Survey Templates Surveys Mobile Phone Access to Online Patient Communities

Mobile Phone Access to Online Patient Communities

Sample Survey

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Hello:

You are invited to participate in a survey regarding mobile phone access to your online communtiy (or communities). In this survey, you will be asked questions about your online community, your mobile phone, and the ways in which you feel you would or would not benefit from combining the two. You will also be asked some brief questions about your health condition; these questions are not compulsory but may help to understand what kind of support you need. It will take approximately 15 minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Dana McKay at +64-7-8384466 x6729 or by email at the email address specified below.

This survey has been checked and approved by the Ethics Committeee of the School of Computing and Mathematical Sciences at the University of Waikato.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

Your online community

This section is about your online community; how you found it, how it fits into your life, and what it means to you. Please remember you do not have to answer any question you do not wish to, and that you answers are confidential.

How many online health communities are you a member of?

Please name your online communities

If you are a member of more than one online community, please answer the following questions about the one you use the most.

What is the name of your online community?

How did you find your online community?

Please estimate the number of countries the people in your community are spread over

How long have you been a community member?

Less than six months

Between six and twelve months

Between one and two years

Between two and five years

More than five years

Are you a posting community member (i.e. do you write as well as read in your community)?

Yes

How many hours per week do you spend in your online community?

Less than two

Between two and five

Between five and ten

Between ten and twenty

More than twenty

Approximately how many members do you chat with regularly in your online community?

Do you or have you ever contacted community members outside online community itself?

Yes

In what ways do you contact (or have you contacted) community members outside the community? (Choose as many as you like).

Instant messaging (e.g. AIM, MSN)

Text messaging

Cellular phone

Landline phone

Letters by mail

Cards by mail

Gifts by mail

Purchased products or services

Face to face as part of a group

Face to face one on one

Other (please specify)

Do members of your community have real life get-togethers?

Yes

Have you been to any of these get-togethers?

Yes

Have you ever travelled a long distance (more than 300 miles/500 kms) to meet anyone from your community?

Yes

How often do you visit your community for each of the following reasons?

	Very often	Often	Occasionally	Rarely	Very rarely
To get information about the health problem	Very often	Often	Occasionally	Rarely	Very rarely

To get information about a treatment or procedure for the health problem	Very often	Often	Occasionally	Rarely	Very rarely

To get information about a related health problem	Very often	Often	Occasionally	Rarely	Very rarely

To chat or catch up with online friends	Very often	Often	Occasionally	Rarely	Very rarely

To get emotional support	Very often	Often	Occasionally	Rarely	Very rarely

To vent frustrations or let off steam	Very often	Often	Occasionally	Rarely	Very rarely

Please give any other reasons you have for visiting the community:

This section is about urgent messages and how often you use them.

	Very often	Often	Occasionally	Rarely	Very rarely
I post an urgent message requiring a response	Very often	Often	Occasionally	Rarely	Very rarely

I post an urgent message that does not require a response	Very often	Often	Occasionally	Rarely	Very rarely

Urgent messages I post are responded to quickly	Very often	Often	Occasionally	Rarely	Very rarely

What do you like most about your online community?

Is there anything else you particularly like about your online community?

What is the thing you dislike the most about your online community?

Is there anything else you dislike about your online community?

Please say anything else you would like to say about your online community

Your health condition

This section is about your health condition, so that I can garner information on what kind of support may be useful to you. Remember, you are under no obligation to answer any question that makes you uncomfortable, and that your responses will be kept anonymous.

Are you a paitent of a chronic condition, or a supporter (parent, partner, child, etc.) of a person with a chronic condition?

Patient

Supporter

If you are a supporter, please answer the condition-specific questions (i.e. those about treatment) as though you were a patient. Please answer all other questions with respect to your own experience

Please state your gender

Male

Female

Please state your age

Under 18

18-25

25-35

35-45

45-65

Over 65

If you are affected by more than one health condition, please answer these questions about the condition for which you visit your most-used online community.

What is the name the health condition you are affected by?

Has your condition required you to spend time in the hospital, or is it likely to?

Yes

What treatments does your condition require?

Medication

Surgery

Lifestyle changes

Please specify

Please explain the way the health condition most affects your day-to-day life (either as a patient or support person)

Please say anything else you would like to say about your experience as a patient/supporter

Your mobile phone

This section is about your mobile phone; how you use it, and what you use it for. Please remember you are under no obligations to answer any question you don't want to answer, and that your responses will be kept confidential.

Do you own a mobile phone?

Yes

Why did you buy a mobile phone?

What make is your phone?

And what model?

How important were each of the following features when choosing your phone?

	Very important	Important	Somewhat important	Minimally important	Not important
Price	Very important	Important	Somewhat important	Minimally important	Not important

The way the phone looks	Very important	Important	Somewhat important	Minimally important	Not important

The network the phone was on	Very important	Important	Somewhat important	Minimally important	Not important

The technical capabilities of the phone	Very important	Important	Somewhat important	Minimally important	Not important

Ease of use	Very important	Important	Somewhat important	Minimally important	Not important

Phone size	Very important	Important	Somewhat important	Minimally important	Not important

Was there anything else that influenced your purchase of your phone?

What is your favourite thing about your phone?

Is there anything else you particularly like about your phone?

What is your least favourite thing about your mobile phone?

Is there anything else you particularly dislike about your phone?

Who pays your mobile phone bill?

Work pays for it

It comes out of the family budget

Myself

It is paid for by my parents/guardians

Other

How much money do you spend per month on your mobile phone bill? Please give the amount:

And the currency:

How do you pay for your phone?

Pay as you go/pre-paid

A mothly plan that includes all services you use

A monthly plan that includes most services, and then more money for extra services

Please briefly describe your monthly plan

If you do not own a mobile phone, please answer the following TWO questions about your ideal mobile phone

What features/capabilities does your phone have?

Text messaging

Caller ID

Calendar

Web browsing

Camera

Picture messaging

Video messaging

Music player

Song download capability

Video calling

Bluetooth or infrared

Games

Please specify

How often do you use your phone for each of the following things?

	Very often	Often	Occasionally	Rarely	Never
Making phone calls	Very often	Often	Occasionally	Rarely	Never

Receiving phone calls	Very often	Often	Occasionally	Rarely	Never

Text messaging	Very often	Often	Occasionally	Rarely	Never

Playing games	Very often	Often	Occasionally	Rarely	Never

Calendar/reminder functions	Very often	Often	Occasionally	Rarely	Never

Picture messaging	Very often	Often	Occasionally	Rarely	Never

Video calling	Very often	Often	Occasionally	Rarely	Never

Taking pictures (not for messaging)	Very often	Often	Occasionally	Rarely	Never

Email	Very often	Often	Occasionally	Rarely	Never

Web browsing	Very often	Often	Occasionally	Rarely	Never

	Very often	Often	Occasionally	Rarely	Never
Listening to music	Very often	Often	Occasionally	Rarely	Never

Have you ever used the internet from a mobile phone?

Yes

Have you ever sent an email from a mobile phone

Yes

Have you ever put a picture taken on a mobile phone on the internet?

Yes

Mobile community access

This section is about how you would like to access your community from your mobile phone. Please remember you do not have to answer any question you do not wish to answer, and all individual answers will be kept confidential.

Would you like to be able to access your online community from your mobile phone?

Yes

Where are you likely to want to access the community on your mobile phone

Your doctor's office or waiting area

The hospital

On vacation

On the move

Other (please specify)

How likely are you to access you community form your phone in the following situations?

	Very likely	Likely	Somehwat likely	Somewhat unlikely	Very unlikely
An urgent situation requiring an immediate response	Very likely	Likely	Somehwat likely	Somewhat unlikely	Very unlikely

A non-urgent situation for which you would like a response in the next hour	Very likely	Likely	Somehwat likely	Somewhat unlikely	Very unlikely

A non-urgent situation for which you would like a response eventually	Very likely	Likely	Somehwat likely	Somewhat unlikely	Very unlikely

A non-urgent situation for which no response is required (e.g. when you are providing information)	Very likely	Likely	Somehwat likely	Somewhat unlikely	Very unlikely

How important are the following features of mobile access to your online community?

	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all
Being able to post using text message	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Being able to receive alerts using text messaging	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Being able to leave voicemail for other community members to access and answer	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Being able to read the community on your mobile phone screen	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Being able to post pictures on your community	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Low cost	Very important	Important	Somewaht important	Somewhat unimportant	Not important at all

Are there any other features you would like?

Situation number one

Situation number two

Situation number three

Please name three things that would PREVENT you using your phone to access your online community

Please name three things that would ENCOURAGE you to access your community on your mobile phone, if you were able

Please add any other comments about using your mobile phone to access your online community

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Mobile Phone Access to Online Patient Communities

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