VHA Customer Value Online Survey / Customer Value Focus Group

OMB No. 2900-0770
Estimated Burden: 25 min.
minutes

Veterans Health Administration

Customer Value Survey

The Paperwork Reduction Act of 1995: 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 complete this survey will
average 25 minutes. This includes the time it will take to follow instructions, gather the necessary
facts and respond to questions asked. Customer satisfaction is used to gauge customer
perceptions of VA services as well as customer expectations and desires. The results of this online
survey will lead to improvements in the quality of service delivery by VA. Participation in this
survey is voluntary and failure to respond will have no impact on benefits to which you may be
entitled.

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Insert VA Webform no. TBD
December 2012

VHA Customer Value Survey
In an effort to continue to meet the needs and expectations of the Veteran population, the Veteran
Health Administration (VHA) seeks to understand Veteran preferences regarding their care and the
types of services they value most. Your responses to this online satisfaction survey will provide the VHA
with information that will be used to develop programs that best meet these needs, expectations,
consumer opinions concerning satisfaction, attitudes and information about financial products and
services. Your responses will assist the survey sponsor in developing better services to provide financial
information to consumers.
The survey takes about 25 minutes to complete. Your answers are anonymous and no personal
identifying information will be released. If you have any questions about this survey, please contact
Panel Relations at (xxx) xxx-xxxx.
The OMB Control Number for this study is 2900-0770. If you have any comments regarding the time
estimates associated with this study or suggestions on making this process simpler, please contact (INSERT
OMB CONTACT INFORMATION)
Thank you in advance for your participation!

1. When did you serve on Active Duty in the US Armed Forces?
September 2001 or later
August 1990 to August 2001 (includes Persian Gulf War)
May 1975 to July 1990
August 1964 to April 1975 (Vietnam era)
July 1964 or earlier [THANK AND TERMINATE SURVEY]
2. Did you deploy in support of Operation Enduring Freedom (OEF) or Operation Iraqi Freedom
(OIF)?
Yes
No
3. In what year did you first enter active duty? _______ (YYYY)
4. In what year were you last released from active duty ________ (YYYY)
5. Do you have a VA service-connected disability rating?
Yes
No

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6.

What is your current VA service-connected disability rating?
0 percent
10 or 20 percent
30 to 40 percent
50 to 60 percent
70 percent or higher
Don’t know

7. Are you currently receiving monthly disability payments from the VA?
Yes
No
The following question is about your use of the Internet.
8. What activities do you participate in online? Please select all that apply. [MULTIPLE RESPONSE]
Banking (paying bills, checking balance, transferring money, etc.)
Downloading/listening to music
Downloading/watching videos
Email
Personal blog
Personal web page
Photo uploading/storing
Professional networking (such as LinkedIn)
Reading news
Sharing and getting product information
Shopping
Social networking (such as Facebook or Twitter)
Uploading video
For the remaining questions, we’re going to ask you to make a series of choices about how you would
prefer to use two different types of health services: health coaching and a Personal Health Record (PHR).
These choices are similar to the choices you might make when deciding which new phone to buy based
on the different features available. While this might seem complicated at first, you’ll get the hang of it
quickly. Please stick with this survey because your responses will help the VHA provide the best service
to you.

Let’s start with health service coaching. Here is some background:
Health coaching is a model of patient care which emphasizes a partnership with each Veteran,
collaboration within a truly inter-professional care team, and promotion of patient behavioral
change in order to optimize the lifelong health of each Veteran.
What will help you choose among health coaching features?

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Each health coaching profile will contain five attributes. Please review the following information carefully
to become familiar with each of the different possible attribute options.

Who provides health
coaching

How coaching is
provided

Coaching duration

Coaching intensity

Motivators and
incentives for
participating

Coaching by a clinician member of your VA care team
Coaching provided by a clinician outside of your VA Care Team
Coaching provided by a non-clinician (fellow Veteran?) outside of
your VA care team
Coaching provided by someone in your community and notaffiliated with VA
Individual coaching face-to-face or by telephone that a health
coach initiates
Individual coaching face-to-face by telephone that you the patient
initiates
Group coaching with peers through face-to-face or telephone
sessions
”On demand” coaching through a telehealth device or
MyHeatheVet website or smart phone
Quick reminders
Shorter informational or motivational coaching sessions
Longer duration coaching over time until a goal is met or a health
issue is under control
Coaching at the beginning to explain a procedure or diseasespecific treatment plan
Coaching that monitors progress, motivates and helps keep you
on track with your self-managed health or treatment plan
Coaching that is more tailored, intensive and integrated to help
you with your life goals and/or longer term health issue (e.g.,
chronic diabetes)
The intrinsic reward of reaching your own personal goal
Sharing in group recognition of achievements, such as an award
presentation to a group, or news articles about individual
accomplishments in a magazine read by Veterans
Perquisites/ rewards for participating in health coaching, such as
discounted gym membership

Now it’s time to make some choices!
These five questions look similar, but each presents slightly different details for two different
program options, plus a “no program” option, so please pay attention! In each question, please
provide your feedback comparing the three boxes and choose the program you would most
prefer to use by marking an X in the box under that program.

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9. Which services program would you most prefer to use?
Program 1

Program 2

Health Coach

Coaching by a non-clinician
outside of your VA care
team

Coaching delivered by a
clinician member of your VA
care team

Mode of Delivery

Individual coaching delivered
face-to-face or by telephone
that a health coach initiates

Individual coaching delivered
face-to-face or by telephone
that you the patient initiate

Coaching
Duration

Shorter informational or
motivational coaching
sessions

Quick reminders

Coaching
Purpose

Coaching at the beginning to
explain a procedure or
disease

Coaching that monitors
progress, motivates and
helps keep you on track with
your life goals

Incentives

Rewards or recognition for
meeting a personal health
goal

Intrinsic reward of reaching
your own goal

No program

10. Which services program would you most prefer to use?
Program 1

Program 2

Health Coach

Coaching by a clinician
outside of your VA care
team

Coaching delivered by a
clinician member of your VA
care team

Mode of Delivery

Individual coaching delivered
face-to-face or by telephone
that a health coach initiates

Group coaching with peers

Coaching
Duration

Quick reminders

Quick reminders

Coaching
Purpose

Coaching that is more
tailored

Coaching that monitors
progress, motivates and
helps keep you on track with
your life goals

Incentives

Rewards or recognition for
meeting a personal health
goal

Sharing in group recognition

No program

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11. Which services program would you most prefer to use?

Program 1

Program 2

Health Coach

Coaching by a non-clinician
outside of your VA care
team

Coaching by a clinician
outside of your VA care team

Mode of Delivery

“On demand” through a
telehealth device

Individual coaching delivered
face-to-face or by telephone
that you the patient initiate

Coaching
Duration

Shorter informational or
motivational coaching
sessions

Longer duration coaching
over time

Coaching
Purpose

Coaching at the beginning to
explain a procedure or
disease

Coaching that is more tailored

Incentives

Rewards or recognition for
meeting a personal health
goal

Intrinsic reward of reaching
your own goal

No program

12. Which services program would you most prefer to use?
Program 1

Program 2

Health Coach

Coaching by someone in
your community outside of
your VA care team

Coaching delivered by a
clinician member of your VA
care team

Mode of Delivery

Group coaching with peers

Group coaching with peers

Coaching
Duration

Longer duration coaching
over time

Quick reminders

Coaching
Purpose

Coaching that is more
tailored

Coaching that is more tailored

Incentives

Sharing in group recognition

Intrinsic reward of reaching
your own goal

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No program

13. Which services program would you most prefer to use?
Program 1

Program 2

Health Coach

Coaching by a non-clinician
outside of your VA care
team

Coaching by someone in your
community outside of your VA
care team

Mode of Delivery

Individual coaching delivered
face-to-face or by telephone
that a health coach initiates

“On demand” through a
telehealth device

Coaching
Duration

Shorter informational or
motivational coaching
sessions

Shorter informational or
motivational coaching
sessions

Coaching
Purpose

Coaching that monitors
progress, motivates and
helps keep you on track with
your life goals

Coaching at the beginning to
explain a procedure or
disease

Incentives

Rewards or recognition for
meeting a personal health
goal

Intrinsic reward of reaching
your own goal

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No program

Now let’s move on to a Personal Health Record (PHR) service. Here is some background:
A PHR is a tool that you can use to collect, track and share past and current information about your
health. It allows you to participate in the management of your health and share information with your
health care providers.
What will help you choose among the PHR features?
Each PHR profile will contain four attributes. Please review the following information carefully to become
familiar with each of the different possible attribute options.

Convenience / access

Type of health
information shared

Confidentiality

Other health resources /
tools

Share information through a VA caregiver, either in-person or by
telephone
Share information through a VA caregiver as well as through
MyHealtheVet website
Share information through all channels (VA caregiver,
MyHealtheVet website and smartphone app)
Medical information (VA health history, caregiver notes,
medications, lab results)
Medical information plus personal information about you (marital
status, dependents, employment, housing)
Medical information, personal information about you, as well as
information you provide about your preferences, values, priorities
and motivators
Share information only with your VA care team
With your consent, share your entire health record with VA care
team and other healthcare providers or caregivers
Share only the parts of your health record that you select with
other healthcare providers or caregivers
Access tailored educational/informational resources through your
PHR
Access tailored educational/informational resources, as well as
health risk assessment tools that provide feedback about your
health age
Access all of the above, plus home monitoring tools and smart
phone apps that you connect/upload to your PHR

Now it’s time to make some choices!
Again, these five questions may look similar, but each presents slightly different details for two different
program options, plus a “no program” option, so please pay attention! In each question, please
compare the three boxes and choose the service program you would most prefer to use by marking an
X in the box under that program.

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14. Which services program would you most prefer to use?
Program 1
Convenience/

Program 2

Share information through a
VA care giver

Share information through a
VA care giver as through
MyHealtheVet

Health
Information
Shared

Medical information

Medical information, personal
information about you, as well
as information you provide
about your preferences,
values, priorities, and
motivators

Confidentiality

Share information only with
your VA care team

Share only the parts of your
health record that you select
with other healthcare
providers or caregivers

Health
Resources/

Access tailored
educational/informational
resources through your PHR

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age

Access

Tools

No program

15. Which services program would you most prefer to use?
Program 1
Convenience/

Program 2
Share information through a
VA care giver

Access

Share information through all
channels (VA care giver,
MyHealtheVet website and
smartphone app

Health
Information
Shared

Medical information plus
personal information about
you

Medical information, personal
information about you, as well
as information you provide
about your preferences,
values, priorities, and
motivators

Confidentiality

With your consent, share
your entire health record
with VA care team and other
providers

With your consent, share your
entire health record with VA
care team and other
providers

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No program

Health
Resources/

Access tailored
educational/informational
resources through your PHR

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age, plus home
monitoring tools and
smartphone app

Tools

16. Which program would you most prefer to use?
Program 1

Program 2

Share information through a
VA care giver as through
MyHealtheVet

Share information through all
channels (VA care giver,
MyHealtheVet website and
smartphone app

Health
Information
Shared

Medical information

Medical information, personal
information about you, as well
as information you provide
about your preferences,
values, priorities, and
motivators

Confidentiality

Share only the parts of your
health record that you select
with other healthcare
providers or caregivers

Share information only with
your VA care team

Health
Resources/

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age, plus home
monitoring tools and
smartphone app

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age

Convenience/
Access

Tools

9

No program

17. Which services program would you most prefer to use?
Program 1
Convenience/

Program 2

Share information through a
VA care giver

Share information through a
VA care giver

Health
Information
Shared

Medical information,
personal information about
you, as well as information
you provide about your
preferences, values,
priorities, and motivators

Medical information plus
personal information about
you

Confidentiality

Share information only with
your VA care team

With your consent, share your
entire health record with VA
care team and other
providers

Health
Resources/

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age

Access tailored
educational/informational
resources through your PHR

Access

Tools

No program

18. Which services program would you most prefer to use?
Program 1
Convenience/

Program 2

Share information through all
channels (VA care giver,
MyHealtheVet website and
smartphone app

Share information through a
VA care giver as through
MyHealtheVet

Health
Information
Shared

Medical information

Medical information plus
personal information about
you

Confidentiality

Share information only with
your VA care team

Share information only with
your VA care team

Health
Resources/

Access tailored
educational/informational
resources, as well as health
risk assessment tools that
provide feedback about your
health age, plus home
monitoring tools and

Access tailored
educational/informational
resources through your PHR

Access

Tools

10

No program

smartphone app

19. Do you have any final comments or suggestions?

You have completed the survey. Thank you so much for your time!

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Demographics—NO Questions
Information provided from panel (not needed to ask):
Age
Household size
Education level
Race/ethnicity
Gender
Employment
Income range
Region of US (9 regions)
Metro vs. non-metro area
Ownership status of living quarters
Marital status

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