0920-XXXX GAOS Consumer Pre-Campaign Web Survey

Attachment C: GAOS Consumer Pre-Campaign Screener and Survey

Form Approved

OMB No. 0920-XXX

Expiration Date XX/XX/XXXX

gaos consumer pre-campaign SCREENER [ALL]

Consumer Audiences

• Cancer patients and their caregivers

• Patients who survived severe COVID-19 or sepsis and their caregivers 

• Parents of children 12 and younger 

• Adults who care for a family member age 65+ 

• Men aged 65+ with one or more chronic conditions 

• Healthy adults 65+ 

General Instructions for Programmer

1. Hide all subheadings of sections and questions from respondents.

2. Hide all programmer’s instructions from respondents.

3. For questions with the “Select all that apply” option, do not allow respondents to select any other option if they select “Prefer not to say,” “Do not know/cannot recall,” “Not sure,” “Nothing,” or “None of the above.”

4. Terminate also means ineligible.

5. Terminate all eligible respondents immediately.

6. Present the “Ineligibility Message” whenever a response terminates the survey.

Thank you for participating in this survey. The results of this survey will help the Centers for Disease Control and Prevention (CDC) refine and improve its ongoing campaign promoting early recognition and timely treatment of sepsis.

Programmer: Include one question per page. Screener should terminate as soon as the respondent selects an option that deems him/her ineligible.

1. May we ask you some questions to see if you are eligible to take this survey?

• Yes

• No [INELIGIBLE/TERMINATE]

Programmer: If “No” to Q1, TERMINATE. If “Yes,” proceed to Q2. 

2. In what ZIP Code and State do you live? _____________________

Programmer: Targeted states include Illinois (IL), Louisiana (LA), and New York (NY)

Programmer: Approved ZIP Codes include XXXXX, XXXXX, XXXXX, etc. If not within one of the target states and approved ZIP Codes, TERMINATE, otherwise, proceed to Q3.

3. How old are you? _ _ years

• Prefer not to answer [INELIGIBLE/TERMINATE]

If the respondent is under 18 years of age, TERMINATE and present the INELIGIBILITY message.

If “Prefer not to answer,” TERMINATE.

If the respondent is eligible based on age, proceed to Q4.

4. What sex were you assigned at birth, on your original birth certificate?

• Male

• Female

• Refused

• I don’t know

5. Do you currently describe yourself as male, female, transgender?

• Male

• Female

• Transgender

• None of these

6. Are you currently the primary caregiver for a family member aged 65 years or older?

• Yes

• No

Programmer: If the respondent selects “Yes” to Q6 and age is between 18-64 years of age in Q3, categorize the respondent as “Adults who care for a family member age 65+ years.”

7. Are you the parent of at least one child who is 12 years old or younger?

• Yes

• No

Programmer: If the respondent selects “Yes” to Q7, proceed to Q8, else skip Q8.

8. Who in your family usually makes the healthcare decisions about your child(ren) who is(are) age 12 or younger regardless of where the child resides?

• Self

• Self and spouse/partner together

• Someone else

Programmer: If the respondent selects “Self” or “Self and spouse/partner together” and he/she is between 18-64 years of age, categorize respondent as “Parent of children 12 years or younger,” then proceed to Q9. If the respondent selects, “Someone else,” do not categorize but proceed to Q9.

9. What language do you primarily use at home (i.e., when speaking with friends or family)?

• English

• Spanish 

• English and Spanish equally

• Another language, please specify: _______________

• Prefer not to answer

10. What language do you primarily use when looking for, reading, or communicating about health information?

• English

• Spanish 

• English and Spanish equally

• Another language, please specify: ___________________________

• Prefer not to answer

11. Have you ever been hospitalized due to COVID-19?

• Yes 

• No 

Programmer: If the respondent selects “Yes,” categorize respondent as “COVID-19 survivor.”

12. Are you currently the primary caregiver for someone who was hospitalized due to COVID-19? 

• Yes 

• No 

Programmer: If the respondent selects “Yes,” categorize respondent as “Caretaker of COVID-19 survivor.”

13. Has a healthcare professional ever diagnosed you with sepsis?

• Yes 

• No 

Programmer: If the respondent selects “Yes,” categorize respondent as “Sepsis survivor.”

14. Are you currently the primary caregiver for someone who is a sepsis survivor or was diagnosed with sepsis by a healthcare professional? 

• Yes 

• No 

Programmer: If the respondent selects “Yes,” categorize respondent as “Caretaker of sepsis survivor.”

15. Has a healthcare professional ever diagnosed you with cancer?

• Yes 

• No 

Programmer: If the respondent selects “Yes” to Q15, proceed to Q16 else skip Q16.

16. Are you currently receiving treatment or recently completed treatment for cancer (e.g., chemotherapy, radiation, surgery, etc.)?

• Yes 

• No 

Programmer: If the respondent selects “Yes” to both Q15 and Q16, categorize respondent as “Cancer patient.”

17. Are you currently the primary caregiver for someone who is a cancer patient or was diagnosed with cancer by a healthcare professional? 

• Yes 

• No 

Programmer: If the respondent selects “Yes” to Q17, proceed to Q18, else skip Q18.

18. Are you currently the primary caregiver for someone who is currently receiving treatment for cancer or who in the past 12 months, completed treatment for cancer (e.g., chemotherapy, radiation, surgery, etc.)?

• Yes 

• No 

Programmer: If the respondent selects “Yes” to Q17 and/or Q18, categorize respondent as “Caregiver of a cancer patient.”

19. Has a healthcare professional ever diagnosed you with a chronic medical condition (e.g., diabetes, lung disease, cancer, kidney disease, etc.)?

• Yes

• No

• Do not know [INELIGIBLE]

Programmer: If the respondent selects “No” to Q19, skip Q20, else proceed to Q20 if “Yes.”

20. Has a healthcare professional ever told you that you have one of the following chronic medical conditions? Select all that apply.

• Arthritis

• Chronic lung disease

• Diabetes

• Heart disease

• Immunosuppression (weakened immune system)

• Kidney disease

• Lung disease

• Stroke

• OTHER: __________________

• None of the above [INELIGIBLE]

Programmer: Do not allow respondents who select “None of the above” to select any other response.

Programmer: If the respondent selects “No” to Q19, and 65+ years of age, categorize respondent as “Healthy adults 65+”

Programmer: If respondent selects “None of the above,” TERMINATE.

If respondent selects “Arthritis,” “Cancer,” “Kidney disease,” “Chronic lung disease,” “Diabetes,” “Heart disease,” “Immunosuppression,” “Other,” and/or “Stroke” and is 65+ years of age, and male, categorize respondent as “Men 65+ with one or more chronic conditions.”

Programmer: If the respondent selects “Yes” to Q15 and/or Q16, skip Q21.

21. How would you rate your overall physical health?

• Excellent

• Very good

• Good

• Fair

• Poor

22. Do you, your spouse/partner, or any other member of your household currently or in the past work for/as:

	Yes	No
A market research company (involved in doing surveys, focus groups, interviews to understand trends, etc.)		
An advertising agency or public relations/marketing firm		
The media (TV/radio/newspapers/magazines)		
A healthcare setting or a health and wellness organization (e.g., doctor’s office, clinic, hospital, health department, fitness center)		
A healthcare professional (e.g., doctor, nurse, pharmacist, physician assistant, medical assistant, dietician, aid, sitter, social worker)		

Programmer: If the respondent selects “Yes” to any of the options, TERMINATE, else ELIGIBLE.

Categorize Respondents

Programmer: 

Categorize respondent as “Adults who care for a family member age 65+ years

• Q3 = 18-64 AND

• Q6 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Parents of children ≤ 12 years

• Q3 = 18-64 AND

• Q7 = Yes AND

• Q8 = Self or Self and spouse/partner together AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Patients who survived severe Covid-19

• Q11 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Caregivers of Patients who survived severe Covid-19”

• Q12 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Patients who survived sepsis”

• Q13 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Caregivers of Patients who survived sepsis”

• Q14 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Cancer patients”

• Q15 = Yes AND

• Q16 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Caregivers of Cancer patients”

• Q17 = Yes AND/OR

• Q18 = Yes AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Healthy adults 65+”

• Q3 = 65+ AND

• Q19 = No AND

• Q9 = English AND

• Q10 = English

Categorize respondent as “Men aged 65+ with one or more chronic conditions ”

• Q3 = 65+ AND

• Q5 = Male AND

• Q19 = Yes AND/OR

• Q20 = Arthritis, Cancer, Chronic kidney disease, Chronic lung disease, Diabetes, Heart disease, Immunosuppression, Other, and/or Stroke

• Q9 = English AND

• Q10 = English

Programmer: If a respondent does not fall into one of the above categories TERMINATE and display the “Ineligibility message,” else display the “Proceed to Survey Message.”

Eligible/Proceed to Survey Message

Thank you for answering the screening questions. We have determined that you are eligible to proceed to with this survey. If you have any questions, please contact [name] at [email] or call phone number [number] or [number].

Please click on “Proceed to Survey” and answer the questions to the best of your ability.

Ineligibility Message 

Thank you for your willingness to participate in this survey. Unfortunately, you are not eligible to proceed with the survey. If you have any questions, please contact [name] at [email] or call phone number [number] or [number].

Thank you for your time. Please click on “Exit Survey” to exit.

GAOS consumer pre-campaign survey

Exposure to Campaign [ALL]

Programmer: Include one question per page.

Now we would like to ask you about a CDC campaign to raise awareness about a medical condition called sepsis that you may or may not have seen or heard about in the past 12 months.

23. Please indicate below whether you have seen or heard any of the following campaign names or slogans in the past 12 months.

Programmer: Rotate Q23 (a - e), the column named “Campaigns” among respondents.

Campaigns	Yes	No	Do not know/cannot recall
Be Smart. Beat Sepsis.			
Be Sepsis Aware			
Health is Precious. Don’t Get Sepsis.			
Get Ahead of Sepsis			
Know the Threat. Prevent Sepsis.			

24. I n the past 12 months, have you heard this slogan and/or seen this logo?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q23d and “Yes” or “Do not know/cannot recall to Q24, classify as “Exposed” and proceed to the FREQUENCY AND CHANNEL OF EXPOSURE section.

If the respondent selects “Do not know/cannot recall” to Q23d and “Yes” to Q24, classify as “Exposed” and proceed to the FREQUENCY AND CHANNEL OF EXPOSURE section.

If the respondent selects “No” or “Do not know/cannot recall” to Q23d and “No” or “Do not know/cannot recall” to Q24, classify as “Unexposed” and proceed to the KNOWLEDGE section. After the quota of unexposed has been met for each target group then TERMINATE.

Frequency and Channel of Exposure [EXPOSED ONLY]

Programmer: Include one question per page.

You indicated that you had seen or heard the campaign name, Get Ahead of Sepsis, or seen the campaign logo in the past 12 months.

25. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Poster, Fact sheet, Brochure, etc.).

Printed Media	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Poster						
Fact sheet						
Brochure						
Graphic						
Newspaper/magazine advertisement						
Flyer						
Other print media, please specify: ______________________						

26. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo on …?

Programmer: Rotate the media options (Facebook, Instagram, Twitter, etc.).

Social Media	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Facebook						
Instagram						
Twitter						
LinkedIn						
YouTube						
Other social media, please specify: ______________________						

27. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo on …?

Programmer: Rotate the media options (Online/Internet Media).

Online/Internet Media	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Health websites /resources (e.g., WebMD, Mayo Clinic)						
Website advertisements						
Online news articles						
Streaming TV/video services (e.g., Hulu, Netflix, [Amazon] Prime Video)						
Streaming Internet radio						
Blogs						
Advertisements on mobile phone (including mobile apps)						
Search engines (e.g., Google)						
Other websites, please specify: ______________________						

28. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo on …?

Programmer: Rotate the media options (TV and Radio Media).

TV and Radio Media	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Television (cable, satellite, or antenna)						
Broadcast radio						
Other media formats, please specify: ______________________						

29. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Public Places).

Public Places	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Billboards						
Bus, train, or subway stations						
On buses or taxi cabs						
Advertisement in mall						
Advertisement in a grocery store						
Advertisement in a store pharmacy						
Advertisement at a shopping center or parking lot						
Other public locations, please specify: ______________________						

30. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Healthcare Settings).

Healthcare Settings	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Videos/commercials shown at doctor’s offices or healthcare facilities						
Other healthcare locations, please specify: ______________________						

31. In the past 12 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Other Media).

Other Media	1-2 times a day	Once a week	1-3 times a month	Less than once a month	Never	Do not know/ cannot recall
Emails or e-newsletters						
Podcast
Webcasts or webinars						
Live events						
Other media, please specify: ______________________						

Programmer: If the respondent selects “Never” and/or “Do not know/cannot recall” as responses to ALL options from Q25 - Q31, proceed with Q32 (open-ended question), else skip Q32.

32. You indicated that you saw or heard the campaign name, Get Ahead of Sepsis, or saw the campaign logo in the past 12 months. Where did you see or hear it?

[open-ended response]

Programmer: If the respondent selects "Never or “Do not know/cannot recall" for ALL options in Q25-Q31, and left Q32 blank, reclassify these respondents as “Unexposed” and proceed to KNOWLEDGE section.

If respondent selects “1-2 times a day,” “Once a week,” “1-3 times a month,” or “Less than once a month” for any of the options in Q25-Q31 and filled in Q32 with more than just N/A or NONE, classify as “Exposed” and proceed to KNOWLEDGE section.

Knowledge [ALL]

Programmer: Include one question per page. RIGHT/WRONG responses have been indicated but do not disclose to respondents.

33. Sepsis is defined as the following:

Programmer: Rotate response options; keep the placement of “None of the above,” “All of the above,” and “Do not know” as is.

• A chronic condition that primarily affects kidney function [WRONG]

• The body’s extreme response to an infection [RIGHT]

• A neurological disorder resulting from the flu [WRONG]

• Contagious illness that commonly peaks in the winter [WRONG]

• All of the above [WRONG]

• None of the above [WRONG]

• Do not know [WRONG]

34. Sepsis is a medical emergency.

• TRUE [RIGHT]

• FALSE [WRONG]

35. Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis.

• TRUE [RIGHT]

• FALSE [WRONG]

36. Infections do not put you or your loved one at risk for a life-threatening condition called sepsis.

• TRUE [WRONG]

• FALSE [RIGHT]

37. When germs get into a person’s body, they can cause an infection. If that infection is not stopped, it can cause sepsis.

• TRUE [RIGHT]

• FALSE [WRONG]

38. Which of the following types of infections, if any, are OFTEN linked with sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “None of the above,” “All of the above,” and “Do not know” as is.

• Ear [WRONG]

• Skin [RIGHT]

• Lung [RIGHT]

• Eye [WRONG]

• Urinary tract [RIGHT]

• Nail [WRONG]

• Gastrointestinal tract [RIGHT]

• Severe COVID-19 [RIGHT]

• All of the above [WRONG]

• None of the above [WRONG]

• Do not know [WRONG]

39. Which of the following groups of individuals are at higher risk for developing infections than can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “None of the above,” “All of the above,” and “Do not know” as is.

• Adults 65 or older [RIGHT]

• People with weakened immune systems [RIGHT]

• People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease [RIGHT]

• Children younger than one year old [RIGHT]

• People who have previously survived sepsis [RIGHT]

• People with recent severe illness or hospitalization [RIGHT]

• Adults with no underlying conditions between the ages of 20 and 35 years [WRONG]

• Do not know [WRONG]

• None of the above [WRONG]

Programmer: If respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.

40. Check all the signs and symptoms of sepsis below:

Programmer: Rotate response options; keep placement of “I do not know any of the signs and symptoms of sepsis”

• Excessive hunger [WRONG]

• Clammy or sweaty skin [RIGHT]

• Confusion or disorientation [RIGHT]

• Extreme pain or discomfort [RIGHT]

• Fever, shivering, or feeling very cold [RIGHT]

• High heart rate or low blood pressure [RIGHT]

• Shortness of breath [RIGHT]

• I do not know any of the signs and symptoms of sepsis. [WRONG]

Programmer: If respondent selects “I do not know any of the signs and symptoms of sepsis,” do not allow them to select other responses.

41. If you or your loved one has an infection that is not getting better or is getting worse, you should ACT FAST and get medical care IMMEDIATELY.

• Yes [RIGHT]

• No [WRONG]

42. Which of the following activities, if any, should you do to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “None of the above,” “All of the above,” and “Do not know” as is.

• Regular handwashing [RIGHT]

• Showering twice daily [WRONG]

• Getting recommended vaccines [RIGHT]

• Avoiding public restrooms [WRONG]

• Keeping cuts and wounds clean and covered until healed [RIGHT]

• Taking good care of chronic conditions [RIGHT]

• All of the above [WRONG]

• None of the above [WRONG]

• Do not know [WRONG]

Programmer: If respondent selects “All of the above” or “None of the above,” do not allow them to select other responses.

Attitudes and Beliefs [ALL]

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Caregivers of Cancer Patients

Programmer: Use the following section for “Caregivers of cancer patients.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis about family members. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please answer the following questions about the cancer patient(s) for whom you are currently the primary caregiver and indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree. 

43. [Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The cancer patient(s) I care for, is/are at risk of developing infections that could lead to sepsis.
The cancer patient(s) I care for, is/are at risk of developing sepsis.
44. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If the cancer patient(s) I care for developed sepsis, it could cause severe problems, such as tissue damage and organ failure.
If the cancer patient(s) I care for developed sepsis, it could lead to death.
45. [Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I help the cancer patient(s) I care for, take proper care of their chronic condition(s) (if the cancer patient has them), this will decrease their chances of developing infections that can lead to sepsis.
If I help the cancer patient(s) I care for, practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.
If I help the cancer patient(s) I care for, keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.
If the cancer patient(s) I care for gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.
Fast recognition of the signs and symptoms of sepsis can increase the chances of survival for the cancer patient(s) I care for.
Fast recognition and treatment of infections can reduce the chance of getting sepsis for the cancer patient(s) I care for.
I should help the cancer patient(s) I care for, seek immediate medical care if they have an infection that is not getting better/getting worse.
46. [Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can help the cancer patient(s) I care for prevent infections that can lead to sepsis.
I am confident that I can help the cancer patient(s) I care for talk to a healthcare professional if they have an infection that is not getting better or is getting worse.
I am confident that I can help the cancer patient(s) I care for recognize the signs and symptoms of sepsis.
I am confident that I can help the cancer patient(s) I care for seek immediate medical care if I/they suspect sepsis.

Cancer Patients

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Cancer patients.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

47.[Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
48. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
49. [Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I take proper care of my health, this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
50. [Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Caregivers of Sepsis or Severe Covid-19 Survivor(s)

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Caregivers of sepsis or severe Covid-19 survivors.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis about family members. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please answer the following questions about the sepsis or severe Covid-19 survivor(s) for whom you are currently the primary caregiver and indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree. 

51.[Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
The sepsis or severe COVID-19 survivor I care for, is at risk of developing infections that could lead to sepsis.
The sepsis or severe COVID-19 survivor I care for, is at risk of developing sepsis.
52. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If the sepsis or severe COVID-19 survivor I care for developed sepsis, it could cause severe problems, such as tissue damage and organ failure.
If the sepsis or severe COVID-19 survivor I care for developed sepsis, it could lead to death.
53. [Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I help the sepsis or severe COVID-19 survivor I care for take proper care of their chronic condition(s) (if the sepsis or severe COVID-19 survivor has them), this will decrease their chances of developing infections that can lead to sepsis.
If I help the sepsis or severe COVID-19 survivor I care for practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.
If I help the sepsis or severe COVID-19 survivor I care for, keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.
If my sepsis or severe COVID-19 survivor gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.
Fast recognition of the signs and symptoms of sepsis can increase my sepsis or severe COVID-19 survivor’s chances of survival.
Fast recognition and treatment of infections can reduce my sepsis or severe COVID-19 survivor’s chance of getting sepsis.
I should help the sepsis or severe COVID-19 survivor I care for, seek immediate medical care if they have an infection that is not getting better/getting worse.
54.[Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can help the sepsis or severe COVID-19 survivor I care for, prevent infections that can lead to sepsis.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for, talk to a healthcare professional if they have an infection that is not getting better or is getting worse.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for, recognize the signs and symptoms of sepsis.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for seek immediate medical care if I/they suspect sepsis.

Sepsis or Severe COVID-19 Survivors

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Sepsis or severe COVID-19 survivors.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

55. [Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
56. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
57.[Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I take proper care of my health, this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
58. [Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Parent of Children 12 years and younger

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Parent of children ≤ 12 years old.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please answer the following questions about YOUR CHILD/CHILDREN WHO IS 12 YEARS OLD OR YOUNGER for whom you currently make healthcare decisions and indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

59.[Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
My child is at risk of developing infections that could lead to sepsis.					
My child is at risk of developing sepsis.					
60. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If my child developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If my child developed sepsis, it could lead to death.					
61. [Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I take proper care of my child’s chronic condition(s) (if my child has them), this will decrease their chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my child’s chances of developing infections that can lead to sepsis.					
If I keep my child’s cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.					
If my child gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my child’s chances of survival.					
Fast recognition and treatment of infections can reduce my child’s chances of getting sepsis.					
I should seek immediate medical care for my child if they have an infection that is not getting better or is getting worse.					
62. [Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis in my child.					
I am confident that I can talk to a healthcare professional if my child has an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis in my child.					
I am confident that I can seek immediate medical care if I suspect sepsis in my child.					

Adults who care for a Family Member Age 65+

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Adults who care for a family member age 65+."

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please answer the following questions about the FAMILY MEMBER AGED 65 YEARS OR OLDER (family member) for whom you are currently the primary caregiver and indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

63. [Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
My family member is at risk of developing infections that could lead to sepsis.					
My family member is at risk of developing sepsis.					
64. [Perceived Severity]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If my family member developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If my family member developed sepsis, it could lead to death.					
65. [Perceived Benefits]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
If I help my family member take proper care of their chronic condition(s) (if my family member has them), this will decrease their chances of developing infections that can lead to sepsis.					
If I help my family member practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.					
If I help my family member keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.					
If my family member gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my family member’s chances of survival.					
Fast recognition and treatment of infections can reduce my family member’s chances of getting sepsis.					
I should help my family member seek immediate medical care if they have an infection that is not getting better or is getting worse.					
66. [Self-Efficacy]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am confident that I can help my family member prevent infections that can lead to sepsis.					
I am confident that I can help my family member talk to a healthcare professional if they have an infection that is not getting better or is getting worse.					
I am confident that I can help my family member recognize the signs and symptoms of sepsis.					
I am confident that I can help my family member seek immediate medical care if I/they suspect sepsis.					

Men aged 65+ with one or more Chronic Conditions and Healthy Adults 65+

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question. NOTE**Subheadings within all tables should not be visible to respondents.

Programmer: Use the following section for “Healthy adults 65+” and “Men 65+ with one or more chronic conditions.”

Next, we are going to ask you some questions to learn more about your perspective on infections and sepsis. Please give us your honest responses.

We would like to provide you with a definition for sepsis to assist you in answering the following questions:

Anyone can get an infection, and almost any infection, including COVID-19, can lead to sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency. Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

Programmer: Do not show Q69a to Health adults 65+. Show to “Men 65+ with one or more chronic conditions.”

67.[Perceived Susceptibility]	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
68. [Perceived Severity]	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
69. [Perceived Benefits]	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
[Programmer: Do not show this question to Health adults 65+. Show to “Men 65+ with one or more chronic conditions] If I take proper care of my chronic condition(s), this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
70. [Self-Efficacy]	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Behavior [ALL]

Caregivers of a Cancer Patient

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Caregivers of a cancer patient.”

Please answer the following questions about the Cancer patient(s) for whom you are currently the primary caregiver. 

71. In the past 12 months, how often did you speak with the healthcare professionals of the cancer patient(s) you care for, or help them to speak with their healthcare professionals about the following? 

	Never	Rarely	Sometimes		Often	Always	Do not know/   cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19
Sepsis
Who is at risk for sepsis
Signs and symptoms of sepsis
How to seek immediate medical care if you suspect sepsis
How to prevent infections that can lead to sepsis

 

72. What are the barriers that make it hard for you to have conversations/help the cancer patient(s) you care for have conversations about how to prevent infections that can lead to sepsis?  Select all that apply. 

• I am not familiar enough with these topics. 

• I do not understand these topics. 

• I am not interested in these topics. 

• I do not have time to educate myself about these topics. 

• I do not think sepsis is a problem for the cancer patient(s) I care for.  

• I do not think infections that can lead to sepsis are a big problem for the cancer patient(s) I care for.

• The cancer patient(s) I care for does not have a healthcare professional with whom I can discuss these topics. 

• I feel frightened or worried when I talk about these topics.  

• Other, please explain: ____________________________________________________________ 

• I do not have any barriers to having conversations about these topics. 

• Do not know/cannot recall 

• Prefer not to answer 

73. Did the cancer patient(s) you care for get a flu vaccine for the 2022-2023 flu season? 

• Yes  

• No 

• Do not know 

74. What are the barriers that make it hard for you to prevent infections that can lead to sepsis in the cancer patient(s) you care for? Select all that apply.

• I am not able to get to a doctor with the cancer patient(s) I care for, to discuss the steps needed to prevent infections that can lead to sepsis. 

• I am afraid to see a doctor or nurse with the cancer patient(s) I care for because I am worried about getting COVID-19 or the cancer patient getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for the cancer patient(s) I care for. 

• I am not familiar enough with how to prevent infections that can lead to sepsis in the cancer patient(s) I care for. 

• I do not know if the cancer patient(s) I care for need to get any vaccinations. 

• I do not want the cancer patient(s) I care for to get vaccinations. 

• I do not think it is possible for me to prevent infections that can lead to sepsis in the cancer patient(s) I care for.

• I do not think sepsis is a problem for the cancer patient(s) I care for.  

• I do not think infections that can lead to sepsis are a problem for the cancer patient(s) I care for. 

• I do not think it is important to prevent infections that can lead to sepsis in the cancer patient(s) I care for.  

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis in the cancer patient(s) I care for. 

• The health of the cancer patient(s) I care for makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis. 

• I’m not confident the healthcare system in the area where the cancer patient(s) I care for reside can respond correctly to sepsis.

• I’m not confident the healthcare professionals in the area where the cancer patient(s) I care for reside can respond correctly to sepsis.

• The cancer patient(s) I care for lives very far from healthcare services.

• The cancer patient(s) I care for does not have easy access to healthcare services.

• The cancer patient(s) I care for relies on telehealth services.

• Other, please explain: ____________________________________________________________ 

• I have not encountered any barriers to preventing infections that can lead to sepsis in the cancer patient(s) I care for.

• I do not try to prevent infections that can lead to sepsis in the cancer patient(s) I care for. 

• Do not know/cannot recall 

• Prefer not to answer 

75. In the last 12 months, have you looked for information about infections that can lead to sepsis for the cancer patient(s) you care for?  

• Yes 

• No 

• Do not know/cannot recall 

Programmer: If the respondent selects “Yes” to Q76, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Cancer Patients

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Cancer patients”.

76. Think about the visits you have had with healthcare professionals over the past 12 months. These include both in-person and telehealth visits. During these visits, how often did you speak with your healthcare professionals about the following?

Programmer: Include “Did not visit a healthcare professional for an illness in the past 12 months” as one option for all of a–f (merged cell).

	Never	Rarely		Sometimes	Often	Always	Do not know/ cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19								
Sepsis							
Who is at risk for sepsis							
Signs and symptoms of sepsis							
How to seek immediate medical care if you suspect sepsis							
How to prevent infections that can lead to sepsis							

77. What are the barriers that make it hard for you to have conversations with your healthcare professional about how to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Do not know/cannot recall,” “Prefer not to answer,” “Other,” and “I do not have any barriers to having conversations about these topics” as is.

• I am not familiar enough with these topics.

• I do not understand these topics.

• I am not interested in these topics.

• I do not have time to educate myself about these topics.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not have a healthcare professional with whom I can discuss these topics.

• I feel frightened or worried when I talk about these topics.

• Other, please explain: _______________________________________

• I do not have any barriers to having conversations about these topics.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I do not have any barriers to having conversations about these topics,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

78. Did you get a flu vaccine for the 2022-2023 flu season?

• Yes

• No

79. What are the barriers that make it hard for you to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” “I do no try to prevent infections…,” and “I have not encountered any barriers to preventing infection…” as is.

• I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.

• I am afraid to see a doctor or nurse because I am worried about getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.

• I am not familiar enough with how to prevent infections that can lead to sepsis.

• I do not know if I need to get any vaccinations.

• I do not want to get vaccinations.

• I do not think it is possible for me to prevent infections that can lead to sepsis.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not think it is important to prevent infections that can lead to sepsis.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis.

• My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.

• I’m not confident the healthcare system in my area can respond correctly to sepsis.

• I’m not confident the healthcare professionals in my area can respond correctly to sepsis.

• I live very far from healthcare services.

• I don’t have easy access to healthcare services.

• I rely on telehealth services.

• Other, please explain: ________________________________________________________

• I have not encountered any barriers to preventing infections that can lead to sepsis.

• I do not try to prevent infections that can lead to sepsis.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I have not encountered any barriers to preventing infections that can lead to sepsis,” “I do not try to prevent infections that lead to sepsis,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

80. In the last 12 months, have you looked for information about infections that can lead to sepsis?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q81, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Caregivers of Sepsis or Severe Covid-19 Survivor(s)

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Caregivers of Sepsis or Severe Covid-19 Survivor.”

Please answer the following questions about the survivor(s) of sepsis or severe COVID-19 for whom you are currently the primary caregiver. 

81. In the past 12 months, how often did you speak with healthcare professionals of the survivor of sepsis or severe COVID-19 you care for, or help them to speak with their healthcare professionals about the following? 

	Never	Rarely	Sometimes	Often	Always	Do not know/   cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19
Sepsis
Who is at risk for sepsis
Signs and symptoms of sepsis
How to seek immediate medical care if you suspect sepsis
How to prevent infections that can lead to sepsis

 

82. What are the barriers that make it hard for you to have conversations/help the survivor of sepsis or severe COVID-19 you care for have conversations about how to prevent infections that can lead to sepsis? Select all that apply. 

• I am not familiar enough with these topics. 

• I do not understand these topics. 

• I am not interested in these topics. 

• I do not have time to educate myself about these topics. 

• I do not think sepsis is a problem for the sepsis or severe COVID-19 survivor I care for.  

• I do not think infections that can lead to sepsis are a problem for the sepsis or severe COVID-19 survivor I care for. 

• The sepsis or severe COVID-19 survivor I care for does not have a healthcare professional with whom I can discuss these topics. 

• I feel frightened or worried when I talk about these topics.  

• Other, please explain: ____________________________________________________________ 

• I do not have any barriers to having conversations about these topics. 

• Do not know/cannot recall 

• Prefer not to answer 

83. Did the sepsis or severe COVID-19 survivor you care for get a flu vaccine for the 2022-2023 flu season? 

• Yes  

• No 

• Do not know 

84. What are the barriers that make it hard for you to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 you care for? Select all that apply.

• I am not able to get to a doctor with the survivor of sepsis or severe COVID-19 I care for to discuss the steps needed to prevent infections that can lead to sepsis. 

• I am afraid to see a doctor or nurse with the survivor of sepsis or severe COVID-19 I care for because I am worried about getting COVID-19 or the survivor of sepsis or severe COVID-19 getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for the survivor of sepsis or severe COVID-19 I care for. 

• I am not familiar enough with how to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.

• I do not know if the survivor of sepsis or severe COVID-19 I care for needs to get any vaccinations. 

• I do not want the survivor of sepsis or severe COVID-19 I care for to get vaccinations. 

• I do not think it is possible for me to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.

• I do not think sepsis is a problem for the survivor of sepsis or severe COVID-19 I care for.  

• I do not think infections that can lead to sepsis are a problem for the survivor of sepsis or severe COVID-19 I care for. 

• I do not think it is important to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.

• The health of the sepsis or severe COVID-19 survivor I care for makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis. 

• I’m not confident the healthcare system in the area where the sepsis or severe COVID-19 survivor I care for can respond correctly to sepsis.

• I’m not confident the healthcare professionals in the area where the sepsis or severe COVID-19 survivor I care for can respond correctly to sepsis.

• The sepsis or severe COVID-19 survivor I care for lives very far from healthcare services.

• The sepsis or severe COVID-19 survivor I care for do not have easy access to healthcare services.

• I rely on telehealth services.

• Other, please explain: ____________________________________________________________ 

• I have not encountered any barriers to preventing infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.

• I do not try to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for. 

• Do not know/cannot recall 

• Prefer not to answer 

85. In the last 12 months, have you looked for information about infections that can lead to sepsis for the survivor of sepsis or severe COVID-19 you care for?  

• Yes 

• No 

• Do not know/cannot recall 

Programmer: If the respondent selects “Yes” to Q86, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Sepsis or Severe COVID-19 Survivors

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Sepsis or sever COVID-19 survivors”.

86. Think about the visits you have had with healthcare professionals over the past 12 months. These include both in-person and telehealth visits. During these visits, how often did you speak with your healthcare professionals about the following?

Programmer: Include “Did not visit a healthcare professional for an illness in the past 12 months” as one option for all of a–f (merged cell).

	Never	Rarely		Sometimes	Often	Always	Do not know/ cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19								
Sepsis							
Who is at risk for sepsis							
Signs and symptoms of sepsis							
How to seek immediate medical care if you suspect sepsis							
How to prevent infections that can lead to sepsis							

87. What are the barriers that make it hard for you to have conversations with your healthcare professional about how to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Do not know/cannot recall,” “Prefer not to answer,” “Other,” and “I do not have any barriers to having conversations about these topics” as is.

• I am not familiar enough with these topics.

• I do not understand these topics.

• I am not interested in these topics.

• I do not have time to educate myself about these topics.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not have a healthcare professional with whom I can discuss these topics.

• I feel frightened or worried when I talk about these topics.

• Other, please explain: _______________________________________

• I do not have any barriers to having conversations about these topics.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I do not have any barriers to having conversations about these topics,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

88. Did you get a flu vaccine for the 2022-2023 flu season?

• Yes

• No

89. What are the barriers that make it hard for you to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” “I do no try to prevent infections…,” and “I have not encountered any barriers to preventing infection…” as is.

• I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.

• I am afraid to see a doctor or nurse because I am worried about getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.

• I am not familiar enough with how to prevent infections that can lead to sepsis.

• I do not know if I need to get any vaccinations.

• I do not want to get vaccinations.

• I do not think it is possible for me to prevent infections that can lead to sepsis.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not think it is important to prevent infections that can lead to sepsis.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis.

• My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.

• I’m not confident the healthcare system in my area can respond correctly to sepsis.

• I’m not confident the healthcare professionals in my area can respond correctly to sepsis.

• I live very far from healthcare services.

• I don’t have easy access to healthcare services.

• I rely on telehealth services.

• Other, please explain: ________________________________________________________

• I have not encountered any barriers to preventing infections that can lead to sepsis.

• I do not try to prevent infections that can lead to sepsis.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I have not encountered any barriers to preventing infections that can lead to sepsis,” “I do not try to prevent infections that lead to sepsis,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

90. In the last 12 months, have you looked for information about infections that can lead to sepsis?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q91, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Parent of Children 12 years and Younger

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Parent of children ≤ 12 years old.”

Please answer the following questions about YOUR CHILD/CHILDREN WHO IS 12 YEARS OLD OR YOUNGER for whom you currently make healthcare decisions.

91. In the past 12 months, how often did you speak with your child’s healthcare professionals about the following?

	Never	Rarely	Sometimes	Often	Always	Do not know/ cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19							
Sepsis						
Who is at risk for sepsis						
Signs and symptoms of sepsis						
How to seek immediate medical care if you suspect sepsis						
How to prevent infections that can lead to sepsis						

92. What are the barriers that make it hard for you to have conversations about how to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” and “I do not have any barriers to having conversations about these topics” as is.

• I am not familiar enough with these topics.

• I do not understand these topics.

• I am not interested in these topics.

• I do not have time to educate myself about these topics.

• I do not think sepsis is a problem for my child.

• I do not think infections that can lead to sepsis are a problem for my child.

• My child does not have a healthcare professional with whom I can discuss these topics.

• I feel frightened or worried when I talk about these topics.

• Other, please explain: _________________________________________________

• I do not have any barriers to having conversations about these topics.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If the respondent selects “I do not have any barriers to having conversations about these topics,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

93. Did your child get a flu vaccine for the 2022-2023 flu season?

• Yes

• No

• Do not know

94. What are the barriers that make it hard for you to prevent infections that can lead to sepsis in your child? Select all that apply.

Programmer: Rotate response options; keep placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” “I do no try to prevent infections…,” and “I have not encountered any barriers to preventing infection…” as is.

• I am not able to get to a doctor with my child to discuss the steps needed to prevent infections that can lead to sepsis.

• I am afraid to see a doctor or nurse with my child because I am worried about getting COVID-19 or my child getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis in my child.

• I am not familiar enough with how to prevent infections that can lead to sepsis in my child.

• I do not know if my child needs to get any vaccinations.

• I do not want my child to get vaccinations.

• I do not think it is possible for me to prevent infections that can lead to sepsis in my child.

• I do not think sepsis is a problem for my child.

• I do not think infections that can lead to sepsis are a problem for my child.

• I do not think it is important to prevent infections that can lead to sepsis in my child.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis in my child.

• My child’s health or my own health make it hard for me to take all the steps needed to prevent infections that can lead to sepsis.

• I’m not confident the healthcare system in the area where my child lives can respond correctly to sepsis.

• I’m not confident the healthcare professionals in the area where my child lives can respond correctly to sepsis.

• My child lives very far from healthcare services.

• My child does not have easy access to healthcare services.

• My child relies on telehealth services.

• Other, please explain: ________________________________________________________

• I have not encountered any barriers to preventing infections that can lead to sepsis in my child.

• I do not try to prevent infections that can lead to sepsis in my child.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I have not encountered any barriers to preventing infections that can lead to sepsis in my child,” “I do not try to prevent infections that lead to sepsis in my child,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

95. In the last 12 months, have you looked for information about infections that can lead to sepsis for your child?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q96, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Adults who care for Family Member Age 65+

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Adults who care for a family member age 65+.”

Please answer the following questions about the FAMILY MEMBER AGE 65+ (family member) for whom you are currently the primary caregiver.

96. In the past 12 months, how often did you speak with your family member over 65+’s healthcare providers/help them to speak with their healthcare professionals about the following?

	Never	Rarely	Sometimes	Often	Always	Do not know/ cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19							
Sepsis						
Who is at risk for sepsis						
Signs and symptoms of sepsis						
How to seek immediate medical care if you suspect sepsis						
How to prevent infections that can lead to sepsis						

97. What are the barriers that make it hard for you to have conversations/help your family member age 65+ have conversations about how to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” and “I do not have any barriers to having conversations about these topics” as is.

• I am not familiar enough with these topics.

• I do not understand these topics.

• I am not interested in these topics.

• I do not have time to educate myself about these topics.

• I do not think sepsis is a problem for my family member.

• I do not think infections that can lead to sepsis are a problem for my family member.

• My family member does not have a healthcare professional with whom I can discuss these topics.

• I feel frightened or worried when I talk about these topics.

• Other, please explain: _________________________________________________________

• I do not have any barriers to having conversations about these topics.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I do not have any barriers to having conversations about these topics,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

98. Did your family member age 65+ get a flu vaccine for the 2022-2023 flu season?

• Yes

• No

• Do not know

99. What are the barriers that make it hard for you to prevent infections that can lead to sepsis in your family member who is age 65+? Select all that apply.

Programmer: Rotate response options; keep placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” “I do no try to prevent infections…,” and “I have not encountered any barriers to preventing infection…” as is.

• I am not able to get to a doctor with my family member to discuss the steps needed to prevent infections that can lead to sepsis.

• I am afraid to see a doctor or nurse with my family member because I am worried about getting COVID-19 or my family member getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for my family member.

• I am not familiar enough with how to prevent infections that can lead to sepsis in my family member.

• I do not know if my family member needs to get any vaccinations.

• I do not want my family member to get vaccinations.

• I do not think it is possible for me to prevent infections that can lead to sepsis in my family member.

• I do not think sepsis is a problem for my family member.

• I do not think infections that can lead to sepsis are a problem for my family member.

• I do not think it is important to prevent infections that can lead to sepsis in my family member.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis in my family member.

• My family member’s health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.

• I’m not confident the healthcare system in my area can respond correctly to sepsis.

• I’m not confident the healthcare professionals in my area can respond correctly to sepsis.

• I live very far from healthcare services.

• I don’t have easy access to healthcare services.

• I’m not confident the healthcare system in my family member’s area can respond correctly to sepsis.

• I’m not confident the healthcare professionals in my family member’s area can respond correctly to sepsis.

• My family member lives very far from healthcare services.

• My family member does not have easy access to healthcare services.

• My family member relies on telehealth services.

• Other, please explain: _________________________________________________________

• I have not encountered any barriers to preventing infections that can lead to sepsis in my family member.

• I do not try to prevent infections that can lead to sepsis in my family member.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I have not encountered any barriers to preventing infections that can lead to sepsis in my family member,” “I do not try to prevent infections that lead to sepsis in my family member,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

100. In the last 12 months, have you looked for information about infections that can lead to sepsis for your family member who is 65+?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q101, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Men aged 65+ with one or more Chronic Conditions and Healthy Adults 65+

Programmer: Include one question per page. Do not allow participants to go back and change their answer to a previous question.

Programmer: Use the following section for “Healthy adults 65+ and Men 65+ with one or more chronic conditions”.

101. Think about the visits you have had with healthcare professionals over the past 12 months. These include both in-person and telehealth visits. During these visits, how often did you speak with your healthcare professionals about the following?

Programmer: Include “Did not visit a healthcare professional for an illness in the past 12 months” as one option for all of a–f (merged cell).

	Never	Rarely		Sometimes	Often	Always	Do not know/ cannot recall	Did not visit a healthcare professional in past 12 months
Infections, including COVID-19								
Sepsis							
Who is at risk for sepsis							
Signs and symptoms of sepsis							
How to seek immediate medical care if you suspect sepsis							
How to prevent infections that can lead to sepsis							

102. What are the barriers that make it hard for you to have conversations with your healthcare professional about how to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “Do not know/cannot recall,” “Prefer not to answer,” “Other,” and “I do not have any barriers to having conversations about these topics” as is.

• I am not familiar enough with these topics.

• I do not understand these topics.

• I am not interested in these topics.

• I do not have time to educate myself about these topics.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not have a healthcare professional with whom I can discuss these topics.

• I feel frightened or worried when I talk about these topics.

• Other, please explain: _______________________________________

• I do not have any barriers to having conversations about these topics.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I do not have any barriers to having conversations about these topics,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

103. Did you get a flu vaccine for the 2022-2023 flu season?

• Yes

• No

104. What are the barriers that make it hard for you to prevent infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep placement of “Don’t know/cannot recall,” “Prefer not to answer,” “Other,” “I do no try to prevent infections…,” and “I have not encountered any barriers to preventing infection…” as is.

• I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.

• I am afraid to see a doctor or nurse because I am worried about getting COVID-19.

• I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.

• I am not familiar enough with how to prevent infections that can lead to sepsis.

• I do not know if I need to get any vaccinations.

• I do not want to get vaccinations.

• I do not think it is possible for me to prevent infections that can lead to sepsis.

• I do not think sepsis is a problem for me.

• I do not think infections that can lead to sepsis are a problem for me.

• I do not think it is important to prevent infections that can lead to sepsis.

• I do not have time to take all the steps needed to prevent infections that can lead to sepsis.

• My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.

• I’m not confident the healthcare system in my area can respond correctly to sepsis.

• I’m not confident the healthcare professionals in my area can respond correctly to sepsis.

• I live very far from healthcare services.

• I don’t have easy access to healthcare services.

• I rely on telehealth services.

• Other, please explain: ________________________________________________________

• I have not encountered any barriers to preventing infections that can lead to sepsis.

• I do not try to prevent infections that can lead to sepsis.

• Do not know/cannot recall

• Prefer not to answer

Programmer: If respondent selects “I have not encountered any barriers to preventing infections that can lead to sepsis,” “I do not try to prevent infections that lead to sepsis,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.

105. In the last 12 months, have you looked for information about infections that can lead to sepsis?

• Yes

• No

• Do not know/cannot recall

Programmer: If the respondent selects “Yes” to Q105, proceed to “SOURCES OF INFORMATION” section, else skip “SOURCES OF INFORMATION” section.

Sources of Information [ALL]

106. To whom or where did you go to learn about infections that can lead to sepsis? Select all that apply.

Programmer: Rotate response options; keep the placement of “Other” and “I have not tried to learn about sepsis” as is.

• My doctor/healthcare professional

• Pharmacist

• Health websites/Health-related mobile apps (e.g., WebMD, Mayo Clinic, etc.), please specify: _______________________________

• Centers for Disease Control and Prevention (CDC) website

• Health magazines (e.g., Women’s Health, Men’s Health, Prevention), please specify: ______________________________

• Family members and/or friends

• Newspapers, please specify: ___________________________

• Television, please specify: ___________________________

• Radio, please specify: _____________________________

• Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.), please specify: ______________________

• Other, please specify: ______________________________

• I have not tried to learn about sepsis

Programmer: If a respondent selects “I have not tried to learn about sepsis” do not allow them to select other responses.

107. If you need to get information about sepsis, where would you prefer to get it? Select all that apply.

Programmer: Rotate response options; keep the placement of “Other” and “Do not know/unsure” as is.

• My doctor/healthcare professional

• Pharmacist

• Health websites/health-related mobile apps (e.g., WebMD, Mayo Clinic, etc.), please specify: ___________________________________

• Centers for Disease Control and Prevention (CDC) website or materials

• Health magazines (e.g., Women’s Health, Men’s Health, Prevention), please specify:

• Family members and/or friends

• Other health groups/organizations (e.g., National Institutes of Health, American Cancer Society, etc.), Please specify: ____________________________________

• Media (e.g., television, radio, newspapers, health magazines, etc.), please specify: ________________________________________

• Television, please specify: ______________________

• Radio, please specify: __________________________

• Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.), please specify:

• Podcasts, please specify: ____________________________

• Blogs, please specify: ______________________________

• Other, please specify: ______________________________

• I do not need to get information about sepsis

• Do not know/unsure

Programmer: If a respondent selects “Do not know/unsure” do not allow them to select other responses.

108. How trusted do you feel CDC is as a source of sepsis information? 

• Very trusted

• Trusted

• Somewhat trusted

• A little trusted

• Not at all trusted

109. Did you know that CDC has a Get Ahead of Sepsis webpage with resources you can use to learn about sepsis?

• Yes

• No

Programmer: If respondent selects “Yes” to Q110 proceed to Q111, else proceed to the DEMOGRAPHIC CHARACTERISTICS section.

110. How did you learn about CDC’s Get Ahead of Sepsis resources? Select all that apply.

Programmer: Rotate response options; keep placement of “Other” and “Do not know/cannot recall” as is.

• My doctor/healthcare provider’s office

• Health websites/health-related mobile apps (e.g., WebMD, Mayo Clinic)

• Centers for Disease Control and Prevention (CDC) website

• Family members and/or friends

• Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.)

• Other, please specify: ______________________________

• Do not know/cannot recall

Programmer: If a respondent selects “Do not know/unsure” do not allow them to select other responses.

111. In the past 12 months, did you talk with family or friends about how almost any infection can lead to sepsis?  

	Yes	No
Family members
Friends

112. In the past 12 months, did you talk with family or friends about signs and symptoms of sepsis?  

	Yes	No
Family members
Friends

113. In the past 12 months, did you talk with family or friends about who is at risk for sepsis?  

	Yes	No
Family members
Friends

114. In the past 12 months, did you talk with family or friends about sepsis being a medical emergency?  

	Yes	No
Family members
Friends

Demographic Characteristics [ALL]

Thank you. Now we would like to know more about you.

115. What is your ethnicity?

• Hispanic or Latino

• Not Hispanic or Latino

116. What is your race?

• American Indian or Alaska Native

• Asian  

• Black or African American  

• Native Hawaiian or Other Pacific Islander  

• White 

117. What is the highest degree you have received? Please select only one.

Programmer: If a respondent selects “Prefer not to answer” do not allow them to select other responses.

• Some high school

• High school graduate (or equivalent)

• Some college or technical school (1–4 years, no degree)

• Associate or technical degree

• Bachelor’s (4-year college) degree

• Master’s degree

• Professional or doctoral degree (MD, JD, PhD, etc.)

• Prefer not to answer

End of Survey Message

Thank you for taking the time to participate in this important survey!

Public reporting burden of this collection of information is estimated to average 20 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 Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX