Attachment 6: Introductory Questions
Introductory Questions
Form Approved
OMB No. 0920-0572
Expiration Date: xx-xx-xxxx
(Questions can be used for Central Location Intercept Interviews, Telephone Interviews, Individual In-depth Interviews [Cognitive Interviews], Focus Group Screeners, and Focus Groups.)
Have you ever looked for health information from any source?
Yes
No
When you looked for health information, where did you go?
Books
Brochures, pamphlets, etc.
Organization
Family
Friend/Co-Worker
Health care provider
Internet
Library
Magazines
Telephone information number (1-800-Number)
Complementary or alternative practitioner
Other: _________________________
Do not look or go anywhere
The most recent time you looked for information was it for
Yourself
Someone else you care for or take care of, such as a spouse/partner, child, parent, relative, or friend
Both?
In general, how much would you trust information about health or medical topics from a doctor or health care professional? Would you say a lot, some, a little, or not at all?
A lot
Some
A little
Not at all
In general, how much would you trust information about health or medical topics? Would you say a lot, some, a little, or not at all?
How about from family and friends?
How about in newspapers or magazines?
How about on the radio?
How about on the Internet?
How about on television?
How about from charitable organizations?
How about religious organizations and leaders?
How about from government health agencies?
[IF NEEDED: Government health agencies include the National Institutes of Health, the Centers for Disease Control and Prevention, and state and local health departments.]
In general, how much would you trust information about health or medical topics? Would you say a lot, some, a little, or not at all? GRID FORMAT, ROTATE A-D.
A lot Some A little Not at all
1 2 3 4
Family and friends
Charitable organizations
Religious organizations and leaders
Government health agencies
Think about the most recent time you looked up information on [INSERT health topic or behavior] from any source. About how long ago was that?
Days ago
Weeks ago
Months ago
Years ago
Never
What type of information were you looking for in your most recent search?
Organizations that focus on the [INSERT health condition/disease/syndrome/injury/disability]
Causes or risk factors for [INSERT health condition/disease/syndrome/injury/disability]
Coping or dealing with [INSERT health condition/disease/syndrome/injury/disability]
Diagnosis of [INSERT health condition/disease/syndrome/injury/disability]
Information on [INSERT health condition/disease/syndrome/injury/disability]
Paying for medical care/insurance
Prognosis/recovery from [INSERT health condition/disease/syndrome/injury/disability]
Screening/testing/early detection of [INSERT health condition/disease/syndrome/injury/disability]
Symptoms of [INSERT health condition/disease/syndrome/injury/disability]
Treatment/cures for [INSERT health condition/disease/syndrome/injury/disability]
Where to get medical care for [INSERT health condition/disease/syndrome/injury/disability]
Information on complementary alternative or unconventional treatments for [INSERT health condition/disease/syndrome/injury/disability]
Other: __________________________
What type of information were you looking for in your most recent search? Please check all that apply. MULTIPLE MENTION, ROTATE 1-4.
Information on [INSERT health topic/behavior/condition/disease/syndrome/injury/disability]
Help for [INSERT health condition/disease/syndrome/injury/disability]
Where to get medical care for [INSERT health condition/disease/syndrome/injury/disability]
Medication for [INSERT health condition/disease/syndrome/injury/disability]
Information on complementary alternative or unconventional treatments for [INSERT health condition/disease/syndrome/injury/disability]
Other (Please specify):_______________________________________
The next few questions are about various ways you might get health information.
Some newspapers or general magazines publish a special section that focuses on health. In the past 12 months, have you read health sections of the newspaper or of a general magazine?
Yes
No
Some local television and radio news programs include special segments of the newscasts that focus on health issues. In the past 12 months, have you watched or listened to health segments on the local news?
Yes
No
Some people notice information about health on the Internet, even when they are not trying to find out about a health concern they have or someone in the family may have. Have you read such health information on the Internet in the past 12 months?
Yes
No
Here are some ways people use the Internet for health information. Some people have done these things, but other people have not. In the past 12 months, have you done the following things while using the Internet?
Bought medicine or vitamins on-line?
Participated in an on-line support group for people with a similar health or medical issue?
Used Email or the Internet to communicate with a doctor or a doctor’s office?
Used a Web site to help you with your diet, weight, or physical activity?
Looked for a healthcare provider?
Downloaded information to a portable device, such as an iPod, cell phone, or PDA?
Visited a “social networking” site, such as “My Space” or “Facebook”?
Wrote in an online diary or “blog” (i.e., Web log)?
Kept track of personal health information, such as care received, test results, or upcoming medical appointments?
Listened to a pod or web cast about health information?
About how often do you use the Internet?
Several times a day
About once a day
3-5 days a week
1-2 days a week
Every few weeks
Less often
Never
Don’t know/refused
As I read the following list of items, please tell me if you, personally, happen to have each one, or not.
A desktop computer
A laptop computer
A cell phone
A personal digital device, like a Sidekick, Palm Pilot or Blackberry
An iPod or other MP3 player
Have you heard about [INSERT health topic/campaign]?
What can you tell me about [INSERT health topic/campaign]?
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Demographic |
| Author | Angela Ryan |
| File Modified | 0000-00-00 |
| File Created | 2021-09-01 |