PHR Research

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Hello:

I'd like to invite you to participate in a survey I am conducting. The survey should take approximately 3-5 minutes.

Please note your survey responses will be anonymous and data from this survey will be reported only in the aggregate.

If you have questions at any time about the survey or the procedures, you may contact Bhavini Shah by email at [email protected]

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

Gender

Age

Marital and Family Status

Highest level of education

How would you rate your personal health?

Excellent

Good

Average

Below Average

Poor

How many times have you visited a doctor in the last twelve months

How many times have you visited a doctor in the past three years total?

If you had an online tool to track various information about your health, how likely would you be to track the following information for yourself?

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Allergies	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Prescription Medication	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Non-Precription Medication	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Immunizations	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Major Illnesses (ex: Diabetes, AIDS, Seizures)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Radiology (ex: MRI, Xray)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Lab Reports (ex: blood tests)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Surgeries, Hospitalizations	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Dental Treatment History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Vision History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Family History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

If you had an online tool to track various information about your health, how likely would you be to track the following information for yourself?

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Recommended Medical Screenings (ex: pap smear)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Recurring Treatment Information (ex: physical therapy)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Medical Survey (form you fill out as a new patient)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Information related to a pregnancy	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Information related to a medical condition	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

If you had online tools to help you manage and monitor your health, how likely would you be to use any of the following trackers for yourself?

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Blood Pressure	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Cholesterol	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Heart Rate	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Weight	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Blood Sugar	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

A1C	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Tryglycerides	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Basic Exercise Information (date, log)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Detailed Exercise Information (calories, duration, speed, type)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Basic Nutrition Information (journal format)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Detailed Nutrition Information (food, calories, ADA recs, servings)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Other	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

If you had an online tool to track various information about your health, how likely would you be to track the following information for someone else*?

*Ex: child, spouse, or another relative you are caring for such as elderly parent or disabled person

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Allergies	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Prescription Medication	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Non-Precription Medication	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Immunizations	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Major Illnesses (ex: Diabetes, AIDS, Seizures)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Radiology (ex: MRI, Xray)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Lab Reports (ex: blood tests)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Surgeries, Hospitalizations	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Dental Treatment History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Vision History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Family History	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Recommended Medical Screenings (ex: pap smear)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Recurring Treatment Information (ex: physical therapy)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Medical Survey (form you fill out as a new patient)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Information related to a pregnancy	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Information related to a medical condition	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Blood Pressure	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Cholesterol	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Heart Rate	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Weight	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Blood Sugar	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

A1C	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Tryglycerides	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Basic Exercise Information (date, log)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Detailed Exercise Information (calories, duration, speed, type)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Basic Nutrition Information (journal format)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

	Very Likely	Likely	Neutral	Unlikely	Very Unlikely
Detailed Nutrition Information (food, calories, ADA recs, servings)	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Other	Very Likely	Likely	Neutral	Unlikely	Very Unlikely

Which of the following features would you want access to from the online tool where you could track your health information?

The ability to set alerts and recieve alerts (ex: doctor's appointment, colorectal exam overdue)

The ability to see data of how my information compares to other standards (ex: Is my blood pressure normal for my age)

The ability to print my information in a report for my doctor

The ability to allow my doctor access to my online account

The ability to see information I am tracking in charts (ex: chart my weight over time)

The ability to read news articles pertaining to health topics (ex: about diabetes, about Zyrtec, about latest research)

The ability to have articles recommended to me based on my selected interests

The ability to have articles recommended to me based on data I have entered

The ability to see drug to drug interactions

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