Att 3_Web-Based Survey

Form Approved

OMB No. 0920-1182

Expiration Date 5/31/2020

Formative Research to Develop HIV Social Marketing Campaigns for Healthcare Providers

Attachment 3: Web-Based Survey

Public reporting burden of this collection of information is estimated to average 15 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 (0920-1182).

Thank you for your participation in this survey. Here we will ask you questions about your practice, professional development activities, information needs, use of different forms of media to communicate health information to your patients, and the types of health information you discuss with your patients.

For this first set of questions, we recognize that many physicians split their time between private practices (individual or group) and practices that are public or university based. For the following question, please provide responses for both these practice types as applicable to your own practice of medicine. Please use your best estimate.

		Private Practice	Public or University Based Practice
Number of patients you see in a month.		______	______
Number of HIV-positive patients you see in a month.		______	______
What percent of your patients are male? (Please use your best estimate)		______	______
What percent of your patients are female? (Please use your best estimate)		______	______
What percent of your patients identify as transgender? (Please use your best estimate)		______	______
[INSERT patient descriptor here]		______	______

7. Which medical associations do you belong to? Please select one or more of the following associations. [MARK ALL THAT APPLY]

1. American Academy of Family Physicians (AAFP)

2. American College of Physicians (ACP)

3. American Medical Association (AMA)

4. National Medical Association (NMA)

5. HIV Medicine Association (HIVMA)

6. American Academy of HIV Medicine (AAHIVM)

7. Infectious Diseases Society of America (IDSA)

8. American Congress of Obstetricians and Gynecologists (ACOG)

9. International AIDS Society (IAS)

10. American College of Physicians (ACP)

11. Association of Nurses in AIDS Care (ANAC)

12. World Professional Association for Transgender Health (WPATH)

13. Gay and Lesbian Medical Association (GLMA)

14. National Hispanic Medical Association (NHMA)

15. American Nurses Association (ANA)

16. National Hispanic Medical Association

17. National Association of Hispanic Nurses

18. National Black Nurses Association

19. [INSERT MEDICAL ASSOCIATION HERE]

20. Other [Specify:_________________]

21. None of these

Information Needs

8. Would you be interested in receiving information about…

	Yes	No
Reducing HIV transmission
Retention in HIV care or treatment
Initiating antiretroviral therapy (ART)
Communicating about ART medication adherence (e.g., patient compliance)
Conducting HIV screening
Conducting other STD screening
Partner services
Screening for risky sexual behaviors
Screening for risky alcohol and illicit drug use behaviors
Helping patients modify risky sexual behaviors
Helping patients modify alcohol and illicit drug use
Helping patients with HIV self-testing
Providing culturally-competent care to transgender patients
Providing patient-centered care
Initiating pre-exposure prophylaxis (PrEP)
[INSERT TOPIC HERE]

Use of Electronic Media

9. How often do you do the following for professional purposes?

	Daily	Weekly	Monthly	Less than once per month	Never
Use an app on a portable device, such as an iPod/iPad
Download content to a portable device, such as an iPod, cell phone, or PDA
Access content online, such as a medical journal article
Access Medical blogs, such as those available through Medscape or Sermo
Access CMEs online
Use social media, like Twitter or Facebook
Listen to podcasts
[INSERT ACTIVITY HERE]

Patient resources

9. Do you refer your patients to …?

	Yes	No
Your practice’s website
CDC’s website
Other websites (specify)________________________________
Other electronic resources (specify)_______________________
Printed materials
[INSERT RESOURCE HERE]
Other (specify)_______________________________________

Continuing Medical Education (CME)/Continuing Education (CE)

9. How do you obtain CME/CE credits?

Attending conferences
Through employer-provided in-service trainings
Dinner presentations by local chapter of a professional association
Attending meetings of a regional professional association
Journal supplement education programs
Through online courses
[INSERT DELIVERY MODE HERE]
Other (specify) ______________________________________

9. How useful are CME/CE programs about [HIV care, treatment, and prevention/INSERT TOPIC OR FOCUS]?

Never useful
Rarely useful
Somewhat useful
Always useful

9. Have you ever learned about the following topics through a CME/CE course or program?

   	Yes	No
   Reducing HIV transmission
   Retention in HIV care or treatment
   Initiating ART
   Communicating about ART medication adherence (e.g., patient compliance)
   Conducting HIV screening
   Conducting other STD screening
   Partner services
   Screening for risky sexual behaviors
   Screening for risky alcohol and illicit drug use behaviors
   Helping patients modify risky sexual behaviors
   Helping patients modify alcohol and illicit drug use
   Helping patients with HIV self-testing
   Providing culturally-competent care to transgender patients
   Providing patient-centered care
   Initiating pre-exposure prophylaxis (PrEP)
   [INSERT TOPIC HERE]

10. Would you be interested in CME/CE courses or programs about the following topics?

	Yes	No
Reducing HIV transmission
Retention in HIV care or treatment
Initiating ART
Communicating about ART medication adherence (e.g., patient compliance)
Conducting HIV screening
Conducting other STD screening
Partner services
Screening for risky sexual behaviors
Screening for risky alcohol and illicit drug use behaviors
Helping patients modify risky sexual behaviors
Helping patients modify alcohol and illicit drug use
Helping patients with HIV self-testing
Providing culturally-competent care to transgender patients
Providing patient-centered care
Initiating pre-exposure prophylaxis (PrEP)
[INSERT TOPIC HERE]

14A. Of the CME/CE courses or programs that you are interested in, please indicate your top three choices:

1. ______________________________________

2.______________________________________

3. _____________________________________

Communicating with Patients about Risk Behaviors

9. What challenges, if any, prevent you from having discussions regarding high-risk sexual or substance use behaviors with your HIV-infected patients? [MARK ALL THAT APPLY]

   Lack of time
   Cultural differences between you and your patient
   Gender differences between you and your patient
   Lack of trust/relationship with patient
   Lack of skills or training in this area
   Patients are uncomfortable discussing the subject
   I am uncomfortable discussing the subject
   [INSERT CHALLENGE HERE]
   Other (specify) ______________________________
   There are no challenges to such discussion that I can identify

10. Please think about all of your patients, aged 13 – 64, and indicate which category best describes how often you typically do the following:

	Always	Very often	Sometimes	Rarely	Never
Ask patients if they are sexually active
Ask patients if they are engaging in unsafe sex
Recommend consistent and correct condom use to patients during all sexual activity
Refer newly diagnosed HIV patients to appropriate care or treatment
Talk with patients about HIV screening
Talk with patients about PrEP
[INSERT ACTIVITY HERE]

HIV Screening

9. Which one of the following statements most accurately reflects your beliefs about effective HIV prevention?

1. Risk-based HIV screening is the most effective approach

2. HIV screening for all persons age 13 to 64 is the most effective approach

3. HIV screening is a public health concern and not an issue in my clinical practice

9. Which one of the following best describes HIV screening in your practice?

1. Opt-In, where patients must explicitly agree to an HIV test

2. Opt-Out, where patients must explicitly decline an HIV test

3. Other (Specify) ____________________

9. Does CDC recommend HIV screening for all patients ages 13 – 64?

1. Yes

2. No

3. Don’t know

9. In your practice, is HIV self-testing considered part of routine testing

1. Yes

2. No

9. Which of the following are patient benefits of HIV testing?

1. Knowledge of status

2. Reduction of risky behaviors (e.g. unprotected sex)

3. Reduced risk of transmitting HIV to others

4. Cost effectiveness

5. [INSERT BENEFIT HERE]

6. All of the above

7. None of the above

9. To what extent do you agree with the following statements?

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
Routine HIV screening of patients can help to prevent transmission of HIV.
I have the necessary training to counsel my patients about reducing their risk of HIV transmission.
[INSERT STATEMENT HERE]

Thank you for completing this survey.

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