3 Adolescent Interview Survey

OMB Number: 0925-0648

Expiration Date: 01/31/2015

Noisy Planet Mall Interviews

ADOLESCENT INTERVIEW SURVEY

Fact Sheet Titled “How You Hear”

FACT SHEET DESIGN

1. Please take a look at these two fact sheets. Based ONLY on the “look and feel” of these fact sheets—meaning the colors, pictures, and the ways things are arranged—which one do you like better?

( ) Green “wave” fact sheet

( ) Green “grid” fact sheet

Now, focus ONLY on the fact sheet that you said you liked better.

2. On a scale of 1 to 5, where “1” is “poor” and “5” is “excellent,” what is your opinion of the way the pictures and the words are spread out or arranged on this fact sheet? (Circle one number.)

1 ………. 2 ………. 3 ………. 4 ………. 5

Poor ……….………………….…….. Excellent

3. On a scale of 1 to 5, where “1” is “poor” and “5” is “excellent,” what is your opinion of the colors in this fact sheet? (Circle one number.)

1 ………. 2 ………. 3 ………. 4 ………. 5

Poor ……….………………….…….. Excellent

4. On a scale of 1 to 5, where “1” is “poor” and “5” is “excellent,” what is your opinion of the pictures in this fact sheet? Circle one number)

1 ………. 2 ………. 3 ………. 4 ………. 5

Poor ……….………………….…….. Excellent

4a. What is one thing that you would change to the fact sheet’s “look and feel”?

________________________________________________________________

5. For the visuals and images in these facts sheets, would you prefer to see photographs of real people and real things OR line drawings such as those in comic book illustrations and cartoons? (Pick only one.)

( ) Photographs of real people and real things

( ) Line drawings (such as cartoons, comic books, graphic novels)

FACT SHEET INFORMATION—GENERAL COMMENTS

Now, please take a few moments to read the entire fact sheet that you said you liked better.

[Interviewer: Note the approximate amount of time that the respondent took to read the fact sheet: _____ minutes.]

6. On a scale of 1 to 5, where “1” is “very difficult to read” and “5” is “very easy to read,” how easy was the fact sheet to read? (Circle one number.)

1 ………. 2 ………. 3 ………. 4 ………. 5

Very difficult to read ………….… Very easy to read

7. Do you believe the information in the fact sheet?

( ) Yes

( ) No

8. How likely are you to use this information?

( ) Very likely

( ) Somewhat likely

( ) Somewhat unlikely

( ) Very unlikely

( ) I don’t know

9. Will you do something based on the information you read in this fact sheet?

( ) Yes

( ) No

9a. If yes, what will you do based on the information you read in this fact sheet?

_________________________________________________________________________

10. Would you visit the website listed in this fact sheet (www.noisyplanet.nidcd.nih.gov)?

( ) Yes

( ) No

FACT SHEET INFORMATION—SPECIFIC CONTENT

The next questions are not to test you but to test how well the fact sheet is written. [The respondent is welcome to review the fact sheet while answering the next questions.]

11. In your own words, what is this fact sheet trying to tell you?

__________________________________________________________________________

12. Noise-induced hearing loss is preventable—true or false?

( ) True [CORRECT]

( ) False

13. Sound is measured in units called: [Interviewer: Read aloud all response options.]

( ) Watts

( ) Ohms

( ) Decibels [CORRECT]

( ) Kelvins

14. Any sound at or above what number can damage your hearing? [Interviewer: Read aloud all response options.]

( ) 65 decibels

( ) 85 decibels [CORRECT]

( ) 90 decibels

( ) 145 decibels

15. Lawnmowers can reach how many decibels? [Interviewer: Read aloud all response options.]

( ) 65 decibels

( ) 85 decibels

( ) 90 decibels [CORRECT]

( ) 145 decibels

16. Which of the following can protect your hearing? [Interviewer: Read aloud all response options.]

( ) Wearing hearing protectors.

( ) Moving away from the noise.

( ) Lowering the volume.

( ) All of the above. [CORRECT]

17. Who made this fact sheet?

____________________________________________________________________________

[CORRECT RESPONSE: U.S. (Federal) Government, U.S. Department of Health and Human Services, National Institutes of Health (NIH), National Institute on Deafness and Other Communication Disorders (NIDCD) (any of these is correct)].

WEBSITE PAGE

Thank you for your answers so far. I only have a few more questions.

18. Please take a brief look at these sample website page(s). On a scale of 1 to 5, where “1” is “not at all” and “5” is “a lot,” how much do you like these website pages?

Website Page A (Circle one number.)

1 ………. 2 ………. 3 ………. 4 ………. 5

Not at all ……….………………….…….. A lot

Website Page B (Circle one number.)

1 ………. 2 ………. 3 ………. 4 ………. 5

Not at all ……….………………….…….. A lot

19. What is one thing that you would change on Website Page A?

____________________________________________________________________________

19a. What is one thing that you would change on Website Page B?

______________________________________________________________________

MOBILE APP

20. Do you have access to a smartphone?

( ) Yes;

( ) No

20a. What type: iPhone? Android? Other? _____________________

21. If you hear about an app from a teacher, parent, or doctor, does that make you more interested in downloading it?

( ) Yes

( ) No

22. Would you use a mobile app that included information on protecting your hearing?

( ) Yes

( ) No;

22a. Why not? _____________________

23. Would you use a mobile app that tells you when the noise or sound around you is too loud and could damage your hearing?

( ) Yes

( ) No;

23a. Why not? _____________________

24. Would you play an educational game related to protecting your hearing?

( ) Yes

( ) No;

24a. Why not? _____________________

25. What app features would make you want to use an app about hearing loss prevention?

__________________________________________________________________________

Thank you so much for your time. Your valuable feedback will help improve

the National Institutes of Health education materials.

^{____________________________}

^* Public reporting burden for this collection of information is estimated to average 15 minutes, 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 Office of Management and Budget control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: National Institutes of Health, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648). Do not return the completed form to this address.