessimistic

48. Prescriptive

49. Repetitive

50. Rigid

51. Stressful

52. Time-consuming

53. Uncomfortable

54. Unrealistic

55. Inflexible

56. Worthless