Attachment F: GAOS HCP Post-Campaign Screener and Survey
Form Approved
OMB No. 0920-XXX
Expiration Date XX/XX/XXXX
Emergency Medical Services personnel
Nurse practitioners and physician assistants who work at urgent care clinics
Emergency department triage nurses
General medical ward staff
Primary care physicians
Long-Term care (LTC) nurses
LTC medical technicians and sitters
Hide all subheadings of sections and questions from respondents.
Hide all programmer’s instructions from respondents.
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.”
Terminate also means ineligible.
Terminate all eligible respondents immediately.
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.
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.
How old are you? _ _ years
Prefer not to answer [INELIGIBLE]
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 Q3.
Are you a healthcare professional (e.g., doctor, physician assistant, nurse, emergency medical services personnel, medical technician, or medical sitter)?
Yes
No [INELIGIBLE]
Programmer: If the respondent selects “Yes” to Q3, proceed to Q4, else TERMINATE.
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 Q5.
If the respondent is under 18 years of age, TERMINATE and present the INELIGIBILITY message.
What type of healthcare professional are you? Select all that apply.
Physician (MD or DO)
Nurse Practitioner (NP)
Physician Assistant (PA)
Registered Nurse (RN)
Licensed Professional Nurse (LPN)
Licensed Vocational Nurse (LVN)
Certified Medical Technician (CMT)
Certified Nursing Assistant (CNA)
Medical Technician or Medical Sitter
Emergency Medical Services (EMS) personnel
None of the above [INELIGIBLE]
Prefer not to answer [INELIGIBLE]
In what type of setting do you work? Select all that apply.
Ambulances and/or medical transport services companies
Emergency room and/or department
Hospital
Intensive care unit
Urgent care medical clinic
Private practice
Community-based clinic or Federally Qualified Health Center
Managed care medical clinic (e.g., Kaiser)
Long-term care setting (e.g., nursing home, skilled nursing facility, assisted living, residential care community, long-term acute care center, congregate day program)
None of the above [INELIGIBLE]
Prefer not to answer [INELIGIBLE]
Do you provide primary care to adults and/or children?
Programmer: If the respondent selects Physician (MD or DO) to Q5, ask Q7, else skip Q7.
Yes
No
Are you an emergency department triage nurse?
Programmer: If the respondent selects “Registered Nurse (RN)” or “Licensed Professional Nurse (LPN),” or “Licensed Vocational Nurse (LVN)” to Q5 and selects “Emergency room and/or department” to Q6, ask Q8, else skip Q8.
Yes
No
Programmer:
Categorize respondents as “Emergency Medical Services (EMS) personnel” if
Q5 = Emergency Medical Services (EMS) personnel AND
Q6 = ANY of the options except “None of the above” and “Prefer not to answer”
Categorize respondents as “NPs/PAs at Urgent Care Clinics” if
Q5 = Nurse Practitioner (NP) or Physician Assistant (PA) AND
Q6 = Urgent care medical clinic
Categorize respondents as “ED Triage Nurses” if
Q5 = Registered Nurse (RN) or Licensed Professional Nurse (LPN), or Licensed Vocational Nurse (LVN) AND
Q6 = Emergency room and/or department AND
Q8 = Yes
Categorize respondents as “General Medical Ward Staff” if
Q5 = ANY of the options except “EMS,” “None of the above” and “Prefer not to answer” AND
Q6 = Hospital AND
Q7 = No
Categorize respondents as “PCPs” if
Q5 = Physician (MD or DO) AND
Q6=All except “Emergency room and/or department,” “Ambulances and/or medical transport services companies,” “None of the above,” and/or “Prefer not to answer” AND
Q7 = Yes
Categorize respondents as “LTC Nurses” if
Q5 = Nurse practitioner (NP), Registered Nurse (RN), Licensed Professional
Nurse (LPN), or Licensed Vocational Nurse (LVN)
Q6 = Long-term care setting
Categorize respondent as “LTC Medical Technicians and Sitters”
Q5 = Medical Technician or Medical Sitter
Q6 = Long-term care setting
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.”
Thank you for answering the screening questions. We have determined that you are eligible to proceed 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.
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.
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 2-3 months.
Please indicate below whether you have seen or heard any of the following campaign names or slogans in the past 2-3 months.
Programmer: Rotate Q9 (a - e), the column named “Campaigns” among respondents.
Campaigns |
Yes |
No |
Do not know/cannot recall |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I
n
the past 2-3 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 Q9d and “Yes” or “Do not know/cannot recall to Q10, classify as “Exposed” and proceed to the FREQUENCY AND CHANNEL OF EXPOSURE section.
If the respondent selects “Do not know/cannot recall” to Q9c and “Yes” to Q10, 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 Q9 and “No” or “Do not know/cannot recall” to Q10, classify as “Unexposed” and proceed to the KNOWLEDGE section. After the quota of unexposed has been met for each target group then TERMINATE.
In the past 2-3 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: ______________________ |
|
|
|
|
|
|
In the past 2-3 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 (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 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Doximity |
|
|
|
|
|
|
Sermo |
|
|
|
|
|
|
YouTube |
|
|
|
|
|
|
Other social media, please specify: __________________
|
|
|
|
|
|
|
In the past 2-3 months, approximately how often did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo in …?
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) |
|
|
|
|
|
|
Video conferencing background screen |
|
|
|
|
|
|
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: ______________________
|
|
|
|
|
|
|
In the past 2-3 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 (TV and Radio Media).
TV and Radio |
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: ______________________
|
|
|
|
|
|
|
In the past 2-3 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 a mall |
|
|
|
|
|
|
Advertisement in a grocery store |
|
|
|
|
|
|
Advertisement in a store pharmacy |
|
|
|
|
|
|
Advertisement at a shopping center or parking lot |
|
|
|
|
|
|
Other public locations, please specify: ______________________
|
|
|
|
|
|
|
In the past 2-3 months, did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo at your workplace (including at your home workplace for telework)?
Yes, I personally placed or shared CDC’s Get Ahead of Sepsis campaign materials at my workplace in the past 12 months.
Yes, I saw CDC’s Get Ahead of Sepsis campaign at my workplace in the past 12 months, but I was not responsible for placing or sharing it.
No, but I saw materials from another sepsis campaign at my workplace in the past 12 months.
No, I have not seen any materials about sepsis at my workplace in the past 12 months.
Programmer: If the respondent selects “Yes” to Q16, proceed to Q17, else skip Q17 and Q18.
In the past 2-3 months, where did you see CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo at your workplace (including your home workplace for telework)? Select all that apply.
Programmer: Rotate response options; keep the placement of “Other” and “Do not know/cannot recall” as is.
Printed material(s) designed to educate patients about sepsis
Printed material(s) designed to improve sepsis fast recognition and treatment by healthcare professionals
Digital material(s) designed to educate patients about sepsis
Digital material(s) designed to improve sepsis fast recognition and treatment by healthcare professionals
Video displays in patient waiting rooms/areas
Workplace website or internal email/newsletter
Email or e-newsletter from external organization, such as a state or local public health agency or professional society or association
Webcasts or webinars
Live events
Other, please specify: ____________________________________________________________
Do not know/cannot recall
P
rogrammer:
If the
respondent selects “Do not know/cannot recall” to Q16, do
not allow the respondent to select other responses.
You indicated that you saw or heard the campaign name, Get Ahead of Sepsis or saw the campaign logo in the past 2-3 months. Where did you see or hear it? _______________________________________
If respondent selects "Never or “Do not know/cannot recall" for ALL options in Q11-Q15 and "Yes" to Q16 but selects “Do not know/cannot recall” to Q17, and left Q18 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 Q11-Q15, and “Yes”
to Q16 or filled in Q18 with more than N/A or None, classify as
“Exposed” and proceed to KNOWLEDGE section.
Programmer: Include one question per page. RIGHT/WRONG responses have been indicated but do not disclose to respondents.
Thinking about your knowledge and awareness of sepsis, please indicate which statements you believe to be true or false.
About 1 in 3 patients who die in a hospital had sepsis during that hospitalization.
TRUE [RIGHT]
FALSE [WRONG]
Anyone can get an infection, and almost any infection including COVID-19, can lead to sepsis.
TRUE [RIGHT]
FALSE [WRONG]
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]
Programmer: For Q21, if the respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
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]
Programmer: For Q22, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
If your patient and/or resident is healthy, an infection is not anything you need to worry about.
TRUE [WRONG]
FALSE [RIGHT]
Which of the following, if any, are the most frequently identified pathogens that cause infections that can develop into 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.
Staphylococcus aureus [RIGHT]
Bordetella pertussis [WRONG]
Helicobacter pylori [WRONG]
Escherichia coli [RIGHT]
Clostridium botulinum [WRONG]
Some types of streptococci [RIGHT]
All of the above [WRONG]
None of the above [WRONG]
Do not know [WRONG]
Programmer: For Q24, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
With fast recognition and treatment of sepsis, most people survive.
TRUE [RIGHT]
FALSE [WRONG]
Select common signs and symptoms of sepsis below:
Programmer: Rotate response options; keep placement of “I do not know any…of sepsis.” as is.
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: For Q26, if respondent selects “I do not know any of the signs and symptoms of sepsis,” do not allow them to select other responses.
Only doctors need to know their facility’s existing guidance for diagnosing and managing sepsis.
TRUE [WRONG]
FALSE [RIGHT]
Which of the following activities, if any, should you advise your patients and/or residents to 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]
Ensuring proper patient catheter management (doctor or nurse only) [RIGHT]
All of the above [WRONG]
None of the above [WRONG]
Do not know [WRONG]
Programmer: For Q28, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
If your patients and/or residents suspect sepsis or have an infection that’s not getting better or is getting worse, you should discuss with them if the infection could be leading to sepsis.
TRUE [RIGHT]
FALSE [WRONG]
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: For Q30, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
Antibiotic therapy for patients who have developed sepsis should NOT be reassessed during the course of treatment.
TRUE [WRONG]
FALSE [RIGHT]
Which of the following, if any, is true about 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.
Only people with chronic diseases are at risk for sepsis [WRONG]
Sepsis can cause tissue damage, organ failure, and death [RIGHT]
Sepsis is a medical emergency [RIGHT]
With fast recognition and treatment, most people survive [RIGHT]
Sepsis is not a medical emergency [WRONG]
All of the above [WRONG]
None of the above [WRONG]
Do not know [WRONG]
Programmer: For Q32, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
Which of the following is true, if any, about what you should do if you suspect a patient has 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.
Know your facility’s existing guidance for diagnosing and managing sepsis. [RIGHT]
Immediately alert the clinician in charge if it is not you. [RIGHT]
Start antibiotics as soon as possible in addition to other therapies appropriate for the patient. If a specific bacterial cause of sepsis is known, therapy should be targeted to optimize treatment, and broad-spectrum antibiotics might not be needed. [RIGHT]
Check patient progress frequently. Always remember to prescribe the right antibiotic, at the right dose, for the right duration, and at the right time. Reassess antibiotic therapy to stop or tailor treatment based on the patient’s clinical condition and diagnostic test results as appropriate. [RIGHT]
All of the above [RIGHT]
Schedule the next follow-up clinic appointment for the patient to be seen two weeks out [WRONG]
None of the above [WRONG]
Do not know [WRONG]
Programmer: For Q33, if respondent selects “All of the above,” “Do not know,” or “None of the above,” do not allow them to select other responses.
Some hospitalized COVID-19 patients are diagnosed with sepsis.
Programmer: Include one set of questions (e.g., perceived susceptibility, perceived severity) per page. NOTE**Subheadings within all tables should not be visible to respondents.
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. In the below questions, ‘residents’ refers to nursing home or long-term care residents in the facility where you work.
Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Strongly Disagree |
Disagree |
Neutral |
Agree |
Strongly Agree |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Programmer: Include one question per page.
We’d like to know more about conversations you might have had with your patients and/or residents and their caregivers about sepsis.
Please indicate how frequently you discussed the following with your patients and/or residents and their caregivers in the past 2-3 months.
Programmer: Rotate response options in the first column.
Behavior (Information Sharing with Patients, Residents, Caregivers) |
Never |
Rarely |
Sometimes |
Often |
Always |
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
What are the barriers you commonly encounter when educating your patients and/or residents and their caregivers on preventing sepsis or on preventing 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,” “I have not encountered any barriers…,” and “I do not try to educate my…,” as is.
I am not familiar enough with these topics.
I do not feel confident educating my patients and/or residents on these topics.
I do not think my patients/residents, or their caregivers will understand these topics.
I do not think it is important for my patients and/or residents or their caregivers to understand these topics.
I do not think my patients and/or residents, or their caregivers will be interested in or receptive to learning about these topics.
I do not have time to educate my patients and/or residents or their caregivers on these topics.
I do not think sepsis is a big problem for my patients and/or residents.
I’m not confident the healthcare system in the area where my patients and/or residents live can respond correctly to sepsis.
I’m not confident the healthcare professionals in the area where my patients and/or residents live can respond correctly to sepsis.
My patients and/or residents live very far from healthcare services.
My patients and/or residents rely on telehealth services.
My patients and/or residents think that Covid-19 patients have overwhelmed the healthcare system and healthcare professionals, therefore we may not be able to respond to sepsis correctly.
My patients and/or residents are afraid of getting Covid-19 if they go to the Emergency room/department.
Other, please explain: ____________________________________________________________
I have not encountered any barriers to educating my patients and/or residents, or their caregivers on these topics.
I do not try to educate my patients and/or residents, or their caregivers on preventing sepsis or on preventing infections that can lead to sepsis.
Do not know/cannot recall
Prefer not to answer
Programmer: For Q40, if respondent selects “I have not encountered any barriers to educating my patients and/or residents, or their caregivers on these topics,” “I do not try to educate my patients and/or residents, or their caregivers on preventing sepsis or on preventing infections that can lead to sepsis,” “Do not know/cannot recall” or “Prefer not to answer,” do not allow them to select other responses.
In the past 2-3 months, have you suspected that a patient and/or resident at your facility had sepsis?
Yes
No
Programmer: if the respondent selects “No” to Q41, skip Q42 and proceed to the "Behavior ALL" section, else proceed to 42.
Please indicate how many sepsis patients and/or residents you attended to in your facility within the past 2-3 months.
0
1 - 4
5 - 9
10 or more
Do not know
[Behavior - Act fast if sepsis is suspected] Please indicate how often you took the following steps for your sepsis patients in the past 2-3 months. Select all that apply.
Behavior (Act fast if sepsis is suspected) |
Never |
Rarely |
Sometimes |
Often |
Always |
N/A |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Please indicate how many patients you transported to the hospital that you believed had sepsis in the past 2-3 months.
0
1 - 4
5 - 9
10 or more
Do not know
Please select information you collect from patients or caregivers about your patients to help you assess possibility of sepsis, if any.
I ask about the patient’s age [RIGHT]
I ask the patient or caregivers what signs and symptoms the patient is experiencing. [RIGHT]
I ask the patient or caregivers how long the symptoms have been ongoing. [RIGHT]
I do not ask the patient or caregivers any questions about my patients. [WRONG]
I ask if the patient is confused/disoriented, has shortness of breath, in extreme pain, clammy or sweaty, or shivering/feeling cold. [RIGHT]
I ask the patient or caregivers to provide names and/or dosages of medications the patient takes. [RIGHT]
I ask if the patient has any open cut, injuries and /or abscess. [RIGHT]
I collect the patient’s vital signs (such as, temperature, pulse, breathing, blood pressure, etc.). [RIGHT]
I ask if the patient recently received treatment for any bacterial or viral infection. [RIGHT]
I ask if the patient has any underlying health condition. [RIGHT]
I ask for the patient’s DNA. [WRONG]
I assess any injury and/or abscess on the patient [RIGHT]
I do not collect any information about my patients from the patient or caregivers [WRONG]
All of the above [WRONG]
None of the above [WRONG]
[Behavior - Act fast if sepsis is suspected] Please indicate how often you took the following steps for the patients you transported to the hospital that you believed had sepsis in the past 2-3 months. Select all that apply.
Behavior (Act fast if sepsis is suspected) |
Never |
Rarely |
Sometimes |
Often |
Always |
N/A (I did not transport any patient I suspected had sepsis) |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
[Behavioral Intention] I plan to take rapid action and initiate appropriate treatment when sepsis is suspected in my patients and/or residents.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
What are the barriers you experience to taking rapid action and initiating appropriate treatment when sepsis is suspected in your patients and/or residents? Select all that apply.
Programmer: Rotate response options; keep placement of “Other,” “I do not have any…,” and “I have not had to take…,” as is.
I am not confident I can identify the signs and symptoms of sepsis.
I do not know how to alert the clinician in charge (it is not me).
I am not comfortable alerting the clinician in charge (it is not me).
It is not my role to identify sepsis and/or to alert the clinician in charge.
High turnover rate or shortage of staff
I do not have any barriers.
I have not had to take rapid action in my role.
Other, please specify: _________________________________________________
Programmer: For Q48, if respondent selects “I do not have any barriers” or “I have not had to take rapid action in my role,” do not allow them to select other responses.
[ALL HCPs] In the last 2-3 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 Q49, proceed to Q50, else skip Q50.
To whom or where do you go to learn about infections that can lead to sepsis? Select all that apply.
Programmer: Rotate response options; keep placement of “Other” and “I have not looked for information on this topic” as is.
Colleagues, other healthcare professionals
Centers for Disease Control and Prevention (CDC) website or material, please specify: ____________________________________________________
Peer-reviewed journals (Printed or online), please specify: ________________________________
Health websites/health-related mobile apps (e.g., WebMD, Mayo Clinic, Medscape, UpToDate, Epocrates, etc.), please specify: ______________________________________
Medical conferences, please specify: _____________________________________
Local/state health departments
Medical or professional associations, please specify: ____________________________
My place of work.
Continuing education/medical education/training courses (CE/CME, etc.), please specify: _____________________________________
Social media (e.g., Facebook, Instagram, Twitter, LinkedIn, Doximity, Sermo), please specify: _____________________________________
Sepsis organizations (e.g., Sepsis Alliance, etc.), please specify: _______________________________
Other, please specify: _____________________________________________
I have not looked for information on this topic.
Programmer: If the respondent selects “I have not looked for information on this topic” do not allow them to select other responses.
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
Do you have Infection Prevention and Control (IPC) practices/guidelines at your facility?
Yes
No
Do not know
Programmer: If the respondent selects “Yes” to Q52, proceed to Q53, else skip Q53.
Do you know the content of the Infection Prevention and Control (IPC) practices/guidelines at your facility?
Do you have a sepsis protocol at your facility?
Yes
No
Do not know
Programmer: If the respondent selects “Yes” to Q54, proceed to Q55, else skip Q55.
Do you know the content of your facility’s sepsis protocol?
Did you know that CDC has a Get Ahead of Sepsis webpage with resources you can use to help educate your patients about preventing infections that can lead to sepsis?
Yes
No
(Material and Questions should be on the same page).
Have you been contacted by any of these organizations in the last 2-3 months about sepsis?
Local Health Department, please specify: _____________________________________
State Health Department, please specify: ______________________________________
Other, please specify: __________________________________________
None of these organizations
A.
Did your partners provide this infographic for you to use to help educate your patients and/or residents about sepsis?
Yes
No
Do not know/cannot recall
Programmer: If the respondent selects “Yes” to Q58, proceed to Q59, else skip Q59-Q60.
Please select how often in the past 2-3 months you used this infographic to educate your patients about sepsis?
I did not use this brochure |
Rarely |
Sometimes |
Often |
Always |
Do not know |
|
|
|
|
|
|
Programmer: If the respondent selects “I did not use this brochure” to Q59, skip Q60 else proceed to Q60.
How helpful for you was this infographic in educating your patients about sepsis?
Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful
|
|
B. |
|
Did your partners provide this fact sheet for you to use to help educate your patients and/or residents about sepsis?
Yes
No
Do not know/cannot recall
Programmer: If the respondent selects “Yes” to Q61, proceed to Q62, else skip Q62-Q63.
Please select how often in the past 2-3 months you used this fact sheet to educate your patients and/or residents about sepsis?
I did not use this brochure |
Rarely |
Sometimes |
Often |
Always |
Do not know |
|
|
|
|
|
|
Programmer: If the respondent selects “I did not use this material” to Q62, skip Q63 else proceed to Q63.
How helpful for you was this fact sheet in educating your patients and/or residents about sepsis?
Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful
Programmer: If respondent selected: “I did not use this brochure” to both Q59 and Q62, proceed to Q67, else skip Q67 and proceed to the DEMOGRAPHIC CHARACTERISTICS section.
Why have you not used CDC Get Ahead of Sepsis resources to educate your patients and/or residents about sepsis? Select all that apply.
Programmer: Rotate response options; keep placement of “Other,” and “Do not know” as is.
I did use CDC Get Ahead of Sepsis resources to educate my patients, but they were not the ones shown above. If so, what resources did you use? Please specify: ___________________________________________________________________
I do not usually use patient education resources when educating my patients on any topics
I/my organization has my/our own resources
I use resources developed by other organizations
I forget to use them
I do not have time to use them
I do not know where to find these resources
I looked at them, but did not find them helpful
I am not familiar enough with these resources to feel comfortable using them
Other, please specify: ______________________________________
Do not know
Programmer: Include one set of questions (e.g., printed media, social media) per page.
We would like to ask you a few questions about your media use and habits.
In an average month, how often do you…
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 |
Read printed magazines |
|
|
|
|
|
|
Read printed newspapers |
|
|
|
|
|
|
Read brochures or flyers on health-related topics |
|
|
|
|
|
|
Read other printed media, please specify: ____________________
|
|
|
|
|
|
|
In an average month, how often do you…
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 |
Use Facebook |
|
|
|
|
|
|
Use Instagram |
|
|
|
|
|
|
Use Twitter |
|
|
|
|
|
|
Use LinkedIn |
|
|
|
|
|
|
Use Doximity |
|
|
|
|
|
|
Use Sermo |
|
|
|
|
|
|
Use YouTube |
|
|
|
|
|
|
Use other social media, please specify: ___________________
|
|
|
|
|
|
|
In an average month, how often do you…
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 |
Read health websites /resources |
|
|
|
|
|
|
Read news online |
|
|
|
|
|
|
Read magazines online |
|
|
|
|
|
|
Listen to internet radio |
|
|
|
|
|
|
Watch TV/movies using streaming services (e.g., Netflix, Hulu, [Amazon] Prime Video) |
|
|
|
|
|
|
Read blogs |
|
|
|
|
|
|
Streaming internet radio |
|
|
|
|
|
|
Use search engines (e.g., Google) |
|
|
|
|
|
|
Visit other websites, please specify: _______________________
|
|
|
|
|
|
|
In an average month, how often do you…
TV and Radio |
1-2 times a day |
Once a week |
1-3 times a month |
Less than once a month |
Never |
Do not know/cannot recall |
Watch television (cable, satellite, or antenna) |
|
|
|
|
|
|
Listen to broadcast radio |
|
|
|
|
|
|
Listen to satellite radio |
|
|
|
|
|
|
Watch or listen to other TV or radio media, please specify: _______________________
|
|
|
|
|
|
|
In an average month, how often do you…
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 |
See billboards |
|
|
|
|
|
|
Use buses, subways, or trains |
|
|
|
|
|
|
Use taxi cabs |
|
|
|
|
|
|
Shop in malls |
|
|
|
|
|
|
Shop in grocery stores |
|
|
|
|
|
|
Shop in pharmacies (e.g., CVS, Walgreens, Walmart) |
|
|
|
|
|
|
Visit other public places, please specify: ______________________
|
|
|
|
|
|
|
In an average month, how often do you…
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 |
Read email newsletters from healthcare professional associations |
|
|
|
|
|
|
Listen to webcasts or webinars related to my profession |
|
|
|
|
|
|
Listen to podcasts |
|
|
|
|
|
|
Attend live events (presentation at a conference) |
|
|
|
|
|
|
Use other media, please specify: _____________________
|
|
|
|
|
|
|
To whom or where do you go to learn about infections that can lead to sepsis? Select all that apply.
Programmer: Rotate response options; keep placement of “Other” and “I have not looked for information on this topic” as is.
Colleagues, other healthcare professionals
Centers for Disease Control and Prevention (CDC) website or material, please specify: ____________________________________
Peer-reviewed journals (Printed or online), please specify: ______________________________
Health websites/health-related mobile apps (e.g., WebMD, Mayo Clinic, Medscape, UpToDate, etc.), please specify: ____________________________________
Medical conferences, please specify: _________________________________
Local/state health departments
Medical or professional associations, please specify: ___________________________________
My place of work or organization
Continuing education/medical education/training courses (CE/CME, etc.), please specify: ____________________________________________
Social media (e.g., Facebook, Instagram, Twitter, LinkedIn), please specify: ________________________________________
Sepsis organizations (e.g., Sepsis Alliance, etc.), please specify: _______________________________
Other, please specify: _____________________________________________
I have not looked for information on this topic
Thank you. Now we would like to know more about you.
How long have you worked as a healthcare professional performing the same duties as your current role?
Less than one year
1-5 years
6-9 years
10 or more years
Prefer not to answer
What sex were you assigned at birth, on your original birth certificate?
Male
Female
Refused
I don’t know
Do you currently describe yourself as male, female, transgender?
Male
Female
Transgender
None of these
What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino
What is your race?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
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.
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
Thank you for taking the time to participate in this important survey!
FOR POSTTEST ONLY: To learn more about infection prevention and sepsis, please visit https://www.cdc.gov/sepsis/
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
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Deborah W Gould |
File Modified | 0000-00-00 |
File Created | 2023-08-31 |