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<p><a href="arra-cer.pdf">PDF File</a> - 2.76 MB</p>
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<h1 class="page__title title" id="page-title">Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts</h1>
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<div class="field field-name-field-subtitle field-type-text field-label-hidden">
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<h2 class="field-item even">Appendix B: Consumer Survey</h2>
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</div>
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</div>
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<div class="field field-name-field-description field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"></div></div></div><div class="field field-name-ahrq-generic-body field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><h3>Part A. Awareness—Patient Centered Outcomes Research (PCOR) Unaided Awareness</h3>
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<p>There are a many ways to treat most medical illnesses and conditions. Different treatment options have different levels of benefits and risks of side effects, as well as costs.</p>
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<p>Q1. Have you heard of the concept of comparing health care treatments with your clinician to decide what options will work best for you?</p>
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<p>___ YES<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q2. Have you heard about research that can help you compare treatment choices?</p>
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<p>___ YES<br><br />
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___ NO → SKIP Part B intro<br><br />
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___ DON'T KNOW → SKIP TO Part B intro<br><br />
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___ REFUSED → SKIP TO Part B intro</p>
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<p>Q3. Have you heard this research referred to by a specific name?</p>
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<p>___ YES<br><br />
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___ NO → SKIP Part B intro<br><br />
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___ DON'T KNOW → SKIP TO Part B intro<br><br />
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___ REFUSED → SKIP TO Part B intro</p>
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<p>Q4. What is the name of this kind of research?</p>
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<p>RESPONDENT'S UNPROMPTED ANSWER MUST MATCH ONE OF FIRST THREE RESPONSE CATEGORIES; OTHERWISE CODE AS "OTHER" OR DON'T KNOW." PROCEED TO QUESTION 5.</p>
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<p>___ COMPARATIVE EFFECTIVENESS RESEARCH<br><br />
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___ SHARED-DECISION MAKING<br><br />
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___ PATIENT CENTERED OUTCOMES RESEARCH<br><br />
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___ OTHER (SPECIFY: _________________________)<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<h3>Part B. Awareness—PCOR Aided Awareness</h3>
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<p>Medical research offers many ways to treat illnesses. There is research, called "comparative effectiveness research," also known as Patient Centered Outcomes Research or PCOR (PRONOUNCED "PEA-CORE"), which evaluates treatment options by comparing the benefits, risks and possible side effects.</p>
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<p>Q5. Prior to this survey, had you ever heard about the existence of research that helps you compare the treatment options?</p>
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<p>___ YES<br><br />
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___ NO → SKIP TO Part C<br><br />
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___ DON'T KNOW→ SKIP TO Part C<br><br />
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||
___ REFUSED→ SKIP TO Part C</p>
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||
<p>Q6. How did you hear about it?</p>
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<p>INTERVIEWER: LISTEN TO RESPONDENT'S ANSWER AND CHECK ALL THAT APPLY.</p>
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<p>___ HEALTH CARE PROVIDER—DOCTOR, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR OTHER<br><br />
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___ FRIEND OR FAMILY MEMBER<br><br />
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___ PERSON/SPEAKER AT AN EVENT<br><br />
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___ CLINIC/WIC/HEALTH DEPARTMENT<br><br />
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___ ORGANIZATION<br><br />
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___ SOCIAL MEDIA/BLOG (TWITTER or Facebook)<br><br />
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___ WEB SITE<br><br />
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___ EMAIL<br><br />
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___ LISTSERVE<br><br />
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___ NEWSPAPER/JOURNAL/MAGAZINE<br><br />
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___ EXHIBIT<br><br />
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___ POSTER/FLYER/BROCHURE<br><br />
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___ OTHER (SPECIFY: _________________________)<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q7. How long ago did you hear about it? Would you say…</p>
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<p>___ Within the last 3 months,<br><br />
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___ Within the last 4-6 months,<br><br />
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___ Within the last 7-9 months, or<br><br />
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___ More than 9 months ago?<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q8. Did the information relate to a specific medical condition?</p>
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<p>___ YES<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q9. Are you aware that there is research on the evaluation of treatment options for specific medical conditions?</p>
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<p>___ YES<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<h3>Part C. Awareness—EHCP Awareness</h3>
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<p>The Effective Health Care Program also called E.H.C.P., funds research that compares treatments for different health conditions. Researchers work with the Agency for Healthcare Research and Quality in developing the research.</p>
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<p>Q10. Prior to this survey, had you ever heard of "Ark," also called the "Agency for Healthcare Research and Quality"?</p>
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<p>___ YES<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q11. Prior to this survey, had you ever heard of the Effective Health Care Program or E.H.C.P.?</p>
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<p>___ YES<br><br />
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___ NO → If Q1 OR Q5 =YES, GO TO Part E Check.Iif Q1 AND Q5 =NO go to Part H<br><br />
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___ DON'T KNOW → SKIP TO Q13<br><br />
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___ REFUSED → SKIP TO Q13</p>
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<p>Q12. How did you hear about it?</p>
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<p>INTERVIEWER: LISTEN TO RESPONDENT'S ANSWER AND CHECK ALL THAT APPLY.</p>
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<p>___ HEALTH CARE PROVIDER—DOCTOR, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR OTHER<br><br />
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___ FRIEND OR FAMILY MEMBER<br><br />
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___ PERSON/SPEAKER AT AN EVENT<br><br />
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___ CLINIC/WIC/HEALTH DEPARTMENT<br><br />
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___ ORGANIZATION<br><br />
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___ SOCIAL MEDIA/BLOG (TWITTER or Facebook)<br><br />
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___ WEB SITE<br><br />
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___ EMAIL<br><br />
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___ LISTSERVE<br><br />
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___ NEWSPAPER/JOURNAL/MAGAZINE<br><br />
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___ EXHIBIT<br><br />
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___ POSTER/FLYER/BROCHURE<br><br />
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___ OTHER (SPECIFY: _________________________)<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<h3>Part D. Awareness—EHCP Web Site Awareness</h3>
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<p>"Ark" has a web site that contains information about research that helps you compare treatment options, and the Effectiveness Health Care Program or E.H.C.P.</p>
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<p>Q13. Prior to this survey, had you ever heard of the Ark's E.H.C.P website, which is: <a href="https://effectivehealthcare.ahrq.gov/">effectivehealthcare.ahrq.gov</a>?</p>
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||
<p>___ YES<br><br />
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___ NO → If Q1 OR Q5 =YES, GO TO Part E,<br><br />
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___ DON'T KNOW → SKIP TO PART E CHECK<br><br />
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___ REFUSED → SKIP TO PART E CHECK</p>
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<p>Q14. How did you hear about it?</p>
|
||
<p>INTERVIEWER: LISTEN TO RESPONDENT'S ANSWER AND CHECK ALL THAT APPLY.</p>
|
||
<p>___ HEALTH CARE PROVIDER—DOCTOR, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR OTHER<br><br />
|
||
___ FRIEND OR FAMILY MEMBER<br><br />
|
||
___ PERSON/SPEAKER AT AN EVENT<br><br />
|
||
___ CLINIC/WIC/HEALTH DEPARTMENT<br><br />
|
||
___ ORGANIZATION<br><br />
|
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___ SOCIAL MEDIA/BLOG (TWITTER or Facebook)<br><br />
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___ WEB SITE<br><br />
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___ EMAIL<br><br />
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___ LISTSERVE<br><br />
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___ NEWSPAPER/JOURNAL/MAGAZINE<br><br />
|
||
___ EXHIBIT<br><br />
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___ POSTER/FLYER/BROCHURE<br><br />
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___ OTHER (SPECIFY: _________________________)<br><br />
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___ DON'T KNOW<br><br />
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||
___ REFUSED</p>
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<p>Q15. Have you ever visited the Effective Health Care Program web site: <a href="https://effectivehealthcare.ahrq.gov/">effectivehealthcare.ahrq.gov</a>?</p>
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<p>___ YES<br><br />
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___ NO → GO TO PART E<br><br />
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___ DON'T KNOW → SKIP TO PART E CHECK</p>
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<p>Q16. When was the last time you visited the web site? Would you say …<br><br />
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___ In the past 3 months,<br><br />
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___ In the past 4-6 months,<br><br />
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___ In the past 7-9 months,<br><br />
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___ In the past 10-12 months, or<br><br />
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___ More than 12 months ago?<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q17. Why did you visit the web site? Would you say …</p>
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<p>INTERVIEWER: READ RESPONSE CATEGORIES TO THE RESPONDENT AND CHECK ALL THAT APPLY.</p>
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<p>___ To learn more about Effective Health Care Program,<br><br />
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___ To learn more about the evaluation of treatment options, in general,<br><br />
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___ To learn more about evaluation of treatment options on a specific topic,<br><br />
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___ To download information, or<br><br />
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___ Some other reason? SPECIFY: ___________________________________<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q18. Were you able to find what you were looking for?<br><br />
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___ YES<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q19. How many times have you visited the web site in the past 6 months? Would you say …</p>
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<p>___ None,<br><br />
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___ One time,<br><br />
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___ Two times,<br><br />
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___ Three times, or<br><br />
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___ More than three times?<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>PART E CHECK:</p>
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<p>IF Q6 = MISSING THEN GO TO Q23<br><br />
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IF Q6 = ANY SOURCE OTHER THAN HEALTH CARE PROVIDER OR DON'T KNOW OR REFUSED, CONTINUE TO Q22.<br><br />
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IF Q6 = HEALTH CARE PROVIDER, CONTINUE TO Q20.</p>
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<h3>Part E. Knowledge/Understanding—Knowledge/Understanding of PCOR</h3>
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<p>Q20. You indicated that you heard through your health care provider about research that helps you compare and evaluate treatment options. Did your health care provider start the discussion about how useful comparing treatments can be?</p>
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<p>___ YES → SKIP TO Q23<br><br />
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___ NO<br><br />
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___ DON'T KNOW<br><br />
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___ REFUSED</p>
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<p>Q21. Did you start the discussion on comparing treatment options?</p>
|
||
<p>___ YES → SKIP TO Q23<br><br />
|
||
___ NO → SKIP TO Q23<br><br />
|
||
___ DON'T KNOW→ SKIP TO Q23<br><br />
|
||
___ REFUSED → SKIP TO Q23</p>
|
||
<p>Q22. You indicated that you heard through (FILL SOURCE FROM Q6 IF Q6 = REFUSED/DON'T KNOW FILL WITH "A SOURCE") about research that helps you compare and evaluate treatment options. Do you understand how it can be useful?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q23. Do you feel you could describe this <strong>idea</strong> of evaluating treatment options to a family member or friend?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part F. Attitudes/Beliefs—Perceived Benefits of PCOR</h3>
|
||
<p>Q24. I am going to read some statements. For each statement, tell me whether you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.</p>
|
||
<p>a. Evaluating treatment options provides information to help you make good medical health care choices. Do you…</p>
|
||
<p>___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree, or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>b. Decisions reached after evaluating treatment options lead to better health outcomes for patients. Do you…</p>
|
||
<p>___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>c. Decisions reached after evaluating treatment options lower medical expenses/costs. Do you…</p>
|
||
<p>___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>d. Evaluating treatment options results in unbiased information. Do you…<br><br />
|
||
___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>e. Evaluating treatment options allows patients and doctors to make choices based on the needs of individual patients. Do you…</p>
|
||
<p>___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>f. Evaluating treatment options provides information I can trust. Do you…</p>
|
||
<p>___ Strongly Agree<br><br />
|
||
___ Agree<br><br />
|
||
___ Neither agree nor disagree<br><br />
|
||
___ Disagree or<br><br />
|
||
___ Strongly Disagree<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part G. Behavior Change/Use—Past/Current Use of PCOR Studies/Products</h3>
|
||
<p>Q25. Do you <em><strong>currently</strong></em> use research that compares or evaluates different treatment options to help you make medical decisions?</p>
|
||
<p>___ YES → SKIP TO Q28<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q26. Have you <em><strong>ever</strong></em> used research that compares or evaluates different treatment options to help make medical decisions?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP TO Q28<br><br />
|
||
___ DON'T KNOW → SKIP TO Q28<br><br />
|
||
___ REFUSED → SKIP TO Q28</p>
|
||
<p>Q27. When did you most recently use research that compares or evaluates different treatments to help you make medical decisions? Would you say….</p>
|
||
<p>___ In the past 3 months,<br><br />
|
||
___ In the past 4-6 months,<br><br />
|
||
___ In the past 7-9 months,<br><br />
|
||
___ In the past 10-12 months, or<br><br />
|
||
___ More than 12 months ago?<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>AHRQ's summaries of treatment option evaluations, which are written for consumers, are available from AHRQ's E.H.C.P website. These are tools to help you understand your condition and the choices that are available to you. Consumer summaries provide you with the evidence that exists about the benefits and risk for each treatment choice.</p>
|
||
<p>Q28. Prior to this survey, were you aware of these consumer summaries?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP TO Q33<br><br />
|
||
___ DON'T KNOW → SKIP TO Q33<br><br />
|
||
___ REFUSED → SKIP TO Q33</p>
|
||
<p>Q29. Have you ever used one or more of these consumer summaries?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP TO Q33<br><br />
|
||
___ DON'T KNOW → SKIP TO Q33<br><br />
|
||
___ REFUSED → SKIP TO Q33</p>
|
||
<p>Q30. I am going to read some statements about these consumer summaries. For each statement, tell me whether you strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree.</p>
|
||
<p>a. In general, these consumer summaries are easy to understand. Do you…</p>
|
||
<p>___ Strongly agree,<br><br />
|
||
___ Agree,<br><br />
|
||
___ Neither agree nor disagree,<br><br />
|
||
___ Disagree, or<br><br />
|
||
___ Strongly disagree?<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>b. You can trust the information in these consumer summaries. Do you…</p>
|
||
<p>___ Strongly agree,<br><br />
|
||
___ Agree,<br><br />
|
||
___ Neither agree nor disagree,<br><br />
|
||
___ Disagree, or<br><br />
|
||
___ Strongly disagree?<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q31. Did you and your health care provider use consumer summaries to make a decision about your health care during an office visit?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP TO Q33<br><br />
|
||
___ DON'T KNOW → SKIP TO Q33<br><br />
|
||
___ REFUSED → SKIP TO Q33</p>
|
||
<p>Q32. Did you feel your health care provider was open to talking to you about the summaries so that you could make decisions together?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q33. Where do you prefer to get your medical information from?</p>
|
||
<p>INTERVIEWER: LISTEN TO RESPONDENT'S ANSWER AND CHECK ALL THAT APPLY.<br><br />
|
||
___ HEALTH CARE PROVIDER—DOCTOR, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR OTHER<br><br />
|
||
___ FRIEND OR FAMILY MEMBER<br><br />
|
||
___ PERSON/SPEAKER AT AN EVENT<br><br />
|
||
___ CLINIC/WIC/HEALTH DEPARTMENT<br><br />
|
||
___ ORGANIZATION<br><br />
|
||
___ SOCIAL MEDIA/BLOG (TWITTER or Facebook)<br><br />
|
||
___ WEB SITE<br><br />
|
||
___ EMAIL<br><br />
|
||
___ LISTSERVE<br><br />
|
||
___ NEWSPAPER/JOURNAL/MAGAZINE<br><br />
|
||
___ EXHIBIT<br><br />
|
||
___ POSTER/FLYER/BROCHURE<br><br />
|
||
___ OTHER (SPECIFY: _________________________)<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part H. Behavior Change/Use—Interest in Learning More About PCOR</h3>
|
||
<p>Q34. Are you interested in learning more about evaluating treatment options for specific medical conditions?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q35. Are you interested in learning more about the Effective Health Care Program?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q36. Are you interested in evaluating treatment options before making medical decisions for yourself, a family member, or close friend?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part I. Behavior Change/Use—Intention to Use PCOR Studies/Products</h3>
|
||
<p>Q37. Within the next year, do you intend to use AHRQ's consumer summaries or other studies that evaluate treatment options to prepare for a medical visit or make medical decisions for you, a family member, or close friend?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part K. Exposure to Dissemination Strategies—Publicity Center: Media and Marketing</h3>
|
||
<p>Q38 CHECK: IF Q5 = Yes and Q6 = ANY SOURCE OTHER THAN HEALTH CARE PROVIDER CONTINUE TO INTRODUCTION BELOW. OTHERWISE SKIP TO Q42.</p>
|
||
<p>If Q1=Yes OR Q5 = Yes then Q42 otherwise go to Part N (Q45)</p>
|
||
<p>Q38. From your earlier responses, you indicated you heard about the evaluation of treatment options from a source other than your health care provider, prior to this survey.</p>
|
||
<p>When was the last time you recall hearing/seeing the information? Would you say …</p>
|
||
<p>___ Within the last month,<br><br />
|
||
___ Within the last 2-4 months,<br><br />
|
||
___ Within the last 5-6 months, or<br><br />
|
||
___ Over six months ago?<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q39. Was the information on a specific medical condition?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q40. The information was useful to you. Do you . . .</p>
|
||
<p>___ Strongly agree, ___ Agree,<br><br />
|
||
___ Neither agree nor disagree,<br><br />
|
||
___ Disagree, or<br><br />
|
||
___ Strongly disagree?<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED<br><br />
|
||
___</p>
|
||
<p>Q41. What would have made it more useful?</p>
|
||
<p>SPECIFY: ____________________________________________</p>
|
||
<h3>Part L. Exposure to Dissemination Strategies—Publicity Center: Virtual Centers</h3>
|
||
<p>Q42. In the past six months, have you seen links to the E.H.C.P. web site or information comparing treatment options on a website?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP to Part M<br><br />
|
||
___ DON'T KNOW → SKIP to Part M<br><br />
|
||
___ REFUSED → SKIP to Part M</p>
|
||
<p>Q43. Which web site(s)?</p>
|
||
<p>SPECIFY: ____________________________________________</p>
|
||
<p>Q44. What medical condition or conditions were addressed by the information you saw?</p>
|
||
<p>SPECIFY: ____________________________________________</p>
|
||
<h3>Part M. Exposure to Dissemination Strategies—Publicity Center and Regional Office: Partnerships</h3>
|
||
<p>Q45. Are you a member of any organization that provides you with information about health care?</p>
|
||
<p>INTERVIEWER, IF NEEDED: For example, the A.A.R.P.</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → PART N<br><br />
|
||
___ DON'T KNOW → SKIP to Part N<br><br />
|
||
___ REFUSED → SKIP to Part N</p>
|
||
<p>Q46. Did the organization inform you about the EHCP or about the <strong>idea</strong> of research that compares or evaluates treatment options?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<h3>Part N. Other—Respondent Characteristics</h3>
|
||
<p>Now I am going to ask you some questions for classification.</p>
|
||
<p>Q47. What is your age?</p>
|
||
<p>CODE RESPONSE INTO APPROPRIATE CATEGORY.</p>
|
||
<p>___ 18-33 YEARS<br><br />
|
||
___ 34-44 YEARS<br><br />
|
||
___ 45-64 YEARS<br><br />
|
||
___ 65 YEARS OR OLDER<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q48. What is your gender?</p>
|
||
<p>CODE RESPONSE INTO APPROPRIATE CATEGORY.<br><br />
|
||
___ MALE<br><br />
|
||
___ FEMALE<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q49. Are you Hispanic or Latino?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q50. What is your race? Are you …</p>
|
||
<p>___ American Indian or Alaska Native,<br><br />
|
||
___ Asian,<br><br />
|
||
___ Native Hawaiian or other Pacific Islander,<br><br />
|
||
___ Black or African American, or<br><br />
|
||
___ White or<br><br />
|
||
___ Other? Please specify__________________________<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q51. Are you currently seeking medical care?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q52. Do you provide care for another person with a medical condition?</p>
|
||
<p>INTERVIEWER, IF NEEDED, PROBE: This could include close friends or a family member.</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q53. Are you a member of a patient advocacy group?</p>
|
||
<p>INTERVIEWER, IF NEEDED: A patient advocacy group supports patient education and assists patients with information about how to obtain the needed medical care.</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q54. Do you participate in the Medicare program?</p>
|
||
<p>INTERVIEWER, IF NEEDED: Medicare is a U.S. government program of hospital and medical insurance for those 65 and over and for certain disabled people under the age of 65.</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q55. Do you participate in the Medicaid program?</p>
|
||
<p>INTERVIEWER, IF NEEDED: Medicaid is a U.S. government program, financed by the federal, state and local governments for hospital and medical insurance for people of all ages that have certain income levels</p>
|
||
<p>___ YES<br><br />
|
||
___ NO<br><br />
|
||
___ DON'T KNOW<br><br />
|
||
___ REFUSED</p>
|
||
<p>Q56. In a few months, we will be conducting focus groups to learn more about patients' understanding of research comparing treatment options. Based on your answers to the questions we just asked, we may want to invite you to participate I these focus groups. You would need to have a telephone and computer to participate and we would pay you for your time. It will take about 90 minutes. Would you be willing to participate if we determine that you are eligible for a focus group?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → SKIP TO CLOSING<br><br />
|
||
___ DON'T KNOW → SKIP TO CLOSING<br><br />
|
||
___ REFUSED → SKIP TO CLOSING</p>
|
||
<p>Q57a. Can you please confirm your full name, address, and telephone number?</p>
|
||
<p>I have your current name as: [PARTICIPANT NAME] Is that correct?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → TYPE IN CORRECT NAME<br><br />
|
||
___ DON'T KNOW → TYPE IN CORRECT NAME<br><br />
|
||
___ REFUSED → SKIP TO CLOSING</p>
|
||
<p>Q57b. I have your address at: [PARTICIPANT ADDRESS]  Is that correct?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → TYPE IN CORRECT ADDRESS<br><br />
|
||
___ DON'T KNOW → TYPE IN CORRECT ADDRESS<br><br />
|
||
___ REFUSED → SKIP TO CLOSING</p>
|
||
<p>Q57c. I have your phone number at:[PARTICIPANT PHONE]  Is this the best phone number to reach you?</p>
|
||
<p>___ YES<br><br />
|
||
___ NO → TYPE IN CORRECT PHONE NUMBER<br><br />
|
||
___ DON'T KNOW → TYPE IN CORRECT PHONE NUMBER<br><br />
|
||
___ REFUSED → SKIP TO CLOSING</p>
|
||
<p><strong>Closing.</strong> Thank you for your help doing the survey. We appreciate your time.</p>
|
||
<p><a href="/research/findings/final-reports/arracer/index.html">Return to Contents</a><br><br />
|
||
<a href="/research/findings/final-reports/arracer/arracer-apc.html">Proceed to Next Section</a></p>
|
||
</div></div></div><div class="field field-name-field-last-reviewed field-type-datestamp field-label-hidden">
|
||
<div class="field-items">
|
||
<div class="field-item even">
|
||
Page last reviewed <span class="date-display-single" property="dc:date" datatype="xsd:dateTime" content="2013-10-01T00:00:00-04:00">October 2013</span> <br />Page originally created December 2014 </div>
|
||
</div>
|
||
</div>
|
||
<div id="block-ahrq-citation" class="block block-ahrq first odd">
|
||
|
||
|
||
Internet Citation: Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts. Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/research/findings/final-reports/arracer/arracer-apb.html<div class="citation-flag"> </div> </div> <!--</div>--> <div class="footnote"> <p> The information on this page is archived and provided for reference purposes only.</p> </div> <p> </p> </div> </div></td> </tr> </tbody> </table> </td> </tr> </tbody> </table> </div>
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