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Surveys
2013
March
M
Medication Instruction Survey
Medication Instruction Survey
0%
Exit Survey
What is your age?
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
75 or older
What is the highest level of education you have completed?
8th grade or less
9th grade
10th grade
11th grade
Graduated from high school
1 year of college
2 years of college
3 years of college
Graduated from college
Some graduate school
Completed graduate school
Do you have insurance that covers medications?
Yes
No
Don't know
Do you have any chronic medical conditions?
Yes
No
Do you have any of the following? (Check all that apply)
wear glasses
legally blind
wear hearing aids
arthritis in your hands or difficulty open things with your hands
have problems understanding or remembering information
any mental or central nervous system problems or diagnosis (this includes strokes, depression, etc.)
Do you have a regular doctor or nurse practioner that you see on a regular basis and/or when you are sick?
Yes
No
Have you ever not taken a medication or completed a medication that your doctor or nurse practitioner had prescribed?
Yes
No (Please skip the next question)
Why did you not take or stop the medication that was prescribed to you? (Mark all that apply)
The cost of the medication was too high
The side effects were unbearable
I don't think the medication was helping me
I felt better after awhile and decided to stop taking it
It was too hard to keep taking the medication
The medication required me to take too many doses each day
I am not sure why I was taking the medication
I was switched to another medication after speaking with my doctor/nurse practitioner
I switched to an over the counter medication that was recommended to me by a healthcare professional
I switched to an over the counter medication that was recommended to me by a friend or relative
I switched to a herbal remedy
I just did not want to take or continue to take the medication
I did not trust my doctor/nurse practitioner
I do not trust the medication developers and/or medication companies
I found out something about the medication on the TV, in the newspaper or from a person that the medication was involved in lawsuits
What do you think picture
#1
is telling you about taking a medication (there are no wrong or right answers)?
What do you think picture
#2
is telling you about taking a medication (there are no wrong or right answers)?
Thank you for participating!
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