BAA Consumer Post Campaign Screener and Survey

Healthy adults who visit urgent care (ages 18-64 for participants who live in TN and IA) and (ages 19-64 for participants who live in NE).
Community dwelling older adults 65+.
Family caregivers of nursing home (long-term care) residents (18+ for participants who live in TN and IA and 19+ for participants in live in NE).

Priority markets

Tennessee (TN)***18+
Iowa (IA)***18+
Nebraska (NE)***19+

classification of Respondents based on their responses to the screener questions

Respondents should be classified as “Healthy adults who visit urgent care” if their response(s) to

Q7 = age is between 18-64 (in TN or IA) or 19-64 (in NE) AND
Q12 = Yes AND
Q13 = Yes AND
Q14 = Excellent, very good, OR good

Respondents should be classified as “Family caregivers of nursing home (long-term care) residents” if their response(s) to

Q7 = age is between 18-64 (in TN or IA) or 19-64 (in NE) AND
Q15 = Yes

Respondents should be classified as “Community dwelling older adults 65+” if their response(s) to

Q7 = age is 65+ AND

Q16 = “By myself” or “With family members”

Tallgrass: Do not send a survey link to participants who did not fall under any intended audience group.

End of screener Message

Programmer: Present this message to participants who completed the screener.

Thank you for answering the screening questions. If you are eligible to participate, you will receive an email with a copy of your signed informed consent and the link to take the survey. The incentive described in the informed consent will be available upon completion of the survey. If you have any questions or concerns, please contact Julie Overby at [email protected] or call phone number 253-238-7787 or 360-942-8466.

Thank you for your time.

SCREENER Ineligibility Message

Programmer: Present this message to participants who do not give their consent and respondents who provide a response that makes them ineligible to continue with the survey.

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 Julie Overby at [email protected] or call phone number 253-238-7787 or 360-942-8466.

Thank you for your time.

BAA COnsumer Screener Begins Here

INFORMED CONSENT TO PARTICIPATE IN AN ONLINE SURVEY

On behalf of the Centers for Disease Control and Prevention (CDC), CATMEDIA, an Atlanta-based program management, training, and creative services company, is conducting an online survey with adults to gather feedback on educational materials related to antibiotic use. We hope to use what we learn from these survey results to improve these materials and/or how and where we promote them to raise awareness within your community. This is the screener. After you are determined as eligible to participate, you will only be asked to complete the survey once. We expect the survey to take about 20 minutes.

Your participation in this survey is completely voluntary. You may choose to skip questions that you do not want to answer and/or stop the survey at any time for any reason. Refusal to participate will not result in any penalties.

If you choose to participate in this survey, we will keep your answers private and will not share your personal information with anyone outside of the survey team.

At the end of the survey, you will receive $25 through Venmo or PayPal, or a $25 gift card as a token of our appreciation for your time. You should receive it within 7 business days.

If you have questions or need a copy of the informed consent, please email Julie Overby at [email protected] or call 253-238-7787 or 360-942-8466.

Please answer the question below and print a copy for your records before proceeding to the next page. If you select “Yes,” it means you understand the information in this consent form and that you agree to take the survey.

All questions with an asterisk [*] require a response.

* Do you agree to participate in this survey?

Programmer: If the respondent selects “Yes” to the question, “Do you agree to participate in this survey” present the next page for the respondent to enter their name as an electronic signature and date of consent.

If the respondent selects “No” terminate the survey and present the INELIGIBILITY MESSAGE.

* Enter your full name here.

Shape1

* Enter today’s date here. (MM/DD/YYYY)

Shape2

Programmer: If the respondent enters their name as an electronic signature and date of consent, do not terminate the survey.

baa consumer posttest SCREENER [ALL]

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

Thank you for participating in this survey. The results of this survey will help the Centers for Disease Control and Prevention (CDC) refine its ongoing campaign to improve antibiotic use by helping CDC staff understand the public’s response to the campaign and its key messages.

OMB Statement

Form Approved

OMB No. 0920-1387

Expiration Date: 03/31/2026

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 0920-1387

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

Yes
No [INELIGIBLE/TERMINATE]

Programmer: If “No” to Q4, TERMINATE else proceed with survey.

In what State do you live? _____________________

Programmer: Create a dropdown option with all U.S. States and options for “Prefer not to answer” and “I cannot find my State.”

In what ZIP Code do you live? _______________________

Programmer: Create a dropdown option with approved ZIP Codes and options for “Prefer not to answer” and “I cannot find my ZIP Code.”

Programmer: Priority markets include Tennessee (TN), Iowa (IA), and/or Nebraska (NE).

Programmer: If not within one of the priority markets and approved ZIP Codes, TERMINATE, otherwise, proceed with survey.

How old are you? _ _ years

Prefer not to answer [INELIGIBLE/TERMINATE]

If the respondent is a resident of Nebraska and under 19 years of age, TERMINATE and present the INELIGIBILITY message.

For all other markets, 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 with survey.

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 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 below:
Prefer not to answer

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 below:
Prefer not to answer

Have you visited an urgent care clinic to receive medical care at least once in the past 12 months for yourself (not for the care of a loved one)? Urgent care clinics are freestanding clinics that treat patients for unscheduled or walk-in infections or injuries but DO NOT include a pharmacy (clinics in CVS or Walgreens are not considered urgent care clinics), a store, or an emergency department.

Yes
No
Not sure

When you visited an urgent care clinic, did you do so for a respiratory infection, such as a common cold, flu, or COVID-19?

Yes
No
Do not know/cannot recall

How would you rate your overall physical health?

Excellent
Very good
Good
Fair
Poor

Are you the primary caregiver of a family member who is in a nursing home or long-term care facility?

What is your current living situation? Select all that apply.

Programmer: Present this question to adults aged 65+ only.

By myself
With family members
In a nursing home or long-term care facility
Other, please specify:

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 Q17 (a-e), TERMINATE and present the ineligibility message.

General Instructions for Programmer and Recruiter

Hide all subheadings of sections and questions from respondents.
Hide all programmer’s instructions from respondents.
Terminate also means ineligible.
Terminate all ineligible respondents immediately.
Present the “Ineligibility Message” whenever a response terminates the survey.
RECRUITER: Terminate after quota for each category, audience, and/or group is met.
RECRUITER: Assign participants to only one intended audience group.

Ineligibility Message

Thank you for your time.

End of Survey Message for posttest

Programmer: Place this message in the collector’s page for custom thank you.

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

To learn more about appropriate antibiotic use, please visit https://www.cdc.gov/antibiotic-use/

Programmer: Place this link in the collector’s page for custom URL to redirect all respondents to this link.

Link: https://www.cdc.gov/antibiotic-use/

Exposure to Campaign [ALL]

Programmer: Include one question per page.

Now, we would like to ask you about a CDC campaign on improving antibiotic use 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 (a - e), the column named “Campaigns” among respondents.

CAMPAIGNS	Yes	No	Do not know/ cannot recall
Get Ahead of Antibiotics			
Flip the Script			
Be Antibiotics Aware			
Get Smart About Antibiotics			
Don’t Miss-take Antibiotics			

I n the past 2-3 months, did you see this logo or hear this logo/slogan (“Be Antibiotics Aware,” “Smart Use, Best Care”) anywhere?

Yes
No
Do not know/cannot recall

Programmer: Categorize respondents as “UNEXPOSED” only if the respondent selects “No,” “Do not know/cannot recall” or did not respond to Q1c and Q2, then proceed to the KNOWLEDGE section.

Respondents with any other combination should be “EXPOSED,” then proceed to FREQUENCY AND CHANNEL OF EXPOSURE section.

Frequency and Channel of Exposure [ALL]

Programmer: Include one question per page.

You indicated that you had seen or heard the campaign name, Be Antibiotics Aware, or seen the campaign logo in the past 2-3 months.

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Poster, Fact sheet, Brochure, etc.). Leave “Other” response last.

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 below:						

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo on …?

Programmer: Rotate the media options (Facebook, Instagram, Twitter, etc.). Leave “Other” response last.

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 below:						

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo in…?

Programmer: Rotate the media options (Online/Internet Media). Leave “Other” response last.

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 below:						

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo on…?

Programmer: Rotate the media options (TV and Radio Media). Leave “Other” response last.

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 below:						

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo on…?

Programmer: Rotate the media options (Public Places). Leave “Other” response last.

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						
Buses or taxi cabs						
Advertisement in a shopping center or parking lot						
Advertisement in a mall						
Advertisement in a grocery store						
Advertisement in a pharmacy (retail or hospital)						
Other public places, please specify below:						

In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo in …?

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 and/or healthcare facilities						
Other campaign placements at healthcare facilities, please specify below:						

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 and/or healthcare facilities



Other campaign placements at healthcare facilities, please specify below:



In the past 2-3 months, approximately how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo in …?

Programmer: Rotate the media options (Other Media). Leave “Other” response last.

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						
Podcasts						
Webcasts or webinars						
Live events						
Other media, please specify below:						

Programmer: If the respondent selects “Never” and/or “Do not know/cannot recall” as responses to ALL options in this section “Frequency and Channel of Exposure” proceed to the next question (open-ended question), else skip it.

You indicated that you saw or heard the campaign name, Be Antibiotics Aware, or saw the campaign logo in the past 2-3 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 this section “Frequency and Channel of Exposure” and leaves the above open-ended question blank, reclassify these respondents as “UNEXPOSED” and proceed to KNOWLEDGE section.

Knowledge [ALL]

Next, we would like to ask you a few questions about antibiotics.

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

Which types of infections do antibiotics treat?

Certain infections caused by viruses, including the one that causes COVID-19 [INACCURATE]
Certain infections caused by bacteria [ACCURATE]
Certain infections caused by bacteria and viruses [INACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Which of the following infections do antibiotics treat? Select all that apply.

Common cold [INACCURATE]
COVID-19 [INACCURATE]
Whooping cough [ACCURATE]
Influenza (flu) [INACCURATE]
Pneumonia (caused by bacteria) [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

When antibiotics are not needed to treat your infection, taking antibiotics will still help.

True [INACCURATE]
False [ACCURATE]
Unsure [INACCURATE]

Taking antibiotics can lead to side effects that could cause harm.

True [ACCURATE]
False [INACCURATE]
Do not know [INACCURATE]

Which of the following are common side effects of antibiotics? Select all that apply.

Rash [ACCURATE]
Nausea [ACCURATE]
Diarrhea [ACCURATE]
Yeast infections [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Which of the following statement(s) is/are true about antibiotic resistance? Select all that apply.

Anytime antibiotics are used, they can contribute to antibiotic resistance [ACCURATE]
Infections caused by antibiotic-resistant germs are always easy to treat with antibiotics [INACCURATE]
Antibiotic resistance happens when germs no longer respond to the antibiotics designed to kill them [ACCURATE]
When antibiotics are needed, the benefits usually outweigh the risks of antibiotic resistance [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

When taking antibiotics, _________________________________________. Select all that apply.

I should take my antibiotics exactly as my healthcare professional prescribed [ACCURATE]
It is okay if I skip doses of my antibiotics [INACCURATE]
I can save leftover antibiotics for later [INACCURATE]
It is okay to share my leftover antibiotics with a family member or friend who is not feeling well [INACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Which of the following can help you feel better when you have a cold? Select all that apply.

Drink plenty of fluids [ACCURATE]
Ask my HCP for an antibiotic [INACCURATE]
Use a clean humidifier or cool mist vaporizer to relieve congestion [ACCURATE]
Use a saline nasal spray or drops to relieve congestion [ACCURATE]
Use honey to relieve cough for adults and children at least 1 year of age or older [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Attitudes and Beliefs [ALL EXCEPT FAMILY CAREGIVER]

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

Keep the following text on the same page as the first question in this section.

Next, we are going to ask you some questions to learn more about your perspective on antibiotics. Please give us your honest responses. There are no right or wrong answers to any of these questions.

We would like to provide you with a definition of a few key terms to assist you in answering the following questions:

Antibiotic resistance happens when germs no longer respond to the antibiotics designed to kill them. That means the germs are not killed and continue to grow. It does not mean your body is becoming resistant to antibiotics.

Clostridioides difficile (often called C. difficile or C. diff) is a germ (bacterium) that causes severe diarrhea and colitis, or inflammation of the colon. C. diff infection can lead to severe colon damage and death.

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

PERCEIVED SUSCEPTIBILITY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that I may have taken antibiotics when I didn’t need them over the last 2-3 months
I believe that I could get an antibiotic-resistant infection.
I believe that any time people take antibiotics, it contributes to antibiotic resistance.
I believe that my healthcare professional(s) may have given me prescriptions for antibiotics when they were not necessary.
I believe that anyone taking antibiotics can experience side effects, such as rash, nausea, and/or diarrhea.
I believe that taking antibiotics can lead to serious side effects, including Clostridioides difficile (or C. diff) infection, life-threatening allergic reactions, or antibiotic-resistant infections.

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

PERCEIVED SEVERITY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I got an antibiotic-resistant infection, it could be very dangerous for me.
I believe that antibiotic resistance is a severe problem that can threaten the health of myself and others.
I believe that antibiotics can sometimes lead to more serious side effects, including Clostridioides difficile (or C. diff) infection, life-threatening allergic reactions, or antibiotic-resistant infections, which can be very dangerous for me.

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

PERCEIVED BENEFITS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that using antibiotics only when needed helps to ensure these drugs will be available for future generations.
I believe that using antibiotics only when needed helps to keep me safe from side effects.
I believe that using antibiotics only when needed helps fight antibiotic resistance.

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

PERCEIVED BARRIERS TO USING ANTIBIOTICS APPROPRIATELY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If my healthcare professional told me to wait a few days to see if I feel better before prescribing antibiotics, I would feel inconvenienced.
If my healthcare professional told me I didn’t need antibiotics for my infection, I would feel worried that I wouldn’t feel better.
c. If my healthcare professional told me I didn’t need antibiotics for my infection, I would feel worried that I might get sicker.

Please indicate your level of confidence for each of the following questions.

SELF-EFFICACY	Not at all Confident	Somewhat Confident	Moderately Confident	Confident	Very Confident
When you have a viral infection, how confident are you that you will not need antibiotics?
How confident are you in your ability to discuss your questions and concerns about antibiotics with your healthcare professional?
How confident are you that you will accept your healthcare professional’s recommendation if they say you do not need antibiotics?

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

PERCEIVED IMPORTANCE OF DISCUSSING APPROPRIATE ANTIBIOTIC USE WITH HCPS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
When I’m sick, it’s important to talk with my healthcare professionals about what the best treatment is for my respiratory infection.
When I’m sick, but antibiotics aren’t needed, it is important to talk with my healthcare professionals about other ways to feel better.
When I’m sick and antibiotics can help, it is important to talk with my healthcare professionals about the risks of taking antibiotics (e.g., side effects, antibiotic resistance).
When I’m sick and antibiotics can help, it is important to talk with my healthcare professional(s) about the benefits of taking antibiotics.

Attitudes and Beliefs [FOR FAMILY CAREGIVER]

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

Keep the following text on the same page as the first question in this section.

Next, we are going to ask you some questions to learn more about your perspective on antibiotics. Please give us your honest responses. There are no right or wrong answers to any of these questions.

We would like to provide you with a definition of a few key terms to assist you in answering the following questions:

Now please think about your older adult family member who lives in a nursing home and who is under your care. Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

PERCEIVED SUSCEPTIBILITY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that my family member may have taken antibiotics when they didn’t need them during the last 2-3 months.
I believe that my family member could get an antibiotic-resistant infection.
I believe that any time people take antibiotics, it contributes to antibiotic resistance.
I believe that my family member’s healthcare professional(s) may have given prescriptions for antibiotics when they were not necessary.
I believe that anyone taking antibiotics can experience side effects, such as rash, nausea, and/or diarrhea.
I believe that if my family member takes antibiotics it can lead to serious side effects such as Clostridioides difficile (or C. diff) infection or life-threatening allergic reactions.

Please continue to think about your older adult family member who lives in a nursing home and who is under your care. Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

PERCEIVED SEVERITY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If my family member got an antibiotic-resistant infection, it could be very dangerous for them.
I believe that antibiotic resistance is a severe problem that can threaten the health of my family member and others.
I believe that antibiotics can lead to serious side effects such as Clostridioides difficile (or C. diff) infection, which can cause diarrhea and death.

Please continue to think about your older adult family member who lives in a nursing home and who is under your care. Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

PERCEIVED BENEFITS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that my family member using antibiotics only when needed helps to ensure these drugs will be available for future generations.
I believe that my family member using antibiotics only when needed helps to keep them safe from side effects.
I believe that my family member using antibiotics only when needed helps fight antibiotic resistance.

Please continue to think about your older adult family member who lives in a nursing home and who is under your care. Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

PERCEIVED BARRIERS TO USING ANTIBIOTICS APPROPRIATELY	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If my healthcare professional told my family member to wait a few days to see if they feel better before prescribing antibiotics, they would feel inconvenienced.
If my healthcare professional told my family member, they didn’t need antibiotics for their respiratory infection, I would feel worried that they wouldn’t feel better.
If my healthcare professional told my family member, they didn’t need antibiotics for their respiratory infection, I would feel worried that they might get sicker.

Please think about your older adult family member who lives in a nursing home and who is under your care. Please indicate your level of confidence for each of the following questions.

SELF-EFFICACY	Not at all Confident	Somewhat Confident	Moderately Confident	Confident	Very Confident
When your family member has a viral infection, how confident are you that they do not need antibiotics to treat the infection?
How confident are you in your ability to discuss your questions and concerns about your family member’s antibiotic use with their healthcare professional?
How confident are you that you can accept your family member’s healthcare professional’s recommendation if they say that they do not need antibiotics?

Please continue to think about your older adult family member who lives in a nursing home and who is under your care. Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree.

PERCEIVED IMPORTANCE OF DISCUSSING APPROPRIATE ANTIBIOTIC USE WITH HCPS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
When my family member is sick, it is important to talk with their healthcare professional(s) about what the best treatment is for their illness.
When my family member is sick, but antibiotics are not needed, it is important to talk with their healthcare professionals about other ways to feel better.
When my family member is sick and antibiotics can help, it is important to talk with their healthcare professional(s) about the risks of taking antibiotics (e.g., side effects, antibiotic resistance).
When my family member is sick and antibiotics can help, it is important to talk with their healthcare professional(s) about the benefits of taking antibiotics.

Behavior [ALL EXCEPT FAMILY CAREGIVER]

Programmer: Include one question per page.

Think about the visits you had with a healthcare professional for a respiratory infection over the past 2-3 months. These include both in-person and telehealth visits. During these visits, how often did you speak with your healthcare professional(s) about the following?

	Never	Rarely	Sometimes	Often	Always	Do not know/cannot recall	Did not visit healthcare professional for an infection in the past 2-3 months
If antibiotics were or were not needed to treat my infection.
How to feel better when I was sick without taking antibiotics.
The risks of taking an antibiotic (e.g., antibiotic resistance, side effects) when I was sick.
The benefits of taking antibiotics when I was sick.

Programmer: If all responses to the above question are “Did not visit healthcare professional for an infection in the past 2-3 months” skip the rest of the questions in this section else proceed to the next question below.

In the past 2-3 months, how often have you expected—but not directly asked—a healthcare professional to prescribe you antibiotics?

Always
Often
Sometimes
Rarely
Never
Do not know/cannot recall

In the past 12 months, did you expect – but not directly ask for -- a healthcare professional to prescribe you antibiotics because you had COVID-19?

Yes, I had COVID-19 and expected antibiotics
No, I had COVID-19 but did not expect antibiotics
No, I have not had COVID-19 in the past 12 months
Do not know/cannot recall

In the past 2-3 months, how often have you directly asked a healthcare professional to prescribe you antibiotics?

Always
Often
Sometimes
Rarely
Never
Do not know/cannot recall

In the past 12 months, did you directly ask a healthcare professional to prescribe you antibiotics because you had COVID-19?

Yes, I had COVID-19 and directly asked a healthcare professional to prescribe antibiotics
No, I had COVID-19 but did not directly ask a healthcare professional to prescribe antibiotics
No, I have not had COVID-19 in the past 12 months
Do not know/cannot recall

In the past 2-3 months, did a healthcare professional prescribe you antibiotics?

Yes
No
Do not know/cannot recall

In the past 12 months, did a healthcare professional prescribe you antibiotics because you had COVID-19?

Yes
No
I did not take antibiotics at all
Do not know/cannot recall
I have not had COVID-19 in the past 12 months

In the past 2-3 months, did you ever take leftover antibiotics previously prescribed to you or someone else by a healthcare professional?

Yes, I took leftover antibiotics previously prescribed to me
Yes, I took leftover antibiotics previously prescribed to someone else
No, I did not take leftover antibiotics previously prescribed to me or someone else
Do not know/cannot remember
Not applicable/I was not sick during this time

In the past 12 months, did you ever take leftover antibiotics previously prescribed to you or someone else by a healthcare professional because you had COVID-19?

Yes, I took leftover antibiotics previously prescribed to me because I had COVID-19
Yes, I took leftover antibiotics previously prescribed to someone else because I had COVID-19
No, I did not take leftover antibiotics previously prescribed to me or someone else
Do not know/cannot remember
I did not test positive for COVID-19 in the past 12 months

Behavior [FOR FAMILY CAREGIVER]

Programmer: Include one question per page.

Think about the visits you had with a healthcare professional for your older adult family member who lives in a nursing home and who is under your care for a respiratory infection over the past 2-3 months. During these visits, how often did you speak with your healthcare professional(s) about the following?

	Never	Rarely	Sometimes	Often	Always	Do not know/cannot recall	My family member did not have a respiratory infection that required antibiotics the past 2-3 months
Whether or not antibiotics were needed to treat my family member’s infection.
How to make my family member feel better when they were sick, without taking antibiotics.
The risks of taking antibiotics (e.g., antibiotic resistance, side effects) when my family member was sick.
The benefits of my family member taking antibiotics when they were sick.

Programmer: If all responses to the above question are “My family member did not have a respiratory infection that may require an antibiotic in the past 2-3 months,” skip the rest of the questions in this section else proceed to the next question below.

In the past 2-3 months, how often have you expected—but not directly asked—a healthcare professional to prescribe your family member antibiotics?

Always
Often
Sometimes
Rarely
Never
Do not know/cannot recall

In the past 12 months, did you expect - but not directly ask for - a healthcare professional to prescribe antibiotics to your family member because they had COVID-19?

Yes, my family member had COVID-19 and I expected the healthcare professional to prescribe antibiotics
No, my family member had COVID-19 but I did not expect the healthcare professional to prescribe antibiotics
No, my family member did not have COVID-19 in the past 12 months
Do not know/cannot recall

In the past 2-3 months, how often have you directly asked a healthcare professional to prescribe your family member antibiotics?

Always
Often
Sometimes
Rarely
Never
Do not know/cannot recall

In the past 12 months, did you directly ask a healthcare professional to prescribe your family member antibiotics because they had COVID-19?

Yes, my family member had COVID-19 and I directly asked the healthcare professional to prescribe antibiotics
No, my family member had COVID-19 but I did not directly ask the healthcare professional to prescribe antibiotics
No, my family member did not have COVID-19 in the past 12 months
Do not know/cannot recall

In the past 2-3 months, did a healthcare professional prescribe your family member antibiotics?

Yes
No
Do not know/cannot recall

In the past 12 months, did a healthcare professional prescribe your family member antibiotics because they tested positive for COVID-19?

Yes
No
Do not know/cannot recall
My family member did not test positive for COVID-19 in the past 12 months [Programmer: Lock response.]

In the past 2-3 months did your family member ever take leftover antibiotics previously prescribed to them or someone else by a healthcare professional?

Yes, my family member took leftover antibiotics previously prescribed to them
Yes, my family member took leftover antibiotics previously prescribed to someone else
Do not know/cannot remember
Not applicable/My family member was not sick during this time

In the past 12 months did your family member ever take leftover antibiotics previously prescribed to them or someone else by a healthcare professional because they had COVID-19?

Yes, my family member took leftover antibiotics previously prescribed to them because they had COVID-19
Yes, my family member took leftover antibiotics previously prescribed to someone else because they had COVID-19
Do not know/cannot remember
My family member did not test positive for COVID-19 in the past 12 months

Sources of Information [ALL]

To whom or where do you go to learn about appropriate antibiotic use? Select all that apply.

My doctor/healthcare professional
Pharmacist
Health websites/Health-related mobile apps (e.g., WebMD, Mayo Clinic, etc.), please specify below:
Centers for Disease Control and Prevention (CDC) website
Health magazines (e.g., Women’s Health, Men’s Health, Prevention), please specify below:
Family members and/or friends
Newspapers, please specify below:
Television, please specify below:
Radio, please specify below:
Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.), please specify below:
Other, please specify below:
I have not tried to learn about antibiotic use [Programmer: Lock response.]

If you need to get information about appropriate antibiotic use, where would you prefer to get it? Select all that apply.

My doctor/healthcare professional
Pharmacist
Health websites/Health-related mobile apps (e.g., WebMD, Mayo Clinic, etc.), please specify below:
Centers for Disease Control and Prevention (CDC) website or materials
Health magazines (e.g., Women’s Health, Men’s Health, Prevention), please specify below:
Family members and/or friends
Other health groups/organizations (e.g., National Institutes of Health, American Cancer Society, etc.), please specify below:
Media (e.g., television, radio, newspapers, health magazines, etc.), please specify below:
Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.), please specify below:
Podcasts, please specify below:
Blogs, please specify below:
Other, please specify below:
Do not know/unsure [Programmer: Lock response.]

Did you know that CDC’s Be Antibiotics Aware campaign has resources you can use to learn about antibiotic use?

Programmer: If respondent selects “Yes” to the question above, proceed to the next question, else skip it.

How did you learn about CDC’s Be Antibiotics Aware resources? Select all that apply.

Fact sheets/handouts at my doctor/healthcare professional’s office
Poster at my doctor/healthcare professional's office
PSA (public service announcement) video at my doctor/healthcare professional's office
Pharmacist

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

Centers for Disease Control and Prevention (CDC) website
Family members and/or friends

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

Do not know/cannot recall [Programmer: Lock response.]

Use of Campaign Materials [exposed only]

Did your healthcare professional (e.g., physician, nurse practitioner, physician assistant, nurse, pharmacist, dentist) give/show you any of these campaign materials in the last 2-3 months? Select all that apply.

Chart

Brochure

Prescription pad

Brochure

None of the above

Programmer: If the respondent selects “none of the above” in the above question, skip to the first question in the demographics’ section.

Programmer: only show campaign images and their corresponding questions to respondents who select them in the above question.

Programmer: Put a page break here.

Did you use this chart to learn about antibiotic use?

Yes
No, I did not use this chart
Do not know/cannot recall

Programmer: Put a page break here and skip logic.

Programmer: If response to the question above is “No, I did not use this chart” or “Do not know/cannot recall”, skip the next question.

How helpful for you was this chart in learning about antibiotic use?

Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful

Programmer: Put a page break here.

Did you use this brochure to learn about antibiotic use?

Yes
No, I did not use this brochure
Do not know/cannot recall

Programmer: Put a page break here and skip logic.

Programmer: If response to the question above is “No, I did not use this brochure” or “Do not know/cannot recall”, skip the next question.

How helpful for you was this brochure in learning about antibiotic use?

Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful

Programmer: Put a page break here.

Did you use this prescription pad to learn about antibiotic use?

Yes
No, I did not use this prescription pad
Do not know/cannot recall

Programmer: Put a page break here and skip logic.

Programmer: If response to the question above is “No, I did not use this prescription pad” or “Do not know/cannot recall”, skip the next question.

How helpful for you was this prescription pad in learning about symptom relief for illnesses when antibiotics are not needed?

Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful

Programmer: Put a page break here.

Did you use this brochure to learn about antibiotic use?

Yes
No, I did not use this brochure
Do not know/cannot recall

Programmer: Put a page break here and skip logic.

Programmer: If response to the question above is “No, I did not use this brochure” or “Do not know/cannot recall”, skip the next question.

How helpful for you was this brochure in learning about antibiotic use?

Very helpful
Helpful
Somewhat helpful
A little helpful
Not at all helpful

Programmer: Put a page break here and skip to demographics section.

Media Use and Habits [unexposed only]

Programmer: Include one question (e.g., printed media, social media) per page. Rotate all media options.

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 below:						

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 YouTube						
Use other social media, please specify below:						

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., Watch Netflix, Hulu, [Amazon] Prime Video)						
Read blogs						
Search engines (e.g., Google)						
Visit other websites, please specify below:						

In an average month, how often do you…

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
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 below:						

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 below:						

In an average month, how often do you…

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
Visit doctor’s offices or healthcare facilities						
Visit urgent care centers that are not in a store						
Visit other healthcare locations, please specify below:						

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 emails						
Read email newsletters about health						
Listen to webcasts or webinars						
Attend live events						
Other, please specify below:						

Where do you prefer to get information about antibiotic use? Select all that apply.

My doctor/healthcare professional
Pharmacist
Health websites/Health-related mobile apps (e.g., WebMD, Mayo Clinic, etc.), please specify below:
Centers for Disease Control and Prevention (CDC) website or materials
Health magazines (e.g., Women’s Health, Men’s Health, Prevention), please specify below:
Family members and/or friends
Other health groups/organizations (e.g., National Institutes of Health, American Cancer Society, etc.), please specify below:
Media (e.g., television, radio, newspapers, health magazines, etc.), please specify below:
Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.), please specify below Podcasts, please specify below:
Blogs, please specify below
Other, please specify below:
Do not know/unsure [Programmer: Lock response.]

Demographic Characteristics [ALL]

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

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.

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

ConSUMER INCENTIVE PAGE [ALL]

Before you go, a $25 incentive through Venmo or PayPal, or a $25 gift card will be sent to you as a token of our appreciation for your time. You should receive it within 7 business days.  

*Please choose your preferred method to receive your incentive and fill out the short form to receive your incentive or click “Exit” if you do not wish to receive incentive.

Venmo Programmer: Link this option to “Venmo page.”
PayPal Programmer: Link this option to “PayPal page.”
Gift card by mail Programmer: Link this option to “Gift card by mail page.”
Digital gift card Programmer: Link this option to “Digital gift card page.”
Exit (I do not wish to receive incentive) Programmer: Link this option to “End of Survey.”

Venmo Page

If you do not feel comfortable providing the information below, please contact Julie Overby at [email protected] or call 253-238-7787 or 360-942-8466.

First and Last Name:

Your Venmo username:

Your email associated with Venmo (optional but recommended):

Your phone number associated with Venmo (optional but recommended):

Programmer: Link this page to “End of Survey.”

PayPal Page

If you do not feel comfortable providing the information below, please contact Julie Overby at [email protected] or call 253-238-7787 or 360-942-8466.

First and Last Name:

Your email associated with PayPal (optional but recommended):

Your phone number associated with PayPal (optional but recommended):

Programmer: Link this page to “End of Survey.”

Gift card by mail Page

If you do not feel comfortable providing the information below, please contact Julie Overby at [email protected] or call 253-238-7787 or 360-942-8466.

First and Last Name:

*Address Line 1:

Address Line 2:

*Town/City:

*State/Territory

*ZIP/Postal Code:

Phone number (optional):

Email (optional):

Programmer: Link this page to “End of Survey.”

Digital gift card Page

If you do not feel comfortable providing the information below, please contact Julie Overby at [email protected] or call 253-238-7787 or 360-942-8466.

First and Last Name:

*Your email:

Your phone number:

Programmer: Link this page to “End of Survey.”

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified	0000-00-00
File Created	0000-00-00

BAA Consumer Post Campaign Screener and Survey

[NCEZID] Assessment for the Be Antibiotics Aware Consumer Campaign

BAA Consumer Post-Campaign web survey

BAA Consumer Post-Campaign web survey

OMB: 0920-1387

Table of Contents

Consumer Intended Audiences

Priority markets

classification of Respondents based on their responses to the screener questions

End of screener Message

SCREENER Ineligibility Message

BAA COnsumer Screener Begins Here

baa consumer posttest SCREENER [ALL]

General Instructions for Programmer and Recruiter

Ineligibility Message

End of Survey Message for posttest

Exposure to Campaign [ALL]

CAMPAIGNS

Frequency and Channel of Exposure [ALL]

PRINTED MEDIA

SOCIAL MEDIA

ONLINE/INTERNET MEDIA

TV AND RADIO MEDIA

PUBLIC PLACES

HEALTHCARE SETTINGS

OTHER MEDIA

Knowledge [ALL]

Attitudes and Beliefs [ALL EXCEPT FAMILY CAREGIVER]

PERCEIVED SUSCEPTIBILITY

PERCEIVED SEVERITY

PERCEIVED BENEFITS

PERCEIVED BARRIERS TO USING ANTIBIOTICS APPROPRIATELY

SELF-EFFICACY

PERCEIVED IMPORTANCE OF DISCUSSING APPROPRIATE ANTIBIOTIC USE WITH HCPS

Attitudes and Beliefs [FOR FAMILY CAREGIVER]

PERCEIVED SUSCEPTIBILITY

PERCEIVED SEVERITY

PERCEIVED BENEFITS

PERCEIVED BARRIERS TO USING ANTIBIOTICS APPROPRIATELY

SELF-EFFICACY

PERCEIVED IMPORTANCE OF DISCUSSING APPROPRIATE ANTIBIOTIC USE WITH HCPS

Behavior [ALL EXCEPT FAMILY CAREGIVER]

Behavior [FOR FAMILY CAREGIVER]

Sources of Information [ALL]

Use of Campaign Materials [exposed only]

Media Use and Habits [unexposed only]

PRINTED MEDIA

SOCIAL MEDIA

ONLINE/INTERNET MEDIA

TV AND RADIO MEDIA

PUBLIC PLACES

HEALTHCARE SETTINGS

OTHER MEDIA

Demographic Characteristics [ALL]