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NATIONAL SURVEY OF
WOMEN VETERANS
Script for Computer Assisted
Telephone Interviewing (CATI)
VA Form 10-21086 (NR)
Sponsored by
U.S. Department of Veterans Affairs
Office of Public Health and
Environmental Hazards
This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995.
Accordingly, we may not conduct or sponsor, and you are not required to respond to, a collection of information
unless it displays a valid OMB number. We anticipate that the time expended by all individuals who must complete
this interview will average 45 minutes. This includes the time it will take to listen to the instructions and answer the
questions. The purpose of the study is to understand women veterans’ use of health care, including what they like
and what they would change about the care they receive, even if that care is not at a VA Medical Center. We are
collecting this information so that we can better understand the health care needs of women veterans. The research
team will make every possible effort to keep your personal information confidential. Your survey responses will be
separated from your name and other information that identifies you. Your information will be combined with that of
other participants and reported only as totals, averages, and other statistics. The results of this survey may be
published, but your name or identity will not be revealed, and your responses will remain confidential unless law
requires disclosure of such. The link between your identity and your participation in this survey will be destroyed as
soon as the survey part of this study is completed. Submission of this information is voluntary and failure to
respond will have no impact on benefits to which you may be entitled.
Privacy Act Information: The information requested during this telephone survey is solicited under the authority of
Public Law 103-446. This collection of information is intended to fulfill the need identified by the Department of
Veterans Affairs to improve women's health care throughout the VA. Information may be disclosed outside the VA
as permitted by law; possible disclosures include those described in the "routine uses" identified in the VA system
of records 34VA11, Veteran, Patient, Employee and Volunteer Research and Development Project Records-VA,
published in the Federal Register in accordance with the Privacy Act of 1974. Disclosure is voluntary. Failure to
furnish the information will have no adverse affect on any benefits to which you may be entitled.
VA FORM
NOV 2007
10-21086 (NR)
NATIONAL SURVEY OF WOMEN VETERANS
TABLE OF CONTENTS
Introduction .......................................................................................................................................2
Screener [1] ......................................................................................................................................5
Summary Table for Military Service Type......................................................................................6
Telephone Consent Agreement ........................................................................................................7
Military Background [2] ...................................................................................................................10
Summary Table for Period of Service Strata ...............................................................................12
Self-Reported Health [3] .................................................................................................................14
Evaluated Health [4] .......................................................................................................................17
Personal Health Practices [5]..........................................................................................................20
Military Experiences and Effects (plus Consent for MST Questions) [6] .........................................23
[6a] – Concerns While On Active Duty ........................................................................................23
[6b] – Combat Exposure .............................................................................................................25
[6c] – Military Sexual Trauma (MST) ...........................................................................................25
[6d] – Post Active Duty Support And Events ...............................................................................28
[6e] – PTSD.................................................................................................................................29
Regular Source of Health Care [7]..................................................................................................31
Summary Table for Source of Care.............................................................................................32
Health Care Use [8] ........................................................................................................................33
Summary Table for User Types ..................................................................................................35
Summary Table for Any-VA.........................................................................................................35
Summary Table for Contract Care ..............................................................................................39
Health Care Preferences & Decision-Making [9].............................................................................41
Distance to Health Care [10]..........................................................................................................45
Care Coordination and Satisfaction [11] ........................................................................................47
VA Information Sources [12] ...........................................................................................................55
Knowledge, Attitudes, and Perceptions about VA [13]....................................................................58
Demographics [14]..........................................................................................................................60
12/07
NATIONAL SURVEY OF WOMEN VETERANS
Introduction
IF YOU DIAL AND DO NOT REACH A PERSON
CALL BACK CODES
RESOLVE CODES
1
7
2
3
4
5
6
No answer
Busy
Answering device
Number changed
Temporarily out of service
Circuits busy
8
9
10
11
12
Pager signal
Pager voicemail
Blocked Number
Fax/Data Line
Non working number
Unspecified resolve
IF YOU REACH AN ANSWERING DEVICE AND ARE PROMPTED TO LEAVE A MESSAGE :
Hello, this is a message for Ms. [VETERAN’S LAST NAME]. My name is [INTERVIEWER’S NAME]. I am calling
to follow up on a letter recently sent to you about the National Survey of Women Veterans. We’d like to ask you to
participate in this important telephone survey that will help improve health care for women veterans. Please call
the survey center at 1-800-xxx-xxxx and we will be happy to answer your questions and set a survey interview
appointment. Again, the number to call is 1-800-xxx-xxxx.
IF YOU REACH AN ANSWERING DEVICE AND ARE PROMPTED TO LEAVE A MESSAGE :
MESSAGE FOR 5TH CALL ATTEMPT:
Hello, this is a message for Ms. [VETERAN’S LAST NAME]. My name is [INTERVIEWER’S NAME]. I am calling
to follow up on a letter recently sent to you about the National Survey of Women Veterans. We’d like to ask you to
participate in this important telephone survey that will help improve health care for women veterans. We will call
you again in a day or two, or if you wish, please call the survey center at 1-800-xxx-xxxx and we will be happy to
answer your questions and set a survey interview appointment. Again, the number to call is 1-800-xxx-xxxx
MESSAGE FOR 6TH CALL ATTEMPT
Hello, this is a message for Ms. [VETERAN’S LAST NAME]. My name is [INTERVIEWER’S NAME]. I am calling
again to follow up on a letter recently sent to you about the National Survey of Women Veterans. We’d like to ask
you to participate in this important telephone survey that will help improve health care for women veterans. Please
call the survey center at 1-800-xxx-xxxx and we will be happy to answer your questions and set a survey interview
appointment. Again, the number to call is 1-800-xxx-xxxx.
IF NOT SPEAKING WITH POTENTIAL PARTICIPANT AND HOUSEHOLD MEMBER KNOWS ABOUT LETTER
AND/OR SURVEY - MESSAGE TO LEAVE WITH HOUSEHOLD MEMBER:
We’d like to ask Ms. [VETERAN’S LAST NAME] to participate in an important telephone survey about women
veterans. Ms. [Veteran’s last name] can call the survey center at 1-800-xxx-xxxx and we will be happy to answer
her questions and set a survey interview appointment. Again, the number to call is 1-800-xxx-xxxx.
2
CALLING A POTENTIAL PARTICIPANT WHO HAS RETURNED A PREFERENCE FOR CONTACT CARD:
Hello, my name is [INTERVIEWER’S NAME]. I am calling from CSRS, an independent research organization
engaged by the Department of Veterans Affairs to conduct a telephone survey with women veterans. You recently
sent us a card indicating this is a good time to contact you about participating in this survey. This is a one-time
telephone survey that takes between 20 and 60 minutes to complete, depending on your answers. I would like to
ask you a few short questions to see if this study applies to you.
1
2
YES, NOW
¨
YES,
AT A LATER TIME
¨
REFUSED
[RF_S1ADD]
DATE: ____/____/____
TELEPHONE:
[OTHS1ADD]
3
Continue with screener
¨
SAME
TIME: ____:_____
AM
PM
OTHER: (_____) _____-______
REASON: _____________________________________________________
End Interview: Thanks very much for listening, and have a great (day/evening).
IF YOU REACH AN ANSWERING DEVICE FOR POTENTIAL PARTICIPANT WHO RETURNED A
PREFERENCE FOR CONTACT CARD:
Hello, this is a message for Ms. [Veteran’s last name]. My name is [INTERVIEWER’S NAME]. I am calling about
the National Survey of Women Veterans and to follow up on the card you recently sent us indicating this is a good
time to contact you about participating in this survey. We will call you again, or if you wish, please call the survey
center at 1-800-xxx-xxxx and we will be happy to set a survey interview appointment. Again, the number to call is
1-800-xxx-xxxx.
IF SOMEONE ANSWERS THE PHONE
“Hello, may I please speak with [VETERAN’S NAME]?
IF NOT SPEAKING WITH POTENTIAL PARTICIPANT AND REASON FOR CALL IS REQUESTED:
This is [INTERVIEWER’S NAME]. I’m calling about a letter sent by the VA to [VETERAN’S NAME].
IF NOT ABLE TO REACH POTENTIAL PARTICIPANT
[STATUS1]
CALL BACK CODES
1
2
3
Temporarily unavailable ¨ (Schedule call back)
DATE: ___/___/___ TIME: ___:____
Number Changed ¨ (Enter new number)
Unspecified Call Back
(____) _____-________
AM
PM
RESOLVE CODES
4
5
6
7
8
9
10
11
Wrong number
Unable to locate
Deceased
Institutionalized (prison or hospital)
Too Ill
Language/Communication Problem
Refused
Unspecified resolve
3
IF SPEAKING WITH THE POTENTIAL PARTICIPANT:
Hello, my name is [INTERVIEWER’S NAME]. I am calling from CSRS, an independent research organization
engaged by the Veterans Administration to conduct a telephone survey with women veterans. The survey is called
the National Survey of Women Veterans. We recently sent you a letter in the mail, telling you about the survey
and asking for your participation. Do you remember receiving this letter?
[S1]
1
2
Yes
No
¨ GO TO SURVEY INFORMATION
¨ CONTINUE
IF POTENTIAL PARTICIPANT DID NOT “RECEIVE LETTER”:
“I can tell you about this survey now, and then send you another letter if you prefer.”
[S2]
Continue with survey introduction ¨ GO TO SURVEY INFORMATION
1
[S2]
Continue with survey introduction AND send another letter ¨ GET CONTACT INFORMATION
2
[HD_S2]
Send another letter first ¨ GET CONTACT INFORMATION
3
Refused ¨ END INTERVIEW -- CODE AS REFUSAL
[RF_S2]
4
CONTACT INFORMATION
[S2CON1]
With your permission, I can look up your address on the computer.
[IF ADDRESS APPEARS ON SCREEN, CONFIRM ADDRESS AND CHANGE AS NECESSARY]
[IF ADDRESS DOES NOT APPEAR ON SCREEN] May I please have the spelling of your name and your
complete address to allow me to resend the letter.
[S2NAME]___________________________________________________
NAME
[S2ADD]_____________________________________________________
_____________________
STREET
APT.
[S2CITY]_____________________________________________
CITY
____
__________ -- ________
STATE
ZIP CODE
[CONTINUE IF S1=1 OR S2 = 1 OR 2] SURVEY INFORMATION:
The purpose of the study is to understand women veterans’ use of health care, including what they like and what
they would change about the care they receive, even if that care is not at a VA Medical Center. We are collecting
this information so that we can better understand the health care needs of women veterans. This is a one-time
telephone survey that takes between 20 and 60 minutes to complete, depending on your answers. I would like to
ask you a few short questions to see if this study applies to you.
A. INTERVIEWER CODE CONSENT TO SCREENER
1
YES, NOW [S3]
¨
Continue with screener
YES,
AT A LATER TIME¨ DATE: ____/____/____
[OTHS3]
TELEPHONE: SAME
2
REFUSED
[RF_S3]
3
¨
TIME: ____:_____
AM
PM
OTHER: (_____) _____-______
REASON: _____________________________________________________
End Interview: Thanks very much for listening, and have a great (day/evening).
4
Screener [1]
1.
Are you a woman who has served in the U.S. Armed Forces?
YES, HAS SERVED
1
GO TO Q2
7
UNCODABLE
8
DON’T KNOW
¨
¨
9
REFUSED
¨
GO TO THANK
AND TERMINATE
NO, HAS NOT SERVED
2
¨
GO TO Q3
NOT A WOMAN
3
GO TO THANK
AND TERMINATE
NOT A VETERAN
4
GO TO THANK
AND TERMINATE
2.
¨
¨
GO TO Q3
GO TO THANK
AND TERMINATE
¨
Are you still serving on active duty in the U.S. Armed Forces?
1
2
3.
DUTY
DUTY
YES, STILL ON ACTIVE
¨
7
UNCODABLE
¨
GO TO THANK
AND TERMINATE
8
DON’T KNOW
¨
GO TO THANK
AND TERMINATE
9
REFUSED
¨
GO TO THANK
AND TERMINATE
GO TO THANK
AND TERMINATE
NO, NOT ON ACTIVE
¨ GO TO Q4
Did you ever serve in the National Guard or on other reservist-type duty?
4.
1
YES, SERVED
¨
GO TO Q4
7
UNCODABLE
¨
GO TO THANK
AND TERMINATE
2
NO, DID NOT SERVE
¨
GO TO THANK
AND TERMINATE
8
DON’T KNOW
¨
GO TO THANK
AND TERMINATE
9
REFUSED
¨
GO TO THANK
AND TERMINATE
Did your military service consist entirely of National Guard or other reservist-type duty?
1
YES, CONSISTED ENTIRELY OF
RESERVIST TYPE DUTY
¨
GO TO Q4A
2
NO, DID NOT CONSIST ENTIRELY OF
RESERVIST TYPE DUTY
¨
GO TO Q4A
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q4A
GO TO Q4A
GO TO THANK
AND TERMINATE
5
4A.
[CONTINUE IF (Q4 = 1/UC/DK) OR (Q1=2/UC AND Q4=2); OTHERWISE GO TO Q4B] Was
your National Guard or Military Reserve Unit ever activated, or were you ever called up
for active duty not counting the four to six months duty for initial training or yearly 2week active duty requirement?
YES, CALLED UP
1
¨
NO, NEVER CALLED UP
2
4B.
5.
¨
7
UNCODABLE
¨
GO TO THANK
AND TERMINATE
8
DON’T KNOW
¨
GO TO THANK
AND TERMINATE
9
REFUSED
¨
GO TO THANK
AND TERMINATE
GO TO Q5
GO TO THANK
AND TERMINATE
[CONTINUE IF (Q1=1 AND Q4=2); OTHERWISE GO TO Q5] Did you ever serve in the
National Guard or on other reservist-type duty?
1
YES
¨
GO TO Q5
2
NO
¨
GO TO Q5
7
UNCODABLE
8
DON’T KNOW
¨
¨
9
REFUSED
¨
GO TO THANK
AND TERMINATE
7
UNCODABLE
¨
GO TO THANK
AND TERMINATE
8
DON’T KNOW
¨
GO TO THANK
AND TERMINATE
9
REFUSED
¨
GO TO THANK
AND TERMINATE
GO TO Q5
GO TO THANK
AND TERMINATE
Are you employed by the Department of Veterans Affairs?
1
YES, WORK FOR VA
GO TO THANK AND TERMINATE
2
NO, NOT A VA EMPLOYEE
¨
¨
PROCEED WITH SURVEY CONSENT
Summary Table for Military Service Type
Type
Military
Service
type
Acronym
MIL_SVC_TYPE
Codes
1
Criterion
Q4B = 1 OR (Q1 = 2 AND Q4 = 2)
2
3
Labels
Regular military +
Reserves/Nat’l Guard
Regular military only
Reserves/Nat’l Guard only
0
Not defined (missing)
(Q4 = UC/DK) OR Q4B = UC
Q4B = 2
Q4 = 1
CATI create variables: Mil_svc_type
[IF SCREENER IS NEGATIVE] THANK AND TERMINATE:
“You’ve answered all the questions I have for you. We very much appreciate your time and thank you for
helping us with this important study.”
6
Telephone Consent Agreement
LONG CONSENT
Before we can begin the survey, I need a few minutes to read you some statements about the study and your
participation. As I read, please feel free to ask questions.
1.
We are asking you to take part in a telephone survey. The survey is part of a research study to improve
women’s health care at the VA. We are asking for your participation in the study regardless of whether
you now use VA healthcare services, formerly used VA healthcare services, or never used VA healthcare.
2.
By taking part in the study, you agree to allow me to interview you. This telephone interview may be
monitored by my supervisor for quality purposes. The interview can take between 20 minutes and 60
minutes to complete, depending on your answers. I will ask about your health and health care use, your
experiences in the military, how satisfied you are with your care, and a few questions about your
background.
1
2
NO MONITORING FLAG
[AGREE2]
MONITORING PERMITTED
3.
In addition, your participation will involve being asked possibly sensitive questions about emotional,
physical and sexual trauma. These questions concerning traumatic experiences in the military could
potentially cause psychological distress. You can refuse to answer any questions of your choosing.
4.
We will also ask for your permission to obtain information from the VA records regarding the clinics you
visited during the past 12 months and whether or not you received a pap smear or mammogram from the
VA. You may still participate in the telephone interview even if you do not wish the research team to
obtain information from your medical records.
5.
This study does not have connections with any commercial product. There are no tests or procedures or
costs to you involved in this study and you will not be compensated for your participation in this survey.
6.
The VA complies with the requirements of HIPAA, the Health Insurance Portability and Accountability Act
of 1996, and its privacy regulations and all other applicable laws that protect your privacy. We will protect
your information according to these laws. Despite these protections, there is a possibility that your
information could be used or disclosed in a way that it will no longer be protected. Our Notice of Privacy
Practices provides more information on how we protect your information. If you do not have a copy of the
Notice, the research team will provide one to you. Your information will be combined with that of other
participants and reported only as totals, averages and other statistics.
7.
Taking part in the study is entirely voluntary. You may refuse to participate and you can withdraw at any
time. There is no penalty for refusing to participate or for withdrawing from the study. Any benefits that
you are entitled to receive will not be affected if you decide to withdraw or refuse to participate. You will
be given the opportunity to ask questions during the telephone interview. By agreeing to participate in the
telephone interview, you authorize us to use the information you give to us over the telephone.
8.
If you would like more information, wish to withdraw, or have any complaints about this study, you can
contact Julia Yosef, the study’s survey manager. Do you have a pen or pencil handy to jot this number
down? The toll-free telephone number is 1-800-xxx-xxxx.
7
SHORT CONSENT
Before we begin, I need to read you some statements about the survey and your
participation.
We may be monitored by my supervisor for quality purposes.
1
2
NO MONITORING FLAG
[AGREEX1]
MONITORING PERMITTED
This survey is part of a research study to improve women’s health care at the VA. We
would like to include your opinion, regardless of whether you have ever used VA
healthcare. The survey may take about 45 minutes to complete. Please feel free to ask
questions at any time.
Your participation will involve being asked possibly sensitive questions about emotional,
physical, and sexual trauma. These questions concerning traumatic experiences in the
military could potentially cause psychological distress. Please remember that you can
refuse to answer these or any other questions.
Taking part in this survey is entirely voluntary. You may refuse to participate and can
withdraw at any time. You will not be compensated for your participation in this survey.
Also, your participation or refusal to participate will in no way affect your VA benefits
and rights.
Your information will be used solely for the purpose of this study, and it will be combined
with that of other participants and reported only as totals, averages, and other statistics.
The VA complies with the Health Insurance Portability and Accountability Act of 1996,
and its privacy regulations and all other applicable laws that protect your privacy.
When I am finished reading these statements, I will ask for your permission for VA
researchers to obtain information from your VA records regarding any clinics you may
have visited in the past year. You may still participate in this survey even if you do not
permit the researchers to obtain this information.
If you would like more information, wish to withdraw, or have any complaints about this
study, you can contact Julia Yosef, the study’s survey manager. Her telephone number
is 800-xxx-xxxx.
By participating in this telephone survey, you expressly authorize the VA researchers to
use the information you give to us over the phone.
8
B. Shall I go ahead with the survey?
1
2
YES, NOW [¨QB]
[CONSENT]
GO TO C (RECORD CONSENT)
YES, AT A LATER TIME¨
[QB] [CONSENT]
DATE: ____/____/____
TELEPHONE:
3
UNSURE, CALL BACK ¨
[QB_RE]
SAME
TIME: (FROM) ____:_____
AM
PM
OTHER: (___) _____ - ________
Thank you very much for your time. We would like to call you again and
explain the enrollment process once more so you can decide then whether
to participate.
DATE: ____/____/____
TELEPHONE:
SAME
TIME: (FROM) ____:_____
AM
PM
OTHER: (___) _____ - ________
[RF_QB – refused on callback]
GO TO RE-ENROLLMENT (WHEN CALLING BACK)
REFUSED
¨
[RF_QB – refused on 1st call]
REASON: [OTHQBBRF]______________________________________
4
GO TO END INTERVIEW
C. [ RECORD CONSENT ]
Will you allow the research team to get information from your VA medical records, if you
have any, about the VA clinics you have visited during the past year? [QC] [MREC_REV]
1
2
3
Yes: Consent to both survey AND medical record review
No: Consent to survey only (declines medical record review)
VOLUNTEERS NOT APPLICABLE (e.g., no VA use in prior 12 months): Consent to survey only
Additional Scripts
RE-ENROLLMENT
Hello Ms. [VETERAN’S LAST NAME]. My name is [INTERVIEWER’S NAME]. We previously called
you regarding the National Survey of Women Veterans. When we last spoke, you were thinking about
participating in the study and asked us to call you back after you had a little time to think about it. Is this
a good time to talk? [PAUSE]
In our last conversation, I had explained what we were asking you to do for this study. I would like to go
over these points again now to make sure you remember them and can then decide whether or not you
would like to participate. [GO TO TELEPHONE CONSENT AGREEMENT]
RESUME INTERVIEW
Hello Ms. [VETERAN’S LAST NAME]. My name is [INTERVIEWER’S NAME]. I’m calling regarding
your participation in the National Survey of Women Veterans. We began an interview on [DATE], but
you requested that it be continued at [another/this] time. If you are available, I would like to complete it
now.
9
NATIONAL SURVEY OF WOMEN VETERANS
Military Background [2]
6.
I’ll start with some questions about your military experience.
6A.
[CONTINUE IF MIL_SVC_TYPE = 1 OR 2 OR 0] Altogether, how long did you serve on
active duty in the military? [IF MIL_SVC_TYPE=1, ADD: I will ask you about your service
in the Reserves or National Guard separately.]
[Q6AYR]
[LN_MIL_YRS]
1
[Q6AMN]
[LN_MIL_MNS]
[Q6ADY]
[LN_MIL_DYS]
6B.
2
.
.
Years
Months
Days
3
[CONTINUE IF MIL_SVC_TYPE = 1 OR 3] Altogether, how long did you serve in the
Reserves or in the National Guard?
[Q6BYR]
[LN_RSRV_YRS]
1
[Q6BMN]
[LN_RSRV_MNS]
[Q6BDY]
[LN_RSRV_DYS]
2
.
.
Years
Months
Days
3
10
7.
When did you serve in the military? [USE LIST IN Q7B AS PROMPT IF NO RESPONSE IS
VOLUNTEERED. INCLUDE BOTH ACTIVE DUTY MILITARY AND NATIONAL
GUARD/RESERVES.]
7A.
Conditions
5A
121.101:Military Experience & Hazards
FROM
Enter
inclusive
dates
AND/OR all
applicable
service
periods.
Minimum
required field
is year
range; add
month and
date if
volunteered.
7B.
DATES [RECORD UP TO 3
RESPONSES]
[Q7B] [SERV_ERA]
TO
DURING WWI (4/6/1917 - 11/11/1918)
1
1
/
/
2
/
/
BETWEEN WWI AND WWII
2
(11/12/1918 - 9/15/1940)
DURING WWII (9/16/1940 - 7/25/1947)
3
3
/
/
4
/
/
4
BETWEEN WWII AND KOREAN CONFLICT
5
DURING KOREAN CONFLICT
6
BETWEEN KOREAN CONFLICT AND
7
8
(7/26/1947 - 6/26/1950)
(6/27/1950 - 1/31/1955)
VIETNAM ERA (2/1/1955 - 8/4/1964)
9
5
/
/
6
/
/
10
11
7C.
[RECORD ONLY IF Q7A NOT
ANSWERED] SERVICE PERIOD
[RECORD UP TO 6 RESPONSES]
DURING VIETNAM ERA (8/5/1964 - 5/7/1975)
DURING POST-VIETNAM ERA
(5/8/1975 - 9/7/1980) or (9/8/1980 - 8/1/1990)
DURING PERSIAN GULF ERA
(8/2/1990 - 2/28/1991)
BETWEEN PERSIAN GULF WAR AND 9-11
(3/1/1991 – 9/10/2001)
POST 9/11 (9/11/2001 TO PRESENT)
(INCLUDES 3/2003 TO PRESENT:
OPERATION IRAQI FREEDOM / OPERATION
ENDURING FREEDOM (OIF/OEF) ERA)
[ASK IF EARLIEST RESPONSE CATEGORY IN Q7B = 8] Did your military service begin
prior to September 1980?
1
2
YES
NO
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
11
8.
[CONTINUE IF Q7A OR Q7B INCLUDES POST 9/11/01 SERVICE; OTHERWISE GO TO Q9]
Did you ever serve in Operation Iraqi Freedom or in Operation Enduring Freedom, either on
the ground, in nearby coastal waters, or in the air above?
1
YES
2
NO
8A.
¨
¨
GO TO Q8A
7
UNCODABLE
GO TO Q9
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q9
GO TO Q9
GO TO Q9
[CONTINUE IF Q8 = YES; OTHERWISE GO TO Q9]
In what country were you located during your most recent OEF or OIF service?
[USE LIST AS PROMPT IF NO RESPONSE VOLUNTEERED.]
1
2
3
4
5
6
7
8
9
10
11
12
13
IRAQ
KUWAIT
SAUDI ARABIA
QATAR
TURKEY
AFGHANISTAN
GEORGIA
KYRGYSTAN
PAKISTAN
UZBEKISTAN
TAJIKISTAN
THE PHILIPPINES
OTHER [SPECIFY]: _________________________
97
98
99
UNCODABLE
DON’T KNOW
REFUSED
8B.
How many times have you been deployed since 9/11/2001?
8C.
When did your [most recent ] deployment end? [ALLOW YEAR +/- MONTH +/- DAY, OR,
#YEARS AND/OR #MONTHS]
[CATI
PROGRAMMING
NOTE: Add ‘most
recent’ if 8B >1.]
/
Month
/
Day
Year
OR
YEARS AGO
MONTHS AGO
Summary Table for Period of Service Strata
Type
Period of
Service strata
Acronym
SVC_PERIOD
OEF/OIF
Service
OEF_OIF
Recent
deployment
Recent_deploy
Codes
1
2
3
1
0
1
0
Labels
Pre-Vietnam and older
Vietnam to pre-9/11
9/11-present
OEF/OIF
not-OEF/OIF
Recent_deployment
No_recent_deploy
Criterion: most recent service period
Q7A_EYY1 < 1964 OR Q7B < 6
(Q7A_EYY1 > 1964 and < 2001) OR
(Q7B > 6 and < 10)
Q7A_EYY1 > 2001 OR Q7B > 10
Q8 = 1
Q8 ≠ 1
Q8C < 6 months
Q8C > 6 months, or Q8C
blank/UC/DK/RF
CATI create variables: SVC_PERIOD
12
9.
10.
In what branch or branches of the Armed Forces did you serve? [DO NOT READ LIST—
RECORD ALL RESPONSES]
1
ARMY (UNSPECIFIED)
2
WOMEN’S AUXILIARY ARMY CORPS (WAAC)
97
UNCODABLE
3
WOMEN’S ARMY CORPS (WAC)
98
DON’T KNOW
4
ARMY NURSING CORPS
99
REFUSED
5
NAVY (UNSPECIFIED)
6
WAVES (WOMEN ACCEPTED FOR VOLUNTARY EMERGENCY SERVICES)
7
NAVY NURSING CORPS (NNC)
8
AIR FORCE (UNSPECIFIED)
9
WOMEN IN THE AIR FORCE (WAF)
10
AIR FORCE NURSING CORPS (AFNC)
11
WOMEN’S AIR FORCE SERVICE PILOTS (WASPS)
12
MARINE CORPS (UNSPECIFIED)
13
COAST GUARD (UNSPECIFIED)
14
SPARS (COAST GUARD WOMEN’S RESERVE)
15
NATIONAL GUARD
16
RESERVES (UNSPECIFIED)
17
ARMY RESERVES
18
NAVY RESERVES
19
AIR FORCE RESERVES
20
MARINE RESERVES
21
OTHER [SPECIFY] _______________________________________________
Do you have a service-connected disability rating? [ANY NUMERIC RESPONSE,
INCLUDING A RESPONSE OF ZERO, SHOULD BE CODED AS “YES”]
1
YES
2
NO
¨
¨
GO TO Q10A
7
UNCODABLE
GO TO Q11
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q11
GO TO Q11
GO TO Q11
10A. What is your service-connected disability rating? [ANY NUMERIC RESPONSE,
INCLUDING A RESPONSE OF ZERO, SHOULD BE CODED]
Enter percent
%
997
UNCODABLE
998
DON’T KNOW
999
REFUSED
13
Self-Reported Health Status (SF-12 v1) [3]
Now I’m going to ask you some general questions about your health.
11.
In general, would you say your health is… [SF12_GH1]
1
EXCELLENT
2
VERY GOOD
7
UNCODABLE
3
GOOD
8
DON’T KNOW
4
FAIR
9
REFUSED
5
POOR
Now I'm going to read a list of activities that you might do during a typical day. As I read each item, please tell me
if your health now limits you a lot, limits you a little, or does not limit you at all in these activities.
12.
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing
golf. Does your health now limit you a lot, limit you a little, or not limit you at all?
¨
¨
¨
1
Limits you a lot
2
Limits you a little
3
Does not limit you at all
4
[VOLUNTEERS: DOES NOT DO ACTIVITY]
GO TO Q12B
GO TO Q12B
GO TO Q12B
¨ GO TO Q12A
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q12B
GO TO Q12B
GO TO Q12B
12A. Is that because of your health? [SF12_PF02_A]
1
2
3
YES, LIMITED A LOT
YES, LIMITED A LITTLE
NO, NOT LIMITED AT ALL
7
8
9
UNCODABLE
DON’T KNOW
REFUSED
12B. Climbing several flights of stairs. Does your health now limit you a lot, limit you a little,
or not limit you at all?
1
2
3
4
Limits you a lot ¨ GO TO Q13
Limits you a little ¨ GO TO Q13
Not limit you at all ¨ GO TO Q13
[VOLUNTEERS: DOES NOT DO ACTIVITY] ¨ GO TO Q12C
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q13
GO TO Q13
GO TO Q13
12C. Is that because of your health? [SF12_PF04_A]
1
2
3
YES, LIMITED A LOT
YES, LIMITED A LITTLE
NO, NOT LIMITED AT ALL
7
8
9
UNCODABLE
DON’T KNOW
REFUSED
14
The following two questions ask you about your physical health and your daily activities.
13.
During the past four weeks,…
[SF12_RP
2]
[SF12_RP
3]
Yes
No
1
2
1
2
Yes
No
1
2
1
2
a. Have you accomplished less than you would
like as a result of your physical health?
b. Were you limited in the kind of work or other
regular daily activities you do as a result of your
physical health?
The following questions ask about your emotions and your daily activities:
14.
During the past four weeks,…
a. Have you accomplished less than you would
[SF12_RE2]
like as a result of any emotional problems,
such as feeling depressed or anxious?
b. Did you do work or other regular daily activities
[SF12_RE3]
15.
less carefully than usual as a result of any
emotional problems, such as feeling
depressed or anxious?
During the past four weeks, how much did pain interfere with your normal work, including
both work outside the home and housework? Did it interfere... [SF12_BP2]
1
2
3
4
5
Not at all
A little bit
Moderately
Quite a bit, or
Extremely
The next questions are about how you feel and how things have been with you during the past four weeks. As I read
each statement, please give me the one answer that comes closest to the way you have been feeling.
16.
How much of the time during the past four weeks…
All
of
the
time
[SF12_MH3]
[SF12_VT2]
A good bit
of the
time
Some
of the
time
A little
of the
time
None
of the
time
a. Have you felt calm
and peaceful?
SF12
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
6
b. Did you have a lot of
energy?
[SF12_MH4]
Most
of
the
time
SF12
c. Have you felt
downhearted and
blue?
[ANXIETY SCREENER]
[SF12_MHI5_ANX] d. Have you been a very
nervous person
MHI5
SF12
MHI5
MHI5
15
17.
During the past four weeks, how much of the time has your physical health or emotional
problems interfered with your social activities like visiting friends or relatives? Has it
interfered… [SF12_SF2]
1
2
3
4
5
All of the time
Most of the time
Some of the time
A little of the time
None of the time
[FOR EACH ITEM IN Q18, IF YES TO PART 1 THEN ASK PARTS 2 & 3]
18.
PART 2
How much has this interfered
with your normal activities or
relationships?
[OIF/OEF ONLY] The next few questions
refer to symptoms you may have
experienced since returning from your
deployment. Have you experienced:
YES
a. Greater irritability?
1
b. Feeling anxious?
1
c. Anger or temper outbursts?
1
[IF Q16C > SOME OF THE TIME,
PREFACE WITH “YOU MENTIONED”]
d. Feeling down or
depressed?
1
¨ ASK PART 2
¨ ASK PART 2
¨ ASK PART 2
¨ ASK PART 2
NO
Not at
all
A little
bit
A moderate
amount
A great
deal
PART 3:
Have you
received care
for this?
YES
NO
2
1
2
3
4
1
2
2
1
2
3
4
1
2
2
1
2
3
4
1
2
2
1
2
3
4
1
2
16
Evaluated Health [4]
The next few questions are about health conditions and your health care.
19.
Please tell me if a doctor or nurse has ever told you that you had any of the following health
problems:
Yes
No
[Q19A] [DX_CANCER]
a. Cancer (IF YES, THEN ASK Q19A.A IMMEDIATELY)
1
2
[Q19B] [DX_HEART]
b. A heart attack
1
2
[Q19C] DX_LUNG]
c. Chronic lung disease, emphysema, asthma or bronchitis
[READ IF NECESSARY: COPD]
1
2
[Q19D] [DX_CHF]
d. Congestive heart failure
1
2
[Q19E] [DX_DIABETES]
e. Diabetes
1
2
[Q19F] [DX_ARTH]
f. Arthritis
1
2
[Q19G] [DX_HBP]
g. Hypertension or high blood pressure
1
2
[Q19H] [DX_PNEU]
h. Pneumonia
1
2
[Q19I] [DX_STROKE]
i. A stroke
1
2
[Q19J] [DX_DEPRES]
j. Depression
1
2
[Q19K] [DX_PTSD]
k. PTSD or Post Traumatic Stress Disorder
1
2
[Q19L] [DX_OSTEO]
l. Osteoporosis or thinning of the bones
1
2
[Q19M] [DX_OTHER]
m. OTHER VOLUNTEERED RESPONSES [SPECIFY]
________________________________________
1
2
19A. A [CONTINUE IF Q19a (CANCER) = YES; OTHERWISE GO TO Q19b]
What type of cancer did you have? [DO NOT READ RESPONSE OPTIONS. IF
RESPONDENT SAYS SKIN CANCER, THEN ASK: “What kind of skin cancer?”]
[DX_CA_TYPE]
DO NOT READ
1
2
3
4
5
6
7
8
9
10
LUNG
COLON (COLO-RECTAL)
BREAST
CERVICAL
OVARIAN
ENDOMETRIAL, UTERINE
MELANOMA (SKIN CANCER)
NON-MELANOMA SKIN CANCER
SKIN CANCER NOT OTHERWISE SPECIFIED
OTHER TYPE OF CANCER (SPECIFY)
_________________________
17
20.
Have you ever been pregnant?
1
YES
2
NO
¨
¨
GO TO Q20A
7
UNCODABLE
GO TO Q21
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q21
GO TO Q21
GO TO Q21
20A. [CONTINUE IF Q20=YES; OTHERWISE GO TO Q21] How many children have you given
birth to?
21.
22.
97
UNCODABLE
98
DON’T KNOW
99
REFUSED
Have you had a hysterectomy?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
How many different prescription medications do you currently take?
97
UNCODABLE
98
DON’T KNOW
99
REFUSED
[IF ZERO, SKIP TO Q23]
22A. Do you get any of these from the VA?
23.
YES
7
UNCODABLE
1
NO
8
DON’T KNOW
2
9
REFUSED
Are there medicines or supplements that your doctor has told you to take that you buy
without a prescription?
1
YES
2
NO
¨
¨
GO TO Q23A
7
UNCODABLE
GO TO Q24
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q24
GO TO Q24
GO TO Q24
23A. How many?
97
UNCODABLE
98
DON’T KNOW
99
REFUSED
18
The next few questions are about health care tests that you or may not have had.
24.
When, if ever, was your last: [DO NOT READ RESPONSE OPTIONS]
≤ 12
MONTHS
AGO
a. [CONTINUE IF Q21
(HYSTERECTOMY)
= NO; OTHERWISE
GO TO Q24b]
>1 YEAR
BUT < 2
YEARS AGO
>2 BUT < 4
YEARS
AGO
>4
YEARS
AGO
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
b. Mammogram
for osteoporosis
25.
UC
DK
RF
7
8
5
7
8
5
7
8
5
_______
6
__________
Pap smear
c. DEXA Scan or
bone density test
OTHER
(SPECIFY)
NEVER
_______
__________
6
_______
__________
6
[EVERYONE] Next, I am going to read you a list of health care services. Please tell me if
you think that the VA definitely, probably, probably does not, or definitely does not offer
these services?
Definitely
offers
Probably
offers
Probably
does not
offer
Definitely
does not
offer
UC
DK
RF
a. Treatment for ongoing health conditions,
such as diabetes
1
2
3
4
7
8
9
b. Mammograms
1
2
3
4
7
8
9
c. Gynecological services (e.g., pap smears)
1
2
3
4
7
8
9
d. Prenatal care
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
e. Contraception. [IF NECESSARY: family
planning]
f. Specialized counseling for sexual
harassment or sexual assault that occurred
in the military
g. Depression treatment
h. Counseling for adjustment problems after
military service
i. Help with quitting smoking
j. Weight loss counseling. [IF NECESSARY:
weight loss treatment or care]
19
Personal Health Practices [5]
The next few questions are about personal health practices that may affect your health.
26.
Have you smoked at least 100 cigarettes over your entire lifetime?
1
YES
2
NO
¨
¨
GO TO Q26A
7
UNCODABLE
GO TO Q27
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q26A
GO TO Q26A
GO TO Q27
26A. Do you now smoke everyday, some days, or not at all?
DO NOT READ
1
2
3
EVERYDAY
SOME DAYS
NOT AT ALL
[ AUDIT-C ]
27. How often have you had a drink containing alcohol in the last year? [IF NECESSARY,
PROMPT WITH: By “drink” I mean either a bottle or can of beer, a wine cooler, a glass of
wine, a shot of liquor, or a mixed drink.] [AUDIT-C 1]
1
2
3
4
5
6
Never ¨ GO TO Q28
Monthly or less
2-4 days a month
2-3 days a week
4-5 days a week
6 or more days a week
DRINK CONVERSION TABLE
1 12 oz. BOTTLE OR CAN OF
BEER
1 DRINK
1 8oz. GLASS OF WINE
1 DRINK
1 “SHOT” (1oz.) OF HARD LIQUOR
1 DRINK
1 “QUART” (32oz.) BOTTLE OF
BEER
3 DRINKS
1 “FORTY” (40 oz.) BOTTLE OF
BEER
4 DRINKS
1 “SIX PACK” OF BEER
6 DRINKS
1 “TWELVE PACK” OF BEER
12 DRINKS
1 “CASE” OF BEER
24 DRINKS
1 BOTTLE OF WINE
6 DRINKS
1 “PINT” (16 oz.) OF HARD LIQUOR
16 DRINKS
1 “FIFTH” (26 oz.) OF HARD
LIQUOR
26 DRINKS
20
27A. How many drinks containing alcohol did you have on a typical day when you were
drinking in the last year? [AUDIT-C 2]
1
2
3
4
5
6
I do not drink ¨ GO TO Q28
1-2 drinks
3-4 drinks
5-6 drinks
7-9 drinks
10 or more drinks
27B. How often in the last year have you had 4 or more alcoholic drinks on one occasion?
(READ RESPONSE OPTIONS) [AUDIT-C 3]
1
2
3
4
5
28.
Never
Less than monthly
Monthly
Weekly
Daily or almost daily
On average, how many days per week do you exercise at least 30 minutes, enough to make
you breathe hard and/or sweat? [VIP Survey]
96
[CODE # OF DAYS 0-7]
29.
VOLUNTEERS UNABLE TO EXERCISE DUE TO PHYSICAL DISABILITY,
E.G., BEING CONFINED TO A WHEELCHAIR
97
UNCODABLE
98
DON’T KNOW
99
REFUSED
About how tall are you without shoes?
[Q31FT]
[HGHT_FT]
1
.
Feet
[Q31IN]
[HGHT_IN]
30.
Inches
2
About how much do you weigh without shoes? [WEIGHT]
Enter Number of Pounds
21
31.
Are you currently trying to lose weight?
1
YES
2
NO
¨
¨
GO TO Q31A
7
UNCODABLE
GO TO Q31B
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q31A
GO TO Q31A
GO TO Q31B
31A. To what extent do the following issues interfere with you losing weight?
Not at all
a. Having a health condition that limits
your ability to exercise
A small
amount
A moderate
amount
A great deal
1
2
3
4
b. Not enough time to exercise
1
2
3
4
c. Difficulty preparing healthy foods
1
2
3
4
d. Lack of determination
1
2
3
4
e. Too many emotional triggers
1
2
3
4
31B. If the VA were to offer a weight loss program specifically for women how likely would
you be to participate? Would you say:
1
Very likely
2
Somewhat likely
3
Not very likely
4
Not likely at all, or
5
Not applicable [BECAUSE DOES NOT NEED TO LOSE WEIGHT]
22
Military Experiences and Effects [6]
[CONSENT TO PROCEED WITH PHYSICAL/SEXUAL ABUSE QUESTIONS]
32.
The next questions are about traumatic or upsetting events that may have happened to you
while you were in the military. Before we begin with these questions, I want to confirm that
it is okay for me to ask you questions regarding any physical or sexual trauma that you
may have experienced while in the military.
1
YES
2
NO
¨
¨
CONTINUE
GO TO Q45
(START OF POST-ACTIVE DUTY SECTION)
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q45
GO TO Q45
GO TO Q45
Military Experiences and Effects
[6A] – Concerns While On Active Duty
First, I would like you to think back to when you (were on active duty/served in the military) and to think
about your life and family at home during that time. As I read each of the following statements, tell me how
strongly you agree or disagree with the statement, or whether the statement does not apply to you.
33.
While you were on active duty….
[SOURCE: Items b, d, & f adapted from DRRI Section E]
a. You learned valuable skills that opened up future job
opportunities.
b. [OEF/OIF ONLY] Your relationships with those
closest to you were harmed by your absence.
c. You were able to get away from a negative situation
or home environment.
d. [OEF/OIF ONLY] You missed out on your children’s
growth and development.
e. Your relationships with others who served with you
were a strong source of support to you.
f. [OEF/OIF ONLY] You were able to provide adequate
financial support to your family.
34.
Strongly
Agree
Somewhat
agree
1
2
1
2
1
2
1
Somewhat
Disagree
3
Strongly
Disagree
N/A
(b-d,f)
4
4
5
3
4
5
2
3
4
5
1
2
3
4
1
2
3
4
3
5
[OEF/OIF Only] During active duty, did you have children under the age of 18 at home?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
23
Now the next few statements refer to how prepared you felt to serve in your military role. Again, I would like
you to tell me how strongly you agree or disagree with each statement.
35.
While you were on active duty:
[IF NECESSARY, PROMPT WITH: “any time during your military service”]
[Source: Adapted from DRRI Section C]
Strongly
Agree
a. You felt adequately trained for the duties assigned to you.
b. Unexpected changes in your assignment or duties caused
you stress or anxiety.
c. The equipment provided for you was adequate for the
duties assigned to you.
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
1
2
3
4
1
2
3
4
1
2
3
4
The next few statements refer to your safety while in the military.
36.
While in the military, how much of the time:
[PROMPT WITH, “any time during your military service”]
[Source: WAVCUP; Skinner 11, 11a]
a. Were you afraid of enemy
action
b. Did you feel safe around the
local inhabitants where you
were stationed.
c. Were you fearful of other
military personnel
All of
the
time
Most of
the time
Some of
the time
A little of
the time
None of
the time
VOLUNTEERS
NOT
APPLICABLE
(valid response
for Q36a & b)
1
2
3
4
5
6
1
2
3
4
5
6
1
2
3
4
5
24
Military Experiences and Effects
[6B] – Combat Exposure
Please answer yes or no to the next series of questions.
37.
During your military service:
[Source: Items a & b adapted from DRRI, Sections I and J]
YES
NO
a. Did you ever serve in a combat or war zone?
[If no, state, “I am going to ask a couple of other questions about experiences you
may have had even outside of a combat zone.”]
1
2
1
2
1
2
b. Did you or members of your unit or squadron receive hostile fire from small arms,
artillery, rockets, mortars, bombs, or IED’s?
c. During your military service, did you ever see people who were severely wounded,
disfigured, or killed?
Military Experiences and Effects
[6C] – Military Sexual Trauma (MST)
The next few statements ask about experiences you may or may not have had with sexual harassment, and
physical and sexual trauma while in the military.
38.
39.
While you were in the military, were you ever subjected to uninvited or unwanted sexual
attention, such as touching, cornering, pressure for sexual favors, or verbal
remarks?[HARASS]
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
Did you ever have an experience where you were physically assaulted, other than as a
result of combat, while you were in the military? By physical assault I mean being pushed,
shoved, grabbed, or otherwise attacked. [ASSAULT]
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
25
40.
41.
Did you ever have an experience where someone used force or the threat of force to have
sexual relations with you against your will while you were in the military? Sexual relations
can include intercourse, or oral or anal sex, using body parts or objects.
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
Did you ever have sexual contact with a superior while in the military because you thought
there would be negative consequences for you if you did not?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
[ CATI PROGRAMMING FLAG: COMBAT_MST FLAG = YES if Q37a, Q37b, Q37c, Q39, Q40, or
Q41 = YES; otherwise COMBAT_MST FLAG = NO ]
42.
43.
[CONTINUE IF Q38, Q39, Q40, OR Q41 = YES; OTHERWISE GO TO Q45 AT START OF
POST-ACTIVE DUTY SECTION] Did you ever avoid using the VA, or not use it at all,
because of this [these] experience[s]?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
Did you ever seek counseling or other care for this [these] experience[s]?
1
YES
2
NO
¨
¨
GO TO Q43A
7
UNCODABLE
GO TO Q44
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q44
GO TO Q44
GO TO Q44
43A. When did you seek counseling or other care? Was that while you were in the military,
after you were discharged, or both?
1
WHILE IN THE MILITARY
2
AFTER BEING DISCHARGED FROM THE MILITARY
3
BOTH IN THE MILITARY AND AFTER BEING
DISCHARGED
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
43B. Did you get counseling or care at: [CHECK YES OR NO FOR EACH ITEM]
YES
a. A military facility
b. A VA facility, or
c. Somewhere other than a military or VA
facility
NO
1
2
1
2
1
2
26
44.
[CONTINUE IF Q43 = NO/UC/DK/RF; OTHERWISE GO TO Q44D] Thinking of all of the
healthcare that you have received since you left the military, have any of your primary care
or women’s health care providers ever asked you whether or not you had these types of
experiences while in the military?
1
YES
2
NO
¨
¨
GO TO Q44A
7
UNCODABLE
GO TO Q44C
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q44C
GO TO Q44C
GO TO Q44C
44A. [CONTINUE IF Q44 = YES; OTHERWISE GO TO Q44C] Was this a VA healthcare
provider?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
44B. Did this provider offer to refer you for counseling or other care?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
44C. Please tell me how much you agree or disagree with the following reasons about why
you did not seek counseling or other care:
a. You did not want or feel you needed counseling
or other care
b. You did not know where to go for counseling or
other care
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
1
2
3
4
1
2
3
4
44D. [CONTINUE IF Q43=NO/UC/DK/RF OR Q43B ≠ VA FACILITY (i.e., did not receive
counseling, or received counseling at non-VA site); OTHERWISE GO TO Q45] If you
could call a confidential, toll free number set up for people who have experienced
military sexual trauma, and talk with one person regarding your eligibility for VA
benefits, how likely would you be to use this toll free number?
1
Very likely
2
Somewhat likely
3
Not very likely
7
UNCODABLE
4
Not likely at all
8
DON’T KNOW
5
Not sure
9
REFUSED
6
VOLUNTEERS NOT APPLICABLE;
ALREADY USES THE VA
[PROMPT FOR TRAUMATIC EXPERIENCES PROTOCOL] “At the end of this interview, I will give you
information on how you can contact the VA if you are interested”
27
Military Experiences and Effects
[6D] – Post Active Duty Support And Events
45.
The next few questions refer to the time since you last served in the active military. Please
tell me how strongly you agree or disagree with each statement
[INTENT IS TO COMPARE OEF/OIF VETS WITH OTHERS]
[Source: Items a-c adapted from DRRI, Section L]
Since you completed active duty:
a. The people you work with respect the fact that
you are a veteran.
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
NOT
APPLICABLE
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
d. You view your overall experience in the military
as positive.
1
2
3
4
5
e. You have been able to maintain the social
support of your military friends.
1
2
3
4
5
b. There are people you can talk to about your
military experiences.
c. People who have not been in the military don't
understand what you went through while in the
Armed Forces.
46.
[FOR OEF/OIF ONLY] The next few questions refer to events you may have experienced
since returning from your deployment. Since returning from your deployment…
[Source: Items b.1, d, & e adapted from DRRI, Section M]
a. Has your job or employment changed?
b.1 Did you lose your job?
b.2 Have you had a major change in your job duties
or type of work?
b.3 Did you choose to change jobs?
c. Is that because your employer did not hold your
job for you while you were deployed?
d. Have you been unemployed, and seeking
employment for at least 3 months?
e. Have you gone through a divorce or become
separated from your partner or significant other?
1
YES GO TO ITEM (b)
2
NO GO TO ITEM (d)
1
YES GO TO ITEM (c)
2
NO GO TO ITEM (b2)
1
YES GO TO ITEM (c)
2
NO GO TO ITEM (b3)
1
YES GO TO ITEM (d)
2
NO GO TO ITEM (d)
1
YES
2
NO
1
YES
2
NO
1
YES
2
NO
28
Military Experiences and Effects
[6E] – PTSD
Now I would like to ask you about the effects on you of any traumatic events you may have experienced or
witnessed in your lifetime.
47.
[CONTINUE IF COMBAT_MST FLAG = YES; OTHERWISE GO TO Q47A] In discussing your
experiences in the military, you mentioned:
[CATI PROGRAMMING NOTE – LIST ALL APPLICABLE EXPOSURES FROM Q37a-c, Q39-Q41]
[IF Q37a OR Q37b = 1, “exposure to hostile fire or other combat experiences;”]
[IF Q37c = 1, “seeing people who were severely wounded, disfigured, or killed;”]
[IF Q39 OR Q40 OR Q41 = 1, “unwanted sexual experiences in the military.”]
I’d like for you to think about your thoughts and feelings related to these events when I ask
you the following questions. Because of these events…
YES
NO
UC
DK
RF
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
a. Did you avoid being reminded of this experience by
staying away from certain places, people or activities?
b. Did you lose interest in activities that were once
important or enjoyable?
c. Did you begin to feel more isolated or distant from other
people?
d. Did you find it hard to have love or affection for other
people?
e. Did you begin to feel that there was no point in planning
for the future?
f. After this experience were you having more trouble than
usual falling asleep or staying asleep?
g. Did you become jumpy or get easily startled by ordinary
noises or movements?
47A. [CONTINUE IF COMBAT_MST FLAG = NO; OTHERWISE GO TO Q48]
Have you ever experienced or witnessed or had to deal with a frightening, horrible, or
extremely upsetting event that included actual or threatened death or serious injury to
you or someone else?
READ IF NECESSARY: Examples of traumatic events include: physical assault or rape;
being held hostage or kidnapped; being in a fire or flood or natural disaster; discovering
a body; being in a serious accident; being in combat; seeing someone badly injured or
killed; the sudden death of someone close to you.
1
YES
2
NO
¨
¨
GO TO Q47B
7
UNCODABLE
GO TO Q48
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q48
GO TO Q48
GO TO Q48
29
47B. Now, thinking about the most traumatic experience you have had, because of this
experience..
YES
NO
UC
DK
RF
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
a. Did you avoid being reminded of this experience by
staying away from certain places, people or activities?
b. Did you lose interest in activities that were once
important or enjoyable?
c. Did you begin to feel more isolated or distant from
other people?
d. Did you find it hard to have love or affection for other
people?
e. Did you begin to feel that there was no point in
planning for the future?
f. After this experience were you having more trouble
than usual falling asleep or staying asleep?
g. Did you become jumpy or get easily startled by
ordinary noises or movements?
30
Regular Source of Health Care (RSOC) [7]
Now I would like to ask you some questions about the health care services that you use.
48.
Is there one particular doctor's office, clinic, health center, or other place that you usually
go to if you are sick or need advice about your health?
1
2
3
YES, ONE PLACE FOR HEALTH CARE
¨
VOLUNTEERS MORE THAN ONE
PLACE FOR HEALTH CARE
¨
NO USUAL PLACE FOR HEALTH CARE ¨
GO TO Q49
7
UNCODABLE
GO TO Q48B
8
DON’T KNOW
GO TO Q48A
9
REFUSED
¨
¨
¨
GO TO Q48A
GO TO Q48A
GO TO Q48A
48A. What is the main reason that you do not go to one particular place when you are sick or
need advice about your health? [READ LIST]
You seldom or never get sick ¨ GO TO Q53
You recently moved into the area ¨ GO TO Q53
1
2
3
4
5
6
7
8
9
You don’t know where to go for care ¨ GO TO Q53
Your usual source of medical care in this area is no
longer available ¨ GO TO Q53
You like to go to different places for different health
needs ¨ GO TO Q48B
You just changed insurance plans ¨ GO TO Q53
97
98
99
UNCODABLE ¨ GO TO Q53
DON’T KNOW ¨ GO TO Q53
REFUSED ¨ GO TO Q53
You don’t use doctors / you treat yourself ¨ GO TO
Q53
Another reason: [__________________________
¨ GO TO Q53
VOLUNTEERS: DOES NOT HAVE INSURANCE OR
CANNOT AFFORD HEALTH CARE ¨ GO TO Q53
48B. Do you go to one of these places first or most often when you need healthcare?
1
YES
2
NO
3
49.
¨
¨
GO TO Q49
7
UNCODABLE
GO TO Q53
8
DON’T KNOW
9
REFUSED
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
OTHER _________________________ ¨
GO TO Q49
¨
¨
¨
GO TO Q53
GO TO Q53
GO TO Q53
What type of place is this? Is it a…
1
Ob-gyn/gynecologist or other women’s health
provider or clinic
2
General medical [general primary care]
provider or clinic
3
Specialist provider or clinic
4
Emergency department or urgent care center,
or,
5
Some other sort of place
6
[VOLUNTEERS: HOSPITAL]
31
50.
51.
Is this at a VA healthcare facility?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
Is there one provider you usually see there, or do you see any provider who is available?
DO NOT READ
1
2
3
4
ONE USUAL PROVIDER
MORE THAN ONE USUAL PROVIDER
ANY AVAILABLE PROVIDER
OTHER: _________________
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
Summary Table for Source of Care
Type
Regular Site
of Care
[RSOC]
Acronym
RSOC
Codes
0
1
2
3
Regular
Doctor
[REGMD
REGMD
0
1
2
Labels
None
VA
Non-VA
Yes,
NOS
No
Yes
Multiple
Criterion
Q50 ≠1, 2, UC, DK, R
Q50 = 1
Q50 = 2
Q50 = UC/DK/R
Q51 ≠ 1, 2
Q51 = 1
Q51 = 2
CATI create variables: RSOC, REGMD
52.
[CONTINUE IF RSOC ≠ NONE; OTHERWISE GO TO Q53] What kind of services do you
usually get from this [place/ provider]? Is it…
Conditions
CATI to
program:
“place” if
REGMD=0/2
/UC/DK/R,
“provider” if
REGMD=1
1
2
3
4
Women’s health care only, such as pap smears
Only routine medical care other than women’s health care
Both
Or do you mainly use specialty care providers [INCLUDING
MENTAL HEALTH]
7
8
9
UNCODABLE
DON’T KNOW
REFUSED
32
Health Care Use [8]
53.
[CONTINUE IF RSOC ≠ VA; OTHERWISE GO TO Q54] Have you ever used any VA
healthcare services since being discharged from the military? [EVRUSE_VA]
1
YES
2
NO
3
54.
¨
¨
GO TO Q54
UNCODABLE
8
DON’T KNOW
9
REFUSED
GO TO Q56
VOLUNTEERS SERVICE DISABILITY EXAM ONLY (COMP
AND PEN EXAM ONLY)¨ GO TO Q56
¨
¨
¨
GO TO Q56
GO TO Q56
GO TO Q56
[CONTINUE IF RSOC=VA OR Q53=1; OTHERWISE GO TO Q56] When did you first start
using the VA? [ALLOW YEAR +/- MONTH, OR, #YEARS AND/OR #MONTHS]
/
Month
55.
7
AND/OR
Year
YEARS AGO
MONTHS AGO
Do you still use the VA?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
55A. About how long ago was it that you last used the VA? [ALLOW ANY COMBINATION OF
DATE, OR, #YEARS AND/OR #MONTHS]
/
Month
/
Day
AND/OR
Year
YEARS AGO
MONTHS AGO
WEEKS AGO
56.
57.
[OIF/OEF ONLY] Have you ever been to a health clinic that was set up just for veterans
returning from OEF/OIF? [INTERVIEWER NOTE: AKA DEPLOYMENT HEALTH CLINIC]
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
[OEF/OIF ONLY] Have you ever been to a Veteran Service Center? [INTERVIEWER NOTE:
AKA VET CENTER]
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
33
Next, I would like you to think about all the healthcare you have used in the past 12 months.
58.
Were you hospitalized at any time in the past 12 months?
1
YES
2
NO
¨
¨
GO TO Q58A
7
UNCODABLE
GO TO Q59
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q59
GO TO Q59
GO TO Q59
58A. [CONTINUE IF Q53 ≠ NO; OTHERWISE GO TO Q59 ]
Were these hospitalizations only in VA hospitals, only in non-VA hospitals, or both?
1
VA ONLY
2
NON-VA ONLY
3
59.
BOTH VA AND
NON-VA
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
[CONTINUE IF Q53 ≠ NO OR RSOC = VA; OTHERWISE GO TO Q60] Thinking about all of
the health care visits you had during the past 12 months, about how many visits were at the
VA or paid for by the VA? [IF Q58A = 1 or 3, ADD: Don’t include visits you had while you
were a patient in the hospital.] [CODE ALL NUMERIC RESPONSES, INCLUDING ZERO]
CATI to program: IF Q58A
=1 or 3, add “Don’t include
visits you had while you
were a patient in the
hospital
Enter Number
DOES NOT SPECIFY EXACT NUMBER OF VISITS (>0)
UNCODABLE
DON’T KNOW
REFUSED
996
OR
997
998
999
60.
During the past 12 months, about how many health care visits did you have outside of the
VA and that the VA did not pay for? [CODE ALL NUMERIC RESPONSES, INCLUDING
ZERO] [IF Q58A = 2 or 3, ADD: Don’t include visits you had while you were a patient in the
hospital.]
CATI to program: IF Q58A
=2 or 3, add “Don’t
include visits you had
while you were a patient
in the hospital
Enter Number
OR
996
DOES NOT SPECIFY EXACT NUMBER OF VISITS (>0)
997
UNCODABLE
998
DON’T KNOW
999
REFUSED
34
Summary Table for User Types
User Type
Description (“current” defined as past 12
months)
Criterion
VA Only User
Respondent currently only uses the VA
for care
Respondent currently uses both VA and
non-VA sources of care
Respondent currently only uses non-VA
source(s) of care, but formerly used the
VA for care
Respondent currently only uses non-VA
source(s) of care, and never used the
VA for care
Respondent currently does not use any
ambulatory care services, but formerly
used the VA for care
Respondent currently does not use any
ambulatory care services, and never
used the VA for care
Q59 ≠ 0/UC/DK/RF AND
Q60 = 0/UC/DK/RF
Q59 ≠ 0/UC/DK/RF AND
Q60 ≠ 0/UC/DK/RF
Q53 ≠ NO/UC/DK/RF AND
Q59 = 0/UC/DK/RF
AND
Q60 ≠ 0/UC/DK/RF
Q53 = NO/UC/DK/RF AND
Q59 = BLANK, 0/UC/DK/RF AND
Q60 ≠ 0/UC/DK/RF
Q53 ≠ NO/UC/DK/RF AND
Q59 = 0/UC/DK/RF
AND
Q60 = 0/UC/DK/RF
Q53 = NO/UC/DK/RF AND
Q59 = BLANK,0/UC/DK/RF AND
Q60 = 0/UC/DK/RF
Dual User
Non-VA
Only User
Former User
Never User
NonAmbCare
User
Former User
Never User
Codes
1
2
3
4
5
6
CATI create variable Usertype
Summary Table for Any-VA
Description
Any current VA use (VA-only and Dual users)
No current VA use (non-VA-only and non-ambcare
users)
Criterion
USER_TYPE = 1 OR 2
USER_TYPE = 3, 4, 5, OR 6
Code
1
0
CATI create variable ANY-VA
61.
[CONTINUE IF USERTYPE = DUAL OR FORMER; OTHERWISE GO TO Q62]
Please tell me which one of the following statements best describes how you get your
medical care
1
2
3
4
5
6
You get all your medical care through the VA
You get most of your medical care through the VA, but sometimes get health
care outside the VA
You only use the VA as a back-up
You use the VA for disability or specific services only
You no longer use the VA for medical care
Other: __________________________________
35
62.
[CONTINUE IF USERTYPE = 1, 2, 3, OR 4; OTHERWISE GO TO Q62A.4] Now I would like to
ask you about the types of health care services you have used during the past 12 months.
62A. During the past 12 months, have you used women’s health care services, for example,
for pap smears or prenatal care?
1
YES
2
NO
¨
¨
GO TO 62A.1
7
UNCODABLE
GO TO Q62A.4
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q62A.4
GO TO Q62B
GO TO Q62B
62A.1 [AGE IS FROM SAMPLE: CONTINUE IF AGE < 50; OTHERWISE GO TO Q62A.2]
Was that for prenatal care, or for other women’s health care?
1
OTHER WOMEN’S HEALTH CARE
7
UNCODABLE
2
PRENATAL CARE
8
DON’T KNOW
2
BOTH
9
REFUSED
62A.2 Did you get any of these [IF Q62A.1=1/UC/DK/RF/BLANK, “women’s health care”;
IF Q62A.1 = 2 or 3, “prenatal”] services at…
YES
a. [VA-ONLY OR DUAL] A primary care clinic at a VA facility
b. [VA-ONLY OR DUAL]
A women’s health clinic or gynecology clinic at a VA facility
c. [VA-ONLY OR DUAL]
A provider or facility outside the VA, but paid for by the VA
d. [DUAL OR NON-VA-ONLY]
A primary care provider or facility outside the VA
e. [DUAL OR NON-VA-ONLY]
A women’s healthcare provider or clinic outside the VA
NO
1
2
1
2
1
2
1
2
1
2
62A.3 [CONTINUE IF RESPONSES TO Q62A.2 ARE SOME COMBINATION OF VA AND
NON-VA (A OR B OR C) AND (D or E); OTHERWISE GO TO Q62A.4]
(Other than prenatal care,) Where do you usually go when you need women’s
health care? Is it…
[CATI TO PROGRAM “Other than for prenatal care,” IF 62A.1 = 2 OR 3]
[CATI PROGRAM “A” FOR USERTYPE=5]
The/A VA Facility, or
7
UNCODABLE
1
The/A provider or facility outside the VA
8
DON’T KNOW
2
VOLUNTEERS: BOTH, EQUALLY
9
REFUSED
3
62A.4 [CONTINUE IF (Q62A = 2 OR UC) OR USERTYPE=5; OTHERWISE GO TO Q62B]
Where do you usually go when you need women’s health care? Is it…
1
[USERTYPE 1, 2, OR 5] A primary care clinic at a VA facility
2
[USERTYPE 1, 2, OR 5] A women’s health clinic or gynecology clinic at a VA
facility
7
UC
3
[USERTYPE 1, 2, OR 5] A provider or facility outside the VA, but paid for by the VA
8
DK
4
[USERTYPE ≠ 1] A primary care provider or facility outside the VA
9
RF
5
[USERTYPE ≠ 1] A women’s healthcare provider or clinic outside the VA
36
62B. [CONTINUE IF USERTYPE = 1, 2, 3, OR 4; OTHERWISE GO TO Q62B.3] During the past
12 months, have you used primary care or general health services, other than women’s
health care?
1
YES
2
NO
¨
¨
GO TO 62B.1
7
UNCODABLE
GO TO Q62B.3
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q62B.3
GO TO Q62C
GO TO Q62C
62B.1 Did you get any of these primary care or general health services at…
YES
a. [VA-ONLY OR DUAL]
A primary care clinic at a VA facility
b. [VA-ONLY OR DUAL]
A women’s health clinic at a VA facility
c. [VA-ONLY OR DUAL]
A provider or facility outside the VA, but paid for by the VA
d. [DUAL OR NON-VA-ONLY]
A primary care provider or facility outside the VA
e. [DUAL OR NON-VA-ONLY]
A women’s healthcare provider or clinic outside the VA
NO
1
2
1
2
1
2
1
2
1
2
62B.2 [IF RESPONSES TO 62B.1 ARE SOME COMBINATION OF VA AND NON-VA (A OR
B OR C) AND (D or E), then ask:]
“Where do you usually go for primary care or general health services? Is it:”
[CATI PROGRAM “A” FOR USERTYPE=5]
The/A VA Facility, or
7
UNCODABLE
1
The/A provider or facility outside the VA?
8
DON’T KNOW
2
VOLUNTEERS: BOTH, EQUALLY
9
REFUSED
3
62B.3 [CONTINUE IF (Q62B = 2 OR UC) OR USERTYPE=5; OTHERWISE GO TO Q62C]
Where do you usually go for primary care or general health services? Is it…
1
2
3
[USERTYPE 1, 2, OR 5] A primary care clinic at a VA facility
[USERTYPE 1, 2, OR 5]
A women’s health clinic or gynecology clinic at a VA facility
[USERTYPE 1, 2, OR 5]
A provider or facility outside the VA, but paid for by the VA
4
[USERTYPE ≠ 1] A primary care provider or facility outside the VA
5
[USERTYPE ≠ 1] A women’s healthcare provider or clinic outside the VA
7
UC
8
DK
9
RF
37
62C. During the past 12 months, have you used mental health services?
1
YES
2
NO
¨
¨
GO TO 62C.1
7
UNCODABLE
GO TO Q62D
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q62D
GO TO Q62D
GO TO Q62D
62C.1 Did you get any of these mental health services at…
YES
a. [VA-ONLY OR DUAL]
A mental health clinic or provider at a VA facility
b. [VA-ONLY OR DUAL]
A mental health provider or facility outside the VA, but paid for by the VA
c. [DUAL OR NON-VA-ONLY]
A mental health provider or facility outside the VA
NO
1
2
1
2
1
2
62D. During the past 12 months, have you received care from a specialist such as a
cardiologist or dermatologist?
1
YES
2
NO
¨
¨
GO TO 62D.1
7
UNCODABLE
GO TO Q62E
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q62E
GO TO Q62E
GO TO Q62E
62D.1 Did you get any of these specialist services at…
YES
a. [VA-ONLY OR DUAL]
A specialty clinic or provider at a VA facility
b. [VA-ONLY OR DUAL]
A specialty clinic or provider outside the VA, but paid for by the VA
c. [DUAL OR NON-VA-ONLY]
A specialty clinic or provider outside the VA
NO
1
2
1
2
1
2
62E. During the past 12 months, have you used prescription services?
1
YES
2
NO
¨
¨
GO TO 62E.1
7
UNCODABLE
GO TO Q63
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q63
GO TO Q63
GO TO Q63
62E.1 Did you get any of these prescription services at…
YES
a. [VA-ONLY OR DUAL]
A VA pharmacy or VA mail pharmacy services
b. [DUAL OR NON-VA-ONLY]
A pharmacy or facility outside the VA
NO
1
2
1
2
38
63.
[VA-ONLY OR DUAL] In the past 12 months, have you used any other type of healthcare
services not already mentioned, outside the VA, but paid for by the VA? [DO NOT READ
RESPONSE OPTIONS AND CHECK ALL THAT APPLY]
YES, PRIMARY CARE
YES, WOMEN’S HEALTH CARE
YES, MENTAL HEALTH CARE
YES, SPECIALTY CARE (CARE FROM A SPECIALIST)
YES, EMERGENCY DEPARTMENT CARE
YES, SURGERY
YES, OTHER IN-PATIENT/HOSPITAL CARE
YES, NOT OTHERWISE SPECIFIED
NO
1
2
3
4
5
6
7
8
9
Summary Table for Contract Care
If Q62A.2 = c OR Q62B.1 = c OR Q62C.1 = b OR Q62D.1 = b OR Q63 = any 1 through 8
Then contract care = YES
Else contract care = NO
CATI create variables: CONTRACT CARE
64.
[CONTINUE IF Q20 (EVER PREGNANT) = YES AND USERTYPE = 1, 2, 3, OR 5 (CURRENT
OR FORMER USER); OTHERWISE GO TO Q65] During any of your pregnancies, did you get
prenatal care that was provided or paid for by the VA?
1
YES
2
NO
¨
¨
GO TO Q64A
7
UNCODABLE
GO TO Q64B
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q64B
GO TO Q64B
GO TO Q64B
64A. [CONTINUE IF Q64 = YES; OTHERWISE GO TO Q64B] Where did you get this care? Was
it at a VA facility or was it at a facility outside of the VA but paid for by the VA?
AT VA ¨ GO TO Q65
1
FACILITY OUTSIDE VA, BUT PAID FOR BY VA
2
BOTH ¨ GO TO Q64B
3
¨ GO TO Q64B
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q64B
GO TO Q64B
GO TO Q64B
64B. After your delivery, how soon, if at all, did you go back to using VA healthcare? [OPENENDED; DO NOT READ RESPONSE OPTIONS] [ALTERNATE WORDING FOR Q64A = 3:
Thinking about the last time you used prenatal care outside of the VA that the VA paid
for, how soon, if at all, did you go back to the VA?]
1
2
3
4
5
6
7
8
9
< 3 MONTHS (INCLUDING NO GAP IN USING VA / CONTINUED USING VA)
> 3 MONTHS BUT < 6 MONTHS
> 6 MONTHS BUT < 1 YEAR
> 1 YEAR BUT < 2 YEARS
> 2 YEARS
DID NOT GO BACK
NOT APPLICABLE BECAUSE CURRENTLY PREGNANT
NOT APPLICABLE BECAUSE ONLY STARTED USING VA AFTER DELIVERY
NOT APPLICABLE BECAUSE STOPPED USING VA BEFORE DELIVERY
39
65.
[CONTINUE IF USERTYPE = 5 OR 6 (NON-AMBCARE USER); OTHERWISE GO TO Q66] I
am going to read you a list of reasons why you might have not used any healthcare in the
past 12 months. For each reason please tell me how strongly you agree or disagree. [IF
VOLUNTEERS THAT USED CARE, ASK USER TYPE QUESTIONS]
Strongly
Agree
Somewhat
Disagree
Strongly
Disagree
a. You did not need healthcare
1
2
3
4
b. You did not know where to go to get care
1
2
3
4
1
2
3
4
1
2
3
4
c. You did not like the healthcare options available
to you
d. You could not afford care
66.
Somewhat
Agree
At any time in the past 12 months, did you delay or go without medical care that you
thought you needed?
1
YES
2
NO
¨
¨
GO TO Q66A
7
UNCODABLE
GO TO Q67
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q67
GO TO Q67
GO TO Q67
66A. Thinking about the times that you needed medical care (in the past 12 months) but
delayed getting it, or were unable to get it, was it because of:
YES
NO
a. Childcare responsibilities or other care-giver
responsibilities
1
2
1
2
1
2
d. Transportation difficulties
1
2
e. Being too sick to go for care
1
2
f. Difficulties scheduling an appointment
1
2
1
2
1
2
b. Being unable to take time off work
c. Not being able to afford medical care [includes not
having insurance]
g. Not having the type of healthcare service or
provider that you need near where you live
h. Some other reason:
SPECIFY:________________________
40
Health Care Preferences & Decision-Making [9]
Now I am going to ask some questions about how you choose where to go for health care.
67.
When it comes to making decisions about where to go for healthcare, how important to you
is ...
Very
important
Somewhat
important
Not very
important
Not at all
important
a. Being able to get both your gynecological care and
your general health care all in one place? [IF
NECESSARY, CLARIFY “I.E., GET ALL CARE AT
THE SAME HEALTH CARE SITE”]
1
2
3
4
b. The convenience of the location?
1
2
3
4
c. How much it costs you?
1
2
3
4
1
2
3
4
d. The ability to get an after-hours appointment? [By
after-hours we mean before 8am, after 5pm, or on
weekends]
68.
[CONTINUE IF USERTYPE ≠ VA-ONLY OR DUAL; OTHERWISE GO TO Q68A ]
How important is it for you to get your women’s health care from a doctor or clinic that is
just for women? Would you say:
1
2
3
4
Very important
Somewhat important
Not very important, or,
Not important at all
68A. [CONTINUE IF USERTYPE = VA-ONLY OR DUAL; OTHERWISE GO TO Q69]
When you use the VA for care, how important is it for you to get your women’s health
care from a doctor or clinic that is just for women? Would you say…
1
2
3
4
Very important
Somewhat important
Not very important, or,
Not important at all
68B. [CONTINUE IF USERTYPE = DUAL; OTHERWISE GO TO Q69]
When you use places outside the VA for care, how important is it for you to get your
women’s health care from a doctor or clinic that is just for women? Would you say…
1
2
3
4
Very important
Somewhat important
Not very important, or,
Not important at all
41
[REASONS FOR HEALTHCARE CHOICE]
69. These next questions are about the reasons people use the places they do for healthcare.
69A. [CONTINUE IF USERTYPE = VA-ONLY OR DUAL; OTHERWISE GO
TO Q69C] I am going to read a list of reasons why you might have
chosen to use VA health care in the past 12 months. Please tell me how
strongly you agree or disagree with each of these reasons. You chose to
use the VA for healthcare because:
Strongly
Agree
a. VA care costs less than other care
available to you
b. The VA provides services you
cannot get elsewhere
c. The VA’s location is convenient
d. The VA provides a higher quality of
care
e. The VA has women’s health clinics
f. The VA provides prescription
benefits
g. [CONTINUE IF USERTYPE = VAONLY; OTHERWISE GO TO h]
The VA is the only source of health
care available to you
h. You like the doctors at the VA, or
you have been going there for
years [i.e., you are familiar with the
VA]
i. You can get care for a service
connected disability
j. You are entitled to it
k. The VA provides mental health
services (for example, depression,
anxiety, PTSD, and substance
abuse treatment)
l. Your spouse or friends suggested
that you get care at the VA
m. You lost or had inadequate levels
of insurance coverage
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
69B. Which of these is
the main reason you
chose to use VA health
care in the past 12
months?
[IF NECESSARY, PROMPT WITH
RESPONDENT’S Q69.A “SRONGLY
AGREE” AND “SOMEWHAT AGREE”
RESPONSES]
1
2
3
4
1
1
2
3
4
2
1
2
3
4
3
1
2
3
4
4
1
2
3
4
5
1
2
3
4
6
1
2
3
4
7
1
2
3
4
8
1
2
3
4
9
1
2
3
4
10
1
2
3
4
11
1
2
3
4
12
1
2
3
4
13
42
69C. [CONTINUE IF USER TYPE ≠ VA-ONLY] I am going to read a list of
reasons why you might have chosen to use healthcare services outside
69D. Which of these is
of the VA [during the past 12 months]. Please tell me how strongly you
the main reason ?
agree or disagree with each reason. You chose to use healthcare
services outside the VA [during the past 12 months] because: [CATI TO [IF NECESSARY, PROMPT WITH
PROGRAM: “during the past 12 months” FOR DUAL AND NON-VA ONLY] RESPONDENT’S Q69.C “SRONGLY
Strongly
Agree
a. You already have insurance that
covers your healthcare outside of
the VA
b. The location of other sources of
care are more convenient than the
VA
c. Your healthcare provider is more
sensitive to the concerns of women
than healthcare providers at the VA
d. Your out-of-pocket costs for
medical services outside the VA are
lower
e. It is difficult to get an appointment
at the VA
f. The quality of care outside the VA
is higher
g. VA staff or facilities are not
appropriate for women
h. [DUAL & FORMER USERS] You use
the VA only for backup care
i. [DUAL & FORMER USERS] You use
the VA only for prescriptions
j. [NEVER USERS] You did not know
you were entitled to VA care
k. [NEVER USERS] You weren’t
familiar with how to apply for VA
benefits
l. [FORMER & NEVER] You did not
want assistance from the VA
m. [FORMER & NEVER] You did not
feel like you belong at the VA
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
AGREE” AND “SOMEWHAT AGREE”
RESPONSES]
1
2
3
4
1
1
2
3
4
2
1
2
3
4
3
1
2
3
4
4
1
2
3
4
5
1
2
3
4
6
1
2
3
4
7
1
2
3
4
8
1
2
3
4
9
1
2
3
4
10
1
2
3
4
11
1
2
3
4
12
1
2
3
4
13
43
70.
[CONTINUE IF USERTYPE = NEVER USER; OTHERWISE GO TO Q70C] Have you ever
considered using VA health care?
1
YES
2
NO
¨
¨
GO TO Q70A
7
UNCODABLE
GO TO Q70B
8
DON’T KNOW
9
REFUSED
70A. [CONTINUE IF Q70=YES;
70B. [CONTINUE IF Q70=NO;
OTHERWISE GO TO Q70B]
OTHERWISE GO TO Q71]
What kept you from using
Why have you never
the VA?
considered using VA
health care?
¨
¨
¨
GO TO Q70A
GO TO Q70A
GO TO Q71
70C. [CONTINUE IF USERTYPE =
FORMER USER OR Q55=2;
OTHERWISE GO TO Q71]
Why do you no longer use
the VA?
[DO NOT READ RESPONSE OPTIONS; CHECK ALL THAT APPLY]
70A
70B
70C
1
1
1
2
2
3
3
4
4
4
e. YOU FEEL THAT THE VA IS MAINLY FOR MEN
5
5
5
f. YOU FEEL THAT THE VA IS MAINLY FOR OLDER VETERANS
6
6
6
7
7
7
8
8
8
i. THE VA IS NOT SENSITIVE TO OEF/OIF ISSUES
9
9
9
j. THE VA IS NOT SENSITIVE TO YOUR MILITARY EXPERIENCES
10
10
10
k. VA STAFF OR FACILITIES ARE NOT ADEQUATE FOR WOMEN
11
11
11
a. IT IS TOO DIFFICULT TO FIND OUT ABOUT VA HEALTHCARE
SERVICES
b. [Q70A & Q70B] YOU WEREN’T FAMILIAR WITH HOW TO APPLY
FOR VA BENEFITS
c. [Q70A & Q70B] YOU DON’T THINK YOU ARE ELIGIBLE (OR YOU
ARE NOT ELIGIBLE) FOR SERVICES THROUGH THE VA
d. YOU DO NOT FEEL LIKE A VETERAN, OR LIKE YOU BELONG AT
THE VA
g. YOU FEEL THAT THE VA IS MAINLY FOR LOWER INCOME
VETERANS / PATIENTS
h. YOU FEEL THAT THE VA IS MAINLY FOR VETERANS WHO ARE
VERY SICK OR WHO HAVE SERIOUS MENTAL HEALTH PROBLEMS
l. [Q70C] YOU HAD A BAD EXPERIENCE WITH THE VA IN THE PAST
12
m. THE VA DOES NOT PROVIDE WOMEN’S HEALTH CARE SERVICES
13
13
13
n. THE VA DOES NOT PROVIDE THE SERVICES THAT YOU NEED
14
14
14
15
15
15
16
16
16
q. THE CLOSEST VA IS TOO FAR FROM YOUR HOME
17
17
17
r. THE VA HOURS DO NOT FIT WITH YOUR SCHEDULE
18
18
18
19
19
19
t. THE QUALITY OF CARE OUTSIDE THE VA IS HIGHER
20
20
20
u. YOU NO LONGER WANT TO BE ASSOCIATED WITH THE MILITARY
21
21
21
22
22
w. OTHER 1 (SPECIFY): [______________________________________
23
23
23
x. OTHER 2 (SPECIFY): [______________________________________
24
24
24
o. YOU (ALREADY HAVE / GOT) INSURANCE THAT COVERS YOUR
HEALTHCARE OUTSIDE OF THE VA [CATI PROGRAM “ALREADY
HAVE” FOR Q70A & Q70B; PROGRAM “GOT” FOR Q70C]
p. YOUR OUT-OF-POCKET COSTS FOR MEDICAL SERVICES
OUTSIDE THE VA ARE LOWER
s. IT IS DIFFICULT TO GET AN APPOINTMENT AT THE VA WHEN
NEEDED
v. [Q70A & Q70B] YOU NEVER THOUGHT ABOUT USING THE VA FOR
HEALTHCARE
44
Distance to Health Care [10]
71.
[CONTINUE IF RSOC ≠ NONE; OTHERWISE GO TO Q72] Now I am going to ask you some
questions about where your healthcare provider is and how you get there…
A. About how many
miles from where you
live is…
[FOR VA USERS, DUAL USERS, OR
Q55=YES]
[FOR DUAL USERS, NON-VA-ONLY,
USERTYPE=6, OR Q55≠YES]
The VA you usually go to for care?
The clinic or healthcare facility outside
the VA where you usually go for care?
A1.
A2.
(IF NECESSARY:
your best guess is
fine)
997
B. About how long
does it take you to get
to…
UC
MILES
TO
998
DK
999
RANGE
RF
B1.
997
997
UC
MILES
TO
998
DK
999
RANGE
RF
B2.
UC
MINUTES and/or
MINUTES and/or
HOURS
OR
HOURS
TO
MINUTES or
TO
MINUTES or
TO
HOURS
TO
HOURS
998
DK
999
RF
997
UC
998
OR
DK
999
RF
45
[FOR VA USERS, DUAL USERS, OR
Q55=YES]
[FOR DUAL USERS, NON-VA-ONLY,
USERTYPE=6, OR Q55≠YES]
The VA you usually go to for care?
The clinic or healthcare facility outside the
VA where you usually go for care?
C1. Are there any VA clinics or sites
closer to you that you do not use?
C2. [CONTINUE IF Q71B2>30 MINUTES;
OTHERWISE GO TO Q71E2] Are there
other clinics or health care sites much
closer to you that you do not use?
1
YES
2
NO
7
UC
8
DK
RF
9
D1. [IF YES TO Q71C1] What is the
main reason you do not get care at
the VA site closest to you?
It does not have a women’s health clinic
1
or provide women’s healthcare services
It does not provide mental health
2
services
3
It does not provide other services I need
The quality of care is better at the VA site
4
that I use
5
E. How difficult
is it for you to
travel to and
from your
appointments
at…
72.
OTHER [SPECIFY]:_______________
E1. Would you say it is:
1
YES
2
NO
7
UC
8
DK
1
There is not a closer place that I can afford
It does not have a women’s health clinic or
2
provide women’s healthcare services
3
It does not provide mental health services
4
It does not provide other services I need
The quality of care is better at the health
5
care site that I use
6
OTHER [SPECIFY]:__________________
E2. Would you say it is:
1
1
Not at all difficult
2
A little difficult
2
A little difficult
3
Moderately difficult
3
Moderately difficult
4
Very difficult
4
Very difficult
7
UC
DK
RF
D2. [IF YES TO Q71C2] What are the
reasons you do not get care at the
health care sites that are closer to you?
Not at all difficult
8
9
9
RF
7
UC
8
DK
9
RF
How much does transportation, or lack of it, affect your decisions about where you go for
healthcare?
1
2
3
4
Not at all
A small amount
A moderate amount
A great deal
46
Care Coordination and Satisfaction [11]
73.
These next questions ask about getting information from health care providers.
[FRAGMENTATION OF CARE WITHIN THE VA]
73.1. [CONTINUE IF USERTYPE=VA-ONLY AND CONTRACT CARE = NO; OTHERWISE GO TO
Q73.2]
Now thinking about only the healthcare services you have used during the past 12 months at a
VA facility, please tell me….
[SOURCES: Rosenfeld except b]
All of
the time
a. How often do your VA medical providers know
about tests you have had or the test results?
b. How often do you know how to get the results of
your tests or medical procedures that were done at
a VA facility?
c. In the past 12 months, have you been seen by
more than one VA provider ?
d. How often does one VA provider tell you
something different about your health or healthcare
than what another VA provider tells you?
e. How often does there seem to be good
communication about your healthcare between the
various VA providers that care for you?
f. When you have problems with your health, how
often do you know who to call among your VA
medical providers?
Most
of the
time
Some
of the
time
Rarely
Never
1
2
3
4
5
1
2
3
4
5
YES
È Continue with
items (d) – (f)
1
NO
Æ Skip items (d) – (f)
2
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
47
[FRAGMENTATION OF CONTRACT CARE]
73.2. [CONTINUE IF (USERTYPE = VA-ONLY OR DUAL) AND CONTRACT CARE = YES;
OTHERWISE GO TO Q73.3]
Previously you indicated that you have received services outside the VA, but that were paid for
by the VA. These are often referred to as “contract or fee-basis services.” For the next few
questions, we will call this “contract care.” Now thinking about only the healthcare services
you have used during the past 12 months at a facility outside the VA, but that was paid for by
the VA, please tell me….
[SOURCES: Rosenfeld except b]
IF VOLUNTEERS ONLY USED CONTRACT CARE ONCE,
INSTRUCT THEM TO ANSWER “ALL OF THE TIME” OR
“NEVER”
a. How often do your medical providers at the VA know
about test results or tests you have had at a contract facility?
a.1 VOLUNTEERS, USED CONTRACT CARE ONLY ONCE.
All of
the
time
1
Most
of the
time
2
Some
of the
time
3
Rarely
Never
4
5
Check box if yes
1
1
2
3
4
5
d. How often does a VA provider tell you something different
about your health or healthcare than what a provider at a
contract facility has told you?
1
2
3
4
5
e. How often does there seem to be good communication
about your healthcare between your providers at the VA and
providers at the contract facility?
1
2
3
4
5
f. When you have problems with your health, how often do
you know who to call among your VA and non-VA medical
providers?
1
2
3
4
5
1
2
3
4
5
b. How often do you know how to get the results of your tests
or medical procedures that were done at a VA contract
facility?
c. [ THERE IS NO ITEM c; “c” WAS NOT USED FOR
CONSISTENCY OF QUESTION NUMBERING FOR ITEMS
a, b, d, e, AND f OF Q73.1-Q73.4 ]
g. How often can you get an appointment at a time that is
convenient for you for contract services?
48
[FRAGMENTATION OF CARE FROM DUAL VA/NON-VA USE]
73.3. [CONTINUE IF USERTYPE=DUAL AND CONTRACT CARE = NO; OTHERWISE GO TO
Q73.4]
Now thinking about all of the healthcare services you have used during the past 12 months,
including services you used at any VA facility and at any health care facility outside the VA,
please tell me….
[SOURCES: Rosenfeld except b]
a. How often do your medical providers know about
tests you have had or the test results?
b. How often do you know how to get the results of
your tests or medical procedures?
All of the
time
Most of
the time
Some of
the time
Rarely
Never
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
c. [ THERE IS NO ITEM c; “c” WAS NOT USED FOR
CONSISTENCY OF QUESTION NUMBERING FOR
ITEMS a, b, d, e, AND f OF Q73.1-Q73.4 ]
d. How often does one provider tell you something
different about your health or healthcare than what
another provider tells you?
e. How often does there seem to be good
communication about your healthcare between the
various providers that care for you?
f. When you have problems with your health, how
often do you know who to call among your medical
providers?
49
[FRAGMENTATION OF CARE OUTSIDE THE VA]
73.4.
[CONTINUE IF USERTYPE=NON-VA-ONLY; OTHERWISE GO TO Q74.1]
Now thinking about the healthcare services you have used during the past 12 months at
healthcare facilities outside of the VA, please tell me….
[SOURCES: Rosenfeld except b]
All of the
time
a. How often do your medical providers know
about tests you have had or the test results?
b. How often do you know how to get the results
of your tests or medical procedures?
c. In the past 12 months, have you been seen by
more than one healthcare provider ?
d. How often does one provider tell you
something different about your health or
healthcare than what another provider tells you?
e. How often does there seem to be good
communication about your healthcare between
the various providers that care for you?
f. When you have problems with your health, how
often do you know who to call among your
medical providers?
Most
of the
time
Some of
the time
Rarely
Never
1
2
3
4
5
1
2
3
4
5
YES
È Continue with
items (d) – (f)
1
NO
Æ Skip items (d) – (f)
2
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
50
[SATISFACTION]
74.
74.1. [CONTINUE IF USERTYPE = VA-ONLY OR DUAL; OTHERWISE GO TO Q74.2 ]
For each of the following aspects of your VA health care during the past 12 months, please tell
me how satisfied you were with:
Very
satisfied
a. The period of time between requesting
a VA appointment and the actual
appointment date
b. The amount of time you waited to see
your VA provider, once you were
checked in for your appointment
c. Your ability to get an appointment with
a gynecologist at the VA if you felt you
needed one
d. The amount of time it takes to get an
appointment with another type of
specialist at the VA if you felt you
needed one
Somewhat
satisfied
Somewhat
dissatisfied
Very
dissatisfied
Not Applicable
(valid response
for c & d)
1
2
3
4
1
2
3
4
1
2
3
4
5
1
2
3
4
5
74.2.
[CONTINUE IF USERTYPE = NON-VA-ONLY; OTHERWISE GO TO Q75]
For each of the following aspects of your health care during the past 12 months, please tell me
how satisfied you were with:
Very
satisfied
a. The period of time between requesting an
appointment and the actual appointment
date
b. The amount of time you waited to see
your provider, once you were checked in
for your appointment
c. Your ability to get an appointment with a
gynecologist if you felt you needed one
d. The amount of time it takes to get an
appointment with another type of
specialist if you felt you needed one
Somewhat
satisfied
Somewhat
dissatisfied
Very
dissatisfied
Not Applicable
(valid response
for c & d)
1
2
3
4
1
2
3
4
1
2
3
4
5
1
2
3
4
5
51
[PCSSW, OTHER THAN ITEMS B1 & B2]
75.
[IF (USERTYPE=VA-ONLY or DUAL) AND RSOC=VA AND REGMD=1]
You said earlier that you have a VA provider you usually see for care, thinking about all of the care that you
received from this provider during the past 12 months, . . .
[IF (USERTYPE=VA-ONLY or DUAL) AND RSOC=VA AND REGMD ≠1]
You said earlier that the VA is the place you usually go to for healthcare, thinking about all of the care that
you received from the VA during the past 12 months, . . .
[IF (USERTYPE=VA-ONLY or DUAL) AND (RSOC = none, non-VA, or yes-NOS)]
You said earlier that you have used VA healthcare in the past 12 months, thinking about all of the care that
you received from the VA during the past 12 months, . . .
[IF USERTYPE=NON-VA-ONLY AND (RSOC = none, VA or yes-NOS)]
You said earlier that in the past 12 months you have had healthcare visits at places other than the VA,
thinking about all of the care that you received outside of the VA during the past 12 months, . . .
[IF USERTYPE=NON-VA-ONLY AND RSOC=non-VA AND REGMD=1]
You said earlier that you have a health care provider you usually see for care, thinking about all of the care
that you received from this provider during the past 12 months, . . .
[IF USERTYPE=NON-VA-ONLY AND RSOC=non-VA AND REGMD ≠1]
You said earlier that you have one place you usually go to most often for health care, thinking about all of
the care that you received from this place during the past 12 months, . . .
[IF USERTYPE=NONUSER AND RSOC=VA]
You said earlier that the VA is the place you usually go to for healthcare, thinking about the care you receive
from the VA, …
[IF USERTYPE=NONUSER AND RSOC=non-VA]
You said earlier that you have one place you usually go to most often for health care, thinking about the
care you receive from this place, …
[NOTE that if USERTYPE=NONUSER AND (RSOC = none or yes-NOS) then Q75 is skipped.]
52
Please tell me how satisfied you were with:
[Source: adapted from PCSSW, other than
items b1 and b2; Modified from selfadministered to interview format]
a. The health professionals’ focus
on prevention
Not at all
satisfied
Somewhat
satisfied
Satisfied
Very
satisfied
Extremely
satisfied
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
b2. The health professionals’
sensitivity to the concerns of
women patients
1
2
3
4
5
c. The information you got about
healthy living (such as diet and
exercise)
1
2
3
4
5
d. The health professionals’
interest in your mental and
emotional health
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
h. How well the health
professionals explain the results of
test or procedures
1
2
3
4
5
i. The chance to get both
gynecological and general health
care at the same place
1
2
3
4
5
1
2
3
4
5
b. The health professionals’
knowledge of women’s health
issues
b1. The health professionals’ skills
in providing women’s health care
e. Help with finding information
resources in women’s health
f. How well your healthcare fits
your stage of life
g. Information about how to get the
results of your tests
j. Your overall trust in the health
professionals
53
[CAHPS – QUALITY RATING]
76.
76.1. [CONTINUE IF USERTYPE = VA-ONLY OR DUAL; OTHERWISE GO TO Q76.2]
Using a number from 0 to 10, where “0” is the lowest quality health care and “10” is the
highest quality health care, what number would you use to rate your VA health care in general,
during the past 12 months?
1
76.2. [CONTINUE IF USERTYPE = DUAL; OTHERWISE GO TO Q76.3]
Using a number from 0 to 10, where “0” is the lowest quality health care and “10” is the
highest quality health care, what number would you use to rate your health care outside the
VA in general during the past 12 months? [QUAL_NONVA]
1
76.3. [CONTINUE IF USERTYPE = NON-VA-ONLY; OTHERWISE GO TO Q77]
Using a number from 0 to 10, where “0” is the lowest quality health care and “10” is the
highest quality health care, what number would you use to rate your health care in general
during the past 12 months? [QUAL_OTH]
1
54
VA Information Sources [12]
These next questions are about your familiarity with your veterans’ healthcare benefits.
77.
[CONTINUE IF USERTYPE = NEVER USER; OTHERWISE GO TO Q77A]
Have you ever gotten or tried to get information about VA healthcare or benefits? [INFO]
1
YES
2
NO
3
¨
¨
GO TO Q77A
VOLUNTEERS: WANTED INFORMATION, BUT DID
NOT KNOW HOW TO GET IT ¨ GO TO Q77C
(CURRENT OR FORMER USER) OR IF Q77 = YES;
OTHERWISE GO TO Q77C] From what
sources have you gotten or tried to get
information about the VA? [RECORD ALL
MENTIONS AND UP TO 2 “OTHERS”]
[ D O
Check all that apply
N O T
REFUSED
Check one
2
c.
HEALTH PROVIDER OR HEALTH GROUP
3
d.
MEDIA – TV, NEWSPAPER, MAGAZINE, OR
OTHER WRITTEN MATERIAL
4
WORD OF MOUTH – FAMILY, FRIEND, OR
OTHER VETERAN
5
f.
INTERNET – VA WEBSITE
6
g.
INTERNET – NON-VA WEBSITE
7
h.
VETERANS SERVICE ORGANIZATION
(VSO’S, E.G., AMERICAN LEGION,
VETERANS OF FOREIGN WARS, DAV,
DISABLED VETERANS OF AMERICA)
8
TAP – TRANSITIONAL ASSISTANCE
PROGRAM
9
j.
INSURANCE PROVIDER
10
k.
HAVE NOT TRIED TO GET INFORMATION
RECENTLY
11
OTHER 2:
[____________________________
12
l.
9
R E A D
OTHER GOVERNMENT AGENCY OR
SOURCE
i.
DON’T KNOW
GO TO Q77C
GO TO Q77C
GO TO Q77C
NO/UC/DK/RF; OTHERWISE
GO TO Q78] If you
wanted information
about the VA, what
sources of information
would you use?
sources was the most
useful?
1
e.
8
¨
¨
¨
ONE SOURCE GIVEN IN
Q77A; OTHERWISE GO TO
Q78] Which of these
VA SOURCE (NOT INCLUDING THE VA
WEBSITE), E.G., VETERANS BENEFITS
ADMINISTRATION (VBA)
b.
UNCODABLE
77B. [CONTINUE IF MORE THAN 77C. [CONTINUE IF Q77 =
77A. [CONTINUE IF USERTYPE = 1, 2, 3, OR 5
a.
7
GO TO Q77C
R E S P O N S E
O P T I O N S ]
Check all that apply
m. OTHER 3:
[____________________________
13
55
78.
79.
[CONTINUE IF Q77A OR Q77C ≠ f or g (internet); OTHERWISE GO TO Q79A] Do you have
access to the internet?
1
YES
2
NO
¨
¨
GO TO Q79
7
UNCODABLE
GO TO Q80
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q79
GO TO Q79
GO TO Q79
Have you ever tried to get information about VA health care or benefits from the internet?
1
YES
2
NO
¨
¨
GO TO Q79A
7
UNCODABLE
GO TO Q80
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q80
GO TO Q80
GO TO Q80
79A. Did you try to get information from the internet about your local VA?
1
2
¨
YES
GO TO Q79B
[CODE ‘YES’ IF VOLUNTEERS THAT ATTEMPT WAS
MADE BUT UNABLE TO GET INFORMATION]
NO
¨
GO TO Q80
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q80
GO TO Q80
GO TO Q80
79B. Were you able to get the information you were looking for?
80.
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
In general, how much information do you feel you have about the VA? Would you say you
have…
Conditions:
Do not read
response
option 4; it
is available
for coding if
volunteered
.
1
2
3
4
All or most of the information you need
Some of the information you need
None or almost none of the information you need
[DO NOT READ] VOLUNTEERS: NOT APPLICABLE,
DOES NOT NEED TO KNOW ANYTHING
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
56
81.
[CONTINUE IF USERTYPE = 1, 2, 3, OR 5 (CURRENT OR FORMER USER) OR Q77= YES;
OTHERWISE GO TO Q82] Now I would like to ask you about any experience you’ve had
with trying to get information specifically about VA eligibility or benefits. Please tell me
how strongly you agree or disagree with each statement I read.
Strongly
Agree
a. The enrollment process was
too complicated or time consuming
b. You had difficulty reaching a
department or person that could
give you the information you
needed
c. You submitted information and
did not hear back from the VA in a
timely manner
d. The person or persons you
spoke with were knowledgeable
82.
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
VOLUNTEERS
Not Applicable
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
[NEVER USERS] If the VA were trying to reach you or veterans like yourself to provide
information about eligibility for VA healthcare, what would be the best way? Would it be:
1
2
3
4
5
6
7
By telephone
By mail
By e-mail
Through the internet
Through TV or radio announcements, or
In newspapers or magazines
VOLUNTEERS OTHER (specify) _______________
97
98
99
UNCODABLE
DON’T KNOW
REFUSED
57
Knowledge, Attitudes, and Perceptions about VA [13]
I now have a few general questions about eligibility for VA health care.
83.
Which types of veterans would you say are eligible for VA healthcare? Would you say…
Yes
No
UC
DK
RF
1
2
7
8
9
1
2
7
8
9
1
2
7
8
9
a. Only veterans with low enough
income to meet the VA’s income
limits?
b. Only veterans who had an illness or
injury connected to their military
service?
c. All veterans who ever served on
active duty?
84.
Now I am going to read some statements about healthcare providers at the VA. For each
statement, please tell me how strongly you agree or disagree. In general, healthcare
providers at the VA…
Strongly
agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
UC
DK
RF
a. Are as good as private
healthcare providers
1
2
3
4
7
8
9
b. Lack experience
1
2
3
4
7
8
9
c. Are skilled in treating women
1
2
3
4
7
8
9
1
2
3
4
7
8
9
d. Are sensitive to the concerns
of women patients
85.
Now I am going to read you some general statements about the VA and VA care. Please tell
me how strongly you agree or disagree with each statement. At the VA…
Strongly
agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
UC
DK
RF
a. Facilities are old and
outdated
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
1
2
3
4
7
8
9
b. When you arrive for your
appointment you will be
seen by the healthcare
provider in a timely manner
c. You can see the same
healthcare provider on most
visits
d. You may see a female
healthcare provider if you
wish
e. You can get care for all of
your healthcare needs
58
86.
[EVERYONE] Please tell me how strongly you agree or disagree with the following
statement. As a woman [I feel / would feel] welcome at the VA. Would you say you…
Conditions:
CATI to program:
“I feel” if USERTYPE
= 1, 2, 3, or 5,
“I would feel” if
USERTYPE = 4 or 6
1
2
3
4
87.
Strongly agree
Somewhat agree
Somewhat disagree, or
Strongly disagree
[CONTINUE IF USERTYPE = FORMER OR NEVER; OTHERWISE GO TO Q88]
Using a number from 0 to 10, where “0” is the lowest quality health care and “10” is the
highest quality health care, what number would you use to rate VA health care in general?
1
88.
What do you think has most affected your perceptions about VA healthcare? Would you
say it has been:
1
2
3
4
5
What you have heard about VA healthcare from other veterans
What you have heard about VA healthcare from family or friends
Media reports on the radio, TV, or in newspapers or magazines
Your personal experiences with the VA
Other: [SPECIFY] _____________
59
Demographics [14]
I only have a few more questions left.
89.
In what year were you born?
Enter 4-digit year
90.
What is your current marital status?
Conditions:
Answer
should reflect
most current
situation if
more than one
category
applies.
1
2
3
4
5
91.
Married or living as married
Divorced
Separated
Widowed
Never married
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
Are you of Hispanic or Latino origin?
1
YES
7
UNCODABLE
2
NO
8
DON’T KNOW
9
REFUSED
91A. Given your racial or ethnic background, how do you prefer to identify yourself? [DO
NOT READ RESPONSE CATEGORIES; CODE UP TO 6 RESPONSES]
1
2
3
4
5
6
7
95
96
92.
AMERICAN INDIAN OR ALASKA NATIVE
ASIAN (CHINESE, VIETNAMESE, KOREAN, ETC.)
BLACK OR AFRICAN AMERICAN
HISPANIC, LATINA OR OTHER SPANISH BACKGROUND
(INCLUDING MEXICAN, CHICANA, CUBAN, PUERTO RICAN,
CENTRAL AMERICAN, ETC.)
NATIVE HAWAIIAN
OTHER PACIFIC ISLANDER (PHILIPINO, SAMOAN, ETC.)
WHITE OR CAUCASIAN
97
UNCODABLE
98
DON’T KNOW
99
REFUSED
7
UNCODABLE
8
DON’T KNOW
9
REFUSED
UNCODABLE – MIXED RACE
UNCODABLE – OTHER (specify):__________________________
What is the highest grade or year of school you have ever completed?
1
2
3
4
5
6
Less than a high school graduate or GED
High school graduate or GED
Trade, vocational or technical training after high school
Some college or an Associate’s degree
Bachelor’s degree
Post graduate training
60
93.
What is your current employment status? Are you: [RECORD THE FIRST YES RESPONSE]
1
2
3
4
5
6
7
8
9
10
94.
Employed for wages
Self-employed
Unable to work (includes disabled)
Unemployed and looking for work (includes recently laid off)
A full-time homemaker
A full-time student
Retired
A full-time caregiver (to child or adult parents)
[VOLUNTEERS: DOES VOLUNTEER WORK]
[VOLUNTEERS: UNEMPLOYED, BUT NOT LOOKING FOR WORK]
Do you have health insurance coverage or a health plan?
1
YES
2
NO
¨
¨
GO TO Q94A
7
UNCODABLE
GO TO Q95
8
DON’T KNOW
9
REFUSED
¨
¨
¨
GO TO Q94A
GO TO Q95
GO TO Q95
94A. Please tell me if you currently have any of the following types of health insurance or
health plan coverage. Do you have…
Yes
No
1
2
1
2
1
2
1
2
a. Medicare? READ IF NECESSARY: Medicare is a federal
health program for seniors over 65 and certain younger
disabled people.
b. Do you have Medicaid? READ IF NECESSARY: Medicaid is
a state-run health insurance program for people whose
income is below a certain level. [CATI PROGRAM: IN CA,
MEDI-CAL; IN MA, MASS HEALTH]
c. Private insurance, such as Blue Cross or Kaiser? [IF ANY
TYPE OR NAME OF INSURANCE VOLUNTEERED, CODE
AS YES]
d. Any other type of medical insurance or health plan
coverage?
61
95.
How many people, including yourself, live in your household? [HSE_SIZE]
96
ENTER NUMBER
OR
97
98
99
96.
LIVES IN A GROUP SETTING
UNCODABLE
DON’T KNOW
REFUSED
And finally, what is your total annual household income ? Your best estimate is fine.
ENTER AMOUNT
,
7
¨ GO TO CLOSING
STATEMENT
OR
8
9
¨
DON’T KNOW
¨
REFUSED ¨
UNCODABLE
GO TO Q96A
GO TO Q96A
GO TO CLOSING
STATEMENT
96A. Can you tell me which of these categories is the best estimate of your total annual
household income. Would you say…
1
2
3
4
5
6
7
$10,000 or less
$10,001-$20,000
$20,001-$30,000
$30,001-$40,000
$40,001-$50,000
$50,001-$100,000
Over $100,000
97
98
99
UNCODABLE
DON’T KNOW
REFUSED
CLOSING STATEMENT
FOR (USERTYPE = 1 OR 2) OR (Q55 = 1)
Those are all the questions I have. If you would like additional information about the study, again, you can
contact Julia Yosef, the study’s survey manager, at 1-800-xxx-xxxx. Thank you for taking part in this
important survey.
FOR (USERTYPE = 3, 4, 5, OR 6) OR (Q55 = NO/UC/DK/RF/BLANK)
Those are all the questions I have. If you would like additional information about the study, again, you can
contact Julia Yosef, the study’s survey manager, at 1-800-xxx-xxxx. Also, we would like you to know that
the VA does offer services to women veterans [IF (Q38, Q39, Q40, OR Q41 = YES) AND (Q43 =
NO/UC/DK/RF OR Q43B ≠ VA), THEN ADD: “including counseling for military sexual trauma.”]. For
more information about these services you can call 1-800-827-1000 or go online to
www.va.gov/womenvet. Thank you for taking part in this important survey.
62
| File Type | application/pdf |
| File Title | Reference #: __________________ |
| Author | vhaglayosefj |
| File Modified | 2008-03-20 |
| File Created | 2008-03-20 |