Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers

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0990-0379 SurveyMonkeyQuestionnaire_Updated_12-9-21

Customer Feedback on Previously Developed Health Messaging to Promote Vaccination Among Older African American Community Health Workers

OMB: 0990-0379

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PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Form Approved
OMB No. 0990-0379
Exp. Date 09/30/2020

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PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Introduction
Welcome and thank you for participating! We are interested in working together with you to increase vaccine uptake among nonHispanic Black and African American adults in the United States who are aged 50 years and older. Vaccines are an important public
health tool, but not enough adults are using them to stay healthy. We look forward to your opinions and input!
This survey is voluntary and anonymous. The survey should take no longer than 20 minutes. The survey is being administered by the
Office of Regional Health Operations in the Office of the Assistant Secretary for Health, part of the U.S. Department of Health and
Human Services. To learn more about us, click here.

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
* 1. I identify as Hispanic.
Yes
No

* 2. I identify as:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other

* 3. How old are you?
18-49
50-59
60-69
70+

* 4. Do you identify yourself as a Community Health Worker (a frontline public health worker who is a trusted
member of and/or has a close understanding of the community served)? Examples of a Community Health
Worker could include health ambassadors, champions for health, peer navigators, promotores, community
health advisors, peer health educators, or other roles.
A. Yes
B. No
C. I don't know

* 5. What is your gender?
Male
Female
Other
I prefer not to answer

* 6. What state or territory do you live in?

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
We will ask you several questions about your attitudes and beliefs on health issues and health
messages. There are no wrong answers, and we want to know your opinions.
* 7. Please indicate how strongly you agree or disagree with the following statements.
Strongly
Disagree

Disagree

Neutral

Agree

Strongly Agree

Don't know

I am aware of the
shingles disease.
Shingles is a serious
disease.
I am worried about
getting shingles.
I can easily avoid getting
shingles.
I am aware of
pneumonia.
Pneumonia is a serious
disease.
I am worried about
getting pneumonia.
I can easily avoid getting
pneumonia.
Vaccines are not very
important.
I stay current with my
vaccinations.
Vaccines help me stay
healthy.
Vaccines are safe and
effective.

* 8. Have any of the following factors ever prevented you from getting vaccinated?
Yes

Not Sure

Distance to a vaccine
clinic
Cost
Concerns about side
effects
Not trusting that the
vaccine is safe
Lack of information
about the vaccine
Someone (family
member, friend, etc.) told
me not to get it
Other factors (please describe)

* 9. Have you ever not gotten a vaccine because you felt like you didn’t need it?
Yes
No
Not Sure

* 10. Who do you trust the most to provide accurate health information? Choose only one.
Doctor or physician
Community leader
Nurse
Family member
Internet sources
News media
Faith-based leader
Other (please specify):

* 11. Why do you trust this person or information source?

* 12. Please rank whom you trust to provide accurate health messages to your community, with a rank of 1
meaning most trustworthy and 7 meaning least trustworthy. Each ranking number may only be used once.

Doctor or physician

Community leader

Nurse

Family member

Internet sources

News media

Faith-based leader

13. Please share any other trustworthy person(s) not listed above in question 12.

* 14. How important is it that the person providing accurate health messages be Black or African American?
Not at all important
Not very important
Neutral
Somewhat important
Very important

* 15. How important is it that the person providing accurate health messages be a person of color?
Not at all important
Not very important
Neutral
Somewhat important
Very important

* 16. What is the best method for sharing health information in your community? Choose only one.
Print Materials (e.g., brochures)
Social Media
Digital Ad on a Website
TV
Radio
Other (please specify):

Thank you for answering these questions. The next set of questions will ask about your perspective on health messages related to
shingles and pneumonia.

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
We want you to tell us how you feel about the following messages, and how the messages impact the
way you think about shingles and getting vaccinated.

* 17. Based on the messages you just read, how much do you agree or disagree with the following
statements?
Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I understand these
messages.
I understand where to
get the vaccine.
These messages
are believable.
These messages
motivate me to get a
vaccine.
These messages are
relevant to me and my
cultural background.
I would remember these
messages if I saw them
in a advertisement.
Please share anything you liked or disliked about this message.

* 18. Based on the message you just read, how much do you agree or disagree with the following statements?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I understand this
message.
I liked this message.
This message is
believable.
This message motivates
me to get a vaccine.
This message is relevant
to me and my cultural
background.
I would remember this
message if I saw it in a
advertisement.
Please share anything you liked or disliked about the message.

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Next, we want to share with you several messages about pneumonia. We want you to tell us how you
feel about the messages, and how the messages impact the way you think about pneumonia or
getting vaccinated.

* 19. Based on the message you just read, how much do you agree or disagree with the following statements?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

* 20. Based on the message you just read, how much do you agree or disagree with the following statements?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

I understand this
message.
I understand where to
get the vaccine.
This message is
believable.
This message motivates
me to get a vaccine.
This message is relevant
to me and my cultural
background.
I would remember this
message if I saw it in a
advertisement.
Please share anything you liked or disliked about the message.

* 21. Based on the message you just read, how much do you agree or disagree with the following statements?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Next, we want to share with you a general message about vaccines. We want you to tell us how you
feel about the message, and how the message impacts the way you think about getting vaccinated.

* 22. Based on the message you just read, how much do you agree or disagree with the following statements?

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Finally, we would like to ask you a few questions about how messages like these might impact COVID19 vaccine uptake among Black and African American adults aged 50 and older in your community.
* 23. How much do you agree or disagree with the following statements?
Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

A relatable story should
be included in COVID-19
vaccine messaging.
Messages should
include data or statistics.
Customizing messages
to be specific to the
Black and African
American population is
important.
Images should reflect
Black and African
American men and
women
Images that reflect
adults aged 50 years
and older are best.

PILOT - HHS Health Messaging: Tailored Messaging to Address Racial and Ethnic Disparities in
Adult Immunizations
Thank you for taking the time to complete this survey.

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