VA Pittsburgh Reseach Survey

Veteran Feedback Survey on
Research at VA Pittsburgh

OMB No. 2900-0770
Estimated Burden: 3 minutes

Expiration Date: 08/31/2017

The Paperwork Reduction Act of 1995: 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 survey will average 3 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this in-person paper survey will lead to improvements in the quality of service delivery by helping to through the development of more preferred/effective communication methods about VA Pittsburgh medical research. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.

This collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the near future.

1. What is your current perception of medical research?

Check one:

Somewhat negative	Neutral	Somewhat positive
		

2. How important is medical research to you?

Check one:

Not very important	Somewhat important	Very Important
		

3. Did you know that are opportunities for Veterans to participate in research at VA Pittsburgh?

Check one:

	Yes
	No

4. Have you ever participated in a research study?

Check one:

	Yes, at VA Pittsburgh
	Yes, but not at VA Pittsburgh
	No, I have never participated in research

5. Would you be willing to participate in a research study at VA Pittsburgh in the future?

Check one:

I’m not sure	Not very/not at all willing	Somewhat willing	Very willing
			

6. How important are the following statements when considering if you would participate in a research study at VA Pittsburgh in the future?

Answer each row:

	Not important	Somewhat important	Very important
The research study could directly benefit me or make me feel better			
The research doesn’t take up too much of my time			
Compensation or money is given for my participation			
The research study has the potential to help other Veterans, even if I don’t receive any direct benefit myself			
The person who is approaching me about research is my Doctor or someone currently involved with my healthcare			
The research sounds interesting or exciting			

7. Is there anything else that would be important to you when considering participating in a research study at VA Pittsburgh in the future?

8. What do you think are the most effective ways to learn about research at VA Pittsburgh?

Check all that apply:

	Posters or pamphlets found in a doctor’s office or clinic at VA Pittsburgh
	Posters or pamphlets found in Heroes Hall, near the cafeteria and coffee shop, or other public spaces at VA Pittsburgh
	Advertisements seen on the official VA Pittsburgh Facebook page or other social media sites
	Television, Bus Ads, Radio or Newspapers advertisements
	Listing of active research studies on the VA Pittsburgh website or ClinicalTrials.gov
	Information about research on the digital media boards throughout VA Pittsburgh
	Posters or pamphlets given at local Veteran focused community events or group meetings

9. Do you have any other ideas on how we can spread the news about research at VA Pittsburgh?

10. Do you have any other comments or suggestions about research at VA Pittsburgh?

Thank you for completing this survey!

v2.0 APR2017