Generic Veterans Health Administration Customer Satisfaction Surveys

Generic Veterans Health Administration Customer Satisfaction Surveys

My HealtheVet Pilot Survey Veteran Questionnaire 2007[1]

Generic Veterans Health Administration Customer Satisfaction Surveys

OMB: 2900-0570

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My HealtheVet Pilot Survey

Veteran Questionnaire

2007


Introduction:


As a participant in the My HealtheVet Pilot Program, you have had an opportunity to use the My HealtheVet Pilot website at www.health-evet.va.gov to view health education information, request and view copies of some portions of your VA medical record, and use the self-entry features to record and track health information such as weight, blood pressure and blood sugar. Your willingness to participate in this Pilot Program is greatly appreciated and we hope that you have found the My HealtheVet Pilot to be a valuable experience.


Your feedback about the My HealtheVet Pilot is important to us and will help us to continue to develop the My HealtheVet Program so that it best meets your needs. Please take a few minutes to participate in this online survey and share your comments about the Pilot and your experience in using it.


We appreciate your time in responding to this important survey. We will use the information you provide to evaluate the use of My HealtheVet so that we can provide the best services possible to veterans.


Instructions:


This survey is estimated to take about 10-20 minutes of your time. Your response to each question is voluntary. Your answers are protected under the Privacy Act and section 5701 if Title 38 U.S. Code. The survey has been approved by the Office of Management and Budget (OMB # XXXX) and meets the requirements of the Paperwork Reduction Act. You may send comments about this questionnaire to XXXX. If you need help in completing the survey questions, please call XXXX.


Most of the survey questions will ask you to choose one of several options; however a few of the questions will ask you to write your answer. Please use specific examples whenever possible. There are no right or wrong answers. We want to know what you think about the My HealtheVet Pilot website and whether you think its use helps make your health care better. At the end of the survey we’ll ask you a few questions about your background that will help us to interpret the results of this survey. Your response to these questions is optional.


After answering all of the survey questions, press the submit button at the end to complete your survey. Thank you for your help in evaluating the My HealtheVet Pilot Program.













Questions:


  1. How did you first hear about the My HealtheVet Pilot project?


From my doctor

From another veteran

From a friend or co-worker

From a VA Staff member

From a flyer, brochure, or newsletter

From my Veteran Service Organization

Other


If other, please explain:

_____________________________________________


  1. Where did you sign up for the My HealtheVet Pilot?


Albany, NY

Bath, NY

Bay Pines, FL

Buffalo, NY

Canandaigua, NY

Portland, OR

Syracuse, NY

Tampa, FL

Washington, DC


  1. How long have you been using the My HealtheVet Pilot website?

(www.health-evet.va.gov )


Less than 1 month

More than 1 month but less than 6 months

More than 6 months but less than 12 months

More than 1 year but less than 2 years

More than 2 years but less than 4 years

More than 4 years


  1. On average, how often have you used the My HealtheVet Pilot website in the last 90 days?


Daily

Weekly

Monthly

Less than once a month

Have not used in the last 90 days

Have never used


  1. If you received training prior to using the My HealtheVet Pilot website, please indicate the type of training you received:

(Please check all that apply)


Group instruction with from VA staff

Individual instruction from VA staff

Non-VA staff showed me how to use it (ex. student, volunteer, another veteran)

Self-instruction using provided materials

No training


  1. If you received training prior to using the My HealtheVet Pilot website, did it help you in using the website?


Very helpful

Somewhat helpful

Not helpful

No training


  1. Why did you decide to participate in the My HealtheVet Pilot?

(Please check all that apply)


Access health education materials

Track my self-entered health information (blood pressure, weight, etc.)

Track my personal information (emergency contacts, etc.)

Access information from my VA medical record (test results, doctor’s notes, etc.)

Improve my understanding of my medical treatment

Provide other people with access to my medical information (doctors, family members, etc.)

Access someone else’s personal health record as a delegate or grantee

My doctor suggested it

Other


If other, please explain:

_____________________________________________


  1. Most often, where do you access the My HealtheVet Pilot website?


My home computer

Other computer (work, public library, family member, etc.)

Public computer at a VA Medical Center


  1. Most often, what type of Internet connection do you use to access the My HealtheVet Pilot website?


Dial-up access

Broad band access

Not sure


  1. Please rate your general level of skill in using the Internet:


Beginner/Novice

Intermediate

Advanced


  1. Which of the following My HealtheVet Pilot website features have you used?

(please check all that apply)


Health Education Library

VA Administrative Info (appointments, wellness reminders, co-payments, etc.)

My VA Patient Record (admissions, prescriptions, progress notes, labs, etc.)

VA Update Requests (requested updated VA Medical Record data)

Self-entered Information (personal info, medications, allergies, etc.)

Self-entered Data (logs such as blood pressure, blood sugar, cholesterol, etc.)

Someone else’s personal health journal (as a grantee or delegate)


  1. How have you used My HealtheVet Pilot site features?

(please check all that apply)


Looked up information on a disease, condition, or treatment

Discussed information obtained from the website with my health care provider

Shared my self-entered data with my health care provider

Granted access to my Personal Health Journal to my VA health care provider

Granted access to my Personal Health Journal to a non-VA health care provider

Granted access to my Personal Health Journal to a spouse, family member, or advocate

Other


If other, please explain:

_____________________________________________


13. Choose your top five most useful My HealtheVet Pilot website services from the list provided below. Please enter the number 1- 5 in the box, with 1 being most useful, 2 being second most useful, etc.


Entering my own health information

Viewing portions of my official medical record (ex. lab results)

Prescription History

Co-payments

Appointments

Health Education Library

Providing delegate/grantee access

Wellness Reminders

Linking to other VA sites

Other service


If other, please explain:

_____________________________________________


  1. How easy is it for you to understand the information in the Health Education Library?


Very Easy

Easy

Difficult

Very Difficult


  1. When you update or read your personal medical record, how easy is it for you to understand your medical information?


Very Easy

Easy

Difficult

Very Difficult


For the following questions, please select the answer that most closely matches your opinion.


  1. I find the My HealtheVet Pilot website easy to navigate and locate information relevant to my healthcare.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. On average, I find the information and services provided by the My HealtheVet Pilot website to be useful.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. The My HealtheVet wellness reminders have helped me to take action.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

Not applicable


  1. Using the My HealtheVet Pilot website has improved communication between my health care provider and me.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. Using the My HealtheVet Pilot website helps me stick to my treatment plan.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. The My HealtheVet Pilot website adequately protects the privacy of my personal health data.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. I find that the My HealtheVet Pilot website helps improve my healthcare.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. I would recommend the use of My HealtheVet to other veterans.


Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree


  1. All veterans and VA staff are eligible to use the National My HealtheVet website (www.myhealth.va.gov). Are you currently registered at the National My HealtheVet website?


Yes

No

Not Sure


  1. Please share your thoughts on the My HealtheVet Pilot experience and how it has affected your health care:


__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


  1. Please provide any additional comments you have about the My HealtheVet Pilot. If you wish to elaborate on any of the survey responses you provided you may also do so here.

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________


In the following section we’ll ask you a few questions about your background that will help us to interpret the results of this survey. Your response to these questions is optional. (If you choose to not answer please move to the end of survey and press the submit button to complete your survey.)


27. Please select the category that includes your age:


<20 years

20-24

25-29

30-34

35-39


40-44

45-49

50-54

55-59

60-64


65-69

70-74

75-79

80-84

85-89

90+ years


28. What is your gender?


Male

Female


29. Which of the following best describes the highest level of education you have completed?


Did not complete high school

High school graduate

Some college or vocational school

Current college or graduate student

College graduate

Some postgraduate school

Graduate or professional degree


30. Do you have any impairment that would affect your ability to use the website?


Visual

Hearing

Mobility

Dexterity

None



Would you be willing to participate in a focus group to offer additional information about your experiences with the My HealtheVet Pilot Program? If so please send us an email indicating your interest to MHVPilotEvaluation@va.gov . Please provide your name, email address, telephone number and mailing address so that we may contact you. This information will be kept confidential.


Thank you for your help in evaluating the My HealtheVet Pilot Program.

The VA My HealtheVet Program Office


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File Typeapplication/msword
File TitleMy HealtheVet Pilot Survey
AuthorKim M. Nazi
File Modified2007-08-06
File Created2007-08-06

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