Form 1019 2017 1019 DHA MSO-VSO Outreach Functional 5.23.17

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Overview

Model Questions
Custom Questions

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Sheet 1: Model Questions

Model Name		DHA MSO-VSO Outreach Functional					Red & Strike-Through: Delete
Model ID		NEW MEASURE needs MID					Underlined & Italicized: Re-order
Partitioned		No					Pink: Addition
Date		5/23/2017
Model Version		NA					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
					Satisfaction			Recommend Meetings and Engagements (1=Very Unlikely, 10=Very Likely)
				Satisfaction - Overall	What is your overall satisfaction with meetings and engagements that you have had with the Defense Health Agency/Military Health System? (1=Very Dissatisfied, 10=Very Satisfied)		Recommend Meetings and Engagements	How likely are you to recommend meetings and engagements with DHA/MHS to someone else?
				Satisfaction - Expectations	How well have meetings and engagements with the DHA/MHS met your expectations? (1=Falls Short, 10=Exceeds)
				Satisfaction - Ideal	How do the meetings and engagements with DHA/MHS compare to ideal organizational meetings and engagements? (1=Not Very Close, 10=Very Close)

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Sheet 2: Custom Questions

Model Name	DHA MSO-VSO Outreach Functional				Red & Strike-Through: Delete
Model ID	NEW MEASURE needs MID				Underlined & Italicized: Re-order
Partitioned	No				Pink: Addition
Date	5/23/2017				Blue: Reword
QID	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
		How do you prefer to get information from the DHA/MHS?	Meetings (physical location)		Y	Radio button, one-up vertical	Skip Logic Group*	Info Channel Preference
			Online meetings
			From my supervisor or through my organization
			Website
			Social media
			Email
			RSS feeds
			Printed materials (regular mail or pickup)
			Other	A
			No preference
	A	Please tell us how you prefer to receive DHA/MHS information:			N	Text field, <100 char	Skip Logic Group*	Info Channel OE
		Does your organization share DHA/MHS content with others?	Yes	A, B	Y	Radio button, one-up vertical	Skip Logic Group*	Share Content
			No	B
			Not sure	B
	A	How often does your organization share DHA/MHS content?	Constantly		Y	Radio button, one-up vertical	Skip Logic Group*	Share Frequency
			Weekly or several times a week
			Monthly or several times a month
			Every few months
			Once every six months or less often
			Not sure
	A	In what ways does your organization share DHA/MHS content with others? (Please select all that apply.)	In meetings		Y	Checkbox, one-up vertical	Skip Logic Group*	Share Method
			Email alerts
			Social media
			Website
			Blog posts
			RSS feeds
			Printed material (newsletter, brochures, etc.)
			Other
			Not sure
	B	Is there anything we could do further to make it more likely that you would repurpose communications material from DHA/MHS?	Yes	B1	Y	Radio button, one-up vertical	Skip Logic Group*	Share Improve Idea
			No, nothing further needed
			Not sure
	B1	If you have any ideas on how we can make it easier to repurpose our communications (or content) please share them here.			N	Text area, no char limit	Skip Logic Group*	Share Improve OE
		Have you attended DHA/MHS meetings? (physical or online)	Yes	A, B	Y	Radio button, one-up vertical	Skip Logic Group*	Meeting Attended
			No
	A	Please indicate which type of meeting you have attended. (Please select all that apply.)	Quarterly executive meetings	Q	Y	Checkbox, one-up vertical	Skip Logic Group*	Meeting Type
			Working Group meetings (8 per year)	W
			Other meetings provided by DHA/MHS
	A	How long ago was the last meeting you attended?	Less than a month ago		Y	Radio button, one-up vertical	Skip Logic Group*	Meeting Last Attend
			1 to 2 months ago
			3 to 4 months ago
			5 to 6 months ago
			More than 6 months ago
	A	Were you asked for your input on the next meeting topic?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Meeting Topic Requested
			No
			Not applicable
	A	Are you aware that you can suggest topics for future meetings?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Meeting Topic Aware
			No	A1
			Not applicable	A1
	A1	If you have any ideas for future meeting topics that you would like to share in this survey, please provide them here.			N	Text area, no char limit	Skip Logic Group*	Meeting Topic OE
	B	Where have you attended meetings? (Please select all that apply.)	Gatehouse Facility	C	Y	Checkbox, one-up vertical	Skip Logic Group*	Meeting Venue
			DHA building	C
			Other physical location
			Via telecom / attended online	D
	C	If you have any comments regarding physical aspects or access to the Gatehouse or DHA building venues, please share them here.			N	Text area, no char limit	Skip Logic Group*	Meeting Venue OE
	D	Did you have any issues with connecting, or your ability to participate in discussion, during your last online or telecom meeting?	Yes I had issues	D1	Y	Radio button, one-up vertical	Skip Logic Group*	Meeting Online Issues
			No issues
	D1	Please describe the issue you had with your online connection or your ability to participate.			N	Text area, no char limit	Skip Logic Group*	Meeting Online OE
	Q	Please select the answer that best completes the following statements about quarterly meetings: The length of the quarterly executive meetings is:	Too short		Y	Radio button, one-up vertical	Skip Logic Group*	Meet Q Length
			About right
			Too long
	Q	Quarterly executive meetings should be held:	Less often		Y	Radio button, one-up vertical	Skip Logic Group*	Meet Q Frequency
			Current schedule is about right
			More often
	Q	The topics chosen for quarterly meeting are:	Never of interest		Y	Radio button, one-up vertical	Skip Logic Group*	Meet Q Topic Interest
			Rarely of interest
			Sometimes of interest
			Often of interest
			Always of interest
	Q	The degree of usefulness of quarterly meeting content is:	Never useful	Q1	Y	Radio button, one-up vertical	Skip Logic Group*	Meet Q Usefulness
			Rarely useful	Q1
			Sometimes useful	Q1
			Often useful
			Always useful
	Q1	Please share any ideas on how we can make the quarterly meetings more useful for you.			N	Text area, no char limit	Skip Logic Group*	Meet Q Useful OE
	W	Please select the answer that best completes the following statements about working group meetings: The length of the working group meetings is:	Too short		Y	Radio button, one-up vertical	Skip Logic Group*	Meet W Length
			About right
			Too long
	W	Working group meetings should be held:	Less often		Y	Radio button, one-up vertical	Skip Logic Group*	Meet W Frequency
			Current schedule is about right
			More often
	W	The topics chosen for working group meetings are:	Never of interest		Y	Radio button, one-up vertical	Skip Logic Group*	Meet W Topic Interest
			Rarely of interest
			Sometimes of interest
			Often of interest
			Always of interest
	W	The degree of usefulness of working group meeting content is:	Never useful	W1	Y	Radio button, one-up vertical	Skip Logic Group*	Meet W Usefulness
			Rarely useful	W1
			Sometimes useful	W1
			Often useful
			Always useful
	W1	Please share any ideas on how we can make the working group meetings more useful for you.			N	Text area, no char limit	Skip Logic Group*	Meet W Useful OE
		Have you reviewed or shared any of the communication Toolkits provided by DHA/MHS?	Yes	T	Y	Radio button, one-up vertical	Skip Logic Group*	Toolkit Access
			No
			Not sure
	T	Please select your level of agreement with the following statements about DHS/MHS Toolkits: Toolkit content is clear and easy to understand.	1=Strongly Disagree		Y	Radio button, scale, has don't know	Skip Logic Group*	Toolkit Clarity
			2
			3
			4
			5
			6
			7
			8
			9
			10=Strongly Agree
			Don’t know
	T	Toolkit information is thorough and complete.	1=Strongly Disagree		Y	Radio button, scale, has don't know	Skip Logic Group*	Toolkit Complete
			2
			3
			4
			5
			6
			7
			8
			9
			10=Strongly Agree
			Don’t know
	T	Toolkit information has been useful to me or my organization.	1=Strongly Disagree		Y	Radio button, scale, has don't know	Skip Logic Group*	Toolkit Useful
			2
			3
			4
			5
			6
			7
			8
			9
			10=Strongly Agree
			Don’t know
	T	Overall, I've been satisfied with the Toolkits I've reviewed.	1=Strongly Disagree	T1	Y	Radio button, scale, has don't know	Skip Logic Group*	Toolkit Satisfaction
			2	T1
			3	T1
			4	T1
			5	T1
			6	T1
			7
			8
			9
			10=Strongly Agree
			Don’t know
	T1	If you have any comments about how we might improve any Toolkits you have reviewed, please share them here. (Please include the Toolkit topic as well.)			N	Text area, no char limit	Skip Logic Group*	Toolkit Improve OE
		Have you worked with DHA/MHS to help you or your organization to understand and/or implement aspects of the NDAA (National Defense Authority Act)?	Yes	N	Y	Radio button, one-up vertical	Skip Logic Group*	NDAA Help Given
			No
	N	How satisfied were you with the NDAA support you received from DHA/MHS?	1=Very Dissatisfied	N1	Y	Radio button, scale, has don't know	Skip Logic Group*	NDAA Satisfaction
			2	N1
			3	N1
			4	N1
			5	N1
			6	N1
			7
			8
			9
			10=Very Satisfied
			Don’t know
	N1	If you have any ideas on how we could improve our NDAA support to your or others, please share them here.			N	Text area, no char limit	Skip Logic Group*	Acquisition Source - Other
		Which best describes you?	Active duty service member (includes all uniformed services)		Y	Radio button, one-up vertical		Role
			Retired service member
			National Guard or Reserve member (active, reserve or retired)
			Family of active duty service member
			Family of retired service member
			Family of National Guard or Reserve member
			Other (provider, staff, government, media, etc.)
		Do you belong to any of these Military or Veteran Service Organizations? (Please select all that apply.)	Air Force Association (AFA)	B	Y	Checkbox, one-up vertical	Skip Logic Group*	MSO Key Groups
			American Legion	B
			AMVETS (American Veterans)	B
			AMSUS, the Society of Federal Health Professionals	B
			Association of Military Surgeons of the US	B
			Association of the United States Army (AUSA)	B
			Association of the United States Navy (AUSN)	B
			Blue Star Families	B
			Fleet Reserve Association (FRA)	B
			Military Officers Association of America (MOAA)	B
			National Guard Association of the United States (NGAUS)	B
			National Military Family Association (NMFA)	B
			Reserve Officers Association (ROA)	B
			VFW (Veterans of Foreign Wars)	B
			I belong to another Military or Veterans Service Organization	A, B
			I do not belong to any Military or Veteran Service organizations				Mutually Exclusive
	A	Are you a member of any of these other organizations? (Please select all that apply.)	Army Aviation Association of America (AAAA)		N	Checkbox, one-up vertical	Skip Logic Group*	MSO Other Groups
			Blue Star Families
			Commissioned Officers Association of the US Public Health Service (COA)
			Chief Warrant Officers Association of the US Coast Guard (CWOA)
			Enlisted Association of the National Guard of the United States (EANGUS)
			Gold Star Wives of America (GSW)
			Jewish War Veterans of the United States of America (JWV)
			Marine Corps League (MCL)
			Iraq and Afghanistan Veterans of America
			Marine Corps Reserve Association (MCRA)
			Military Chaplains Association of the United States of America (MCA)
			Military Order of the Purple Heart (MOPH)
			Naval Enlisted Reserve Association (NERA)
			Non Commissioned Officers Association (NCOA)
			Service Women's Action Network (SWAN)
			The Retired Enlisted Association (TREA)
			Tragedy Assistance Program for Survivors (TAPS)
			United States Army Warrant Officers Association (USAWOA)
			USCG Chief Petty Officers Association (CPOA)
			Vietnam Veterans of America (VVA)
			None of the above				Mutually Exclusive
	B	If there are consistent themes or issues raised by your members around health care and benefits for which DHA/MHS could provide support, please share them here.			N	Text area, no char limit	Skip Logic Group*	MSO Concerns OE
	B	Would your group be interested in having a DHA speaker speak at any of your meetings or conferences?	We already do this		N	Radio button, one-up vertical	Skip Logic Group*	MSO wants DHA
			Yes we would like to explore this
			Not at this time
			Don't know
	B	Which of these social media applications are used by your organization? (Please select all that apply.)	Facebook		N	Checkbox, one-up vertical	Skip Logic Group*	MSO/VSO Social Media
			Flickr
			Google+
			Instagram
			LinkedIn
			Pinterest
			reddit
			StumbleUpon
			Tumblr
			Twitter
			YouTube
			Other type of social media
			Not sure
		We value your feedback! If you have thoughts on how to improve future DHA/MHS events or communications, please share them with us here.			N	Text area, no char limit		Improvements OE
		Finally, if there are any new topics you would like to see covered in future events, communications, or toolkits, please share your ideas here.			N	Text area, no char limit		New Topics OE