Social Marketing &
Consumer Testing
Item Bank
OMB Number: CMS-10437
Centers for Medicare & Medicaid Services (CMS)
Office of Communications, Division of Research
July 7, 2020
Questions in this item bank will be used to conduct consumer research to support and improve
communication with diverse audiences that are affected by CMS initiatives and programs.
Contents
Description .................................................................................................................................................... 3
Example of Study Initiation Request Form ........................................................................................... 5
Survey Item Bank .......................................................................................................................................... 6
Attitudes ................................................................................................................................................... 6
Awareness ................................................................................................................................................. 7
Behaviors................................................................................................................................................... 9
Decision Making ...................................................................................................................................... 12
Demographics ......................................................................................................................................... 12
Health Insurance Satisfaction ................................................................................................................. 15
Health Status ........................................................................................................................................... 15
Information Sources................................................................................................................................ 16
Health Insurance Status .......................................................................................................................... 18
Internet Use ............................................................................................................................................ 21
Knowledge .............................................................................................................................................. 24
Mobile Technology.................................................................................................................................. 26
Perceptions ............................................................................................................................................. 26
Screening Questions ............................................................................................................................... 30
Qualitative Item Bank ................................................................................................................................. 34
Awareness ............................................................................................................................................... 34
Behavior .................................................................................................................................................. 34
Knowledge .............................................................................................................................................. 34
Perceptions ............................................................................................................................................. 35
Preferences ............................................................................................................................................. 36
Usability .................................................................................................................................................. 37
Sources of Information ........................................................................................................................... 37
General Questions .................................................................................................................................. 38
Activities .................................................................................................................................................. 38
Social Marketing Research Item Bank 2
Description
Before CMS disseminates program communications and messages to the public and other intended
audiences consumer research is undertaken to better understand the target audience. A key feature of
this work is developing an understanding of how consumers see the world - the “consumer reality.”
Factors such as the age, sex, and ethnic background of participants are important, as are their attitudes,
perceptions, values, culture, and knowledge. This understanding of the audience helps CMS craft
preliminary versions of messages that aim to convey important characteristics of programs and benefits
to consumers and other key target audiences. Additional testing is undertaken to help insure that the
messages will be understood and that they will encourage people to take appropriate actions.
Messages are typically tested on dimensions such as awareness, clarity, salience, appeal, and
persuasiveness. This allows messages to be tailored to specific audience segments. Communication
campaigns using the tailored messages are then launched. The effects of those campaigns are
monitored to help gauge the impact of the communications and to identify areas for quality
improvement.
The item battery in this package is designed to facilitate such testing by establishing a set of preapproved generic questions that will allow for the rapid turn-around required for CMS to communicate
more effectively with its audiences and assess the impact of communication campaigns. Questions from
this Social Marketing & Consumer Research Item Bank will be drawn for use in studies that employ
OMB-approved methods for data collection for key CMS audiences. The methods include telephone
interviews, individual or small group in-depth/cognitive interviews, usability testing, focus groups, and
online/web-based surveys.
The questions in the Social Marketing & Consumer Research Item Bank are divided into two major
categories. Items in the Survey Item Bank are typically employed to identify characteristics of
individuals and for structured use in quantitative online or telephone surveys. The following domains
are represented:
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Attitudes
Awareness
Behaviors
Decision Making
Demographics
Health Insurance Satisfaction
Health Status
Information Sources
Internet Use
Knowledge
Mobile Technology
Perceptions
Screening Questions
Social Marketing Research Item Bank 3
Items in the Qualitative Item Bank are typically used in less structured one on one and small group
discussion formats. These items are more open ended and are often designed to elicit comments or
discussion about specific topics or products. The following domains are represented:
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Awareness
Behavior
Knowledge
Perceptions
Preferences
Usability
Sources of Information
General Questions
Activities
Items will be selected to meet the requirements for the specific research undertaken. In a typical study,
items from the Demographic and Screening Questions will be used to identify appropriate individuals for
the research. Core questions will be drawn from the specific domain categories to reflect the type of
information needed from the participants. The relevant health topic, behavior, message, phrase, or
organization will be inserted into the standard questions to provide the context for the information
collection. Taken together, these will define the information collection instrument for that study. To
facilitate monitoring of research undertaken as part of this generic clearance, the following information
will be provided to OMB on a “Study Initiation Request Form” prior to study initiation:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Title of the project
Description of the research
Contact for lead researcher
Audience characteristics
Purpose of study
Methods to be used
Sample size
Items to be included
Timeline
Estimated burden hours
Administrative contact for research
An example of the format for this Study Initiation Request Form is provided below.
Social Marketing Research Item Bank 4
Example of Study Initiation Request Form
Study Title:
Baseline Survey of Consumers without Health Insurance
Description:
The Centers for Medicare and Medicaid Services will be implementing research to assist the Agency in
developing communication materials to provide outreach to uninsured individuals. These individuals
may be eligible for help paying for insurance costs through a number of mechanisms. To help identify
themes and issues that are top priority for communicating with these audiences, CMS will conduct a
telephone survey with uninsured individuals aimed at examining their current state of awareness,
knowledge, and attitudes about health insurance.
Lead Researcher:
Audience Characteristics:
Sabreet Kang Rajeev
500 uninsured adults, age 21-60, throughout the
Office of Communication/Division of Research
United States
Centers for Medicare and Medicaid Services
7500 Security Blvd
Baltimore, MD 21244
[email protected]
410-786-5616
Purpose of the Study:
Methods to be Used:
Examine current knowledge, awareness, and
The data collection will be undertaken using CATIattitudes about health insurance among
based telephone survey methodology.
uninsured adults to assist with development of
appropriately targeted outreach messaging.
Sample Size:
Items to be Included:
We expect to interview 500 consumers for this
SG1, SG2, ING1, ING3, ING4, ING6, ATG1, ATG2,
research. The sample will be provided by Survey
ATG5, ATG6, ATG7, AWG1, AWG2, AWG5, BG1,
Sampling International as representative of US
BG2, BG3, BG8 [Etc.]
adult consumers. The sample draw will be
sufficient to yield the required number of
interviews for assuming a 20% response rate.
Assuming a 20% response rate and a 50% eligibility
rate, we plan to select approximately 2,100 sample
cases.
Timeline:
Estimated Burden Hours:
December 1, 20XX – January 10, 20XX
500 participants x 0.25 hours = 125 hours
For Information on this project please contact:
Clarese Astrin, Director
Division of Research/Office of Communications
(410)786-5424
[email protected]
Social Marketing Research Item Bank 5
Survey Item Bank
Attitudes
ATG1. Using a scale from 1 to 7, where 1 means you completely disagree and 7 means you completely
agree, how would you rate each of the following statements
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Someone else takes care of health care issues so I don’t really need to
It is very important for me to be informed about health issues
I have other people I can always turn to if I need help
I’m concerned about not being able to pay for healthcare
I have a financial plan that includes funding for future healthcare costs
I don’t think much about my health
People often ask me for advice on healthcare issues
I’m very interested in
ATG2. Do you think you will be better or worse off under , or do you think it won’t make much difference?
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Better off
Worse off
No difference
DK
REF
ATG3. Under , do you think worse, or stay about the same?
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Get better
Stay about the same
Get worse
DK
REF
ATG4. Would you say that changes due to
have made your impression of more or less favorable?
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Much more favorable
Somewhat more favorable
Stayed about the same
Somewhat less favorable
Much less favorable
DK
REF
Social Marketing Research Item Bank 6
ATG5. How do you feel will impact your ? Do you feel it will have a:
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Positive impact
No impact at all
Negative impact
DK
REF
ATG6. Thinking about the future of do you think things are
becoming more positive, negative, or do you think things will stay about the same?
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More positive
More negative
Stay about the same
DK
REF
ATG7. Overall, would you say that your opinion of is favorable or
unfavorable/positive or negative?
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Very favorable/positive
Somewhat favorable/positive
Somewhat unfavorable/negative
Very unfavorable/negative
DK
REF
Awareness
AWG1. How much attention do you pay to news about ?
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A lot
Some
A little
None
DK
REF
AWG2. have you seen, heard, or ready anything about ?
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Yes
No
Social Marketing Research Item Bank 7
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DK
REF
AWG2A. Can you briefly tell me what you saw, read, or heard? (OPEN END)
AWG2B. Was that in an advertisement, a news story, or both?
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Advertisement
News story
Both
DK
REF
AWG3. Where did you see, hear, or read about ? (OPEN END)
AWG4. Would you say that what you saw, read, or heard about
was positive, negative, or neutral?
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Positive
Neutral
Negative
DK
REF
AWG5. where have you seen, heard or
read anything about on…
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Television
Radio
Newspaper
Magazine
Internet
Poster or billboard
In the mail
Other (Specify)
Have not seen anything
AWG6. I am going to describe an that you may have
seen within . . Do you recall seeing or hearing this
within ?
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Yes
No
REF
DK
Social Marketing Research Item Bank 8
AWG7. There are special toll-free telephone numbers for
you to call if you have questions about . Before today, did you know that this phone
numbers exists?
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Yes
No
REF
DK
Behaviors
BG1. Have you
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Considered buying health insurance
Attempted to purchase health insurance
Researched available health insurance plans
Contacted an to help you to find health insurance
Inquired about Medicaid or other government health insurance programs
Shopped online for health insurance
SCALE:
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Yes
No
DK
REF
BG2. How many different prescription medicines do you take on a regular basis, if any?
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None
1 to 2 a day
3 to 5 a day
6 or more a day
1 to 2 a week
3 to 5 a week
6 or more a week
DK
REF
Social Marketing Research Item Bank 9
BG3. How often do you ?
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Always
Usually
Sometimes
Never
Not applicable
DK
REF
BG5. have you visited ?
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Yes
No
DK
REF
BG6. have you used ?
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Yes
No
DK
REF
BG6A. What information were you looking for when you used ? (OPEN ENDED)
BG6B. Did you get the information you needed from ?
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Yes
No
DK
REF
BG7. have you called/used to get help?
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Yes
No
REF
DK
Social Marketing Research Item Bank 10
BG7A. Thinking about the most recent call you made to this number, what was the reason you
called? (OPEN ENDED)
BG6B. Did you get the information you needed from ?
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Yes
No
DK
REF
BG8. How likely is it that you will
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Very likely
Somewhat likely
Not very likely
Not at all likely
BG9. As a result of hearing about , what, if any, action did you take? (OPEN END)
BG10. Have you ?
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Yes
No
DK
REF
BG11. When researching/selecting health insurance for do you
use/have you used/do you plan to use ?
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Yes
No
DK
REF
BP1. Does your practice use ?
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Yes
No
DK
REF
BP2. Do you communicate with patients via (MODE OF COMMUNICATION EX: EMAIL, TEXT, PHR)?
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Yes
No
Social Marketing Research Item Bank 11
BP3. What percentage of your patients do you communicate with via (MODE OF COMMUNICATION EX:
EMAIL, TEXT, PHR)? (OPEN ENDED)
Decision Making
DMG1. When it comes to , do you usually make decisions on your own, with someone else’s
help, or do you rely on someone else to make those decisions for you?
[IF NECESSARY, READ LIST TO CLARIFY.]
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I make those decisions on my own without talking to anyone else
I make those decisions on my own, but talk with others about it
I make those decisions with someone else’s help
I rely on someone else to make those decisions for me
DK
REF
DMG2. Who usually helps you to make (or makes) your decisions? (OPEN ENDED)
DMG3. How long have you used to
help you with ? (OPEN END)
DMG4. Have you ever heard of ?
DMG4A. You mentioned that you have heard of . Which of the following best describes your
level of with .
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I have heard the term, but do not know much more about it
I have read or heard something about it and know some details
I have discussed the idea of doing
I am actively considering doing
I am in the process of starting
I am actively doing
Demographics
DG1. What is your gender? (OPEN ENDED)
DG2. In what year were you born/What is your current age? (OPEN ENDED)
DG3. Are you Hispanic, Latino/a, or Spanish origin? (One or more categories may be selected)
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No, not of Hispanic, Latino/a, or Spanish origin
Yes, Mexican, Mexican American, Chicano/a
Yes, Puerto Rican
Yes, Cuban
Yes, Another Hispanic, Latino/a or Spanish origin (Specify)
Social Marketing Research Item Bank 12
DG4. What is your race?
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White
Black or African American
American Indian or Alaska Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian (Specify)
Guamanian or Chamorro
Samoan
Other Pacific Islander (Specify)
DG5. What is the highest level of education you have completed?
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Less than high school
High school graduate
Some college
College graduate
Post graduate
DK
REF
DG6. What is your marital status?
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Single, never married
Married
In a committed relationship
Living with a partner
Separated
Divorced
Widowed
REF
DK
DG7. Including you, how many people live in your household? (OPEN END)
DG8. How many children under the age of 18 live in your household? (OPEN END)
Social Marketing Research Item Bank 13
DG8A. Are you currently pregnant?
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Yes
No
DK
REF
DG9. What is your current employment status?
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Employed full time
Employed part time
Retired
Unemployed
Not in the labor force (student, homemaker, etc.)
Other (Specify)
DK
REF
DG10. What is your household’s total annual income before taxes? :
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$0-14,999
$15,000-24,999
$25,000-34,999
$35,000-49,999
$50,000-74,999
$75,000-99,999
100,000-149,999
$150,000 or more
DK
REF
DG11. In what state do you ? (OPEN END)
DG12. What is the zip code of your primary ? (OPEN END)
DP1. What is your area of medical specialization? (OPEN ENDED)
Social Marketing Research Item Bank 14
DP2.Which of the following best describes your primary work environment;
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Hospital
Emergency room
Clinic
Office
Field
Academic
Research
Home or telecommute
Other (Specify)
Health Insurance Satisfaction
ISG1. How satisfied would you say you are with ?
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Very satisfied
Somewhat satisfied
Somewhat dissatisfied
Very dissatisfied
DK
REF
Health Status
HSG1. Do < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD> have any
disabilities?
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Yes
No
DK
REF
HSG2. Do < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD> have a chronic
illness or health condition?
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Yes
No
DK
REF
Social Marketing Research Item Bank 15
HSG3. How does your condition affect your ability to ?
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Does not affect my ability
Has some effect on my ability
Affects my ability a lot
DK
REF
HSG3. How would you rate your overall health?
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Excellent
Very good
Good
Fair
Poor
Very poor
HSG4. how many times have you
? (OPEN ENDED)
HSG5. How would you rate your
overall quality of life?
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Excellent
Very good
Good
Fair
Poor
Very poor
Information Sources
ISG1. Have you ever looked for information on health topics like ?
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Yes
No
DK
REF
Social Marketing Research Item Bank 16
ISG2. Where to find
information on topics like ?
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The internet
My doctor or health care provider
Family or friends
The library
The pharmacist
A like <
ORGANIZATION EX: SHIP COUNSELOR, AARP, STATE DEPARTMENT ON HEALTH>
An insurance agent or broker
DK
REF
ISG3. How often do you use when you have a question about ?
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Often
Sometimes
Occasionally
Rarely
Never
DK
REF
ISG4. What health insurance plan features are most important to you when comparing health plans?
(Rank features below on a comparative scale)
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Cost of the premium
Deductible amount
Co-payments
Co-insurance
Out of Pocket Maximum
Types of treatment or services covered
What prescription drugs are covered
Quality of medical care provided by the plan
Quality of the service provided by the plan
Don’t recall what I compared
Other (Specify)
Social Marketing Research Item Bank 17
ISG4A. Where would you go to find this information?
ISG5. How do you prefer to receive information about ?
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Cell phone call or voicemail
Search engines
Email
Wiki
YouTube, videos
Text messages
Social networking sites
Blogs
Podcasts
US mail
Other (Specify)
ISG6. How much do agree or disagree with the following statements: I trust to .
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Strongly agree
Somewhat agree
Somewhat disagree
Strongly Disagree
DK
REF
Health Insurance Status
ING1. Do currently have
health insurance coverage?
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Yes
No
DK
REF
Social Marketing Research Item Bank 18
ING2. How do < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD> currently
get health insurance to cover your hospital expenses or doctor’s visits? Do you get it through
:
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Current or former employer
Spouse or partner’s current or former employer
Parent’s current or former employer
A plan you purchase on your own directly from a health insurance company
A COBRA health insurance plan
Medicare and a supplemental insurance policy, sometimes called Medigap
A Medicare HMO or PPO plan, also known as Medicare Advantage, where you have to see a
doctor from the plan’s list
Medicare plus employer or retiree coverage
Medicaid or State Assistance
VA or Veterans’ Health Insurance
Tricare
Indian Health Services
Other (specify)
A combination (specify)
DK
REF
ING3. For how long have < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD>
been without/had/offered health insurance?
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Less than 6 months
6 months to less than one year
One year to less than two years
More than two years
Never had health insurance
DK
REF
ING4. What is the main reason < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR
HOUSEHOLD, BUSINESS> do not have insurance? (OPEN ENDED)
ING5. Do < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD> have an
insurance plan or insurance coverage that pays for your prescription medications?
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Yes
No
DK
REF
Social Marketing Research Item Bank 19
ING6. Did < HEALTH INSURANCE UNIT EX: YOU, YOUR CHILDREN, YOUR HOUSEHOLD> sign up for
?
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Yes
No
DK
REF
ING7. Here is a list of the kinds of insurance and health plans that some people have that help pay for
their prescription drugs. Please tell me which you have:
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Medigap, or Medicare Supplemental insurance
A Medicare Advantage plan
A health insurance plan that also covers prescription drugs
A standalone prescription drug plan
An HMO
A PPO
Employer, Union, or retiree health insurance
VA or Veterans benefits
Military retiree benefits or TRICARE
Other (Specify)
DK
REF
ING8. Did you purchase your directly from an
insurance company or is that something you pay for or receive as a benefit from your employer or
union?
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From an insurance company
Through employer or union
Other (Specify)
DK
REF
ING9. Does your insurance plan allow you to go to any doctor you choose or do you have to pick from a
list of doctors provided by their insurance company?
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Can go to any doctor
Can go to any doctor, but might have to pay more if not on list
Must pick doctor from a list
DK
REF
ING10. How do currently get health insurance? (OPEN END)
Social Marketing Research Item Bank 20
INBO1. Do you currently provide health insurance for the employees in your company?
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Yes – All
Yes – Some
No
DK
REF
INBO2. What was/were the main decision factor(s) for whether to provide health insurance for the
employees in your company? (OPEN END)
INBO3. What percent of the premium for the cost of insurance do you pay for your employees? (OPEN
END)
Internet Use
IUG1. Do you have access to the Internet, either on your own or with someone else’s help?
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Yes
No
DK
REF
IUG2. Do you require the help of someone else in order to access the internet?
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Yes
No
DK
REF
IUG3. Do you personally use the Internet?
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Use Internet
Do not use internet
DK
REF
IUG4. How often do you access the internet on your own or with someone else’s help? [READ LIST]
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Daily
Almost daily
3 to 5 days a week
1 to 2 days a week
Once every few weeks
A few times a year
Don’t have internet access/don’t use the internet
REF
DK
Social Marketing Research Item Bank 21
IUG5. Where you do you usually access the internet?
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Home
Work
Home and work
Other (Specify)
Do not use internet
DK
REF
IUG6. What type of internet connection do you have at ?
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Cable
DSL
Broadband
Dial-up
Wireless (Wi-Fi)
Satellite
Other (Specify)
I do not have internet at
DK
REF
IUG8. When you use the Internet, do you use a (Select all that apply)
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A personal desktop or laptop computer
An iPad or other tablet computer
A smart cell phone, like an iPhone or Blackberry
Other [please specify):_______________________
IUG9. How do you use the Internet? :
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To send and receive email
To search for information in general
To search for information about health and wellness
To shop
To manage credit cards, banking, or saving accounts
To manage investments
To manage health insurance
To watch videos or play games
To connect with people on social networking sites like Facebook and LinkedIn
Other (specify):_______________________
Social Marketing Research Item Bank 22
IUG14. Do you participate in any sort of online social networking?
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Yes
No
DK
REF
IUG15. Which of the following social networking sites do you use? :
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Facebook
Pinterest
Twitter
Google +
Foursquare
Other (Specify)
None of these
IUG16. Do you use the internet to view photos or videos through sites like YouTube and Flickr?
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Yes
No
DK
REF
IUG17. Have you ever used the internet to find out information about ?
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Yes
No
DK
REF
IUG18. Have you (or someone who helps you) used the
internet to ?
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Yes
No
DK
REF
IUG21. Do you use the internet to ?
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Yes
No
DK
REF
Social Marketing Research Item Bank 23
IUG22. On a scale of 1 to 7, where 1 means not at all comfortable, and a 7 means very comfortable, how
comfortable would you be entering the following information into a secure online server for the
purposes of enrolling in health insurance :
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Full name
Date of birth
Social security number
Income
Children’s full names
Children’s dates of birth
Children’s social security numbers
Immigration status
Knowledge
KG1. As you might know, . Do you feel you have enough information about < TOPIC OR PROGRAM > to understand
how it will impact you personally?
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Yes, have enough information
No, don’t have enough information
DK
REF
KG2. Using the following scale, to what extent do you agree or disagree with the following statement: I
have the information and resources I need to .
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Completely agree
Somewhat agree
Somewhat disagree
Completely disagree
DK
REF
KG3. To your knowledge, does a like this exist?
•
•
•
•
Yes
No
DK
REF
KG3A. [If YES] What is the name of that ? [Open End]
Social Marketing Research Item Bank 24
KG4. How likely do you think it is that < UNIT EX: YOU, YOUR CHILD, YOUR EMPLOYEES> would be
eligible for
•
•
•
•
•
•
Very likely
Somewhat likely
Not very likely
Not at all likely
DK
REF
KG5. Using the following scale, to what extent do you agree or disagree with the following statement: I
have the information and resources I need to make an informed comparison among different
.
•
•
•
•
•
•
Completely agree
Somewhat agree
Somewhat disagree
Completely disagree
DK
REF
KG6. Can you provide a brief definition of for me? (OPEN END)
KG7. Please tell me if the following statement is true or false/accurate or inaccurate .
•
•
•
•
True/Accurate
False/Inaccurate
DK
REF
KG8. I am going to read you a description of , and I’d like for
you to tell me whether you think it already exists, is likely to exist within the next , is not
likely to exist within the next .
•
•
•
Already in place
Likely to be in place in
Unlikely to be in place in
Social Marketing Research Item Bank 25
Mobile Technology
MTG1. Do you own a ?
• Yes
• No
• DK
• REF
MTG2. Do you use text messaging?
•
•
•
•
Yes
No
DK
REF
MTG3. use a
to access the internet?
•
•
•
•
•
•
•
Yes/Very frequently
Somewhat frequently
Somewhat infrequently
Very infrequently
No/Never
DK
REF
MTG3. Do use smart phone applications (apps) to using your phone?
•
•
•
•
Yes
No
DK
REF
MTG4. What kind/brand of do you own? (OPEN
END)
Perceptions
PG1. How difficult do you think it is (or would be) to ?
•
•
•
•
•
•
Very easy
Somewhat easy
Somewhat difficult
Very difficult
DK
REF
Social Marketing Research Item Bank 26
PG2. What, if anything, makes difficult? (OPEN END)
PG3. Using a scale of 1 to 7, where 1 means not at all important and 7 means very important, how
important are each of the following when making your health insurance plan choices ?
•
•
•
•
•
•
•
•
•
The monthly amount you pay for the plan (the premium)
Out-of-pocket costs you pay when you use the plan (co-pay, coinsurance, and deductible)
The cost of prescription drugs
An expert rating of how well the plan keeps people healthy
An expert rating of patient satisfaction with the plan
Coverage of tests and screenings to diagnose and prevent disease (e.g., annual physicals,
mammograms)
Coverage to help you when you are sick
The doctors and hospitals included in the plan
Maximum amount you would pay each year, not including the monthly premium.
PG4. Now I am going to read you a list of things that may be included on a website designed to help
people find and compare health insurance plans. Please tell me how helpful you think each of these
would be to you personally :
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The website offers unbiased information about health insurance
The website allows you to review and compare health insurance plans from many companies in
one place
The website uses a simple ranking system that shows which plans offer more comprehensive
coverage
The website offers information about what each plan covers and how much each plan costs
The website allows you to sort health plans by different criteria, such the size of the premiums,
the cost of co-pays, and total out-of-pocket expenditures
The website allows you to easily determine if you qualify for government assistance to help pay
for your health insurance
The website allows you to easily determine if you qualify for tax credits or tax rebates to help
offset the cost of your health insurance
The website allows you to search, compare and obtain health insurance on a single website
The website only offers health insurance plans that meet a set of federal quality standards
The website provides you someone to talk to regarding your health insurance plan choices
The website tells you how much your health insurance would cost you without having you
register or follow up in any way
The website allows you to compare your existing health insurance plan to others available in
your area
The website provides access to health insurance plans similar to those available to Federal
employees
Your member of Congress was required to get their health insurance from the new Health
Insurance website
Social Marketing Research Item Bank 27
SCALE:
•
•
•
•
•
•
Very helpful
Somewhat helpful
Not very helpful
Not helpful at all
DK
REF
PG5. Which of the following statements best describes how you feel about ? It:
•
•
•
•
•
•
Is a necessity, something I would never give up
Is very important, but not a necessity
Is good to have, but not all that important
Has little or no value to me
DK
REF
PG6. In general, how favorable or unfavorable is your opinion of ?
•
•
•
•
•
•
Very favorable
Somewhat favorable
Somewhat unfavorable
Very unfavorable
DK
REF
PG7. How confident are you that you can ?
•
•
•
•
•
•
Very confident
Somewhat confident
Not very confident
Not at all confident
DK
REF
Social Marketing Research Item Bank 28
PG8. How is the information you found
on/at/in ?
•
•
•
•
•
•
Very
Somewhat
Not very
Not at all
DK
REF
PG9. Please indicate how much you agree or disagree with the following
•
•
•
•
•
•
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
DK
REF
PG10. What is your opinion of ? Do you find it to be
•
•
•
•
•
•
Very positive/useful/informative/favorable
Somewhat positive/useful/informative/favorable
Somewhat negative/unfavorable Not very useful/informative
Very negative/unfavorable Not at all useful/informative
DK
REF
PG11. (Present multiple): Which term do you find to be
most/least ?
PG12. Compared to , how would you rate
the health insurance options available to . Would you say that your
options are:
•
•
•
•
•
Better
About the same
Worse
DK
REF
Social Marketing Research Item Bank 29
Screening Questions
SG1. Have you or any member of your household or immediate family ever worked for:
•
•
•
•
•
•
•
•
•
•
A market research company
An advertising agency or public relations firm
The media (TV/radio/newspapers/magazines)
A healthcare profession (as a doctor, nurse, other healthcare professional, in a pharmacy, for a
pharmaceutical company, etc.)
A health insurance provider
A managed care organization or any healthcare provider
A medical practice
DK
REF
SG2. Have you (or anyone in your household) ever worked for the Social Security Administration or the
Centers for Medicare & Medicaid Services (CMS), formerly known as the Health Care Financing
Administration?
•
•
•
•
Yes
No
DK
REF
SG3. What is the primary language spoken in your household/What language do you usually speak when
you are at home? (OPEN END)
SG4. help or assistance to with
•
•
•
•
Yes
No
DK
REF
Social Marketing Research Item Bank 30
SG5. What types of assistance do you/have you provided for :
•
•
•
•
•
•
•
•
•
Insurance decisions
Health care decisions
Spoken with a healthcare provider on behalf of or along with someone else
Financial and legal decisions
Paying bills
Transportation
Household chores or grocery shopping
Other (Specify)
None of these
SG6. What is your relationship to the person for whom you provide assistance?
•
•
•
•
•
•
•
•
Spouse
Child
Parent
Grandparent
Other family member
A friend
Employee
Other (Specify)
SG7. Do you receive any form of compensation for providing assistance to ?
•
•
•
•
Yes
No
DK
REF
SG8. participated in a in which you were asked your opinions regarding a product, service or
advertising?
•
•
•
•
Yes
No
DK
REF
SG9. used ? (OPEN END)
Social Marketing Research Item Bank 31
SG10. Do you have any chronic health conditions that require ongoing care, such as arthritis, chronic
pain, high blood pressure, or heart disease?
•
•
•
•
Yes
No
DK
REF
SG10A. What is the nature of your chronic health condition? (OPEN END)
SG11. Do you have major responsibility for providing care to someone with a disability or another
person, like a parent, spouse, or friend?
•
•
•
•
Yes
No
DK
REF
SP1. What percent of your full-time working hours are typically spent in direct patient care activities, as
opposed to academics, research, or administration?
•
•
•
•
•
Zero to 24% of your working time
25% to 49% of your working time
50% to 74% of your working time
75% or more of your working time
DK
SP2. Approximately what percent of your practice’s revenues would you say come from ?
•
•
•
•
•
•
Zero to 19%
20% to 39%
40% to 59%
60% to 79%
80% or more
DK
SP3. Does your practice currently accept new patients?
•
•
•
Yes
No
DK
Social Marketing Research Item Bank 32
SBO1. Are you the person who makes health insurance decisions for your ?
•
•
•
•
Yes
No
DK
REF
SBO2. Including yourself, how many employees does your company have?
•
•
•
•
•
•
1
2-9
10-19
20-49
50-100
>100
SBO3. What industry does your company serve? (OPEN END)
SBO4. How long have you been in business? (OPEN END)
Social Marketing Research Item Bank 33
Qualitative Item Bank
Awareness
Items listed in this section would be used during qualitative data collection, during focus groups and
interviews. These data collection efforts may take place in person, via the telephone, or on the internet.
AW1. What, if anything, you heard of ?
AW1A. Where did you hear about ?
AW1B. What did you hear that was positive?
AW1C. What did you hear that was negative?
AW1D. What did you hear that was confusing?
AW1E. What did you hear that seemed most important?
AW2. Looking at this , what are the first things you
notice?
AW2A. What is it about that made you notice?
AW2B. What words or phrases stand out to you/got your attention?
AW2C. Are there words or phrases that should be said differently?
AW3. What would be the best way to get information about to you/people like you?
Behavior
B1. Please describe how you would/usually/typically .
B2. What are the reasons that you have/have not
Knowledge
K1. In your own words, please describe /If you wanted to describe
to someone else, what would you say?
K1A. What is positive/good about ?
K1B. What is negative/bad about ?
K1C. What is confusing about ?
K1D. What is important about ?
K2. When you think about , what are the first things that come to
mind?
K3. What do you think is the purpose/main idea of ?
K3A. How well do you think the purpose/main idea comes across?
K3B. What could make it clearer?
K3C. What do you think this wants to motivate
people to do?
K3D. How easy or difficult was to understand?
Social Marketing Research Item Bank 34
Perceptions
PE1. How easy/difficult is the information/material to understand?
PE1A. What could make it easier for people to understand this information?
PE1B. What was a particularly difficult concept?
PE2. What about ?
PE2A. What makes you feel that way about it?
PE2B. What exactly do you ?
PE3. What kind of person do you think is for?
PE3A. What makes it right for that kind of person?
PE3B. What makes it not right for other kinds of people?
PE4. How well do you think would meet needs?
PE6. In your opinion, does prompt
you to ?
PE6A. What would make you more likely to ?
PE6B. What could be done to make more likely to get you to ?
PE7. What, if anything, do you think should be included in that is not there currently?
PE8. How is to you?
PE8A. What makes it ?
PE8B. What do you think means/will mean to you personally?
PE9. What, if anything, did this include
that you did not already know?
PE10. What kind of person do you think is for/Who do you think
does is trying to reach?
PE10A. What makes it right for that kind of person/people?
PE10B. What makes it not right for other kinds of people?
PE10C. Who do you think would benefit most from ?
Social Marketing Research Item Bank 35
PE11. How easy/difficult do you think it would be/is it/was it for you to ?
PE11A. What would make/makes/made it easy/difficult to do?
PE11B. What would make it easier?
PE11C. How likely would you be to ?
PE11D. Have you ever in the past?
PE11E. What are the barriers to ?
PE11F. What would make easier?
PE12. What is your reaction to ?
PE12A. What makes you react in that way?
PE12B. What could improve your reaction?
PE13. How does make you feel?
PE13A. What about makes you feel that way?
PE13B. What could be done to improve the way you feel about it?
PE14. When it comes to what (if anything) do you
agree/disagree with?
PE15. How believable is to you?
PE15A. What makes it believable/unbelievable?
PE15B. What would make it more believable?
PE16. How would it/does it make you feel to know that is involved with ?
PE16A. How do you think the government/HHS/CMS should be involved?
PE16B. What do you think it would mean for the government/HHS/CMS to be involved?
PE16C. How do you think the involvement of the government/HHS/CMS will affect ?
PE16D. What advantages would there be to the government/HHS/CMS being involved?
PE16E. What disadvantages would there be to the government/HHS/CMS being involved?
PE16F. Who should be involved?
Preferences
PR1. Which do you ?
PE1A. What is it that makes you feel like that about it?
PE1B. What made you choose that over other items?
PE1C. What did you like less about ?
PR2. What do you like most/least about ?
PE2A. What makes you feel that way about it?
PR3. What other words can be used to describe ?
PR4. What is your impression of
PR4A. What gives you that impression?
PR5A. How could this be changed to improve your impression?
Social Marketing Research Item Bank 36
PR5. How does of make you feel?
PR5A. What is it that makes you feel that way?
PR6. What was most/least appealing about ?
PE13A. What made that appealing/unappealing?
PE13B. What could make it more appealing?
PR7. Looking at these , which one
do you find most/least ?
PR7A. What is it that makes it most/least ?
PR7B. What could make it more ?
Usability
US1. Using this , please try to .
US1A. Tell me what you are doing as you go through the process.
US1B. How easy/difficult was it to ?
US2B. Do you feel that you were successful in ?
US2C. What was the easiest/most difficult part of ?
US2D. What could have made that task easier?
US2E. How likely is it that you would use this to if you had to do it just like you
did now?
US2F. How (if at all) have you ever done in the past?
US2G. Was harder or easier to do with than how you did it before?
US2H. What made easier/harder today?
US2. How likely would you be to use this to ?
Sources of Information
SOI1. Have you ever looked for information about ?
SOI1AHow have you gone about looking for/trying to get information about/getting answers to
?
SOI1B. Where have you found the most useful information?
SOI1C. How often do you pick up information about from ?
SOI1D. How do you choose where to go for information about ?
SOI2. Have you ever used/how likely would you be to use to
find out about ?
SOI2A. How useful was ?
SOI2B. What could have made it more useful?
SOI2C. Were you able to find the information you needed?
SOI2D. How confident were you that the information you found was correct?
Social Marketing Research Item Bank 37
SOI3. What sources of information do you trust most/least for information about ?
SOI3A. What makes for a trusted source of information?
SOI3B. How trustworthy do you think is for information about ?
SOI3C. What organizations do you trust most?
SOI4. Is this the type of you would expect to come from the government/HHS/CMS?
SOI4A. What makes you feel that way?
SOI5. Where would you expect to see information about ?
SOI5A. Where would you like to be able to see/get information about ?
SOI5B. In what format would you like to see/get information about
General Questions
G1. Please tell me more about why you say .
G2. Please share any suggestions you have for improving of .
G3. What, if anything did you learn from ?
G4. Where would you go to find/what would you enter into a search engine to find
?
G5. What questions do you have about ?
G5A. Where would you go/what would you do to get answers?
Activities
ACT1. {Distribute written materials) Please read this information about and circle the words or
phrases that and put a line through the
words of phrases that
ACT1A. (Going over what was circled/lined) What made you this word/phrase?
ACT1B. What could make this word/phrase more