Form 045 2020 045 MyHealtheVet Mobile Nov 2020 (1)

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Overview

Welcome and Thank You Text
Model Questions
Custom Questions

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Sheet 1: Welcome and Thank You Text

	The text you see here will appear at the top and bottom of your survey, examples below.
	Default text is included and you may modify this text as needed.
	Welcome and Thank You Text
		Welcome Text		Welcome Text - Tablet / Phone
		Thank you for visiting . You've been randomly chosen to take part in a brief survey to let us know what we're doing well and where we can improve. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible.		Thank you for visiting . You've been selected to participate in a brief survey to let us know how we can improve your experience. Please take a minute to share your opinions.
		Thank You Text		Thank You Text - Tablet / Phone
		Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our website.		Thank you for taking our survey - and for helping us serve you better. We appreciate your input!
		Example Desktop		Example Mobile

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Sheet 2: Model Questions

Model Name	VA - My HealtheVet Mobile			Red & Strike-Through: Delete
Model ID				Underlined & Italicized: Re-order
Partitioned	Yes (2MQ)			Pink: Addition
Date				Blue: Reword
Label	Element Questions	Label	Satisfaction Questions	Label	Future Behaviors
	Look and Feel (1=Poor, 10=Excellent, Don't Know)		Satisfaction		Likelihood to Return (1=Not Very Likely, 10=Very Likely)
Look and Feel - Appeal	Please rate the visual appeal of this site.	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	Return	How likely are you to return to this site in the next 12 months?
Look and Feel - Balance	Please rate the balance of graphics and text on this site.	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)		Recommend (1=Not Very Likely, 10=Very Likely)
Look and Feel - Readability	Please rate the readability of the pages on this site.	Satisfaction - Ideal	How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close)	Recommend	How likely are you to recommend this site to someone else?
	Site Performance (1=Poor, 10=Excellent, Don't Know)				Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Loading	Please rate how quickly pages load on this site.			Trust - Level MHV	Please rate your level of trust in My HealtheVet.
Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.				Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Completeness	Please rate how completely the page content loads on this site.			Trust - Level VA	Please rate your level of trust in the VA.
	Navigation (1=Poor, 10=Excellent, Don't Know)				Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely)
Navigation - Organized	Please rate how well the site is organized.			Use Web Channel Over Others	How likely are you to use this site rather than seeking information from other sources?
Navigation - Options	Please rate the options available for navigating this site.
Navigation - Layout	Please rate how well the site layout helps you find what you need.
	Site Information (1=Poor, 10=Excellent, Don't Know)
Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
Site Information - Understandable	Please rate how understandable this site’s information is.
Site Information - Answers	Please rate how well the site’s information provides answers to your questions.
IF Applicable	Task Process (1=Poor, 10=Excellent, Don't Know)
Task Process - Time	Please rate the time it takes to complete task(s) on this site.
Task Process - Procedures	Please rate the procedures to accomplish tasks on this site.
Task Process - Efficiency	Please rate the number of steps needed to complete task(s) on this site.

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Sheet 3: Custom Questions

Model Name			#REF!				Red & Strike-Through: Delete
Model ID			#REF!				Underlined & Italicized: Re-order
Partitioned			#REF!				Pink: Addition
Date							Blue: Reword
QID	AP Question Tag	Skip From	Question Text	Answer Choices	Skip To	AP Answer Tag	Required Y/N	Type	Special Instructions	CQ Label
			For which of the following reasons did you visit the site today? (Please select all that apply)	Use Secure Messaging to communicate with my VA health care team			Y	Checkbox, one-up vertical		Visit Reason
				View my VA Notes (written by my health care team)
				Use the Veterans Health Library
				View my medication information
				Track the status of my prescription refill delivery
				Access my VA health records/Use the Blue Button or VA Health Summary
				View my lab or other test results
				Request a prescription refill
				View my VA Appointments
				Other
			Which of the following best describes you?	Active duty			Y	Radio button, one-up vertical		Role
				National Guard/Reserve
				Veteran
				Family member of a Veteran or Servicemember
				Caregiver of a Veteran or Servicemember (other than family)
				Veteran Service Organization member
				VA employee
				Non-VA federal government employee
				State/local government employee
				General public
				Other role
			How frequently do you visit the My HealtheVet web site?	First time			Y	Radio button, one-up vertical		Visit Frequency
				Daily or more than once a day
				About once a week
				About once a month
				About every 6 months
				Less than every 6 months
				Not sure/Do not recall
			Are you a registered user on the My HealtheVet web site?	Yes			Y	Radio button, one-up vertical		Registered User
				No
				Not sure/Do not recall
			How long have you been using My HealtheVet?	Less than 6 months			Y	Radio button, one-up vertical		Time using
				6 months - less than 1 year
				1-2 years
				More than 2 years
				Not sure/Do not recall
			In the last 12 months, have you used My HealtheVet to access your VA medical record information (lab results, medication lists, visit notes, etc.)?	Yes			Y	Radio button, one-up vertical		Access records
				No
				Not sure/Do not recall
			My use of the My HealtheVet personal health record has improved my ability to manage my health.	Strongly disagree			Y	Radio button, one-up vertical		Improved health
				Disagree
				Not sure
				Agree
				Strongly agree
				Not applicable
			The My HealtheVet website provides articles on topics of interest to Veterans. What topics are you most interested in for upcoming articles?				N	Text area, no char limit		Topics of interest
			Please indicate your military period(s) of service:	Global War on Terror (OEF/OIF/OND)			Y	Radio button, one-up vertical		Period of service
				Desert Shield/Desert Storm
				Vietnam War
				Korean War
				World War II
				Peacetime Service
				Other
				Not Applicable
				Prefer not to respond
			What is your age?	18			N	Drop down, select one		Age
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				Prefer not to respond
			What is your gender?	Male			N	Radio button, one-up vertical		Gender
				Female
				Prefer not to respond
			Which of the following best describes the highest level of education you have completed?	Did not complete high school			N	Radio button, one-up vertical		Education
				High school graduate
				Some college or vocational school
				College graduate
				Some postgraduate school
				Graduate or professional degree
				Prefer not to respond
			How much time does it take for you to travel to the VA location where you receive care?	Less than 30 minutes			N	Radio button, one-up vertical		Distance
				30-60 minutes
				61-90 minutes
				91 minutes to 2 hours
				Over 2 hours
				Prefer not to respond
			How would you describe the area where you live?	Urban (50,000 or more people)			N	Radio button, one-up vertical		Area
				Mid-size (between 10,000 – 49,999 people)
				Small Town (between 2500-9999 people)
				Rural and/or Frontier (2499 or fewer people)
				Prefer not to respond