Parent_Survey_Text_file

Noisy_Planet_Parent

Noisy Planet Parent Survey (English)

Q1. The National Institutes of Health is conducting a customer satisfaction survey about a health education campaign.

The NIH wants to learn about a presentation developed for use in schools for children 8-12 years of age (tweens). You are being asked to participate in this survey because your child attended one such school presentation within the last few weeks. Your participation in this survey is voluntary and will help the NIH create a more effective campaign to reach tweens and their parents.

Completing the survey should take about 5 minutes. We want your opinion, so there are no wrong answers. You should know that:

- Your participation is anonymous.
- Neither your name nor any other personally-identifying information (PII) will be collected.
- Your responses will be added to those of other participants and analyzed as a group.
- You can choose to not answer questions or stop your participation at any time.

The NIH is authorized to conduct this survey under section 42 USC 285f of U.S. Law, and has contracted with NOVA Research to conduct the survey. If you have questions about this survey or your participation, please contact Daniel Eckstein by email at DEckstein@novaresearch.com or by phone at 240-483-4192.

By clicking on the link below, you certify that you are at least 18 years of age and voluntarily consent to participate in this survey. Thank you! (Choose one)    (Choose one)

1 Agree

2 Decline participation

If Q1 is equal to 2, then skip to end of questionnaire.

Noisy Planet Parent

A1. Are you aware that exposure to loud noises over time can damage your hearing?    (This is called noise-induced hearing loss.)    (Choose one)

1 Yes

2 No

7 Not certain

8 Decline to Answer

A2. Did you know that your child participated in the It's a Noisy Planet. Protect Their Hearing®
presentation given at school within the past few weeks?    (Choose one)

1 Yes

2 No

7 Not certain

8 Decline to Answer

If A2 is equal to 1 then skip to A3

If not, then skip to A4.

A3. How did you learn about the presentation?    (Check all that apply)

__ From teacher or school communication

__ From my child

__ From someone else

__ Did not know about this

__ Don’t remember

__ Decline to Answer

If A3 is greater than 1 and A3D is equal to 1 then You may not select 'Did not know about this' and another response.    Please correct. and skip to A3.

A4. Did you see any It's a Noisy Planet. Protect Their Hearing® materials sent home with your child? Please check which items you saw.    (Check all that apply)

__ Parent letter

__ Bookmark

__ Pin

__ Pencil

__ Sticker

__ Pipe cleaners

__ None

__ Other

__ Decline to Answer

If A4G is equal to 1 and A4 is greater than 1 then You may not select 'None' and another response.    Please correct. and skip to A4.

A5. Has your child mentioned the potential effects of loud noise recently?    (Choose one)

1 Yes

2 No

7 Don’t remember

8 Decline to Answer

A6. The Noisy Planet presentation encourages children to "Turn it Down, Walk Away, or Use Hearing Protection." These actions could include lowering the volume on TV shows, video games, the radio or MP3 player; moving away from loud sounds; or wearing hearing protection, such as earplugs or ear muffs. Have you noticed your child taking any of these actions recently?    (Choose one)

1 Yes

2 No

7 Don’t remember

8 Decline to Answer

A7. Experts recommend wearing hearing protectors during loud activities, such as mowing the lawn, using a leaf blower, playing in a band, or attending a stadium event. Do you think that your child would wear hearing protectors, if available?    (Choose one)

1 Yes

2 No

3 Maybe

8 Decline to Answer

A8a. How likely are you to protect your own hearing by doing one of the following: "Turn it Down, Walk Away, or Use Hearing Protection"?    (Choose one)

0 Not at all

1 Somewhat

2 Very Much

7 Don't Know

8 Decline to Answer

A8b. How likely are you to:    Encourage your child to "Turn it Down, Walk Away, or Use Hearing Protection"?    (Choose one)

0 Not at all

1 Somewhat

2 Very Much

7 Don't Know

8 Decline to Answer

A8c. How likely are you to:    Get hearing protectors for your child?    (Choose one)

0 Not at all

1 Somewhat

2 Very Much

7 Don't Know

8 Decline to Answer

If A4A is equal to 1 or A4B is equal to 1 or A4C is equal to 1 or A4D is equal to 1 or A4E is equal to 1 or A4F is equal to 1 or A4H is equal to 1 then skip to instruction before A9a

If not, then skip to A12.

Please tell us what you think about Noisy Planet materials for the next questions.   

A9a. Are the Noisy Planet materials something your child is likely to pay attention to?    (Choose one)

0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A9b. Is the Noisy Planet message clear?    (Choose one) 0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A9c. How likely are the Noisy Planet materials to help you remember to "Turn it Down, Walk Away, or Use Hearing Protection"?    (Choose one)

0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A9d. How likely are the Noisy Planet materials to help your child remember to "Turn it Down, Walk Away, or Use Hearing Protection"?    (Choose one)

0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A9e. How likely are you to use any of the Noisy Planet materials, ideas, tips, or tools in the future?    (Choose one)

0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A9f. How likely is your child to use any of the Noisy Planet materials, ideas, tips, or tools in the future?    (Choose one)

0 Not at all

1 Somewhat

2 Very much

7 Don't Know

8 Decline to Answer

A10. What other kinds of Noisy Planet materials would you find useful?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

A11. Do you have any other comments about or suggestions for Noisy Planet materials?

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

A12. Have you visited the Noisy Planet website? 1 Yes

2 No

8 Decline to Answer

If A12 is equal to 2 then skip to A13

If not, then skip to instruction before A14.

A13. Are you likely to visit the website to learn more about noise-induced hearing loss?    (Choose one)

0 Not at all

1 Somewhat

2 Very Much

8 Decline to Answer

Skip to A16.

If A12 is equal to 1 then skip to A14

If not, then skip to A15.

A14. Did you find the Noisy Planet website to be useful?
1 Yes

2 No

8 Decline to Answer

A15. Why or why not? (Optional)

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

A16. Would an online parent toolkit (an interactive online application with tips and tools for preventing noise-induced hearing loss) be useful to you?    (Choose one)

1 Yes

2 No

7 Not certain

8 Decline to Answer

If A16 is equal to 1 or A16 is equal to 7 then skip to A17

If not, then skip to A18.

A17. What format would be most useful for you, mobile or web?    (Choose one)

1 Mobile

2 Web

7 Not certain

8 Decline to Answer

A18. Are you of Hispanic/Latino/Spanish origin? 1 Yes

2 No

8 Decline to Answer

A19. How would you describe your race? (Select all that apply)    (Check all that apply)

__ White/Caucasian

__ Black/African American

__ Asian

__ American Indian/Alaska Native

__ Native Hawaiian or Other Pacific Islander

__ Decline to Answer

A20. What is your gender? (Choose one) 1 Male

2 Female

8 Decline to Answer

A21. Which of the following categories best describes the highest educational level you attained?    (Choose one)

1 Less than a high school degree

2 High school degree or GED

3 Some college/technical school/associates degree

4 College degree

5 Some graduate school or more

6 Other

8 Decline to Answer

If A21 is not equal to 6, then skip to end of questionnaire.

A21_o. Please specify other educational level:

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Version 1 (DE28942EN) Page 1 01/30/2013