Pre and Post Interview/Focus Group Surveys

6/21/2021

Qualtrics Survey Software

OMB CONTROL NUMBER: XXXX-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0703-XXXX, is estimated to average 10 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. Send comments
regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to
comply with a collection of information if it does not display a currently valid OMB control number.

demographics
What is your age in years?
Age

What is your rank?

Please describe your current marital status:
Not dating or in a relationship
Dating but not exclusively
Dating exclusively for less than 6 months
Dating exclusively for more than 6 months
Engaged
Separated/Divorced
Married
Other
Prefer not to answer

What sex were you assigned at birth, on your original birth certificate?
Male
Female
Prefer not to answer

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How would you describe your current gender?
Male
Female
Transgender, male to female
Transgender, female to male
Not listed, please specify
Prefer not to answer

Do you consider yourself to be Hispanic or Latino (Please check only one)
Yes
No

What is your race? (Please check one or more)
American Indian or Alaska Native
Asian
Black or African American
O Native Hawaiian or Other Pacific Islander
O White

Do you consider yourself to be:
Heterosexual or straight
Gay or Lesbian
Bisexual
Something else, please specify
Prefer not to answer

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Thinking about your entire life, how many sex partners have you had?

Who have you EVER had sex with?
Men only
Women only
Both men and women
I have not had sex
Prefer not to answer

Are you currently involved in any programs to address concerns relating to alcohol use?
(i.e., AA, treatment, other support groups)?
Yes
No
Prefer not to answer

Are you currently involved in any efforts to support sexual harassment and assault
awareness and prevention above and beyond required trainings (i.e., Command resiliency
teams, community groups)?
Yes
No
Prefer not to answer

audit-c

How often did you have a drink containing alcohol in the past year?
Never
Monthly or less
2 to 4 times a month
2 to 3 times a week

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4 or more times a week

How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?
None, I do not drink
1 or 2 drinks
3 or 4 drinks
5 or 6 drinks
7 or 9 drinks
10 or more drinks

How often did you have six or more drinks on one occasion in the past year?
Never
Less than monthly
Monthly
Weekly
Daily or almost daily

demographics continued
How much do you identify with:
0 (Not at all)

1

2

3

4

5

6
(Completely)

The typical female Sailor
The typical male Sailor

Is there another sub-population or group of Sailors that you identify with more?
Yes
No
Prefer not to answer

Which sub-population or group do you identify with more?
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What feedback do you have for making the intervention more helpful or applicable for
Sailors like you?

Generally speaking, what other feedback do you have that might be important for us to
know?

How comfortable were you viewing this intervention?

Very uncomfortable

Moderately
uncomfortable

Slightly
uncomfortable

Neither
comfortable nor
uncomfortable

Slightly
comfortable

Moderately
comfortable

Very comfortable

Moderately helpful

Very helpful

How distressing did you find the intervention content?
Extremely distressing

Quite a bit
distressing

Moderately distressing

A little bit
distressing

Not at all distressing

O

How helpful did you find the intervention content?
Very unhelpful

Moderately
unhelpful

Slightly unhelpful

Neutral

Slightly helpful

How comfortable do you think other Sailors would be viewing this intervention?
Very uncomfortable

Moderately

Slightly

Neither

Slightly

Moderately

Very comfortable

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uncomfortable

uncomfortable

comfortable nor
uncomfortable

comfortable

comfortable

How distressing do you think the intervention content would be for Sailors?
Extremely distressing

Quite a bit
distressing

Moderately distressing

A little bit
distressing

Not at all distressing

O

How helpful do you think the intervention content would be for Sailors?
Very unhelpful

Moderately
unhelpful

Slightly unhelpful

Neutral

Slightly helpful

Moderately helpful

Very helpful

What do you think was missing from the intervention content that Sailors in the military
should know about?

IMI value/usefulness subscale & questions about interest and importance
For each of the following statements, please indicate how true it is for you, using the
following scale:
1 (Not true
at all)

2

3

4
(Somewhat
true)

5

6

7 (Very true)

I believe this activity could be
of some value to me.
I think that doing this activity is
useful.
I think this is important to do.
I would be willing to do this
again because it has some
value to me.
I think this activity could help
me.
I believe doing this activity
could be beneficial to me.
I think this is an important
activity.

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For each of the following statements, please indicate how true it is for you, using the
following scale:
1 (Not true
at all)

2

3

4
(Somewhat
true)

5

6

7 (Very true)

I am interested in doing this
intervention.
I think other Sailors would be
interested in doing this
intervention.
I think this intervention is
important.
I think other Sailors would think
this intervention is important.

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