Attachment A: Survey Questions
Web Survey for Home Medical Device Instructions
The National Family Caregivers Association (NFCA) is working with the Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH) to learn what information caregivers need to use medical equipment safely in the home.
This survey asks about your experience with instructions for medical equipment you have used in the home to care for your family member. Your answers will be used to help FDA ensure that the instructions for medical equipment used at home are easily available and understandable to all caregivers.
Your responses will be kept strictly confidential and will not be linked with your name.
Please answer the following questions based on your own experience.
Please tell us about the family member you care for in the home. What is his or her relationship to you?
Spouse/partner
Child
Parent
Other (please describe)
How old is your family member?
Under 6 years
6-20 years
21-64 years
65 years or over
Where do you care for your family member?
In my/our home
In my family member’s home
Other (please describe)
How long have you cared for your family member?
Less than 2 years
2-5 years
More than 5 years
Which of the following diseases or conditions does your family member have? Please check all that apply.
ALS, also known as Lou Gehrig’s disease
Birth defects
Cancer
Cerebral palsy
Diabetes (sugar)
Heart disease
Kidney disease
Lung disease
Multiple Sclerosis (MS)
Parkinson's Disease
Spinal cord injury
Stroke
Traumatic brain injury (head injury)
Other (Please specify)
Please tell us what medical equipment you use or have used.
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6. What medical equipment have you used to care for your family member in the home? Please check all that apply.
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7. (If checked in Q6) How long have you been using this equipment?
Less than 1 year 1-2 years 3 or more years |
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Blood glucose monitor (to check blood sugar or sugar, also called a glucometer) |
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Nebulizer (breathing machine to deliver medicine to the lungs) |
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Patient lift (power or manual) |
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Wheelchair (power or manual) |
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Specialty bed for pressure ulcers or bed sores (air-fluidized or low-air-loss beds) |
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Home dialysis machine (kidney dialysis) |
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Infusion or IV pump |
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Wound therapy machine (for open wound care) |
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Ventilator (breathes for the patient) |
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Other (please list) |
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I do not use any medical equipment to care for my family member (If checked, skip to Q 40) |
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Of the equipment you checked above, please choose up to three to answer more questions about.
Blood glucose monitor (to check blood sugar or sugar, glucometer)
Nebulizer (breathing machine to deliver medicine to the lungs)
Patient lift (power or manual)
Wheelchair (power or manual)
Specialty bed for pressure ulcers or bed sores (e.g., air-fluidized or low-air-loss beds)
Home dialysis machine (kidney dialysis)
Infusion or IV pump
Wound therapy machine (for open wound care)
Ventilator (breathes for the patient)
Other (Please specify)
The following questions ask about your experience with specific equipment.
Where did you receive the equipment?
It was delivered to my home
In the hospital/rehab center
At the doctor’s office
Other (please describe)
In your opinion, how easy or difficult was it to learn how to use this equipment?
Very easy to learn
Somewhat easy to learn
Somewhat difficult to learn
Difficult to learn
Very difficult to learn
Did you receive any training about how to use the equipment?
Yes
No (skip Q35 )
Did manufacturer’s instructions come with the equipment?
Yes (go to Q13)
No (go to Q17, skip Q19, Q24, Q28, Q29)
I don’t remember
(Note: if manufacturer’s instructions did not come with the equipment, Q13-16 will be skipped)
What kind of instructions came with the equipment? Please check all that apply.
A manual
Several manuals
A booklet
Several booklets
Brochure
Information sheet
Checklist
CD or DVD
Website link or other Internet source
Other (please describe)
The following questions ask about the instructions for specific equipment.
Which of the following was most helpful in finding information you needed in the instructions?
Table of contents
Section headings
Index
Binder tabs
Internet website navigation menus
Other (please describe)
If you needed to use the manufacturer’s instructions to solve a problem you were having (troubleshooting), could you quickly and easily find information you needed?
Yes
No
Comments:
How easy or difficult was it to follow the manufacturer’s instructions in general?
Very easy to follow
Somewhat easy to follow
Somewhat difficult to follow
Difficult to follow
Very difficult to follow
Please comment on the ease or difficulty in using manufacturer’s instructions: (free text)
Did you receive instructions from any of the following sources about how to use the equipment? Please check all that apply.
The hospital
The doctor’s office
The home health care agency or home health nurse
The medical supply company
The rehab hospital or clinic
The physical therapist
Other (please describe)
I did not receive instructions from any other sources (go to Q 20 and skip Q29)
What kind of instructions did you receive from the sources checked above about the equipment? Please check all that apply.
A manual
A booklet
Brochure
Information sheet
Checklist
Other (please describe)
(Note: If they checked No on Q12, Q19 will be skipped)
Did the additional instructions simplify the manufacturers’ instructions or make them clearer?
Yes
No
Comment:
Were there pictures or diagrams in the instructions?
Yes (Go to Q21)
No (Go to Q22)
Were the pictures or diagrams helpful?
Yes
No
Do you still have the instructions for the equipment?
Yes
No
I don’t know
The following questions ask about the use of the instructions for the specific equipment.
When have you used the instructions for the equipment? Please check all that apply.
Only during training or learning to use the equipment
Until I felt comfortable using the equipment
To learn about what the alarms or flashing lights meant
To learn how to calibrate (part of the set-up procedure) or set up the equipment
For information about cleaning
Other (please describe)
I haven’t ever used the instructions (go to Q 24, then skip to Q27--all other answers skip to Q 25)
(Note: if the answer to Q12 is No, Q24 will be skipped)
I haven’t ever used the instructions because:
The training was all I needed
I already knew how to use the equipment
We don’t use the equipment
Instructions I found on the internet were better
Someone showed me how to use it
Other (please describe)
Once you learned to use the equipment, when have you referred back to the instructions?
To check and make sure we were continuing to use it correctly
Every time I use the equipment
To learn more details about how it works or to learn
For troubleshooting, or when something didn’t work right, or there was a problem
To learn new features or how to do something new
To refresh my memory if we haven’t used it in a while
To find out more about battery life or other battery information
To find a phone number to call when we have a problem
Did the instructions tell you what you needed to know when you referred back to them?
Yes
No
Please add any additional comments:
What is the most important information that you need to know about using the equipment? (Free text response)
(Note: If the answer to Q12 is no, Q28-9 will be skipped)
Is that information contained in the manufacturer’s instructions?
Yes
No
I don’t know
Comments:
(Note if they answered Q17 with “I did not receive instructions from any other sources, Q29 will be skipped)
Is that information contained in the instructions you received from other sources?
Yes
No
I don’t know
Comments:
Where do you turn when you need help or information about the device? I turn to (please check all that apply):
Instructions on the equipment
Instructions that came with the equipment
The Internet
The manufacturer (company phone number)
The doctor
The home health nurse
The family member I care for
Support associations (such as NFCA and others)
The medical supply company (the supplier)
The hospital
The rehab center
Friends or others with the same condition or equipment
Other (please describe)
Would a short version or “quick start” set of instructions be helpful for you to use?
Yes
No (skip to Q 33)
What type of information would you want to see in this short version or “quick start?” Please describe.
Where would it be most helpful for you to find instructions for this equipment? Please check all that apply.
On paper (instruction manual, brochure, quick start guide)
On the equipment itself, such as on a screen or a label
On-line (Internet or a website)
Electronic (DVD, CD)
By phone with a company representative or a home health nurse, etc.
Other (Please describe)
When is the best time to receive written instructions about use of the equipment? Please rank in order of importance (with 1 being the best or most important time and 6 being the worst or least important time).
At the hospital
On delivery of the equipment at home
During the first home health visit
When being trained on the equipment
When first using the equipment
Other (Please describe)
For the following questions, think about any training you may have received about how to use the equipment.
Who trained you or taught you how to use the equipment? Please check all that apply.
Hospital staff (such as nurse, physical therapist)
Rehab center staff (such as nurse or physical therapist)
Medical Supply Company rep
Manufacturer’s representative
Home health provider (such as nurse or physical therapist)
My doctor or the doctor’s office staff
The family member that I care for
(Note: If answered No to Q11-Were they trained, Q36 will be skipped)
In what other ways (besides training) did you learn to use the equipment? Please check all that apply.
I followed written, paper instructions from the manufacturer
I followed written, paper instructions from another source
I searched the Internet for instructions and followed them
I watched a video on the Internet, such as a YouTube video
I learned by trial and error
I learned how to use it from a friend/support group
Other (please describe)
Please add any other comments you would like to share about information and instructions that came with the medical equipment you use:
NOTE: Questions 9-37 will repeat about each device checked in question 8 (up to 2 more devices, and can include devices listed in “other”).
The following questions ask about the written instructions for all of the medical equipment that you use to care for your family member at home.
How long do you keep instructions?
As long as I own the equipment
Until I don’t need them any more
I just look them up on the Internet
I lose them as soon as I get them.
I put them in a special place so I don’t lose them.
I don’t know.
Other (please comment)
Where do you keep instructions?
With the equipment
In a file and I know where they are
In a file and I don’t know where they are
In a basket with all the medical information
I don’t know, I can’t find them when I need them
Other (please describe)
Final Questions
Now please think about any other medical equipment that you use. What comments do you have about the instructions for the other equipment? (Free text response)
How comfortable are you with using computers?
Very comfortable
Somewhat comfortable
Not very comfortable
Not comfortable at all
If the FDA created a searchable website that contained instructions for medical equipment used in the home, do you think you would make use of it?
Yes
No
Comments:
What final comments do you have about instructions for any medical equipment that that you have needed or used as a caregiver?
Thank you very much for participating in this important survey.
| File Type | application/msword |
| File Title | Attachment A: Survey Questions |
| Author | Rachel.Kent |
| Last Modified By | gittlesond |
| File Modified | 2011-08-24 |
| File Created | 2011-08-24 |