Form #1 Form #1 CAHPS Health Plan Health Literacy Survey-- English

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

CAHPS^ Health Plan

Health Literacy Survey

DRAFT

JANUARY 2011

Public reporting burden for this collection of information is estimated to average 25 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Survey Instructions

• You should only fill out this survey if you are the person named in the cover letter that came with this survey. Do no fill out this survey if you are not this person.

• Answer each question by marking the box to the left of your answer.

• You are sometimes told to skip over some questions in this survey. When this happens you will see an arrow with a note that tells you what question to answer next, like this:

Yes

No  If No, go to #1 on page 1

You may notice a number on the cover of this survey. This number is ONLY used to let us know if you returned your survey so we don't have to send you reminders.

Your Personal Doctor

1. A personal doctor is the one you would see if you need a check-up, want advice about a health problem, or get sick or hurt. Do you have a personal doctor?

¹ Yes

² No ® If No, go to question 28

2. In the last 12 months, how many times did you visit your personal doctor to get care for yourself?

None ® If None, go to question 28

1

2

3

4

5 to 9

10 or more

3. In the last 12 months, how often did your personal doctor explain things in a way that was easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

4. In the last 12 months, how often were the explanations your personal doctor gave you hard to understand because of an accent or the way the doctor spoke English?

¹ Never

² Sometimes

³ Usually

⁴ Always

5. In the last 12 months, how often did your personal doctor use medical words you did not understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

6. In the last 12 months, how often did your personal doctor talk too fast when talking with you?

¹ Never

² Sometimes

³ Usually

⁴ Always

7. In the last 12 months, how often did your personal doctor use pictures, drawings, or models to explain things to you?

¹ Never

² Sometimes

³ Usually

⁴ Always

8. In the last 12 months, how often did your personal doctor ignore what you told him or her?

¹ Never

² Sometimes

³ Usually

⁴ Always

9. In the last 12 months, how often did your personal doctor interrupt you when you were talking?

¹ Never

² Sometimes

³ Usually

⁴ Always

10. In the last 12 months, how often did your personal doctor listen carefully to you?

¹ Never

² Sometimes

³ Usually

⁴ Always

11. In the last 12 months, how often did your personal doctor show respect for what you had to say?

¹ Never

² Sometimes

³ Usually

⁴ Always

12. In the last 12 months, how often did your personal doctor spend enough time with you?

¹ Never

² Sometimes

³ Usually

⁴ Always

13. In the last 12 months, how often did your personal doctor show interest in your questions and concerns?

¹ Never

² Sometimes

³ Usually

⁴ Always

14. In the last 12 months, how often did this doctor answer all your questions to your satisfaction?

¹ Never

² Sometimes

³ Usually

⁴ Always

15. In the last 12 months, how often did your personal doctor give you all the information you wanted about your health?

¹ Never

² Sometimes

³ Usually

⁴ Always

16. In the last 12 months, how often did your personal doctor encourage you to talk about all your health problems or concerns?

¹ Never

² Sometimes

³ Usually

⁴ Always

17. In the last 12 months, how often did your personal doctor use a condescending, sarcastic, or rude tone or manner with you?

¹ Never

² Sometimes

³ Usually

⁴ Always

18. In the last 12 months, how often did you feel your personal doctor really cared about you as a person?

¹ Never

² Sometimes

³ Usually

⁴ Always

19. Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?

0 Worst personal doctor possible

1

2

3

4

5

6

7

8

9

10 Best personal doctor possible

20. In the last 12 months, did you see your personal doctor for a specific illness or for any health condition?

¹ Yes

² No ® If No, go to 26

21. In the last 12 months, how often did your personal doctor give you easy to understand instructions about what to do to take care of this illness or health condition?

¹ Never

² Sometimes

³ Usually

⁴ Always

22. In the last 12 months, how often did your personal doctor ask you to describe how you were going to follow these instructions?

¹ Never

² Sometimes

³ Usually

⁴ Always

23. In the last 12 months, how often did someone else in your personal doctor’s office ask you to describe how you were going to follow these instructions?

¹ Never

² Sometimes

³ Usually

⁴ Always

24. Sometimes doctors give instructions that are hard to follow. In the last 12 months, how often did your personal doctor ask you whether you would have any problems doing what you need to do to take care of this illness or health condition?

¹ Never

² Sometimes

³ Usually

⁴ Always

25. In the last 12 months, how often did your personal doctor explain what to do if this illness or health condition got worse or came back?

¹ Never

² Sometimes

³ Usually

⁴ Always

Communication with the Nurse Call Line

Some health plans give you a number to call to talk to a nurse. The next questions are about calls you may have made to your health plan’s nurse call line.

26. In the last 12 months, did you call your health plan’s nurse call line for information or help for a health problem or concern?

¹ Yes

² No ® If No, go to question 32

27. In the last 12 months, when you called your health plan’s nurse call how often was the information you received easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

28. In the last 12 months, when you called your health plan’s nurse call line, how often did they give you all the information you wanted?

¹ Never

² Sometimes

³ Usually

⁴ Always

29. In the last 12 months, when you called your health plan’s nurse call line, did they give you instructions for taking care of a health problem or concern?

¹ Yes

² No ® If No, go to question 31

30. Did they ask you to describe how you were going to follow these instructions?

¹ Never

² Sometimes

³ Usually

⁴ Always

31. NOT INCLUDED

Your Medicines

The next questions ask about the information you received for prescription medicines you are taking.

32. In the last 12 months, did your personal doctor prescribe any new medicines or change how much medicine you should take?

¹ Yes

² No ® If No, go to question 36

33. In the last 12 months, how often did your personal doctor give you easy to understand instructions about how to take your medicines?

¹ Never

² Sometimes

³ Usually

⁴ Always

34. In the last 12 months, did your personal doctor explain the possible side effects of your medicines?

¹ Yes

² No ® If No, go to question 36

35. In the last 12 months, how often did your personal doctor explain the possible side effects of your medicines in a way that was easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

Blood Tests, X-rays, or other tests

The next questions ask about your experience with blood tests, x-rays or other tests.

36. In the last 12 months, did your personal doctor order a blood test, x-ray or other test for you?

¹ Yes

² No ® If No, go to question 39

37. In the last 12 months, when your personal doctor ordered a blood test, x-ray or other test for you, how often did someone from your personal doctor’s office follow up to give you those results?

¹ Never

² Sometimes

³ Usually

⁴ Always

38. In the last 12 months, how often were the results of your blood test, x-ray or other test easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

Health Plan Information on the Web

The next questions ask about health plan information available on the Web.

39. In the last 12 months, did you look for any information on your health plan’s Website?

¹ Yes

² No ® If No, go to question 44

40. In the last 12 months, how often was it easy to find the information on your health plan’s Website?

¹ Never

² Sometimes

³ Usually

⁴ Always

41. In the last 12 months, how often was the information on your health plan’s Website easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

42. In the last 12 months, did you use your health plan’s Website to conduct business with your health plan, such as paying a bill, ordering a new identification card, or reporting a change of address?

¹ Yes

² NoIf “No,” go to question 44

43. How often was it easy to conduct the business you wanted on your health plan’s Website?

¹ Never

² Sometimes

³ Usually

⁴ Always

Information About Coverage and Benefits

44. In the last 12 months, did you look for any information about your health plan coverage and benefits in written materials from your health plan or on your health plan’s Website?

¹ Yes

² No  If No, go to question 50

45. Did you find the information you needed about your health plan coverage and benefits?

¹ Yes

² No

46. Did you get all the information you needed when you looked for information on health plan coverage and benefits in the written materials from your health plan or on your health plan’s Website?

¹ Yes

² No

47. In the last 12 months, how often was the information about your health plan coverage and benefits easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always If “Always,” go to question 49

48. Why was the information from about your health plan coverage and benefits not easy to understand? (Mark all that apply)

¹ It was too complicated

² There was too much information

³ It had confusing language

⁴ I didn’t understand what I was supposed to do

⁵ It didn’t apply to me

⁶ It included too many numbers

⁷ The type was too small

49. NOT INCLUDED

Grievances and Appeals

Health plan members have the right to make a complaint to their health plan when they are unhappy with the care or services they received or decisions the health plan made about their payment or treatment. This is often called the Grievance and Appeals Process.

50. Did you know you could make a complaint about the care or services you received or decisions your health plan made?

¹ Yes

² No

51. In the last 12 months, did you look for any information about how to make a complaint to your health plan in written materials from your health plan or on your health plan’s web site?

¹ Yes

² No ® If No, go to question 54

52. In the last 12 months, how easy was it to find the information you needed about how to make a complaint to your health plan?

¹ Very easy

² Easy

³ Not easy

⁴ I could not find the information  Go to question 54

53. In the last 12 months, how often was the information about how to make a complaint to your health plan easy to understand?

¹ Never

² Sometimes

³ Usually

⁴Always If “Always,” go to question 55

54. Why was the information from your health plan about how to make a complaint not easy to understand? (Mark all that apply)

¹ It was too complicated

² There was too much information

³ It had confusing language

⁴ I didn’t understand what I was supposed to do

⁵ It didn’t apply to me

⁶ It included too many numbers

⁷ The type was too small

Information on How To Stay Healthy

Health plans often provide information on how to stay healthy, such as information on eating healthy, exercise, or getting a flu shot. This information is often sent in the mail or put on the health plan’s Web site.

55. In the last 12 months, did you look at information from your health plan on how to stay healthy?

¹ Yes

² No ® If No, go to question 60

56. In the last 12 months, how often did the information from your health plan about how to stay healthy provide the information you needed?

¹ Never

² Sometimes

³ Usually

⁴Always

57. In the last 12 months, how often was the information from your health plan about how to stay healthy easy to understand?

¹ Never

² Sometimes

³ Usually

⁴AlwaysIf “Always,” go to question 59

58. Why was the information from your health plan about how to stay healthy not easy to understand? (Mark all that apply)

¹ It was too complicated

² There was too much information

³ It had confusing language

⁴ I didn’t understand what I was supposed to do

⁵ It didn’t apply to me

⁶ It included too many numbers

⁷ The type was too small

59. NOT INCLUDED

Health Plan’s Customer Service

60. In the last 12 months, did you try to get information or help from your health plan’s customer service?

¹ Yes

² No ® If No, go to question 66

61. In the last 12 months, how often did your health plan’s customer service give you the information or help you needed?

¹ Never

² Sometimes

³ Usually

⁴ Always

62. In the last 12 months, how often was the information you got from staff from your health plan’s customer service easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always skip to Q.64

63. Were any of the following a reason why you did not get the information or help you needed from your health plan’s customer services? (Mark all that apply.)

¹ I could not reach a live person on the phone

² I could not reach a person on the phone who spoke my language

³ The person I reached did not have the answers to my questions or could not help me.

⁴ The answers or directions the person I reached gave me were difficult to understand

⁵ The person I reached was hard to hear

⁶ The person I reached spoke too fast

⁷ The person I reached was difficult to understand

64. In the last 12 months, how often did your health plan’s customer service staff treat you with courtesy and respect?

¹ Never

² Sometimes

³ Usually

⁴ Always

65. Not included

66. In the last 12 months, did you ask your health plan for information or help using email or your health plan’s Web site?

¹ Yes

² No ® If No, go to question Q.69

67. In the last 12 months, how often did your health plan email you the information or help you needed?

¹ Never

² Sometimes

³ Usually

⁴ Always If Always, go to Q.69

68. Why did you not always get the information or help you needed? (Mark all that apply.)

¹ I did not receive a reply.

² The reply was not in a language I speak.

³ The reply was not what I had asked for.

⁴ I could not understand the reply.

⁵ Other

Forms

69. In the last 12 months, did your health plan give you any forms to fill out?

¹ Yes

² No ® If No, go to question 74

70. In the last 12 months, how often were the forms from your health plan easy to fill out?

¹ Never

² Sometimes

³ Usually

⁴ Always

71. In the last 12 months, how often did someone from the health plan explain the purpose of a form before you filled it out?

¹ Never

² Sometimes

³ Usually

⁴ Always

72. In the last 12 months, how often were you offered help by someone from your health plan in filling out a form?

¹ Never

² Sometimes

³ Usually

⁴ Always

73. NOT INCLUDED

Claims Processing

74. Claims are sent to a health plan for payment. You may send in the claims yourself, or doctors, hospitals, or others may do this for you. In the last 12 months, did you look at information from your health plan about how to send a claim to the health plan for payment?

¹ Yes

² No ® If No, go to question 76

75. In the last 12 months, how often was the information from your health plan about how to send in a claim easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

76. In the last 12 months, did you or anyone else send in any claims for your care to your health plan?

¹ Yes

² No ® If No, go to question 78

³ Don’t know ® If Don’t know, go to question 78

77. In the last 12 months, how often did your health plan handle your claims correctly?

¹ Never

² Sometimes

³ Usually

⁴ Always

⁵ Don’t know

Coverage for Prescription Medicines

The next questions are about the coverage you get through your health plan for prescription medicines.

78. (HP6) In the last 12 months, did you look for information from your health plan on how much you would have to pay for specific prescription medicines?

¹ Yes

² No ® If No, go to question 80

79. In the last 12 months, how often was the information from your health plan on how much you would have to pay for prescription medicines easy to understand?

¹ Never

² Sometimes

³ Usually

⁴ Always

Interpreter Services

80. What is your preferred language?

¹ English If English, thank you for completing the survey.

² Spanish

³ Some other language

81. How well do you speak English?

¹ Very well

² Well

³ Not Well

⁴ Not at all

82. How well do you understand English?

¹ Very well

² Well

³ Not Well

⁴ Not at all

83. In the last 12 months, did you call or speak to someone from your health plan for any reason?

¹ Yes

² No ® If No, thank you for completing the survey.

84. An interpreter is someone who helps you talk with others who do not speak your language. Interpreters can include health plan staff or telephone interpreters. In the last 12 months, was there any time when you needed an interpreter to talk with someone from your health plan?

¹ Yes

² No ® If No, thank you for completing the survey.

85. In the last 12 months, was there a time when you needed an interpreter to talk with someone from your health plan and did not get one?

¹ Yes

² No

86. In the last 12 months, did you ever use an interpreter provided by your health plan to help you talk with someone from the health plan?

¹ Yes

² No   If No, thank you for completing the survey.

87. In the last 12 months, how often did you use an interpreter provided by your health plan to help you talk with someone from the health plan?

¹ Never  If Never, thank you for completing the survey.

² Sometimes

³ Usually

⁴ Always

88. In the last 12 months, when you used an interpreter provided by your health plan, who was the interpreter you used most often?

¹ Health plan staff that spoke your language

² Professional interpreters

³ Telephone interpreters

⁴ Other

89. In the last 12 months, how

often did this interpreter

provided by the health plan

treat you with courtesy and

respect?

¹ Never

² Sometimes

³ Usually

⁴ Always

90. We want to know your rating of

the interpreter provided by the health plan that you had most often in the last 12 months. Using any number from 0 to 10, where 0 is the worst interpreter possible and 10 is the best interpreter possible, what number would you use to rate the interpreter provided by your health plan most often in the last 12 months?

0 Worst interpreter possible

1

2

3

4

5

6

7

8

9

10 Best interpreter possible

91. In the last 12 months, how

often did you use a friend or

family member as an

interpreter when you talked

with talked with someone from

your health plan?

¹ Never

² Sometimes

³ Usually

⁴ Always

92. When you used a friend or

family member in the last 12

months, was an interpreter

other than a friend or family

member available from your

health plan?

¹ Yes

² No

93. In the last 12 months, did you use friends or family members as interpreters because that was what you preferred?

¹ Yes

² No

THANK YOU FOR COMPLETING THE SURVEY!

Please return the completed survey in the postage-paid envelope.

Mail to:

DataStat

3975 Research Park Drive

Ann Arbor, MI 48108

 

Revised 01-08-2011