Form 0920-0572 GAOS Consumer Survey Pre-test HMTS

Form Approved
OMB Control No.: 0920-0572
Expiration date: 08/31/2021
Public reporting burden of this collection of information is estimated to average 20 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74,
Atlanta, Georgia 30333; ATTN: PRA 0920-0572

Informed Consent
Before beginning the survey, there are a few things you should know.
On behalf of the Centers for Disease Control and Prevention (CDC), the research firm ICF is
conducting an online survey with adults from the community to gather feedback on educational
materials related to sepsis. These materials were developed in partnership with the CDC, and we hope
to use what we learn from these survey results to improve these materials and/or how and where we
promote them to raise awareness within your community. We expect this survey to take about 20
minutes. You will only be asked to complete this survey once.
We want to learn from you, so we encourage you to answer honestly. There are no right or wrong
answers. If you agree to participate in the survey, here are some points to know:
Rights Regarding Participation: Your participation in this survey is completely voluntary. You may
choose to leave the survey and/or not answer a question at any time for any reason. Refusal to
participate will involve no penalty or loss of benefits.
Privacy: We will take every precaution to protect your identity and ensure your privacy. We will keep
your name and answers to these survey questions private. Your name and contact information will be
kept separate from any survey responses. We will never use your name in any reports.
Benefits: Your participation in the survey will not result in any direct benefits to you. However, your
input will help us to develop and improve educational materials about sepsis for people like you.
Risks: There is no known risk to you for your participation in the survey.
Contact Information: If you have any questions about this survey or the campaign, please contact the
research director, Kristen Cincotta, PhD, at 404-320-4433.
1. Do you agree to participate in the survey?
Yes
No

Screener
The results of this survey will help the Centers for Disease Control and Prevention (CDC) refine its
ongoing campaign to improve antibiotic use by helping CDC staff understand the public’s response to
the campaign and its key messages. You will be asked to complete different versions of the survey
depending on whether you have seen or heard certain messages from the CDC about sepsis.
2. May we ask you some questions to see if you are a good match to take this survey?
Yes
No

3. How old are you?
Prefer not to answer
How old are you?

4. In what zipcode do you live?

5. What is your sex?
Male
Female
Prefer not to answer
Other (please specify)

6. Are you currently the primary caregiver for an older adult family member (age 65 years or older)?
Yes
No

7. Are you the parent of at least one child who is 12 years old or younger?
Yes
No

8. Who in your family usually makes health care decisions about this child/these children?
Self
Self and spouse or partner together
Someone else

9. Has a healthcare professional ever diagnosed you with a chronic medical condition or disease?
Yes
No
Do not know

10. Has a healthcare professional ever told you that you have one of the following chronic conditions or
diseases?
Arthritis
Cancer
Chronic Kidney Disease
Chronic Obstructive Pulmonary Disease
Diabetes
Heart Disease
Immunosuppression
Stroke
None of the above
Other (please specify)

11. Do you, your spouse or partner, or any other member of your household currently or in the past work
for/as:
Yes
A market research company
An advertising agency or public
relations firm
The media
(TV/radio/newspapers/magazines)
A healthcare setting or a health
and wellness organization (e.g.,
doctor’s office, clinic, hospital,
health department, fitness center)
A healthcare professional (e.g.,
doctor, nurse, pharmacist,
physician assistant, medical
assistant, dietician, aid, sitter,
social worker)

No

Disqualification Page
Thank you for your willingness to participate and answer our questions. Unfortunately, you do not
meet the criteria to continue with the survey. If you have any questions about your participation and/or
any questions about this survey, please contact the research director, Kristen Cincotta, Ph.D., at (404)
321-3211 or [email protected]. Thank you for your time.

Eligibility Page
Thank you for answering the questions. We have determined that you are a good match for this
survey. If you have any questions about your participation and/or any questions about this survey,
please contact the research director, Kristen Cincotta, Ph.D., at (404) 321-3211
or [email protected].

Exposure to Campaign
Now we would like to ask you about a CDC campaign to raise awareness about a medical condition
called sepsis that you may or may not have seen or heard about in the past 12 months.

Exposure to Campaign
12. Please indicate below whether you have seen or heard any of following campaign names or slogans in the
past 12 months.
Yes

No

Do not know/cannot recall

Health is Precious. Don’t
Get Sepsis.
Be Sepsis Aware
Get Ahead of Sepsis
Be Smart. Beat Sepsis.
Know the Threat.
Prevent Sepsis.

13.
this logo or hear the slogan on it anywhere?
Yes
No
Do not know/cannot recall

In the past 12 months, did you see

Disqualification Page
Thank you for your willingness to participate and answer our questions. Unfortunately, you do not
meet the criteria to continue with the survey. If you have any questions about your participation and/or
any questions about this survey, please contact the research director, Kristen Cincotta, Ph.D., at (404)
321-3211 or [email protected]. Thank you for your time.

Frequency and Channel of Exposure
You indicated that you had seen or heard the campaign name, Get Ahead of Sepsis, or seen the
campaign logo in the past 12 months.
14. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

Poster
Fact sheet
Brochure
Graphic
Newspaper/magazine
advertisement
Flyer
Other print media
(please specify)
Other print media (please specify)

15. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo on …?
1-2 times a day
Facebook
Instagram
Twitter
LinkedIn
YouTube
Other social media
(please specify:
_____________)
Other social media (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

16. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

Health websites
/resources
Website advertisements
Online news articles
Streaming TV/video
services (e.g., Hulu,
Netflix, [Amazon] Prime
Video)
Blogs
Advertisements on
mobile phone (including
mobile apps)
Search engines (e.g.,
Google)
Other websites (please
specify:
_____________)
Other online/internet media (please specify)

17. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day
Television (cable,
satellite, or antenna)
Broadcast radio
Other media formats
(please specify:
_____________)
Other media formats (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

18. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

Billboards
Bus, train, or subway
stations
On buses or taxi cabs
Advertisement in a mall
Advertisement in a
grocery store
Advertisement in a store
pharmacy (e.g., CVS,
Walgreens, Walmart)
Other public locations
(please specify:
_____________)
Other public locations (please specify)

19. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day
Videos/commercials
shown at doctor’s offices
or healthcare facilities
Other healthcare
locations (please
specify:
_____________)
Other healthcare locations (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

20. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign
messages, campaign name, or logo in …?
1-2 times a day
Emails
Email newsletters
Webcasts or webinars
Live events
Other media (please
specify:
_____________)
Other media (please specify)

Once a week

1-3 times a
month

Less than once
a month

Never

Do not know/
cannot recall

Knowledge
21. Sepsis is defined as the following:
A chronic condition that mainly affects kidney function

Contagious illness that commonly peaks in the winter

A blood infection

All of the above

The body’s extreme response to an infection

None of the above

A neurological disorder resulting from the flu

Do not know

22. Sepsis is a medical emergency.
True
False

23. Almost any infection can lead to sepsis.
True
False

24. Infections do not put you and your family at risk for a life-threatening condition called sepsis.
True
False

25. When germs get into a person’s body, they can cause an infection. If that infection isn’t stopped, it can
cause sepsis.
True
False

26. The following are the most common types of infections that can lead to sepsis EXCEPT:
Skin
Lungs
Urinary tract
Ear

27. Which of the following groups of individuals are at high risk for developing infections than can lead to
sepsis, and sepsis? (Select all that apply)
Adults aged 65 and older

Children or adults who have previously survived sepsis

Children or adults with chronic conditions like diabetes, lung
disease, cancer, and kidney disease

All of the above. Anyone can get an infection.
Do not know

Children younger than 1 years old
None of the above
Children or adults with weakened immune systems

28. Check all the signs and symptoms of sepsis below:
Excessive thirst

Fever, shivering, or feeling very cold

Clammy or sweaty skin

High heart rate

Confusion or disorientation

Shortness of breath

Extreme pain or discomfort

I do not know any of the signs and symptoms of sepsis.

29. If you suspect sepsis or has an infection that’s not getting better or is getting worse, you should ask your
doctor or nurse, “Could this infection be leading to sepsis?”
True
False

30. Which of the following activities, if any, can help prevent infections that can lead to sepsis? (Select all that
apply)
Washing your hands regularly

Keeping cuts and wounds covered and clean until healed

Showering daily

Taking good care of chronic conditions

Getting recommended vaccines

All of the above

Avoiding public restrooms

None of the above

Attitudes and Beliefs
Next, we are going to ask you some questions to learn more about your perspective on infections and
sepsis. Please give us your honest responses. There are no right or wrong answers to any of these
questions.
We’d like to provide you with a definition for sepsis to assist you in answering the following
questions:
Sepsis is the body’s extreme response to an infection. It is life-threatening, and without timely
treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
31. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

I am at risk of developing
infections that could lead
to sepsis.
I am at risk of developing
sepsis.

32. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If I developed sepsis, it
could cause severe
problems, such as tissue
damage and organ
failure.
If I develop sepsis, it
could lead to death.

Disagree

Neutral

Agree

Strongly Agree

33. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If I take proper care of
my chronic condition(s),
this will decrease my
chances of developing
infections that can lead
to sepsis.
If I practice good hand
hygiene, this will
decrease my chances of
developing infections
that can lead to sepsis.
If I keep my wounds
clean and covered until
healed, this will decrease
my chances of
developing infections
that can lead to sepsis.
If I get recommended
vaccinations, this will
decrease my chances of
developing infections
that can lead to sepsis.
Fast recognition of the
signs and symptoms of
sepsis can increase my
chances of survival.
Timely treatment of
infections can increase
my chances of survival
from sepsis.
I should seek immediate
medical care if I have an
infection that is not
getting better, or is
getting worse.

Disagree

Neutral

Agree

Strongly Agree

34. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
I am confident that I can
prevent infections that
can lead to sepsis.
I am confident that I can
talk to a healthcare
professional if I have an
infection that is not
getting better or is
getting worse.
I am confident that I can
recognize the signs and
symptoms of sepsis.
I am confident that I can
seek immediate medical
care if I suspect sepsis.

Disagree

Neutral

Agree

Strongly Agree

Attitudes and Beliefs [Women who care for a child ≤ 12 years old]
Next, we are going to ask you some questions to learn more about your perspective on infections and
sepsis. Please give us your honest responses. There are no right or wrong answers to any of these
questions.
We’d like to provide you with a definition for sepsis to assist you in answering the following
questions:
Sepsis is the body’s extreme response to an infection. It is life-threatening, and without timely
treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
Please answer the following questions about YOUR CHILD/CHILDREN WHO IS 12 YEARS OLD OR
YOUNGER for whom you currently make healthcare decisions and indicate the extent to which you
agree with the following statements, from strongly disagree to strongly agree.
35. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

My child is at risk of
developing infections
that could lead to sepsis.
My child is at risk of
developing sepsis.

36. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If my child developed
sepsis, it could cause
severe problems, such
as tissue damage and
organ failure.
If my child developed
sepsis, it could lead to
death.

Disagree

Neutral

Agree

Strongly Agree

37. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If I take proper care of
my child’s chronic
condition(s) (if my child
has them), this will
decrease their chances
of developing infections
that can lead to sepsis.
If I practice good hand
hygiene, this will
decrease my child’s
chances of developing
infections that can lead
to sepsis.
If I keep my child’s
wounds clean and
covered until healed, this
will decrease their
chances of developing
infections that can lead
to sepsis.
If my child gets
recommended
vaccinations, this will
decrease their chances
of developing infections
that can lead to sepsis.
Fast recognition of the
signs and symptoms of
sepsis can increase my
child’s chances of
survival.
Timely treatment of
infections can increase
my child’s chances of
survival from sepsis.
I should seek immediate
medical care for my child
if they have an infection
that is not getting better,
or is getting worse.

Disagree

Neutral

Agree

Strongly Agree

38. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
I am confident that I can
prevent infections that
can lead to sepsis in my
child.
I am confident that I can
talk to a healthcare
professional if my child
has an infection that is
not getting better or is
getting worse.
I am confident that I can
recognize the signs and
symptoms of sepsis in
my child.
I am confident that I can
seek immediate medical
care if I suspect sepsis
in my child.

Disagree

Neutral

Agree

Strongly Agree

Attitudes and Beliefs [Women who care for an elderly adult 65+]
Next, we are going to ask you some questions to learn more about your perspective on infections and
sepsis. Please give us your honest responses. There are no right or wrong answers to any of these
questions.
We’d like to provide you with a definition for sepsis to assist you in answering the following
questions:
Sepsis is the body’s extreme response to an infection. It is life-threatening, and without timely
treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.
Please answer the following questions about the OLDER ADULT FAMILY MEMBER (AGE 65 YEARS OR
OLDER) for whom you are currently the primary caregiver and indicate the extent to which you agree
with the following statements, from strongly disagree to strongly agree.
39. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

My older adult family
member is at risk of
developing infections
that could lead to sepsis.
My older adult family
member is at risk of
developing sepsis.

40. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If my older adult family
member developed
sepsis, it could cause
severe problems, such
as tissue damage and
organ failure.
If my older adult family
member developed
sepsis, it could lead to
death.

Disagree

Neutral

Agree

Strongly Agree

41. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
If I help my older adult
family member take
proper care of their
chronic condition(s) (if
my family member has
them), this will decrease
their chances of
developing infections
that can lead to sepsis.
If I help my older adult
family member practice
good hand hygiene, this
will decrease their
chances of developing
infections that can lead
to sepsis.
If I help my older adult
family member keep
their wounds clean and
covered until healed, this
will decrease their
chances of developing
infections that can lead
to sepsis.
If my older adult family
member gets
recommended
vaccinations, this will
decrease their chances
of developing infections
that can lead to sepsis.
Fast recognition of the
signs and symptoms of
sepsis can increase my
older adult family
member’s chances of
survival.
Timely treatment of
infections can increase
my older adult family
member’s chances of
survival from sepsis.
I should help my older
adult family member
seek immediate medical
care if they have an
infection that is not
getting better, or is
getting worse.

Disagree

Neutral

Agree

Strongly Agree

42. Please indicate the extent to which you agree with the following statements, from strongly disagree to
strongly agree.
Strongly disagree
I am confident that I can
help my older adult
family member prevent
infections that can lead
to sepsis.
I am confident that I can
help my older adult
family member talk to a
healthcare professional if
they have an infection
that is not getting better
or is getting worse.
I am confident that I can
help my older adult
family member
recognize the signs and
symptoms of sepsis.
I am confident that I can
help my older adult
family member seek
immediate medical care
if I/they suspect sepsis.

Disagree

Neutral

Agree

Strongly Agree

Behavior
43. In the past 12 months, how often did you speak with your healthcare professionals about the following?

Never

Rarely

Sometimes

Often

Always

Do not
know/cannot
recall

Did not visit
healthcare
professional
in past 12
months

Infections
Sepsis
Who is at-risk for sepsis
Signs & symptoms of
sepsis
How to seek immediate
medical care when you
suspect sepsis
How to prevent
infections that can lead
to sepsis and sepsis

44. What are the barriers that make it hard for you to have conversations about how to prevent infections that
can lead to sepsis and sepsis? Select all that apply.
I am not familiar enough with these topics.

I do not have a healthcare provider with whom I can discuss
these topics.

I do not understand these topics.
I feel frightened or worried when I talk about these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.

I do not have any barriers to having conversations about these
topics.

I do not think sepsis is a big problem for me.

Do not know/cannot recall

I do not think infections that can lead to sepsis are a big
problem for me.

Prefer not to answer

Other, please explain

45. Did you get a flu vaccine for the 2019-2020 flu season?
Yes
No

46. What are the barriers that make it hard for you to prevent infections that can lead to sepsis or sepsis?
Select all that apply.
I am not able to get to a doctor to discuss the steps needed to
prevent infections that can lead to sepsis or sepsis.

I do not think it is important to prevent infections that can lead
to sepsis or sepsis.

I am not able to access or afford supplies for wound care that I
would need to prevent infections that can lead to sepsis or
sepsis.

I do not have time to take all the steps needed to prevent
infections that can lead to sepsis or sepsis.

I am not familiar enough with how to prevent infections that
can lead to sepsis or sepsis.
I do not know if I need to get any vaccinations.
I do not want to get vaccinations.

My health makes it hard for me to take all the steps needed to
prevent infections that can lead to sepsis or sepsis.
I have not encountered any barriers to preventing infections
that can lead to sepsis or sepsis.
I do not try to prevent infections that can lead to sepsis or
sepsis.

I do not think it is possible for me to prevent infections that can
lead to sepsis or sepsis.

Do not know/cannot recall

I do not think sepsis is a big problem for me.

Prefer not to answer

I do not think infections that can lead to sepsis are a big
problem for me.
Other, please explain

47. In the last 12 months, have you looked for information about infections that can lead to sepsis or sepsis?
Yes
No
Do not know/cannot recall

Behavior
Please answer the following questions about YOUR CHILD/CHILDREN WHO IS 12 YEARS OLD OR
YOUNGER for whom you currently make health care decisions.
48. In the past 12 months, how often did you speak with your child’s healthcare professionals about the
following?

Never

Rarely

Sometimes

Often

Always

Do not
know/cannot
recall

Did not visit
healthcare
professional
in past 12
months

Infections
Sepsis
Who is at-risk for sepsis
Signs & symptoms of
sepsis
How to seek immediate
medical care when you
suspect sepsis
How to prevent
infections that can lead
to sepsis and sepsis

49. What are the barriers that make it hard for you to have conversations about how to prevent infections that
can lead to sepsis and sepsis? Select all that apply.
I am not familiar enough with these topics.

My child does not have a healthcare provider with whom I can
discuss these topics.

I do not understand these topics.
I feel frightened or worried when I talk about these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.

I do not have any barriers to having conversations about these
topics.

I do not think sepsis is a big problem for my child.

Do not know/cannot recall

I do not think infections that can lead to sepsis are a big
problem for my child.

Prefer not to answer

Other, please explain

50. Did your child get a flu vaccine for the 2019-2020 flu season?
Yes
No
Do not know

51. What are the barriers that make it hard for you to prevent infections that can lead to sepsis or sepsis in
your child? Select all that apply.
I am not able to get to a doctor with my child to discuss the
steps needed to prevent infections that can lead to sepsis or
sepsis.
I am not able to access or afford supplies for wound care that I
would need to prevent infections that can lead to sepsis or
sepsis in my child.
I am not familiar enough with how to prevent infections that
can lead to sepsis or sepsis in my child.
I do not know if my child needs to get any vaccinations.
I do not want my child to get vaccinations.

I do not think it is important to prevent infections that can lead
to sepsis or sepsis in my child.
I do not have time to take all the steps needed to prevent
infections that can lead to sepsis or sepsis in my child.
My child’s health or my own health make it hard for me to take
all the steps needed to prevent infections that can lead to
sepsis or sepsis.
I have not encountered any barriers to preventing infections
that can lead to sepsis or sepsis in my child.
I do not try to prevent infections that can lead to sepsis or
sepsis in my child.

I do not think it is possible for me to prevent infections that
can lead to sepsis or sepsis in my child.

Do not know/cannot recall

I do not think sepsis is a big problem for my child.

Prefer not to answer

I do not think infections that can lead to sepsis are a big
problem for my child.
Other, please explain

52. In the last 12 months, have you looked for information about infections that can lead to sepsis or sepsis for
your child?
Yes
No
Do not know/cannot recall

Behavior
Please answer the following questions about the OLDER ADULT FAMILY MEMBER (AGE 65 YEARS OR
OLDER) for whom you are currently the primary caregiver.
53. In the past 12 months, how often did you speak with your older adult family member’s healthcare
providers/help them to speak with their healthcare professionals about the following?

Never

Rarely

Sometimes

Often

Always

Do not
know/cannot
recall

Did not visit
healthcare
professional
in past 12
months

Infections
Sepsis
Who is at-risk for sepsis
Signs & symptoms of
sepsis
How to seek immediate
medical care when you
suspect sepsis
How to prevent
infections that can lead
to sepsis and sepsis

54. What are the barriers that make it hard for you to have conversations/help your older adult family member
have conversations about how to prevent infections that can lead to sepsis and sepsis? Select all that apply.
I am not familiar enough with these topics.

My older adult family member does not have a healthcare
provider with whom I can discuss these topics.

I do not understand these topics.
I feel frightened or worried when I talk about these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a big problem for my adult family
member.

I do not have any barriers to having conversations about these
topics.
Do not know/cannot recall
Prefer not to answer

I do not think infections that can lead to sepsis are a big
problem for my older adult family member
Other, please explain

55. Did your older adult family member get a flu vaccine for the 2019-2020 flu season?
Yes
No
Do not know

56. What are the barriers that make it hard for you to prevent infections that can lead to sepsis or sepsis in
your older adult family member? Select all that apply.
I am not able to get to a doctor with my older adult family
member to discuss the steps needed to prevent infections that
can lead to sepsis or sepsis.
I am not able to access or afford supplies for wound care that I
would need to prevent infections that can lead to sepsis or
sepsis for my older adult family member.
I am not familiar enough with how to prevent infections that
can lead to sepsis or sepsis in my older adult family member.
I do not know if my older adult family member needs to get any
vaccinations.
I do not want my older adult family member to get vaccinations.
I do not think it is possible for me to prevent infections that can
lead to sepsis or sepsis in my older adult family member.

I do not think it is important to prevent infections that can lead
to sepsis or sepsis in my older adult family member.
I do not have time to take all the steps needed to prevent
infections that can lead to sepsis or sepsis in my older adult
family member.
My older adult family member’s health makes it hard for me to
take all the steps needed to prevent infections that can lead to
sepsis or sepsis.
I have not encountered any barriers to preventing infections
that can lead to sepsis or sepsis in my older adult family
member.
I do not try to prevent infections that can lead to sepsis or
sepsis in my older adult family member.
Do not know/cannot recall

I do not think sepsis is a big problem for my older adult family
member.

Prefer not to answer

I do not think infections that can lead to sepsis are a big
problem for my older adult family member.
Other, please explain

57. In the last 12 months, have you looked for information about infections that can lead to sepsis or sepsis for
your older adult family member?
Yes
No
Do not know/cannot recall

Sources of Information
58. To whom or where did you ACTUALLY go to get information about infections that can lead to sepsis,
and/or sepsis? (select all that apply)
My doctor/healthcare provider’s office

Newspapers

Health websites/health-related mobile apps (e.g., WebMD,
MayoClinic)

Television
Radio

Centers for Disease Control and Prevention (CDC) website
Social media (e.g., Facebook, Twitter, Instagram)
Health magazines
I have not tried to learn about sepsis
Family members and/or friends
Other (please specify)

59. In an ideal world, where would you PREFER to get information about sepsis? (select all that apply)
Family members and/or friends

Social media (e.g., Facebook, Instagram, Twitter, LinkedIn,
etc.). Please specify: _______________.

My doctor/healthcare provider
Podcasts. Please specify: _______________.
Health websites/health-related mobile apps (e.g., WebMD,
Mayo Clinic, etc.). Please specify: _______________.
Health groups/organizations (e.g., National Institutes of Health,
American Cancer Society, etc.). Please specify:
_______________.

Blogs. Please specify: _______________.
Other. Please specify: _______________.
Do not know/unsure

Media (e.g., television, radio, newspapers, health magazines,
etc.). Please specify: _______________.
Other (please specify)

60. Did you know that the CDC has a Get Ahead of Sepsis webpage with resources you can use to learn
about sepsis?
Yes
No

61. How did you learn about CDC’s Get Ahead of Sepsis resources? (select all that apply)
My doctor/healthcare provider’s office

Family members and/or friends

Health websites/health-related mobile apps (e.g., WebMD,
Mayo Clinic)

Social media (e.g., Facebook, Twitter, Instagram)
Do not know/cannot recall

Centers for Disease Control and Prevention (CDC) website
Other (please specify)

Demographic Characteristics
62. How would you describe your racial background? Select all that apply.
White

Native Hawaiian or Other Pacific Islander

Black or African American

American Indian or Alaska Native

Asian

Prefer not to answer

Other (please specify)

63. Are you Hispanic or Latino?
Yes
No
Prefer not to answer

64. What language do you primarily use at home (i.e., when speaking with friends or family)?
English

Portuguese

Spanish

Vietnamese

Chinese (including Mandarin, Cantonese, and other Chinese
languages)

Prefer not to answer

French
Other (please specify)

65. What is the highest degree you have received? (Please select only one)
Some high school

Bachelor’s (4-year college) degree

High school graduate (or equivalent)

Master’s degree

Some college or technical school (1–4 years, no degree)

Professional or doctoral degree (MD, JD, PhD, etc.)

Associate or technical degree

Prefer not to answer

66. How confident are you filling out medical forms by yourself? (Please select only one)
Extremely

A little bit

Quite a bit

Not at all

Somewhat

Thank you for taking the time to participate in this important survey!