Version 6.4
10/16/2012
– page
VAWH Survey Instrument Draft
Note: Population= Never users, current users (within the past 24 months), ever users (can include all categories of users or exclude current users)
SCREENING I - CONTACT AND CONFIRM IDENTITY OF RESPONDENT
S1. Hello, this is [iwr name] calling on behalf of the Department of Veterans Affairs. May I speak with [MS.] [FIRST NAME] [LAST NAME] to conduct an official survey?
I am calling from Altarum Institute, a non-profit health research organization. The Department of Veterans Affairs has requested we conduct a survey about your knowledge of, and interaction with, the health system and services offered by the VA. You may have already received an information packet in the mail about this survey. It is very important that we gather valuable feedback from all women veterans and we appreciate your participation. Portions of this call may be recorded for quality assurance purposes. The length of the survey varies based upon how many questions apply to you, but will not exceed 45 minutes.
SCREENING II - DETERMINE ELIGBILITY TO PARTICIPATE IN SURVEY
S2. Are you a woman who has ever served in the active U.S. Armed Forces?
Yes
No
No, not a woman TERMINATE INTERVIEW
S3. Are you, or were you ever, a Reservist or National Guard member and called to active duty by a Federal Order (for other than training purposes) and completed your full call-up period?
Yes
No
Don’t Know
Refused
S4. Are you currently employed by the Department of Veterans Affairs?
Yes – END
No – PROCEED to CONSENT SCRIPT
Don’t know – END
Refused – END
SCREENING III - CONSENT SCRIPT & PRA STATEMENT GO HERE
PRA Statement: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this registration will average 40 minutes. Submission of this form is voluntary and failure to respond will have no impact on benefits to which you may be entitled.
Before we begin, I want to assure you that providing information in this survey is voluntary. There is no penalty and your VA benefits will not be affected in any way if you choose not to respond. The information you provide will be treated as private, and your name will not linked with your answers. No identifying information about you is provided to the VA. Some questions in this survey deal with health issues and your military experience, and these questions may be upsetting to some people. If you are uncomfortable with any question, just tell me and we will skip it.
May I have your consent to start the interview?
MILITARY BACKGROUND AND RELATIONSHIP WITH THE VA
Let’s get started.
B1. In what year did you begin your initial active military service?
Year (4 digit)
Don’t know
Refused
B2. In what year did you last separate from active service?
Year (4 digit)
XX years ago (calculate year)
Don’t know
Refused
B3. In which branch(s) of the military did you serve? (Select all that apply)
Army or affiliated Corps (WAC, WAAC, ANC)
Marine Corps
Navy or affiliated Corps (WAVES, NNC)
Air Force or affiliated Corps (WAF, AFNC, WASPS)
Coast Guard or affiliated Corps (SPARS)
Don’t know
Refused
B4. What grade did you hold at the time of your last separation from service? (or that you currently hold if still in the military)
Grade
Don’t Know
Refused
B5. Did you ever serve in a combat or war zone as a member of the military? (can be as active duty or mobilized reserve or national guard)
Yes
No
Don’t Know
Refused
B6. Have you ever applied for ANY benefits through the Department of Veterans Affairs (VA)? (health care, claim for disability. home loans, insurance, education, etc.)
Yes
No
Don’t know
Refused
B7. Do you have a VA service-connected disability rating?
Yes
No – SKIP to B8
Don’t know – SKIP to B8
B7a. What is your VA service-connected disability rating?
Any numeric response from zero to 100%
Don’t know
Refused
B8. Are you currently enrolled with the Veterans Health Administration?
Yes
No
Don’t know
Refused
INTRO: During this interview, we are going to talk about three general ways that women Veterans can receive healthcare. The first is directly at a VA site of care, such as a VA medical center, a VA hospital, or a VA outpatient clinic. The second way is when VA pays for care received by a woman Veteran outside of a VA site-of-care; this is sometimes called contract care or fee-basis care. And the third way is when a woman just receives care completely outside the VA system, from regular civilian providers who are not associated with the VA. This next section includes questions about these different categories of care.
B9. In the past 24 months, have you received any care in a VA site of care?
Yes
No
Don’t know
Refused
B10. In some cases, VA pays for a woman to receive care from a non-VA clinic or hospital. This is called “fee basis” or “contract care” care. In the past 24 months, have you received any care through the VA fee basis or contract care system?
Yes
No
Don’t know
Refused
B11. Some women receive other health care outside the VA that they pay for through private insurance, through Medicare or Medicaid, or out of pocket. In the past 24 months, have you received any care in a non-VA setting?
Yes
No
Don’t know
Refused
INTRO: Please remember the three care settings I described earlier: Care received through a VA site of care; Care received through the VA “fee basis” system, and Care received completely outside the VA system. Throughout this survey you will be asked questions separately about each of these three care settings.
B12. When was your MOST RECENT visit to a VA health care site of care?
Date (Need at least a year)
## years ago (would need to calculate year)
Never
Don’t Know
Refused
B13. If you can, please identify the VA site of care nearest to your HOME?
List name or description provided – at least city/state
Don’t know
Refused
IF B9 = YES continue to B14, B15.
IF B9 = NO skip to Section C.
B14. At which VA site of care do you receive most of your healthcare?
Name of facility or city of facility
Don’t know
Refused
B15. About how much of your health care did you receive from a VA site of care in the last 24 months?
All
Most
Some
Little
None
Don’t know
Refused
Comprehension/Outreach
INTRO: The VA offers a range of benefits to Veterans. Telling Veterans about these benefits is an ongoing effort. The next set of questions is about getting information from the VA.
Repeat C1, C2, C3, C4 for each of the following:
(a) Eligibility requirements for VA health care services
(b) Health services at the VA that are available to me
(c) Health services at the VA that are available to women veterans specifically
(d) How to get health care services at the VA
C1. Do you have as much information as you would like about ...
Yes, I have enough
No, I need a little more
No, I need a lot more
Don’t Know
Refused
C2. Do you recall receiving information about…
Yes
No
Don’t know
Refused
IF C2 = NO, Don’t Know, Refused skip to C5.
C3. Did you get this information from (select all) …
(a) Health provider
(b) Newspaper, magazine, or on television
(c) Friends, family, or another veteran
(d) Website or blog
(e) Talking to a VA representative
(f) Brochure or other handout from the VA
IF >= 2 responses for C3 continue to C4.
Otherwise, SKIP to C5.
C4. Which of these sources of information was the most helpful to you in understanding your VA benefits?
Respondent states response from # C3.
Don’t Know
Refused
C5. If the VA were trying to reach you to provide information about eligibility for VA health care, what would be the best way? (CHOOSE ONE) Would it be:
By telephone
By mail
By e-mail
Through a website or blog
Newspapers, magazines, or on television
Through social media
Don’t Know
Refused
If separated in the past 10 years (based upon answer to B2 in previous section) continue to C6. Otherwise skip to Section E.
C6. If VA were trying to reach you to provide information about eligibility and benefits for VA health care, when would you have liked to receive this information? Please select ONE of the following:
Prior to separation from the military
Shortly after separation or post deployment (less than a year)
One year after separation or post deployment
Repeatedly on an annual basis after separation or post deployment
Don’t Know
Refused
Ease of Access (Distance/transportation, childcare, and access)
INTRO: VA is interested in understanding where veterans get their health care and some basic information about how that care is received. In the next section, I will ask you questions about how you access care, and any issues you faced in getting that care.
Some of these questions ask specifically about Primary Health Care. Primary Health Care is defined as general medical care and health prevention services.
E1. Do you currently have one person (or team of providers in one clinic) that you consider to be your primary care provider?
YES
NO
NO, I haven’t gotten Primary Care in the last 24 months – SKIP to E5
Don’t know
Refused
E2. Is your usual source of primary care from the VA or from a non-VA provider?
VA - SKIP to E3
Non-VA
Don’t know
Refused
E2a. Do you get any of your primary care from a VA site of care?
YES
NO
Don’t know
Refused
E3. Thinking about where you usually go for primary care, how long does it typically take you to get there?
Less than 15 minutes
15-29 minutes
30-44 minutes
45-60 minutes
More than one hour
Don’t Know
Refused
(Current User) If B9 ^=Yes -- Continue to E4
(Not Current User) If B9 ^= No -- SKIP to Intro leading into E9
E4. Is the VA site of care nearest you where you normally get your primary care?
Yes SKIP to E6
No proceed to E5
Don’t Know – SKIP to E6
Refused – SKIP to E7
E5. We are interested in why you do not receive primary care services at your nearest VA site of care. Please select the answer that best describes why you do not get VA care at the VA site of care nearest you.
The women’s services I need are not available
The hours I want are not available
I do not feel the providers are good
I am unable to choose whether my provider is a man or woman
Other (specify)
Don’t Know
Refused
E6. The next question asks about transportation for you to get your VA site of care. Would you say that finding transportation to your medical care is:
Very easy
Somewhat easy
Neither easy, nor hard
Somewhat hard, or
Very hard
Don’t Know
Refused
E7. This question asks about transportation for your medical care to a non-VA health care site of care. Would you say that finding transportation to your medical care is:
Very easy
Somewhat easy
Neither easy, nor hard
Somewhat hard, or
Very hard
Don’t know
Refused
(Current User) If B9 ^=Yes -- Continue to E8
(Not Current User) If B9 ^= No -- SKIP to intro leading into E9
E8. Please indicate the mode of transportation you prefer to use when you have an appointment for your health care at a VA site of care. Would you prefer to …
Drive yourself
Have a family member, friend, or significant other drive you
Take public transportation
Use shuttle services
Other (specify)
INTRO: In the next set of questions, I will ask you about the types of health care you may have received in the past 24 months, such as women’s specific health care. Please note that women’s specific health care refers to care such as pap smears, mammograms, birth control, prenatal care, HPV vaccination, or menopausal support. I will also ask about Mental Health Services you may have received.
<<IF YES TO B9 (Current User) THEN ANSWER #E9, Otherwise SKIP to E10>>
E9. What types of health care services have you received at any VA site of care in the past 24 months? Please select all that apply
Yes
No
Don’t Know
Refused
E9a. Primary care (General Medical Care)
E9b. Routine Women’s Health services (such as pap smears, contraception, breast exams)
E9c. Gynecology Referral Services (such as abnormal pap, abnormal bleeding, GYN surgery)
E9d. Maternity care (Pregnancy care)
E9e. Inpatient care
E9f. Emergency Department care
E9g. Mental Health Services
E9h. Specialty care
E9i. Other (specify)
E9j. None
<< IF YES TO B10 (fee basis care) THEN ANSWER E10, otherwise SKIP to E11>>
E10. What types of health care services have you received as FEE BASIS care in the past 24 months? Please select all that apply
Yes
No
Don’t Know
Refused
E10a. Primary care (General Medical Care)
E10b. Routine Women’s Health services (such as pap smears, contraception, breast exams)
E10c. Gynecology Referral Services ((such as abnormal pap, abnormal bleeding, GYN surgery)
E10d. Maternity care (Pregnancy care)
E10e. Inpatient care
E10f. Emergency Department care
E10g. Mental Health Services
E10h. Specialty care
E10i. Other (specify)
E10j. None
<< if responded YES any of items a-d on questions E9 or E10, proceed to E11, otherwise skip to E12. >>
E11. How helpful was VA in coordinating your care (refers to types of E9a-d and/or E10a-d)?
Extremely helpful
Very helpful
Somewhat helpful
Not at all helpful
Don’t Know
Refused
<< if responded YES to E10d (maternity fee-basis care), proceed to E12, otherwise skip to E13. >>
E12. Since your pregnancy, have you received any care from VA?
Yes
No
Don’t Know
Refused
<< if YES
to Mental Health Services (E9g or E10g), proceed to E13, otherwise
skip
to E14 >>
E13. The VA has separate facilities, called Vet Centers, which provide counseling and mental health services. Regarding the Mental Health Services you accessed, did you receive these services from a Vet Center?
Yes
No
Don’t Know
Refused
<<REPEAT QUESTION SET BELOW (E14-E17) FOR EACH TYPE OF CARE (PC, WH, MAT, MH) RESPONDENT LISTED IN E9 (care at a VA site of care). OTHERWISE SKIP TO E18. >>
INTRO to E14-E17: This next set of questions will ask about your experiences getting (or attempting to get) appointments for primary care, women-specific health care, maternity care, or mental health care you received at a VA site of care.
Using a scale from 1 to 5, where 1 is poor and 5 is outstanding, how would you rate your experience in the past 24 months getting an appointment as soon as you thought you needed it for ______________ at your VA site of care?
E14. Primary Care
E15. Routine Women’s Services
E16. Maternity Care
E17. Mental Health Care
1 POOR
2
3
4
5 OUTSTANDING
Don’t know
Refused
<<ask to all>>
E18. In general, does your VA site of care have appointment times that are convenient for you to get care?
YES
NO
Don’t know
Refused
E19. We are interested in what appointment times are most convenient for you to receive health care. In general, which of the following appointment times do you prefer? Would you say… (Choose one)
Mornings
Afternoons
Evenings
Weekends
Don’t know
Refused
E20. Do you have dependent children living with you (aged 17 or younger)?
Yes proceed to E21
No SKIP to E23
Don’t know
Refused
E21. The next question asks about finding childcare while you receive medical care. When you have an appointment for your health care would you say that finding childcare is…
Very easy
Somewhat easy
Neither easy nor hard
Somewhat hard
Very hard
I do not need child care <<skip to E23>>
Don’t know <<skip to E23>>
Refused <<skip to E23>>
E22. How helpful would onsite childcare be for you?
Very helpful
Somewhat helpful
Not helpful
Don’t Know
Refused
<<ask E23 if any VA use indicated in B9 or B10, otherwise SKIP to E24>>
E23. What is the main reason you chose to use VA health care services in the past 24 months? (choose one)
I have no other insurance
It’s the most convenient for me
They have good quality of care
They have good prescription benefits
They are sensitive to needs of Veterans
They have care specific to my Service-connected disability
Other (specify) ______________________
<<ask if non-VA care use was indicated in B11, otherwise skip to section W>>
[Note that dual VA and non-VA users will get both E23 and E24]
E24. What is the main reason you chose to use health care services outside of the VA in the past 24 months? (choose one)
I do not know if I am eligible for VA care
I have insurance outside of the VA
My non-VA care location is more convenient
VA does not have the services I need
VA does not have a women’s clinic
The quality of care outside the VA is better
I do not feel like I belong at the VA
Other (specify) ______________________
Gender Specific and Sensitivity Barriers
INTRO: In this section I will use the term “Comprehensive Primary Care” which means having one provider who can provide your general medical care and your routine women’s health care such as Pap smears, contraception, and menopause care.
W1. Are you currently getting Comprehensive Primary Care?
Yes
No >> SKIP to W4
Don’t know >> SKIP to W4
Refused >> SKIP to W4
W2. Are you receiving it at a women’s only health clinic?
Yes
No >> SKIP to W4
Don’t know >> SKIP to W4
Refused >> SKIP to W4
W3. Are you receiving it in VA?
Yes
No
Don’t know
Refused
<<If W1 = YES , SKIP to W6>>
W4. Where do you get your primary care?
Primary care or family health clinic
Urgent Care center
Emergency Department
Do not get primary care
Don’t know
Refused
W5. Where are you getting women-specific preventive care such as breast exams and PAP smears?
Primary care or family health clinic
Urgent Care center
Clinic just for Pap Smears and breast exams
My Gynecologist
Community Health Clinic (such as planned parenthood)
Not getting any women-specific care
Don’t know
Refused
W6. How important to you is it to receive all or most of your care from a clinic that is just for women?
Very Important
Somewhat Important
Not very Important
Not at all Important
Don’t know
Refused
W7. How important to you is having just one provider provide your primary care and your women’s specific care?
Very Important
Somewhat Important
Not very Important
Not at all Important
Don’t know
Refused
W8. How important to you is it to have a female provider for your women’s specific health care services?
Very Important
Somewhat Important
Not Very Important
Not at all Important
I prefer a male provider
Don’t know
Refused
W9. How strongly do you agree with the following statement: “At VA sites of care, women may see a female provider if they want to”?
<< If a current user (based upon B9), proceed to W10 >>
<< If a ‘non-current ever user’ or ‘non-user’ SKIP to W16>>
W10. Now thinking only about your primary care experience(s) at your VA site of care in the past 24 months, how satisfied are you with the following items:
Completely Satisfied
Somewhat Satisfied
Neither Satisfied Nor Dissatisfied
Somewhat Dissatisfied
Completely Dissatisfied
Don’t know
Refused
W10a. your provider(s)’ general medical knowledge?
W10b. your provider(s)’ knowledge of women’s specific health needs?
W10c. how well your provider(s) understands your needs and concerns as a woman veteran?
W10d. the amount of time your provider(s) spent with you?
W10e. the amount of information you received from your provider(s)?
W11. Considering all of your health care experience(s) at your VA site of care in the past 24 months, please indicate the level of respect you were shown by your primary care provider:
A lot
Some
A little
None
Not applicable
Don’t know
Refused
W12. Considering all of your health care experience(s) at your VA site of care in the past 24 months, please indicate the level of respect you were shown by any other providers you may have seen, such as specialist physicians, nursing staff, or physical therapists:
A lot
Some
A little
None
Not applicable
Don’t know
Refused
W13. Considering all of your health care experience(s) at your VA site of care in the past 24 months, please indicate the level of respect you were shown by office staff at your clinic or facility:
A lot
Some
A little
None
Not applicable
Don’t know
Refused
W14. Many VA facilities have a staff member called the Women Veterans Program Manager or the WVPM. Did you work with a WVPM at the facility you went to?
Yes
No >> Skip to W15
DK >> Skip to W15
W14a. How much do you agree or disagree with the following statement: “The WVPM was helpful with getting the health care and services I needed”?
Strongly Agree
Somewhat Agree
Neither Agree nor Disagree
Somewhat Disagree
Strongly Disagree
DK
Refused
W15. How much would you agree or disagree with the following statements:
Strongly Agree
Somewhat Agree
Neither agree nor disagree
Somewhat Disagree
Strongly Disagree
Don’t know
Refused
W15a. The VA health care system provides quality health care
W15b. The VA health care sites of care are welcoming to women
W15c. The VA providers’ skills are equal to private sector
W15d. The VA health care system provides specialized services for women
Perception of Personal Safety/Comfort
<< This section will be asked only of current users (within the last 24 months) (based upon B9), others SKIP to section MH >>
INTRO: Women’s experiences when coming to a VA site of care are very important. In this next section, I will ask you about your experiences at VA sites of care.
SC1. This set of questions asks about your opinion of the facilities in which care is delivered within the VA. Please indicate how much you agree or disagree with the following statements:
Strongly Agree
Somewhat Agree
Neither agree nor disagree
Somewhat Disagree
Strongly Disagree
Don’t know
Refused
SC1a. The physical facility was well-maintained and clean
SC1b. The parking areas were accessible
SC1c. I could safely get from the parking area to the facility
SC1d. The check-in areas had adequate privacy
SC1e. The waiting areas were comfortable and welcoming
SC1f. I had adequate privacy in the exam room
SC1g. The exam room was clean
SC1h. The women’s restrooms were accessible
SC1i. There was a place for my family members/caregivers to wait for me
SC2. In the last 24 months, did you have an inpatient stay other than for mental health reasons at a VA Medical Center (where you were admitted to the hospital and stayed overnight)?
YES – proceed to SC3
NO - SKIP to SC4
Don’t know - SKIP to SC4
Refuse – SKIP to SC4
SC3. Thinking about your inpatient stay at a VA Medical Center within the last 24 months, please indicate you how much you agree or disagree with the following statements:
Strongly Agree
Somewhat Agree
Neither agree nor disagree
Somewhat Disagree
Strongly Disagree
Don’t know
Refused
SC3a. The admission process was easy
SC3b. My room was clean and had the equipment I needed
SC3c. I felt safe during my inpatient stay
SC3d. I had access to a private bathroom during my stay
SC3e. I was able to secure my door at night during my stay
SC3f. I felt comfortable while showering
SC3g. The admission process did not take a long time
SC4. In the last 24 months, did you have a mental health related inpatient stay at a VA Medical Center or Community Based Outpatient Clinic?
YES – proceed to SC5
NO – SKIP to MH1
Don’t know – SKIP to MH1
Refuse – SKIP to MH1
SC5. Thinking about your mental health inpatient stay at a VA Medical Center within the last 24 months, Please indicate how much you agree or disagree with the following statements:
Strongly Agree
Somewhat Agree
Neither agree nor disagree
Somewhat Disagree
Strongly Disagree
Don’t know
Refused
SC5a. The admission process was easy
SC5b. My room was clean and had the equipment I needed
SC5c. I felt safe during my inpatient stay
SC5d. I had access to a private bathroom during my stay
SC5e. I was able to secure my door at night during my stay
SC5f. I felt comfortable while showering
SC5g. The admission process did not take a long time
Mental Health Stigma and Care
INTRO: In the next section, I will ask you some questions about mental health diagnoses and care. You are free to skip any question you feel uncomfortable answering, and I will move onto the next question.
MH1. Have you ever been diagnosed with a TBI (traumatic brain injury)?
YES
NO
Don’t know
Refused
MH2. Have you ever been diagnosed with PTSD (post traumatic stress disorder)?
YES
NO
Don’t know
Refused
MH3. Have you ever been diagnosed with Depression)?
YES
NO
Don’t know
Refused
MH4. Have you ever felt you needed mental health services related either to your military service or to any other life situation?
YES
NO
Don’t know
Refused
MH5. Have you ever felt hesitant to seek or receive needed mental health care services?
YES - proceed to MH6
NO – SKIP to MH7
Don’t know – SKIP to MH7
Refused – SKIP to MH7
MH6. Thinking about why you felt hesitant to seek care for mental health care services, please tell me how much you agree or disagree with the following statements:
Strongly Agree
Somewhat Agree
Neither agree nor disagree
Somewhat Disagree
Strongly Disagree
Don’t know
Refused
MH6a. I would think less of myself
MH6b. Others would think less of me
MH6c. It could negatively affect my job
MH6d. It could affect my relationship with my spouse, children or family
MH6e. I am not sure that mental health care will help me
MH6f. I am worried about medicines used to treat mental health problems
MH6g. I prefer to try spiritual or religious counseling
MH7. In your life, did you ever receive uninvited or unwanted sexual attention (i.e. touching, cornering, pressure for sexual favors, etc.)?
YES - proceed to MH7a
NO - SKIP to MH8
Don’t know - SKIP to MH8
Refused – SKIP to MH8
MH7a. Did this occur while in the military?
YES
NO
Don’t Know
Refused
MH8. In your life, did anyone ever use force or the threat of force to have sex with you against your will?
YES - proceed to MH8a
NO – SKIP to NEXT Section
Don’t know– SKIP to NEXT Section
Refused – SKIP to NEXT Section
MH8a. Did this occur while in the military?
YES
NO
Don’t Know
Refused
<<IF EITHER MH7 OR MH8 are YES, proceed to MH9; Otherwise SKIP to NEXT Section>>
MH9. Did you ever avoid using the VA because of this (these) experience(s)?
YES
NO
Don’t know
Refused
General Health Status Questions
INTRO: Now a few questions about your health status.
G1 . How would you describe your general health status?
Excellent
Very Good
Good
Fair
Poor
Don’t know
Refused
G2 . How would you describe your mental health status?
Excellent
Very Good
Good
Fair
Poor
Don’t know
Refused
G3. Before the final section, I want to provide the opportunity for you to share any feedback you may have regarding your perceptions of, or experiences with, the health system within the Department of Veterans Affairs. What would you like the VA to know?
<<open ended response>>
End of Survey Demographic Questions
INTRO: Thank you for sharing your feedback about your healthcare experiences. Now I just have some general questions about you.
D1. In what year were you born?
Year (4 digit)
Don’t Know
Refused
D2. Are you …. ?
Married, living as married (heterosexual partnership)
Domestic partnership/civil union(gay relationship)
Divorced
Separated
Widowed
Never married
Don’t know
Refused
D3. Are you of Hispanic, Latino or Spanish origin?
Yes
No
Don’t know
Refused
D4. Regarding your racial or ethnic background, how do you prefer to identify yourself? You may choose one or more.
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White or Caucasian
Don’t know
Refused
D5. What is the highest grade or year of school you have completed?
Less than a high school graduate or GED
High School Graduate or GED
Trade, vocational or technical training after high school
Some college or an Associate’s Degree
Bachelor’s Degree
Graduate degree (MD, PhD, MA, JD)
Don’t know
Refused
D6. What is your current employment status?
Employed for wages or salary
Self-employed
Unable to work (includes disabled)
Unemployed and looking for work (includes recently laid off)
A full-time homemaker
A full-time student
Retired
A full-time caregiver (to a child or adult parents)
Volunteers (does volunteer work),
Don’t know
Refused
<< if responded as “employed for wages or salary” in D6, proceed to D7 – otherwise SKIP to D8 >>
D7. At any time in the last 24 months were you unemployed when you wanted to be working?
Yes
No
Don’t know
Refused
D8. In the last 24 months, was there any time when you had no healthcare insurance or coverage?
Yes
No SKIP to D10
Don’t know
Refused
D9. Do you currently have any type of health care insurance for yourself?
Yes
No SKIP to D11
Don’t know
Refused
D10. What type of health care insurance or health coverage do you have for yourself?
Employer-based or private health insurance
TRICARE (in any form)
Medicaid
Medicare
Other
Don’t know
Refused
D11. At any time in the last 24 months have you been homeless?
Yes
No
Don’t know
Refused
D12. I would like to confirm the ZIP Code where you reside. Our records currently show your ZIP code as <<state ZIP code>>. Is this still correct?
Yes
No – correct ZIP provided by respondent
No – refused
D13. Can you tell me which of these categories best reflects of your total annual household income? Would you say….
$10,000 or less
$10,001 - $20,000
$20,001 - $30,000
$30,001 - $40,000
$40,001 - $50,000
$50,000 - $100,000
Over $100,000
Don’t know
Refused
<< CLOSING SCRIPT>> <<state respondent’s name>> , we really appreciate your participation in this survey. Your input will help the VA make important decisions about delivery of information and healthcare services to women Veterans. I have one final question before you go.
D14. Which has been the most significant barrier that has kept you from using VA care (now or in the past)?
I don’t understand my benefits
I haven’t been provided with any information about VA healthcare
I have no way to get to a VA facility
The VA is too far away
The VA hours are inconvenient
I have no access to child care
VA facilities lack Privacy or Safety
VA providers are not sensitive to women’s needs
There is not enough access to women’s services
I am embarrassed or afraid to seek mental health services
Other
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Laura Nelson |
| File Modified | 0000-00-00 |
| File Created | 2021-01-28 |