BAA HCP Pre Campaign Screener and Survey

Q8 = Physician (MD or DO), Physician Assistant (PA), or Nurse Practitioner (NP)
Q9 = Hospital AND
Q10 = 31 or more hours AND
Q11 = Once a week or multiple times every week

Respondents should be classified as “Dentists” if their response(s) to

Q8= Dentist (DDS or DMD)
Q9 = Dental office AND
Q10 = 31 or more hours AND
Q11 = Once a week or multiple times every week

Respondents should be classified as “Physicians and Advanced Practice Professionals (APPs) in Nursing Homes (NHs)” if their response(s) to

Q8 = Physician (MD or DO), Physician Assistant (PA), Nurse Practitioner (NP)
Q9 = Nursing home/Long Term Care AND
Q10 = 31 or more hours AND
Q11 = Once a week or multiple times every week

Respondents should be classified as “Nurses in NHs” if their response(s)

Q8 = Licensed Nurse (RN, BSN, LPN)
Q9 = Nursing home/Long Term Care AND
Q10 = 31 or more hours AND
Q11 = Once a week or multiple times every week

Respondents should be classified as “Community Pharmacists” if their response(s) to

Q8 = Pharmacist (PharmD or RPh)
Q9 = Pharmacy (Retail) AND
Q10 = 31 or more hours AND
Q11 = Once a week or multiple times every week

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.

Programmer: Customize the collector’s page with this message.

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.

Programmer: Customize the collector’s page with this 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 Julie Overby at [email protected] or call phone number 253-238-7787 or 360-942-8466.

Thank you for your time.

BAA HCP 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 $75 through Venmo or PayPal, or a $75 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 HCP Pretest 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 and improve its ongoing campaign to improve antibiotic use.

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

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 Q4, TERMINATE else proceed with survey.

Are you a healthcare professional (e.g., physician, physician assistant, nurse practitioner, nurse, pharmacist, or dentist)?

Yes
No [INELIGIBLE/TERMINATE]

In what State do you perform the majority of your work? _____________________

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 perform the majority of your work? _____________________

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 Iowa (IA), Nebraska (NE), Tennessee (TN), and Alabama (AL).

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

Specifically, what type of healthcare professional are you?

Physician (MD or DO)
Physician Assistant (PA)
Dentist (DDS or DMD)
Pharmacist (PharmD or RPh)
Nurse Practitioner (NP)
Registered Nurse (RN, including ADNs and BSNs)
None of the above [INELIGIBLE/TERMINATE]

* What type of setting do you spend the most time providing patient care?

Hospital
Nursing home/Long-Term Care
Retail pharmacy
Dental office
Urgent care facility [INELIGIBLE/TERMINATE]
Primary care practice/facility [INELIGIBLE/TERMINATE]
Outpatient [INELIGIBLE/TERMINATE]

None of the above [INELIGIBLE/TERMINATE]

* On average, how many hours a week do you provide patient care?

0-10 hours [INELIGIBLE/TERMINATE]
11-20 hours [INELIGIBLE/TERMINATE]
21-30 hours [INELIGIBLE/TERMINATE]
31 or more hours

* On average, how often do you prescribe antibiotics/provide antibiotics to patients?

Multiple times every week
Once a week
1-3 times a month [INELIGIBLE/TERMINATE]
Never [INELIGIBLE/TERMINATE]

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 Pretest

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 appropriate antibiotic use that you may or may not have seen or heard about in the past 12 months.

Please indicate below whether you have seen or heard any of the following campaign names or slogans in the past 12 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 12 months, did you see 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 [EXPOSED ONLY]

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 12 months.

In the past 12 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 12 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						
Doximity						
Sermo						
YouTube						
Other social media, please specify below:						

In the past 12 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 (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						
Advertisement on mobile phone (including mobile apps)						
Search engines (e.g., Google)						
Others, please specify below:						

In the past 12 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 12 months, how often did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo in …?

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						
On buses or taxi cabs						
Advertisement in a mall						
Advertisement in a grocery store						
Advertisement in a retail pharmacy						
Advertisement at a shopping center or parking lot						
Other public places, please specify below:						

In the past 12 months, did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo at your workplace (including at your home workplace for telework)?

Yes, I personally placed or shared CDC’s Be Antibiotics Aware Campaign materials at my workplace in the past 12 months
Yes, I saw CDC’s Be Antibiotics Aware 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 antibiotic use campaign at my workplace in the past 12 months
No, I have not seen any materials about antibiotic use at my workplace in the past 12 months

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

In the past 12 months, where did you see or hear CDC’s Be Antibiotics Aware campaign messages, campaign name, or logo at your workplace (including at your home workplace for telework)? Select all that apply.

Posters or other print material(s) designed to educate patients about appropriate antibiotic use
Posters or other print material(s) designed to improve antibiotic prescribing by healthcare professionals
Digital material(s) designed to educate patients about appropriate antibiotic use
Digital material(s) designed to improve antibiotic prescribing by healthcare professionals
Video displays in patient waiting areas
Workplace website or internal email/newsletter
Email or e-newsletter from an external health organization, such as a state or local public health agency or professional association
Other, please specify below:
Do not know/cannot recall [Programmer: Lock response.]

Programmer: If the respondent is presented the question above, after responding or if they choose to skip, proceed to “RISKS AND BENEFITS...” section.

You indicated that you saw or heard the campaign name, Be Antibiotics Aware, or saw the campaign logo in the past 12 months. Where did you see or hear it? [Open-ended response]

Programmer: If the respondent leaves the above open-ended question blank, reclassify these respondents as “UNEXPOSED” and proceed to “RISKS AND BENEFITS...” section.

Risks and Benefits of Antibiotics – Attitudes and Beliefs [ALL GROUPS EXCEPT PHARMACISTS]

Programmer: Include one question per page. Include disclaimer statement below only with the first question in this section. Do not allow participants to go back and change their response to a previous question.

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 antibiotic prescribing. Research shows that healthcare professionals face challenges with antibiotic prescribing. Your responses to this survey will help CDC understand how to better support healthcare professionals’ antibiotic prescribing habits. Please give us your honest responses. There are no right or wrong answers to any of these questions.

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
Antibiotic resistance is a serious public health issue.					
Antibiotic resistance can have serious consequences for my patients.					
Side effects caused by antibiotics could be very serious for my patients.					

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
If my patients are prescribed antibiotics, they could experience minor side effects, like a rash.					
If my patients are prescribed antibiotics, they could experience very serious health problems, such as Clostridioides difficile (or C. diff) infection.					

PERCEIVED SUSCEPTIBILITY

Strongly Disagree

Disagree

Neither

Agree nor Disagree

Agree

Strongly Agree

If my patients are prescribed antibiotics, they could experience minor side effects, like a rash.



If my patients are prescribed antibiotics, they could experience very serious health problems, such as Clostridioides difficile (or C. diff) infection.



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
Prescribing antibiotics judiciously and only for certain infections caused by bacteria is the best care for my patients.					
Prescribing antibiotics judiciously and only for certain infections caused by bacteria helps protect my patients from unnecessary antibiotic use.					
Prescribing antibiotics judiciously and only for certain infections caused by bacteria helps combat antibiotic resistance.					

In the past 12 months, please indicate how often you did the following when prescribing antibiotics.

BEHAVIOR (PRESCRIBING)	Never	Rarely	Sometimes	Often	Always
I factor patient satisfaction into my decisions to prescribe antibiotics.					
I prescribe antibiotics according to clinical guidelines.					
I consider antibiotic resistance when prescribing an antibiotic to my patients.					
I take antibiotic resistance into consideration when choosing which antibiotic to prescribe to my patients.					
I consider antibiotic adverse events, like C. diff infection, when prescribing antibiotics to my patients.					

What barriers do you commonly experience in prescribing antibiotics to your patients? Select all that apply.

Current clinical guidance does not always apply to my patients
I am not as familiar as I would like to be with current clinical guidance for prescribing antibiotics
My patients will be dissatisfied with their visit if I do not prescribe antibiotics and they believe they need them for their illness
My patients demand antibiotics, even if I don’t think an antibiotic is needed to treat their illness
My patients are not concerned about antibiotic resistance
My patients are unconcerned about potential side effects of antibiotics, such as rash, nausea, or C. diff infection
My patients are unaware of potential side effects of antibiotics, such as rash, nausea, or C. diff infection
Uncertainty of diagnosis can make it challenging to determine if the patient needs antibiotics
Other, please explain below:
I have not encountered any barriers to following clinical guidelines regarding antibiotic prescribing [Programmer: Lock response.]

Risks and Benefits of Antibiotics – Attitudes and Beliefs [PHARMACISTS ONLY]

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
Antibiotic resistance is a serious public health issue.
Antibiotic resistance can have serious consequences for my patients.
Side effects caused by antibiotics could be very serious for my patients.

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

If my patients are prescribed antibiotics, whether needed or not needed, they could experience minor side effects, like a rash.

If my patients are prescribed antibiotics, whether needed or not, they could experience very serious health problems, such as Clostridioides difficile (or C. diff) infection.

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

Providing antibiotics judiciously only for certain infections caused by bacteria helps combat antibiotic resistance.

Discussing Antibiotics with Patients: Attitudes,

Discussing Antibiotics with Patients: Attitudes, Beliefs and Behaviors [ALL EXCEPT PHARMACISTS]

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

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

KNOWLEDGE OF NEED FOR CONVERSATIONS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
It is important for me to discuss with my patients that antibiotics can cause side effects that can range from minor issues, like a rash, to adverse events, such as C. diff infection.					
It is important for me to discuss with my patients that antibiotic use can contribute to antibiotic resistance.					
It is important for me to help my patients understand ways they can feel better, such as taking over the counter (OTC) medications that can help relieve symptoms, regardless of whether an antibiotic is needed to treat their illness.					
It is important for me to educate patients about when antibiotics are and are not needed for their illness.					

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

PERCEIVED BENEFITS OF CONVERSATIONS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that educating my patients about appropriate antibiotic use can protect them from unnecessary side effects.					
I believe that educating my patients about appropriate antibiotic use can help reduce unnecessary antibiotic use, thus helping to combat antibiotic resistance.					
I believe that educating my patients about which infections antibiotics do and do not treat helps them understand my decision on whether to prescribe antibiotics for their illness.					

When prescribing antibiotics, please indicate how frequently you discuss the following with your patients.

BEHAVIOR (CONVERSATIONS)	Never	Rarely	Sometimes	Often	Always
Whether antibiotics are needed for their illness.					
Other ways to feel better, such as taking OTC medications that can help relieve symptoms, including when a patient has an infection that does not need an antibiotic.					
Common side effects, such as rash, diarrhea, and nausea, when prescribing antibiotics.					
Possible severe side effects, such as C. diff infection or allergic reactions.					
Antibiotic use contributes to antibiotic resistance.					

What are the barriers you commonly encounter when educating your patients on the topics of appropriate antibiotic use and antibiotic resistance? Select all that apply.

I am not familiar enough with these topics
I do not feel confident educating my patients on these topics
I do not think my patients will understand these topics
I do not think it is important for my patients to understand these topics
I do not think my patients will be interested in or receptive to learning about these topics
I do not have time to educate my patients on these topics
I do not have access to educational materials about these topics
Other, please specify below:
I have not encountered any barriers to educating my patients on these topics [Programmer: Lock response.]

Did you know that CDC’s Be Antibiotics Aware campaign has resources you can use to help educate your patients about appropriate antibiotic use?

Discussing Antibiotics with Patients: Attitudes, Beliefs, and Behaviors [PHARMACISTS ONLY]

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

KNOWLEDGE OF NEED FOR CONVERSATIONS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
It’s important for me to discuss with my patients that antibiotics can cause side effects that can range from minor issues, like a rash, to adverse events, such as C. diff infection.
It’s important for me to discuss with my patients that antibiotic use can lead to antibiotic resistance.
It is important for me to help my patients understand ways they can feel better, such as taking over the counter (OTC) medications that can help relieve symptoms, including when an antibiotic is not needed to treat their illness.
It is important for me to educate my patients about when antibiotics are and are not needed for their illness.

Please indicate the extent to which you agree with the following statements, from strongly disagree to strongly agree. Educating includes providing verbal or written information on how to take antibiotics correctly.

PERCEIVED BENEFITS OF CONVERSATIONS	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I believe that educating my patients about appropriate antibiotic use can protect them from common side effects, such as rash, diarrhea, and nausea.
I believe that educating my patients about appropriate antibiotic use can protect them from more serious side effects, including life-threatening allergic reactions or C. diff infection.
I believe that educating my patients about viral vs. bacterial causes of acute respiratory infections (ARI), including COVID-19, can help reduce unnecessary antibiotic use.
I believe that educating my patients about appropriate antibiotic use can help reduce unnecessary antibiotic use, thus helping to combat antibiotic resistance.

When prescribing antibiotics, please indicate how frequently you discuss the following with your patients.

BEHAVIOR (CONVERSATIONS)	Never	Rarely	Sometimes	Often	Always	N/A
Common side effects, such as rash, diarrhea, and nausea.
More serious side effects, such as C. diff infection.
The threat of antibiotic resistance.
The importance of taking antibiotics as prescribed.

Did you know that CDC’s Be Antibiotics Aware campaign has resources you can use to help educate your patients about appropriate antibiotic use?

Covid-19 Behavior [ALL Except dentists]

In the past 12 months, how often did you feel patients expected you to provide antibiotics because they believed they had COVID-19?

Always
Often
Sometimes
Rarely
Never
I did not see any patients who believed they had COVID-19 [Programmer: Lock response.]

In the past 12 months, how often did your patients specifically ask for antibiotics because they believed they had COVID-19?

Always
Often
Sometimes
Rarely
Never
I did not see any patients who believed they had COVID-19 [Programmer: Lock response.]

In the past 12 months, how often did you provide antibiotics to patients to treat COVID-19?

Always
Often
Sometimes
Rarely
Never
I did not see any patients who believed they had COVID-19 [Programmer: Lock response.]

Demographic Characteristics [ALL]

Programmer: Include one set of questions per page.

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, or 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

HCP INCENTIVE PAGe [ALL]

Before you go, a $75 incentive through Venmo or PayPal, or a $75 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 HCP Pre Campaign Screener and Survey

[NCEZID] Assessment for the Be Antibiotics Aware Consumer Campaign

BAA HCP Pre-Campaign web survey

BAA HCP Pre-Campaign web survey

OMB: 0920-1387

Table of Contents

HCP Intended Audiences

Priority markets

classification of Respondents based on their responses to the screener questions

End of screener Message

SCREENER Ineligibility Message

BAA HCP Screener Begins Here

baa HCP Pretest SCREENER [ALL]

General Instructions for Programmer and Recruiter

Ineligibility Message

End of Survey Message for Pretest

Exposure to Campaign [ALL]

CAMPAIGNS

Frequency and Channel of Exposure [EXPOSED ONLY]

PRINTED MEDIA

SOCIAL MEDIA

ONLINE/INTERNET MEDIA

TV AND RADIO MEDIA

PUBLIC PLACES

Risks and Benefits of Antibiotics – Attitudes and Beliefs [ALL GROUPS EXCEPT PHARMACISTS]

PERCEIVED SEVERITY

PERCEIVED SUSCEPTIBILITY

PERCEIVED BENEFITS

BEHAVIOR (PRESCRIBING)

Risks and Benefits of Antibiotics – Attitudes and Beliefs [PHARMACISTS ONLY]

PERCEIVED SEVERITY

PERCEIVED SUSCEPTIBILITY

PERCEIVED BENEFITS

Discussing Antibiotics with Patients: Attitudes, Beliefs and Behaviors [ALL EXCEPT PHARMACISTS]

KNOWLEDGE OF NEED FOR CONVERSATIONS

PERCEIVED BENEFITS OF CONVERSATIONS

BEHAVIOR (CONVERSATIONS)

Discussing Antibiotics with Patients: Attitudes, Beliefs, and Behaviors [PHARMACISTS ONLY]

KNOWLEDGE OF NEED FOR CONVERSATIONS

PERCEIVED BENEFITS OF CONVERSATIONS

BEHAVIOR (CONVERSATIONS)

Covid-19 Behavior [ALL Except dentists]

Demographic Characteristics [ALL]