Form #3 Form #3 Baseline/Control Arm Post-test

C

ID: ________________

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

AHPS III Reports Team Experimental Research:

Web Post-Exposure Survey for Consumer Choice Experiment

Clinician Experiment – Post-Test Baseline

1. How easy or difficult was it for you to use the website?

Very easy	Somewhat easy	Neither easy nor difficult	Somewhat difficult	Very difficult
□	□	□	□	□

2. How easy or difficult was it for you to select a doctor?

Very easy	Somewhat easy	Neither easy nor difficult	Somewhat difficult	Very difficult
□	□	□	□	□

3. How satisfied were you with the choice of doctors available to you?

Very satisfied	Somewhat satisfied	Neither satisfied nor dissatisfied	Somewhat dissatisfied	Very dissatisfied
□	□	□	□	□

4. If you checked Somewhat dissatisfied or Very dissatisfied: Why were you dissatisfied with the choices available to you?

______________________________________________________________________

______________________________________________________________________

5. If you could have free access to a website like this one when you need to choose a doctor in real life, how likely would you be to use this website?

Definitely would use	Probably would use	Not sure	Probably would not use	Definitely would not use
□	□	□	□	□

Public reporting burden for this collection of information is estimated to average 7 minutes per response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

6. Would you recommend that your friends and family use a website like this one when they make their own choices about a primary care doctor?

Definitely recommend	Probably Recommend	Not sure	Probably not recommend	Definitely not recommend
□	□	□	□	□

7. We’re interested in knowing what you remember about the website and how useful the information was. This question is about service quality, or what patients typically report when surveyed about their care and experiences with their doctors and office staff. This type of information comes from a survey of a scientific sample of each doctor’s patients.

Types of Information About Doctors	Do you remember seeing this information?		If you do remember seeing the information: How easy or difficult was it to tell which doctors were best using this information?
	No	Yes 	Very Easy	Somewhat Easy	Somewhat Difficult	Very Difficult
a. The courtesy and helpfulness of the doctor’s office staff.	□	□ 	□	□	□	□
b. The doctor’s ability to communicate.	□	□	□	□	□	□
c. Getting appointments and health care from the doctor when needed.	□	□ 	□	□	□	□
d. Patients’ ratings of the doctor.	□	□ 	□	□	□	□

8. The website provided information from a survey of a scientific sample of patients who had visited the doctors. How useful was this survey information in helping you select a doctor?

Very useful	Somewhat Useful	Not very Useful	Not at all useful
□	□	□	□

9. If you said “Not very useful” or “Not at all useful”: Why wasn’t the survey information useful to you?

______________________________________________________________________

______________________________________________________________________

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10. How much do you think the information on the website told you about the quality of each doctor listed there?

A lot	A little	Nothing	Don’t know
□	□	□	□

We’d like to ask you some questions about how you usually make decisions in your life. Please indicate how much you agree or disagree with each of the following statements:

		Completely disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Completely agree
	Whenever I make a choice, I’m curious about what would have happened if I had chosen differently.	□	□	□	□	□
	Whenever I make a choice, I try to get information about how the other alternatives turned out.	□	□	□	□	□
	If I make a choice and it turns out well, I still feel like something of a failure if I find out that the other choice would have turned out better.	□	□	□	□	□
	When I think about how I’m doing in life, I often assess opportunities I have passed up.	□	□	□	□	□
	Once I make a decision, I don’t look back.	□	□	□	□	□
	When I watch TV, I channel search, often scanning through the available options even while attempting to watch one program.	□	□	□	□	□
	While I am in the car listening to the radio, I often check other stations to see if something better is playing, even if I’m relatively satisfied with what I’m listening to.	□	□	□	□	□
	Renting movies is really difficult. I’m always struggling to pick the best one.	□	□	□	□	□
		Completely disagree	Somewhat disagree	Neither agree nor disagree	Somewhat agree	Completely agree
	No matter what I do, I have the highest standards for myself.	□	□	□	□	□
	I never settle for second best.	□	□	□	□	□
	When making decisions, I rely on my instincts.	□	□	□	□	□
	I often need the assistance of other people when making important decisions.	□	□	□	□	□
	I avoid making important decisions until the pressure is on.	□	□	□	□	□
	I make decisions in a logical and systematic way.	□	□	□	□	□
	I rarely make important decisions without consulting other people.	□	□	□	□	□
	My decision-making requires careful thought.	□	□	□	□	□
	When I make a decision, I trust my inner feelings and reactions.	□	□	□	□	□
	I often procrastinate when it comes to making important decisions.	□	□	□	□	□
	I use the advice of other people in making my important decisions.	□	□	□	□	□

Finally, we’d like to learn more about how you make decisions about consumer products. The information below represents a choice among DVD players. The ratings run from 1=Very Low to 3= Average to 5=Very High, with a higher number signifying better product performance.

			Features
DVD Brand	Picture Quality	Sound Quality	Programming Options	Reliability of Brand	Price
A	2	5	5	1	$199
B	1	2	5	2	$199
C	5	5	4	2	$199
D	3	3	5	3	$199
E	2	5	2	4	$199

30. If one of your friends told you that he wanted to buy the most reliable DVD of this bunch, which would you recommend that he select?

□ Brand A

□ Brand B

□ Brand C

□ Brand D

□ Brand E

31. If another friend told you that she wanted to buy a DVD with the very highest sound quality and, among those with the best sound, the one with the best programming options, which would you recommend that she select?

□ Brand A

□ Brand B

□ Brand C

□ Brand D

□ Brand E

32. If a different friend told you that he cared about all these features equally and wanted to buy the DVD that had the best scores overall, which would you suggest that he select?

□ Brand A

□ Brand B

□ Brand C

□ Brand D

□ Brand E

33. If one other friend told you that she wanted a DVD that scored no worse than average on every feature, which would you advise her to select?

□ Brand A

□ Brand B

□ Brand C

□ Brand D

□ Brand E

These two questions are about you and will help us to describe all the people we interview.

34. Are you Hispanic or Latino/Latina?

□ No

□ Yes

35. What is your race? Please mark one or more.

□ American Indian or Alaskan Native

□ Asian

□ Black or African American

□ Native Hawaiian or Other Pacific Islander

□ White

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