GAOS Consumer Pre-Campaign Web Survey

Adults (between 18-64 years of age) who care for a family member age 65+.
Parents of children 12 years of age or younger (parents between 18-64 years of age).

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

Cancer patients and their caregivers.

Healthy adults 65+.
Men aged 65+ with one or more chronic conditions.

Priority markets

New York (NY)***18+
Illinois (IL)***18+
Louisiana (LA)***18+

classification of Respondents based on their responses to the screener questions

Respondents should be classified as “Adults who care for a family member age 65+” if their response(s) to

Q7 = age is between 18-64 AND
Q10 = Yes AND

Respondents should be classified as “Parents of children 12 years of age or younger” if their response(s) to

Q7 = age is between 18-64 AND

Q11 = Yes AND

Q12 = “Self” or “Self and spouse/partner together”

Respondents should be classified as “Patients who survived severe Covid-19 or sepsis and their caregivers” if their response(s) to

Q7 = age is 18+ AND
Q15 = Yes OR
Q16 = Yes OR
Q17 = Yes OR
Q18 = Yes

Respondents should be classified as “Cancer patients and their caregivers” if their response(s) to

Q7 = age is 18+ AND
Q19 = Yes OR
Q20 = Yes OR
Q21 = Yes OR
Q22 = Yes

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

Q7 = age is 65+ AND

Q23 = No

Respondents should be classified as “Men aged 65+ with one or more chronic conditions” if their response(s) to

Q7 = age is 65+ AND
Q9 = Male AND
Q19 = Yes OR
Q20 = Yes OR
Q23 = Yes OR
Q24 = Arthritis, Chronic lung disease, Diabetes, Heart disease, Immunosuppression (weakened immune system), Kidney disease, Lung disease, Stroke, and/or OTHER.

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.

GAOS 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 sepsis. 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 this 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.

Screener Survey Introduction

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 promoting early recognition and timely treatment of sepsis.

OMB Statement

Form Approved

OMB No. 0920-1384

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 0920-22CB

* 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 New York (NY), Illinois (IL), and/or Louisiana (LA).

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 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

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

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

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

Self
Self and spouse/partner together
Someone else

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 ever been hospitalized due to COVID-19?

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

Has a healthcare professional ever diagnosed you with sepsis?

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

Has a healthcare professional ever diagnosed you with cancer?

Programmer: If the respondent selects “Yes” to this question, skip Q23 through Q25.

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

Programmer: If the respondent selects “Yes” to this question, skip Q23 through Q25.

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

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

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

Programmer: If the respondent selects “Yes” to this question, skip Q24 & Q25.

Yes
No
Do not know [INELIGIBILITY WILL BE DETERMINED AFTER SCREENING]

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

Arthritis
Chronic lung disease
Diabetes
Heart disease
Immunosuppression (weakened immune system)
Kidney disease
Lung disease
Stroke
OTHER: __________________
None of the above [INELIGIBILITY WILL BE DETERMINED AFTER SCREENING]

How would you rate your overall physical health?

Programmer: If the respondent selects “Yes” to Q19, Q20, or Q23, skip this question.

Excellent
Very good
Good
Fair
Poor

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 Q26 (a-e), TERMINATE and present the ineligibility message.

General Instructions for Programmer

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!

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

Link: https://www.cdc.gov/sepsis/

Exposure to Campaign [ALL]

Programmer: Include one question per page.

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

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
Be Smart. Beat Sepsis.			
Be Sepsis Aware			
Health is Precious. Don’t Get Sepsis.			
Get Ahead of Sepsis			
Know the Threat. Prevent Sepsis.			

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

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 Q1d 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, Get Ahead of Sepsis, 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 Get Ahead of Sepsis 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 Get Ahead of Sepsis 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 12 months, approximately how often did you see or hear CDC’s Get Ahead of Sepsis campaign messages, campaign name, or logo on …?

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)						
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 12 months, approximately how often did you see or hear CDC’s Get Ahead of Sepsis 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, approximately how often did you see or hear CDC’s Get Ahead of Sepsis 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						
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 places, please specify below:						

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

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

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



Other healthcare locations, please specify below:



In the past 12 months, approximately how often did you see or hear CDC’s Get Ahead of Sepsis 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.

Y ou indicated that you saw or heard the campaign name, Get Ahead of Sepsis, or saw the campaign logo in the past 12 months. Where did you see or hear it? [open-ended response]

Programmer: If the respondent selects "Never or “Do not know/cannot recall" for ALL options in 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]

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

Sepsis is defined as the following:

A chronic condition that primarily affects kidney function. [INACCURATE]
The body’s extreme response to an infection. [ACCURATE]
A neurological disorder resulting from the flu. [INACCURATE]
A Contagious illness that commonly peaks in the winter. [INACCURATE
All of the above [INACCURATE]
None of the above [INACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Sepsis is a medical emergency.

TRUE [ACCURATE]
FALSE [INACCURATE]

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

TRUE [ACCURATE]
FALSE [INACCURATE]

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

TRUE [INACCURATE]
FALSE [ACCURATE]

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

TRUE [ACCURATE]
FALSE [INACCURATE]

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

Ear [INACCURATE]
Skin [ACCURATE]
Lung [ACCURATE]
Eye [INACCURATE]
Urinary tract [ACCURATE]
Nail [INACCURATE]
Gastrointestinal tract [ACCURATE]
Severe COVID-19 [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

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

Adults 65 or older [ACCURATE]
People with weakened immune systems [ACCURATE]
People with chronic medical conditions, such as diabetes, lung disease, cancer, and kidney disease [ACCURATE]
Children younger than one year old [ACCURATE]
People who have previously survived sepsis [ACCURATE]
People with recent severe illness or hospitalization [ACCURATE]
Adults with no underlying conditions between the ages of 20 and 35 years [INACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Check all the signs and symptoms of sepsis below:

Excessive hunger [INACCURATE]
Clammy or sweaty skin [ACCURATE]
Confusion or disorientation [ACCURATE]
Extreme pain or discomfort [ACCURATE]
Fever, shivering, or feeling very cold [ACCURATE]
High heart rate or low blood pressure [ACCURATE]
Shortness of breath [ACCURATE]
I do not know any of the signs and symptoms of sepsis. [INACCURATE] [Programmer: Lock response.]

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

Yes [ACCURATE]
No [INACCURATE]

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

Regular handwashing [ACCURATE]
Showering twice daily [INACCURATE]
Getting recommended vaccines [ACCURATE]
Avoiding public restrooms [INACCURATE]
Keeping cuts and wounds clean and covered until healed [ACCURATE]
Taking good care of chronic conditions [ACCURATE]
Do not know [INACCURATE] [Programmer: Lock response.]

Attitudes and Beliefs [ALL]

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

Caregivers of Cancer Patients

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

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 infections and sepsis about family members. Please give us your honest responses.

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

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

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

[Perceived Susceptibility]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
The cancer patient(s) I care for is/are at risk of developing infections that could lead to sepsis.
The cancer patient(s) I care for is/are at risk of developing sepsis.
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If the cancer patient(s) I care for developed sepsis, it could cause severe problems, such as tissue damage and organ failure.
If the cancer patient(s) I care for developed sepsis, it could lead to death.
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I help the cancer patient(s) I care for take proper care of their chronic condition(s) (if the cancer patient has them), this will decrease their chances of developing infections that can lead to sepsis.
If I help the cancer patient(s) I care for practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.
If I help the cancer patient(s) I care for keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.
If the cancer patient(s) I care for gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.
Fast recognition of the signs and symptoms of sepsis can increase the chances of survival for the cancer patient(s) I care for.
Fast recognition and treatment of infections can reduce the chance of getting sepsis for the cancer patient(s) I care for.
I should help the cancer patient(s) I care for seek immediate medical care if they have an infection that is not getting better/getting worse.
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can help the cancer patient(s) I care for prevent infections that can lead to sepsis.
I am confident that I can help the cancer patient(s) I care for talk to a healthcare professional if they have an infection that is not getting better or is getting worse.
I am confident that I can help the cancer patient(s) I care for recognize the signs and symptoms of sepsis.
I am confident that I can help the cancer patient(s) I care for seek immediate medical care if I/they suspect sepsis.

Cancer Patients

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

Programmer: Use the following section for “Cancer patients”

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 infections and sepsis. Please give us your honest responses.

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

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 am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I take proper care of my health, this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

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

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

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 infections and sepsis about family members. Please give us your honest responses.

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

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

[Perceived Susceptibility]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
The sepsis or severe COVID-19 survivor I care for is at risk of developing infections that could lead to sepsis.
The sepsis or severe COVID-19 survivor I care for is at risk of developing sepsis.
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If the sepsis or severe COVID-19 survivor I care for developed sepsis, it could cause severe problems, such as tissue damage and organ failure.
If the sepsis or severe COVID-19 survivor I care for developed sepsis, it could lead to death.
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I help the sepsis or severe COVID-19 survivor I care for take proper care of their chronic condition(s) (if the sepsis or severe COVID-19 survivor has them), this will decrease their chances of developing infections that can lead to sepsis.
If I help the sepsis or severe COVID-19 survivor I care for practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.
If I help the sepsis or severe COVID-19 survivor I care for keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.
If my sepsis or severe COVID-19 survivor gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.
Fast recognition of the signs and symptoms of sepsis can increase my sepsis or severe COVID-19 survivor’s chances of survival.
Fast recognition and treatment of infections can reduce my sepsis or severe COVID-19 survivor’s chance of getting sepsis.
I should help the sepsis or severe COVID-19 survivor I care for seek immediate medical care if they have an infection that is not getting better/getting worse.
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can help the sepsis or severe COVID-19 survivor I care for prevent infections that can lead to sepsis.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for talk to a healthcare professional if they have an infection that is not getting better or is getting worse.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for recognize the signs and symptoms of sepsis.
I am confident that I can help the sepsis or severe COVID-19 survivor I care for seek immediate medical care if I/they suspect sepsis.

Sepsis or Severe COVID-19 Survivors

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

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 infections and sepsis. Please give us your honest responses.

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

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 am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I take proper care of my health, this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Parent of Children 12 years and younger

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

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 infections and sepsis. Please give us your honest responses.

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

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

[Perceived Susceptibility]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
My child is at risk of developing infections that could lead to sepsis.					
My child is at risk of developing sepsis.					
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If my child developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If my child developed sepsis, it could lead to death.					
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I take proper care of my child’s chronic condition(s) (if my child has them), this will decrease their chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my child’s chances of developing infections that can lead to sepsis.					
If I keep my child’s cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.					
If my child gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my child’s chances of survival.					
Fast recognition and treatment of infections can reduce my child’s chances of getting sepsis.					
I should seek immediate medical care for my child if they have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can prevent infections that can lead to sepsis in my child.					
I am confident that I can talk to a healthcare professional if my child has an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis in my child.					
I am confident that I can seek immediate medical care if I suspect sepsis in my child.					

Adults who care for a Family Member Age 65+

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

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 infections and sepsis. Please give us your honest responses.

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

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

[Perceived Susceptibility]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
My family member is at risk of developing infections that could lead to sepsis.					
My family member is at risk of developing sepsis.					
[Perceived Severity]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If my family member developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If my family member developed sepsis, it could lead to death.					
[Perceived Benefits]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
If I help my family member take proper care of their chronic condition(s) (if my family member has them), this will decrease their chances of developing infections that can lead to sepsis.					
If I help my family member practice good hand hygiene, this will decrease their chances of developing infections that can lead to sepsis.					
If I help my family member keep their cuts and wounds clean and covered until healed, this will decrease their chances of developing infections that can lead to sepsis.					
If my family member gets recommended vaccinations, this will decrease their chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my family member’s chances of survival.					
Fast recognition and treatment of infections can reduce my family member’s chances of getting sepsis.					
I should help my family member seek immediate medical care if they have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly Disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly Agree
I am confident that I can help my family member prevent infections that can lead to sepsis.					
I am confident that I can help my family member talk to a healthcare professional if they have an infection that is not getting better or is getting worse.					
I am confident that I can help my family member recognize the signs and symptoms of sepsis.					
I am confident that I can help my family member seek immediate medical care if I/they suspect sepsis.					

Men aged 65+ with one or more Chronic Conditions

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 infections and sepsis. Please give us your honest responses.

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

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 am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
[Perceived Severity]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
[Perceived Benefits]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
If I take proper care of my chronic condition(s), this will decrease my chances of developing infections that can lead to sepsis.					
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Healthy Adults 65+

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

Programmer: Use the following section for “Healthy adults 65+”

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 infections and sepsis. Please give us your honest responses.

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

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 am at risk of developing infections that could lead to sepsis.					
I am at risk of developing sepsis.					
[Perceived Severity]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
If I developed sepsis, it could cause severe problems, such as tissue damage and organ failure.					
If I develop sepsis, it could lead to death.					
[Perceived Benefits]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
If I practice good hand hygiene, this will decrease my chances of developing infections that can lead to sepsis.					
If I keep my cuts and wounds clean and covered until healed, this will decrease my chances of developing infections that can lead to sepsis.					
If I get recommended vaccinations, this will decrease my chances of developing infections that can lead to sepsis.					
Fast recognition of the signs and symptoms of sepsis can increase my chances of survival.					
Fast recognition and treatment of infections can reduce my chances of getting sepsis.					
I should seek immediate medical care if I have an infection that is not getting better or is getting worse.					
[Self-Efficacy]	Strongly disagree	Disagree	Neither Agree nor Disagree	Agree	Strongly agree
I am confident that I can prevent infections that can lead to sepsis.					
I am confident that I can talk to a healthcare professional if I have an infection that is not getting better or is getting worse.					
I am confident that I can recognize the signs and symptoms of sepsis.					
I am confident that I can seek immediate medical care if I suspect sepsis.					

Behavior [ALL]

Caregivers of a Cancer Patient

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

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

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

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

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

Programmer: If all responses to the above question are “Did not visit healthcare professional for an infection in the past 12 months” skip the rest of the questions in this section else proceed to the next question below.

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for the cancer patient(s) I care for.
I do not think infections that can lead to sepsis are a big problem for the cancer patient(s) I care for.
The cancer patient(s) I care for does not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

Yes
No
Do not know

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

I am not able to get to a doctor with the cancer patient(s) I care for to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse with the cancer patient(s) I care for because I am worried about getting COVID-19 or the cancer patient getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for the cancer patient(s) I care for.

I am not familiar enough with how to prevent infections that can lead to sepsis in the cancer patient(s) I care for.
I do not know if the cancer patient(s) I care for need to get any vaccinations.
I do not want the cancer patient(s) I care for to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis in the cancer patient(s) I care for.
I do not think sepsis is a problem for the cancer patient(s) I care for.
I do not think infections that can lead to sepsis are a problem for the cancer patient(s) I care for.
I do not think it is important to prevent infections that can lead to sepsis in the cancer patient(s) I care for.
I do not have time to take all the steps needed to prevent infections that can lead to sepsis in the cancer patient(s) I care for.
The health of the cancer patient(s) I care for makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in the area where the cancer patient(s) I care for reside can respond correctly to sepsis.
I’m not confident the healthcare professionals in the area where the cancer patient(s) I care for reside can respond correctly to sepsis.
The cancer patient(s) I care for lives very far from healthcare services.
The cancer patient(s) I care for does not have easy access to healthcare services.
The cancer patient(s) I care for relies on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis in the cancer patient(s) I care for. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Cancer Patients

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

Programmer: Use the following section for “Cancer Patients”

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for me.I do not think infections that can lead to sepsis are a problem for me.
I do not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

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

I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse because I am worried about getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.
I am not familiar enough with how to prevent infections that can lead to sepsis.
I do not know if I need to get any vaccinations.
I do not want to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis.
I do not think sepsis is a problem for me.I do not think infections that can lead to sepsis are a problem for me.
I do not think it is important to prevent infections that can lead to sepsis.I do not have time to take all the steps needed to prevent infections that can lead to sepsis.
My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in my area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my area can respond correctly to sepsis.
I live very far from healthcare services.I don’t have easy access to healthcare services.
I rely on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

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

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

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for the sepsis or severe COVID-19 survivor I care for.I do not think infections that can lead to sepsis are a problem for the sepsis or severe COVID-19 survivor I care for.The sepsis or severe COVID-19 survivor I care for does not have a healthcare professional with whom I can discuss these topics.I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

Yes
No
Do not know

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

I am not able to get to a doctor with the survivor of sepsis or severe COVID-19 I care for to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse with the survivor of sepsis or severe COVID-19 I care for because I am worried about getting COVID-19 or the survivor of sepsis or severe COVID-19 getting COVID-19.

I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for the survivor of sepsis or severe COVID-19 I care for.I am not familiar enough with how to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.
I do not know if the survivor of sepsis or severe COVID-19 I care for needs to get any vaccinations.
I do not want the survivor of sepsis or severe COVID-19 I care for to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.
I do not think sepsis is a problem for the survivor of sepsis or severe COVID-19 I care for.
I do not think infections that can lead to sepsis are a problem for the survivor of sepsis or severe COVID-19 I care for.I do not think it is important to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.
I do not have time to take all the steps needed to prevent infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for.
The health of the sepsis or severe COVID-19 survivor I care for makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.I’m not confident the healthcare system in the area where the sepsis or severe COVID-19 survivor I care for can respond correctly to sepsis.
I’m not confident the healthcare professionals in the area where the sepsis or severe COVID-19 survivor I care for can respond correctly to sepsis.
The sepsis or severe COVID-19 survivor I care for lives very far from healthcare services.
The sepsis or severe COVID-19 survivor I care for do not have easy access to healthcare services.
I rely on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis in the survivor of sepsis or severe COVID-19 I care for. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Sepsis or Severe COVID-19 Survivors

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

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for me.I do not think infections that can lead to sepsis are a problem for me.
I do not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:

I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

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

I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse because I am worried about getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.
I am not familiar enough with how to prevent infections that can lead to sepsis.
I do not know if I need to get any vaccinations.
I do not want to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis.
I do not think sepsis is a problem for me.
I do not think infections that can lead to sepsis are a problem for me.
I do not think it is important to prevent infections that can lead to sepsis.I do not have time to take all the steps needed to prevent infections that can lead to sepsis.
My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in my area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my area can respond correctly to sepsis.
I live very far from healthcare services.I don’t have easy access to healthcare services.
I rely on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Parent of Children 12 years and Younger

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

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for my child.I do not think infections that can lead to sepsis are a problem for my child.
My child does not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

Yes
No
Do not know

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

I am not able to get to a doctor with my child to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse with my child because I am worried about getting COVID-19 or my child getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis in my child.
I am not familiar enough with how to prevent infections that can lead to sepsis in my child.
I do not know if my child needs to get any vaccinations.
I do not want my child to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis in my child.
I do not think sepsis is a problem for my child.I do not think infections that can lead to sepsis are a problem for my child.
I do not think it is important to prevent infections that can lead to sepsis in my child.I do not have time to take all the steps needed to prevent infections that can lead to sepsis in my child.
My child’s health or my own health make it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in the area where my child lives can respond correctly to sepsis.
I’m not confident the healthcare professionals in the area where my child lives can respond correctly to sepsis.
My child lives very far from healthcare services.My child does not have easy access to healthcare services.My child relies on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis in my child. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Adults who care for a Family Member Age 65+

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

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for my family member.
I do not think infections that can lead to sepsis are a problem for my family member.
My family member does not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

Yes
No
Do not know

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

I am not able to get to a doctor with my family member to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse with my family member because I am worried about getting COVID-19 or my family member getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis for my family member.
I am not familiar enough with how to prevent infections that can lead to sepsis in my family member.
I do not know if my family member needs to get any vaccinations.
I do not want my family member to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis in my family member.
I do not think sepsis is a problem for my family member.I do not think infections that can lead to sepsis are a problem for my family member.
I do not think it is important to prevent infections that can lead to sepsis in my family member.I do not have time to take all the steps needed to prevent infections that can lead to sepsis in my family member.
My family member’s health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in my area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my area can respond correctly to sepsis.
I live very far from healthcare services.I don’t have easy access to healthcare services.

I’m not confident the healthcare system in my family member’s area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my family member’s area can respond correctly to sepsis.
My family member lives very far from healthcare services.
My family member does not have easy access to healthcare services.My family member relies on telehealth services.

Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis in my family member. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Men aged 65+ with one or more Chronic Conditions

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

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for me.

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

I do not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:

I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

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

I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse because I am worried about getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.
I am not familiar enough with how to prevent infections that can lead to sepsis.
I do not know if I need to get any vaccinations.
I do not want to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis.
I do not think sepsis is a problem for me.I do not think infections that can lead to sepsis are a problem for me.
I do not think it is important to prevent infections that can lead to sepsis.I do not have time to take all the steps needed to prevent infections that can lead to sepsis.
My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in my area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my area can respond correctly to sepsis.
I live very far from healthcare services.I don’t have easy access to healthcare services.
I rely on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Healthy Adults 65+

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

Programmer: Use the following section for “Healthy adults 65+”.

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

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

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

I am not familiar enough with these topics.
I do not understand these topics.
I am not interested in these topics.
I do not have time to educate myself about these topics.
I do not think sepsis is a problem for me.I do not think infections that can lead to sepsis are a problem for me.
I do not have a healthcare professional with whom I can discuss these topics.
I feel frightened or worried when I talk about these topics.
Other, please explain below:
I do not have any barriers to having conversations about these topics. [Programmer: Lock response.]

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

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

I am not able to get to a doctor or nurse to discuss the steps needed to prevent infections that can lead to sepsis.
I am afraid to see a doctor or nurse because I am worried about getting COVID-19.
I am not able to access or afford supplies for cuts and wound care that I would need to prevent infections that can lead to sepsis.
I am not familiar enough with how to prevent infections that can lead to sepsis.
I do not know if I need to get any vaccinations.
I do not want to get vaccinations.
I do not think it is possible for me to prevent infections that can lead to sepsis.
I do not think sepsis is a problem for me.
I do not think infections that can lead to sepsis are a problem for me.
I do not think it is important to prevent infections that can lead to sepsis.
I do not have time to take all the steps needed to prevent infections that can lead to sepsis.
My health makes it hard for me to take all the steps needed to prevent infections that can lead to sepsis.
I’m not confident the healthcare system in my area can respond correctly to sepsis.
I’m not confident the healthcare professionals in my area can respond correctly to sepsis.
I live very far from healthcare services.
I don’t have easy access to healthcare services.
I rely on telehealth services.
Other, please explain below:
I have not encountered any barriers to preventing infections that can lead to sepsis. [Programmer: Lock response.]

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

Yes
No
Do not know/cannot recall

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

Sources of Information [ALL]

To whom or where did you go to learn about infections that can lead to sepsis? 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 sepsis. [Programmer: Lock response.]

If you need to get information about sepsis, 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:

Television, please specify below:
Radio, 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.]

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

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

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

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

My doctor/healthcare provider’s office
Health websites/health-related mobile apps (e.g., WebMD, Mayo Clinic)
Centers for Disease Control and Prevention (CDC) website
Family members and/or friends
Social media (e.g., Facebook, Twitter, Instagram, LinkedIn, etc.)
Other, please specify below:
Do not know/cannot recall [Programmer: Lock response.]

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

	Yes	No
Family members
Friends

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

	Yes	No
Family members
Friends

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

	Yes	No
Family members
Friends

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

	Yes	No
Family members
Friends

Demographic Characteristics [ALL]

Include one question per page.

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
Author	Deborah W Gould
File Modified	0000-00-00
File Created	2023-07-29

GAOS Consumer Pre-Campaign Web Survey

[NCEZID] Assessment for the Get Ahead of Sepsis Consumer and Healthcare Professional Campaign