Form Approved
OMB No. 0920-0920
Exp. Date 11/30/21
Data Collection Through Web Based Surveys for Evaluating Act Against AIDS Social Marketing Campaign Phases Targeting Consumers
Attachment 3
Sample Survey Items
CDC estimates the average public reporting burden for this collection of information as 30 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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, SD-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0920).
SECTION 1: CAMPAIGN EXPOSURE
SCRIPT: We’d now like to ask you some questions about some campaign advertising that you may or may not have seen over the past 12 months [Self-reported exposure to specific AAA campaigns]
1.1 Please complete the following sentence if you have heard or seen this campaign.
Let’s _________ HIV ________.
Start ________. Stop ________.
Doing ___.
HIV Treatment ________.
[INSERT FILL IN HERE]
1.2 In the past 12 months, did you see or hear the following campaign slogans or messages? Check all that apply.
|
Yes |
No |
Don’t know/ Can’t recall |
Prefer not to answer |
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1 |
2 |
8 |
9 |
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1 |
2 |
8 |
9 |
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1 |
2 |
8 |
9 |
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8 |
9 |
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8 |
9 |
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8 |
9 |
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1 |
2 |
8 |
9 |
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1 |
2 |
8 |
9 |
1.3 You said you saw or heard a(n) [INSERT CAMPAIGN] campaign slogan or message. On a scale of 0 to 5, where 0 means ‘not very effective’ and 5 means ‘very effective’, how effective do you think this campaign slogan or message is at getting you to [Insert behavior]?
Not Very Effective 0 |
1 |
2 |
3 |
4 |
Very Effective 5 |
Prefer not to answer |
1 |
2 |
3 |
4 |
5 |
6 |
9 |
1.4 In the past 12 months, how often did you see or hear the following campaign slogans or messages?
[INSERT CAMPAIGN SLOGAN/MESSAGE AND IMAGE]
1 Very often
2 Often
3 Sometimes
4 Rarely
5 Never
9 Prefer not to answer
SECTION 2: CAMPAIGN AD RECEPTIVITY
[Message Receptivity]
SCRIPT: The following questions are about advertisements or ads related to [Insert topic]. First you will be shown some potential messages for a [Insert topic] campaign and asked some questions. Next, you will be shown the ads and asked some additional questions. Then you will be asked some questions about potential logos for a campaign.
[PROGRAMMER: ROTATE ORDER OF MESSAGES]
SCRIPT: We are going to show you [insert number] messages that might appear in an ad about [Insert topic]. Some messages may look similar, but each message is different.
2.1 Tell us how strongly you disagree or agree with the following as a message to include in an ad about [Insert topic]:
Message 1
|
Strongly agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Prefer not to answer |
1. Overall, I liked this message. |
1 |
2 |
3 |
4 |
5 |
9 |
2. [INSERT descriptor] |
1 |
2 |
3 |
4 |
5 |
9 |
Please explain what, if anything, you liked about this message. ____
[DO NOT FORCE RESPONSE]
How would you change the message to make it better? ___
[DO NOT FORCE RESPONSE]
[REPEAT FOR REMAINING MESSAGES]
Please rank these messages from 1-[insert number]. Drag and drop the message that motivates you the most to [Insert behavior] in the box on the right. Your first choice should be on top, followed by your second choice underneath it, and so on. If you want to change your response, move the ad back to its original location on the left or drag it above or below another ad.
Rank (1–[insert number]) |
Message |
|
Message 1 |
|
Message 2 |
|
Message 3 |
9 Prefer not to answer
[Ad Receptivity]
SCRIPT: Now we are going to show you some ads that could be part of a campaign about [Insert topic]. We will show the ads to you in a collage format and ask you some questions after each grouping.
[ROTATE the order of concepts. For concepts with multiple executions, participants will rate only one execution. Executions will be rotated. They will be shown the alternative(s) AFTER the rating/ranking exercise and asked to choose their favorite.]
2.5. Please tell us how much you agree or disagree with each of the following statements about the ad.
Perceived Effectiveness Scale |
Strongly agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
9 |
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1 |
2 |
3 |
4 |
5 |
9 |
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Please explain what, if anything, was offensive. ____
[DO NOT FORCE RESPONSE]
How would you change the ad to make it better? ___
[DO NOT FORCE RESPONSE]
Please rank these ads from 1-[insert number]. Drag and drop the group of ads that motivates you the most to [Insert here] in the box on the right. Your first choice should be on top, followed by your second choice underneath it, and so on. If you want to change your response, move the ad back to its original location on the left or drag it above or below another ad.
Rank (1–[insert number]) |
Ad |
|
[INSERT CONCEPT NAME] |
|
[INSERT ADDITIONAL CONCEPT NAMES] |
9 Prefer not to answer
[Execution Testing]
SCRIPT: Now we are going to show you different versions of one of the ads you just saw. Please look at the new version, which is on the left, and compare it to the version of the ad you saw before, which is on the right.
Select which version of the ad would most motivate you to [Insert here]. [Executions shown side by side]
Why did you select this version?__________________
[DO NOT FORCE RESPONSE]
[REPEAT FOR ALL EXECUTIONS. ROTATE EXECUTIONS]
[Logo Testing]
2.11 Now we would like to show you a logo that could be used on the ads you just saw and ask you a few questions.
|
Strongly agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
9 |
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1 |
2 |
3 |
4 |
5 |
9 |
SECTION 3: THEORETICAL CONSTRUCTS
[NORMS]
Please tell us how much you agree or disagree with each of the following statements.
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Strongly agree |
Agree |
Neither agree nor disagree |
Disagree |
Strongly disagree |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
9 |
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1 |
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4 |
5 |
9 |
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[Self-Efficacy]
3.2 Please tell us how much you agree or disagree with the following statement: I am confident that I can [Insert here].
1 Strongly agree
2 Agree
3 Neither agree nor disagree
4 Disagree
5 Strongly disagree
9 Prefer not to answer
3.3 How easy or hard would it be for you to [Insert behavior] if you…
|
Very Easy |
Easy |
Neither easy nor hard |
Hard |
Very hard |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
9 |
[ATTITUDES]
3.4 Please answer the following questions by choosing the answer that best describes your opinion.
|
Very Impor-tant |
Some-what impor-tant |
Neither impor-tant nor unimpor-tant |
Some-what unimpor-tant |
Very unimpor-tant |
Prefer not to answer |
a. Having access to [Insert here] is… |
1 |
2 |
3 |
4 |
5 |
9 |
b. Taking better care of my sexual partner is… |
1 |
2 |
3 |
4 |
5 |
9 |
c. Keeping myself healthy is… |
1 |
2 |
3 |
4 |
5 |
9 |
d. Doing things to help my future is… |
1 |
2 |
3 |
4 |
5 |
9 |
e. Knowing my HIV status is… |
1 |
2 |
3 |
4 |
5 |
9 |
f. [Insert here] |
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[BEHAVIORAL BELIEFS]
3.5 Please tell us how much you agree or disagree with each of the following statements:
[Insert behavior here]…
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Strongly agree |
Agree |
Neither agree or disagree |
Disagree |
Strongly disagree |
Prefer not to answer |
a. …will help me stay strong. |
1 |
2 |
3 |
4 |
5 |
9 |
b. …will help me make informed decisions. |
1 |
2 |
3 |
4 |
5 |
9 |
c. …will help me take better care of my sexual partner. |
1 |
2 |
3 |
4 |
5 |
9 |
d. …keeps me healthy. |
1 |
2 |
3 |
4 |
5 |
9 |
e. …will help my future. |
1 |
2 |
3 |
4 |
5 |
9 |
f. …is fast, free, and confidential. |
1 |
2 |
3 |
4 |
5 |
9 |
g. …is important for my health. |
1 |
2 |
3 |
4 |
5 |
9 |
h. …is something everyone should do in their lifetime. |
1 |
2 |
3 |
4 |
5 |
9 |
i. …[Insert here]. |
1 |
2 |
3 |
4 |
5 |
9 |
[INTENTIONS]
3.6 Please tell us how likely or unlikely it is that you intend to...
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Very likely |
Somewhat likely |
Neither likely nor unlikely |
Somewhat unlikely |
Very unlikely |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
9 |
SECTION 4: COMMUNICATION
4.1 In the past 12 months, have you had a conversation about [Insert topic] with any of the following people?
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Yes |
No |
Don’t know/ Can’t recall |
Prefer not to answer |
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1 |
2 |
3 |
9 |
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1 |
2 |
3 |
9 |
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9 |
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3 |
9 |
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9 |
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9 |
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9 |
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9 |
SECTION 5: INFORMATION SEEKING/ MEDIA USE
[MEDIA USE]
SCRIPT: The next question is about sources you would want to go to for health related information.
5.1 Please tell us from which of the following sources you’d be most interested in getting health information. (Select up to 10)
|
Top 10 |
a. Doctor’s office or community health clinic |
1 |
b. Community center |
1 |
c. Church |
1 |
d. Community health fair |
1 |
e. Sporting event |
1 |
f. Night club |
1 |
g. Coffee shop |
1 |
h. Health club or gym |
1 |
i. Advertisements in shopping malls |
1 |
j. Government service offices (e.g. social services, DMV) |
1 |
k. College campuses |
1 |
p. Newspaper |
1 |
q. Magazine |
1 |
r. Radio advertisement |
1 |
s. Television advertisement |
1 |
t. Billboard |
1 |
u. Bus or train stop advertisement |
1 |
v. Social networking sites or mobile app (e.g. Facebook, Twitter) |
1 |
w. Dating or hook up sites or mobile app (e.g. Match, Adam4Adam) |
1 |
x. Text message to your cell phone |
1 |
y. Health websites |
1 |
9 Prefer not to answer
SCRIPT: The next several questions are about different media you may use.
5.2 In an average month, how often do you…
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Daily |
2 -5 Times a Week |
Once a Week |
2-3 Times a Month |
Once a Month |
Less than Once a Month |
Never |
Prefer not to answer |
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9 |
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Please list what dating/hook-up sites or mobile apps you use. ____
[DO NOT FORCE RESPONSE]
[HIV/AIDS INFORMATION SEEKING BEHAVIOR]
5.4 In the past 12 months, about how often have you seen [or heard] HIV/AIDS-related ads on…?
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Very often |
Often |
Some-times |
Rarely |
Never |
Don’t know/ Can’t recall |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
8 |
9 |
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8 |
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8 |
9 |
5.5 In the past 12 months, how often have you…
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Very often |
Often |
Some-times |
Rarely |
Never |
Don’t know/ Can’t recall |
Prefer not to answer |
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1 |
2 |
3 |
4 |
5 |
8 |
9 |
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1 |
2 |
3 |
4 |
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8 |
9 |
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8 |
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[trust in cdc]
Please tell us if you agree or disagree with the following statement: I trust the Centers for Disease Control, or CDC, as a source for HIV information.
1 Strongly agree
2 Agree
3 Neither agree nor disagree
4 Disagree
5 Strongly disagree
9 Prefer not to answer
SECTION 6: HIV PERCEPTIONS
[PERCEPTION OF HIV AS A PROBLEM]
On a scale from 1 to 10, where 1 is the least important and 10 is the most important, how would you rate the importance of HIV as a health problem facing the nation today?
INSERT SLIDER 1- least important to 10- most important
9 Prefer not to answer
[Perceived risk of HIV infection]
Thinking about the sex you’ve had over the past 12 months, do you consider yourself to be low, medium or high risk for getting HIV?
1 Low risk
2 Medium risk
3 High risk
9 Prefer not to answer
SECTION 7: HIV PREVENTION STRATEGIES
7.1 In the past 12 months, how often did you use condoms for vaginal or anal sex with a non-main/casual partner? (A non-main or casual sexual partner is someone who you do not consider to be a spouse, significant other, or life partner.)
1 Always
2 Usually
3 Occasionally
4 Never
5 Not Applicable: I have not had a non-main/casual partner in the past 12 months.
9 Prefer not to answer
7.2 True or false: There are medicines available to treat HIV.
1 True
2 False
8 Don’t know
9 Prefer not to answer
7.3 Before today, have you ever heard of people who do not have HIV taking HIV medicines (PrEP or Truvada) before sex, to keep from getting HIV?
1 Yes
2 No
9 Prefer not to answer
7.4 Before today, have you ever heard of people who do not have HIV taking HIV medicines (PEP or post-exposure prophylaxis) after sex, to keep from getting HIV?
1 Yes
2 No
9 Prefer not to answer
7.5 True or false: If a person’s viral load is “undetectable”, they are cured and no longer have HIV.
1 True
2 False
8 Don’t know
9 Prefer not to answer
7.6 In the past 12 months, have you taken HIV medicines (PEP or post-exposure prophylaxis) after sex because you thought it would keep you from getting HIV?
1 Yes
2 No
9 Prefer not to answer
7.7 In the past 12 months, have you taken HIV medicines (PrEP or Truvada) before sex because you thought it would keep you from getting HIV?
1 Yes
2 No
9 Prefer not to answer
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Boudewyns, Vanessa |
| File Modified | 0000-00-00 |
| File Created | 2021-11-17 |