Form Q_VAMyHealtheVet_W Q_VAMyHealtheVet_Web_Browse_20180326_DOT
E-Government Website Customer Satisfaction Surveys
Q_VAMyHealtheVet_Web_Browse_20180326_DOT.xlsx
Mapping and Questionnaire Documents IA 30820 A0 (VHA)
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Model Qsts v2
Current CQs
CQs (3-27-18)
CQs (3-26-18)
CQs (9-18-17)
CQs (2-14-17)
CQs (11-1-16)
CQs (8-22-16)
CQs (3-30-16)
CQs (3-25-16)
CQs (3-16-16)
CQs (2-16-16)
CQs (10-14-15)
Overview
Welcome and Thank You TextModel Qsts v2
Current CQs
CQs (3-27-18)
CQs (3-26-18)
CQs (9-18-17)
CQs (2-14-17)
CQs (11-1-16)
CQs (8-22-16)
CQs (3-30-16)
CQs (3-25-16)
CQs (3-16-16)
CQs (2-16-16)
CQs (10-14-15)
Sheet 1: Welcome and Thank You Text
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| Welcome and Thank You Text | ||||||
| Welcome Text | Thank You Text | |||||
| Thanks for visiting our site. 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. All input you provide is strictly confidential. No personal information is being collected. Please take a few minutes to share your opinions, which are essential in helping us provide the best online experience possible. |
Thank you for taking our survey - and for helping us serve you better. Since all responses are confidential, 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. |
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Sheet 2: Model Qsts v2
| Model Name | VA - My HealtheVet V2 |
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| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||
| Partitioned | Yes (2MQ) | Pink: Addition | |||
| Date | 6/19/2015 | 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. |
Sheet 3: Current CQs
| Model Name | VA - My HealtheVet V2 |
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| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes (2MQ) | Pink: Addition | |||||||
| Date | 6/19/2015 | Blue: Reword | |||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | |||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | Anchor Answer Choice | |||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | |||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | BB | ||||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | |||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders | |
| No | |||||||||
| Not sure | |||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | ||
| No | |||||||||
| Not sure | |||||||||
| I tried to access my VA Health Summary, but was unable to view it | |||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | DD | ||||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | |||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | |||
| 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 | |||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I entered my username and/or password incorrectly | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | F | ||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| RUS0186524 | F | What type of information was unavailable (please be as specific as possible without entering any personal information)? | N | Text area, no char limit | Skip Logic Group* | OE_Log In Info Unavailable | |||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | ||||||||
| Partially | B | ||||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | Anchor Answer Choice | |||||||
| Do you receive medical care from a VA medical center? | Yes | AAA | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | |||
| No | |||||||||
| AAA | In which state do you receive medical care? | Do not have a primary medical center | Y | Drop down, select one | Skip Logic Group* | State | |||
| Alaska | A | ||||||||
| Alabama | B | ||||||||
| Arkansas | C | ||||||||
| Arizona | D | ||||||||
| California | E | ||||||||
| Colorado | F | ||||||||
| Connecticut | G | ||||||||
| District of Columbia | H | ||||||||
| Delaware | I | ||||||||
| Florida | J | ||||||||
| Georgia | K | ||||||||
| Hawaii | L | ||||||||
| Iowa | M | ||||||||
| Idaho | N | ||||||||
| Illinois | O | ||||||||
| Indiana | P | ||||||||
| Kansas | Q | ||||||||
| Kentucky | R | ||||||||
| Louisiana | S | ||||||||
| Massachusetts | T | ||||||||
| Maryland | U | ||||||||
| Maine | V | ||||||||
| Michigan | W | ||||||||
| Minnesota | X | ||||||||
| Missouri | Y | ||||||||
| Mississippi | Z | ||||||||
| Montana | AA | ||||||||
| North Carolina | BB | ||||||||
| North Dakota | CC | ||||||||
| Nebraska | DD | ||||||||
| New Hampshire | EE | ||||||||
| New Jersey | FF | ||||||||
| New Mexico | GG | ||||||||
| Nevada | HH | ||||||||
| New York | II | ||||||||
| Ohio | JJ | ||||||||
| Oklahoma | KK | ||||||||
| Oregon | LL | ||||||||
| Pennsylvania | MM | ||||||||
| Puerto Rico | NN | ||||||||
| Rhode Island | OO | ||||||||
| South Carolina | PP | ||||||||
| South Dakota | |||||||||
| Tennessee | RR | ||||||||
| Texas | SS | ||||||||
| Utah | TT | ||||||||
| Virginia | UU | ||||||||
| Vermont | VV | ||||||||
| Washington | WW | ||||||||
| Wisconsin | XX | ||||||||
| West Virginia | YY | ||||||||
| Wyoming | ZZ | ||||||||
| A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | |||
| B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Alabama | |||
| Montgomery - Central Alabama Veterans Health Care System | |||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | |||||||||
| Tuskegee - Central Alabama Veterans Health Care System | |||||||||
| C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Y | Radio button, one-up vertical | Skip Logic | Arkansas | |||
| Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Arizona | |||
| Prescott - Northern Arizona VA Health Care System | |||||||||
| Tucson - Southern Arizona VA Health Care System | |||||||||
| E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Y | Radio button, one-up vertical | Skip Logic | California | |||
| Livermore - VA Palo Alto Health Care System | |||||||||
| Loma Linda - VA Loma Linda Healthcare System | |||||||||
| Long Beach - VA Long Beach Healthcare System | |||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | |||||||||
| Mather - VA Northern California Health Care System | |||||||||
| Menlo Park - VA Palo Alto Health Care System | |||||||||
| Palo Alto - VA Palo Alto Health Care System | |||||||||
| San Diego - VA San Diego Healthcare System | |||||||||
| San Francisco - San Francisco VA Medical Center | |||||||||
| F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Y | Radio button, one-up vertical | Skip Logic | Colorado | |||
| Grand Junction - Grand Junction VA Medical Center | |||||||||
| G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Connecticut | |||
| West Haven - VA Connecticut Healthcare System | |||||||||
| H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | DC | |||
| I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | |||
| J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Florida | |||
| Miami - Miami VA Healthcare System | |||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | |||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | |||||||||
| Orlando - Orlando VA Medical Center | |||||||||
| Tampa - James A. Haley Veterans' Hospital | |||||||||
| West Palm Beach - West Palm Beach VA Medical Center | |||||||||
| K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Georgia | |||
| Decatur - Atlanta VA Medical Center | |||||||||
| Dublin - Carl Vinson VA Medical Center | |||||||||
| L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Y | Radio button, one-up vertical | Skip Logic | Hawaii | |||
| M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Iowa | |||
| Iowa City - Iowa City VA Medical Center | |||||||||
| N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | |||
| O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | Illinois | |||||
| Danville - VA Illiana Health Care System | |||||||||
| Hines - Edward Hines Jr. VA Hospital | |||||||||
| Marion - Marion VA Medical Center | |||||||||
| North Chicago – Captain James A. Lovell Federal Healthcare Center | |||||||||
| P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Indiana | |||
| Indianapolis - Richard L. Roudebush VA Medical Center | |||||||||
| Marion - VA Northern Indiana Health Care System | |||||||||
| Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Y | Radio button, one-up vertical | Skip Logic | Kansas | |||
| Topeka - VA Eastern Kansas Health Care System | |||||||||
| Wichita - Robert J. Dole VA Medical Center | |||||||||
| R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Y | Radio button, one-up vertical | Skip Logic | Kentucky | |||
| Lexington - Lexington VA Medical Center (Leestown Division) | |||||||||
| Louisville - Louisville VA Medical Center | |||||||||
| S | Which Medical Center in Louisiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Louisiana | |||
| Pineville - Alexandria VA Medical Center | |||||||||
| Shreveport - Overton Brooks VA Medical Center | |||||||||
| T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Massachusetts | |||
| Brockton - VA Boston Healthcare System | |||||||||
| Jamaica Plain - VA Boston Healthcare System | |||||||||
| Leeds – Central Western Massachusetts Health Care System | |||||||||
| West Roxbury - VA Boston Healthcare System | |||||||||
| U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Y | Radio button, one-up vertical | Skip Logic | Maryland | |||
| Perry Point - Perry Point VA Medical Center | |||||||||
| V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | |||
| W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Michigan | |||
| Battle Creek - Battle Creek VA Medical Center | |||||||||
| Detroit - John D. Dingell VA Medical Center | |||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | |||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | |||||||||
| X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Minnesota | |||
| St. Cloud - St. Cloud VA Medical Center | |||||||||
| Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Missouri | |||
| Kansas City - Kansas City VA Medical Center | |||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | |||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | |||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | |||||||||
| Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Mississippi | |||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | |||||||||
| AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Montana | |||
| BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Carolina | |||
| Durham - Durham VA Medical Center | |||||||||
| Fayetteville - Fayetteville VA Medical Center | |||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | |||||||||
| CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Dakota | |||
| DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Nebraska | |||
| EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New Hampshire | |||
| FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Jersey | |||
| Lyons - VA New Jersey Health Care System | |||||||||
| GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Mexico | |||
| HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | Nevada | |||||
| Reno - VA Sierra Nevada Health Care System | |||||||||
| II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New York | |||
| Batavia - VA Western New York Healthcare System | |||||||||
| Bath - Bath VA Medical Center | |||||||||
| Bronx - James J. Peters VA Medical Center | |||||||||
| Brooklyn - VA NY Harbor Healthcare System | |||||||||
| Buffalo - VA Western New York Healthcare System | |||||||||
| Canandaigua - Canandaigua VA Medical Center | |||||||||
| Castle Point - VA Hudson Valley Health Care System | |||||||||
| Montrose - VA Hudson Valley Health Care System | |||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | |||||||||
| Northport - Northport VA Medical Center | |||||||||
| Syracuse - Syracuse VA Medical Center | |||||||||
| JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Ohio | |||
| Cincinnati - Cincinnati VA Medical Center | |||||||||
| Cleveland - Louis Stokes VA Medical Center | |||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | |||||||||
| Dayton - Dayton VA Medical Center | |||||||||
| KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Oklahoma | |||
| Oklahoma City - Oklahoma City VA Medical Center | |||||||||
| LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Oregon | |||
| Portland - Portland VA Medical Center | |||||||||
| MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Pennsylvania | |||
| Butler - VA Butler Healthcare System | |||||||||
| Coatesville - Coatesville VA Medical Center | |||||||||
| Erie - Erie VA Medical Center | |||||||||
| Lebanon - Lebanon VA Medical Center | |||||||||
| Philadelphia - Philadelphia VA Medical Center | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | |||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | |||||||||
| NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Puerto Rico | |||
| OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Rhode Island | |||
| PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | South Carolina | |||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | |||||||||
| Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Y | Radio button, one-up vertical | Skip Logic | South Dakota | ||||
| Hot Springs - VA Black Hills Health Care System | |||||||||
| Sioux Falls - Sioux Falls VA Medical Center | |||||||||
| RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Tennessee | |||
| Mountain Home - Mountain Home VA Medical Center | |||||||||
| Murfreesboro - Tennessee Valley Healthcare System | |||||||||
| Nashville - Tennessee Valley Healthcare System | |||||||||
| SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Texas | |||
| Big Spring - West Texas VA Health Care System | |||||||||
| Dallas - VA North Texas Health Care System | |||||||||
| El Paso - El Paso VA Health Care System | |||||||||
| San Antonio - South Texas Veterans Health Care System | |||||||||
| Temple - Central Texas Veterans Health Care System | |||||||||
| Bonham - VA North Texas Health Care System | |||||||||
| Houston - Michael E. DeBakey VA Medical Center | |||||||||
| Kerrville - Kerrville VA Medical Center | |||||||||
| Waco - Central Texas Veterans Health Care System | |||||||||
| TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Y | Radio button, one-up vertical | Skip Logic | Utah | |||
| UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Virginia | |||
| Richmond - Hunter Holmes McGuire VA Medical Center | |||||||||
| Salem - Salem VA Medical Center | |||||||||
| VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Vermont | |||
| WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Y | Radio button, one-up vertical | Skip Logic | Washington | |||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | |||||||||
| Spokane - Spokane VA Medical Center | |||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | |||||||||
| XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Wisconsin | |||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | |||||||||
| Tomah - Tomah VA Medical Center | |||||||||
| YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | West Virginia | |||
| Clarksburg - Louis A. Johnson VA Medical Center | |||||||||
| Huntington - Huntington VA Medical Center | |||||||||
| Martinsburg - Martinsburg VA Medical Center | |||||||||
| ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Wyoming | |||
| Sheridan - Sheridan VA Medical Center | |||||||||
| Which of the following social media tools have you used? (Check all that apply) | A | Y | Checkbox, one-up vertical | Skip Logic | Social Media | ||||
| B | |||||||||
| Google+ | |||||||||
| YouTube | |||||||||
| Blogs | |||||||||
| Podcasts | |||||||||
| Other | |||||||||
| None | |||||||||
| A | Do you follow 'Veterans Health' on Facebook? | Yes | Y | Radio button, one-up vertical | Skip Logic | SM_Facebook | |||
| No | |||||||||
| Not sure | |||||||||
| B | Do you follow 'Veterans Health' on Twitter? | Yes | Y | Radio button, one-up vertical | Skip Logic | SM_Twitter | |||
| No | |||||||||
| Not sure | |||||||||
| Were you aware that you can subscribe to receive the My HealtheVet bi-weekly newsletter by email? | Yes | A, B, C | Y | Radio button, one-up vertical | Skip Logic | Newsletter | |||
| No | |||||||||
| A | Have you subscribed to receive the My HealtheVet update newsletter by email? | Yes | Y | Radio button, one-up vertical | Skip Logic | Subscribe | |||
| No | |||||||||
| B | On a scale of 1 to 10, generally how useful is the information that you receive in the My HealtheVet update newsletter? | 1= Not at all useful | Y | Scale, no don't know | Skip Logic | Newsletter Useful | |||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10= Very useful | |||||||||
| C | Please share any additional comments about the My HealtheVet bi-weekly newsletter. | N | Text area, no char limit | OE_Newsletter | |||||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do not recall | |||||||||
| JIB0149304 | 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 | 12mosAccessVAMedRecords | ||||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| JIB0149305 | 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 | OE_Topics | |||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | 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 | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
Sheet 4: CQs (3-27-18)
| Model Name | VA - My HealtheVet V2 | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes (2MQ) | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | 6/19/2015 | Blue: Reword | ||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | |||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | Anchor Answer Choice | |||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | |||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | BB | ||||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | |||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders | |
| No | |||||||||
| Not sure | |||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | ||
| No | |||||||||
| Not sure | |||||||||
| I tried to access my VA Health Summary, but was unable to view it | |||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | DD | ||||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | |||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | |||
| 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 | |||||||||
The new look and feel is visually pleasing. |
|||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I entered my username and/or password incorrectly | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | F | ||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| RUS0186524 | F | What type of information was unavailable (please be as specific as possible without entering any personal information)? | N | Text area, no char limit | Skip Logic Group* | OE_Log In Info Unavailable | |||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | ||||||||
| Partially | B | ||||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | Anchor Answer Choice | |||||||
| Do you receive medical care from a VA medical center? | Yes | AAA | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | |||
| No | |||||||||
| AAA | In which state do you receive medical care? | Do not have a primary medical center | Y | Drop down, select one | Skip Logic Group* | State | |||
| Alaska | A | ||||||||
| Alabama | B | ||||||||
| Arkansas | C | ||||||||
| Arizona | D | ||||||||
| California | E | ||||||||
| Colorado | F | ||||||||
| Connecticut | G | ||||||||
| District of Columbia | H | ||||||||
| Delaware | I | ||||||||
| Florida | J | ||||||||
| Georgia | K | ||||||||
| Hawaii | L | ||||||||
| Iowa | M | ||||||||
| Idaho | N | ||||||||
| Illinois | O | ||||||||
| Indiana | P | ||||||||
| Kansas | Q | ||||||||
| Kentucky | R | ||||||||
| Louisiana | S | ||||||||
| Massachusetts | T | ||||||||
| Maryland | U | ||||||||
| Maine | V | ||||||||
| Michigan | W | ||||||||
| Minnesota | X | ||||||||
| Missouri | Y | ||||||||
| Mississippi | Z | ||||||||
| Montana | AA | ||||||||
| North Carolina | BB | ||||||||
| North Dakota | CC | ||||||||
| Nebraska | DD | ||||||||
| New Hampshire | EE | ||||||||
| New Jersey | FF | ||||||||
| New Mexico | GG | ||||||||
| Nevada | HH | ||||||||
| New York | II | ||||||||
| Ohio | JJ | ||||||||
| Oklahoma | KK | ||||||||
| Oregon | LL | ||||||||
| Pennsylvania | MM | ||||||||
| Puerto Rico | NN | ||||||||
| Rhode Island | OO | ||||||||
| South Carolina | PP | ||||||||
| South Dakota | |||||||||
| Tennessee | RR | ||||||||
| Texas | SS | ||||||||
| Utah | TT | ||||||||
| Virginia | UU | ||||||||
| Vermont | VV | ||||||||
| Washington | WW | ||||||||
| Wisconsin | XX | ||||||||
| West Virginia | YY | ||||||||
| Wyoming | ZZ | ||||||||
| A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | |||
| B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Alabama | |||
| Montgomery - Central Alabama Veterans Health Care System | |||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | |||||||||
| Tuskegee - Central Alabama Veterans Health Care System | |||||||||
| C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Y | Radio button, one-up vertical | Skip Logic | Arkansas | |||
| Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Arizona | |||
| Prescott - Northern Arizona VA Health Care System | |||||||||
| Tucson - Southern Arizona VA Health Care System | |||||||||
| E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Y | Radio button, one-up vertical | Skip Logic | California | |||
| Livermore - VA Palo Alto Health Care System | |||||||||
| Loma Linda - VA Loma Linda Healthcare System | |||||||||
| Long Beach - VA Long Beach Healthcare System | |||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | |||||||||
| Mather - VA Northern California Health Care System | |||||||||
| Menlo Park - VA Palo Alto Health Care System | |||||||||
| Palo Alto - VA Palo Alto Health Care System | |||||||||
| San Diego - VA San Diego Healthcare System | |||||||||
| San Francisco - San Francisco VA Medical Center | |||||||||
| F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Y | Radio button, one-up vertical | Skip Logic | Colorado | |||
| Grand Junction - Grand Junction VA Medical Center | |||||||||
| G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Connecticut | |||
| West Haven - VA Connecticut Healthcare System | |||||||||
| H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | DC | |||
| I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | |||
| J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Florida | |||
| Miami - Miami VA Healthcare System | |||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | |||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | |||||||||
| Orlando - Orlando VA Medical Center | |||||||||
| Tampa - James A. Haley Veterans' Hospital | |||||||||
| West Palm Beach - West Palm Beach VA Medical Center | |||||||||
| K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Georgia | |||
| Decatur - Atlanta VA Medical Center | |||||||||
| Dublin - Carl Vinson VA Medical Center | |||||||||
| L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Y | Radio button, one-up vertical | Skip Logic | Hawaii | |||
| M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Iowa | |||
| Iowa City - Iowa City VA Medical Center | |||||||||
| N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | |||
| O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | Illinois | |||||
| Danville - VA Illiana Health Care System | |||||||||
| Hines - Edward Hines Jr. VA Hospital | |||||||||
| Marion - Marion VA Medical Center | |||||||||
| North Chicago – Captain James A. Lovell Federal Healthcare Center | |||||||||
| P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Indiana | |||
| Indianapolis - Richard L. Roudebush VA Medical Center | |||||||||
| Marion - VA Northern Indiana Health Care System | |||||||||
| Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Y | Radio button, one-up vertical | Skip Logic | Kansas | |||
| Topeka - VA Eastern Kansas Health Care System | |||||||||
| Wichita - Robert J. Dole VA Medical Center | |||||||||
| R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Y | Radio button, one-up vertical | Skip Logic | Kentucky | |||
| Lexington - Lexington VA Medical Center (Leestown Division) | |||||||||
| Louisville - Louisville VA Medical Center | |||||||||
| S | Which Medical Center in Louisiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Louisiana | |||
| Pineville - Alexandria VA Medical Center | |||||||||
| Shreveport - Overton Brooks VA Medical Center | |||||||||
| T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Massachusetts | |||
| Brockton - VA Boston Healthcare System | |||||||||
| Jamaica Plain - VA Boston Healthcare System | |||||||||
| Leeds – Central Western Massachusetts Health Care System | |||||||||
| West Roxbury - VA Boston Healthcare System | |||||||||
| U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Y | Radio button, one-up vertical | Skip Logic | Maryland | |||
| Perry Point - Perry Point VA Medical Center | |||||||||
| V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | |||
| W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Michigan | |||
| Battle Creek - Battle Creek VA Medical Center | |||||||||
| Detroit - John D. Dingell VA Medical Center | |||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | |||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | |||||||||
| X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Minnesota | |||
| St. Cloud - St. Cloud VA Medical Center | |||||||||
| Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Missouri | |||
| Kansas City - Kansas City VA Medical Center | |||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | |||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | |||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | |||||||||
| Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Mississippi | |||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | |||||||||
| AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Montana | |||
| BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Carolina | |||
| Durham - Durham VA Medical Center | |||||||||
| Fayetteville - Fayetteville VA Medical Center | |||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | |||||||||
| CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Dakota | |||
| DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Nebraska | |||
| EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New Hampshire | |||
| FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Jersey | |||
| Lyons - VA New Jersey Health Care System | |||||||||
| GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Mexico | |||
| HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | Nevada | |||||
| Reno - VA Sierra Nevada Health Care System | |||||||||
| II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New York | |||
| Batavia - VA Western New York Healthcare System | |||||||||
| Bath - Bath VA Medical Center | |||||||||
| Bronx - James J. Peters VA Medical Center | |||||||||
| Brooklyn - VA NY Harbor Healthcare System | |||||||||
| Buffalo - VA Western New York Healthcare System | |||||||||
| Canandaigua - Canandaigua VA Medical Center | |||||||||
| Castle Point - VA Hudson Valley Health Care System | |||||||||
| Montrose - VA Hudson Valley Health Care System | |||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | |||||||||
| Northport - Northport VA Medical Center | |||||||||
| Syracuse - Syracuse VA Medical Center | |||||||||
| JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Ohio | |||
| Cincinnati - Cincinnati VA Medical Center | |||||||||
| Cleveland - Louis Stokes VA Medical Center | |||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | |||||||||
| Dayton - Dayton VA Medical Center | |||||||||
| KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Oklahoma | |||
| Oklahoma City - Oklahoma City VA Medical Center | |||||||||
| LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Oregon | |||
| Portland - Portland VA Medical Center | |||||||||
| MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Pennsylvania | |||
| Butler - VA Butler Healthcare System | |||||||||
| Coatesville - Coatesville VA Medical Center | |||||||||
| Erie - Erie VA Medical Center | |||||||||
| Lebanon - Lebanon VA Medical Center | |||||||||
| Philadelphia - Philadelphia VA Medical Center | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | |||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | |||||||||
| NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Puerto Rico | |||
| OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Rhode Island | |||
| PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | South Carolina | |||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | |||||||||
| Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Y | Radio button, one-up vertical | Skip Logic | South Dakota | ||||
| Hot Springs - VA Black Hills Health Care System | |||||||||
| Sioux Falls - Sioux Falls VA Medical Center | |||||||||
| RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Tennessee | |||
| Mountain Home - Mountain Home VA Medical Center | |||||||||
| Murfreesboro - Tennessee Valley Healthcare System | |||||||||
| Nashville - Tennessee Valley Healthcare System | |||||||||
| SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Texas | |||
| Big Spring - West Texas VA Health Care System | |||||||||
| Dallas - VA North Texas Health Care System | |||||||||
| El Paso - El Paso VA Health Care System | |||||||||
| San Antonio - South Texas Veterans Health Care System | |||||||||
| Temple - Central Texas Veterans Health Care System | |||||||||
| Bonham - VA North Texas Health Care System | |||||||||
| Houston - Michael E. DeBakey VA Medical Center | |||||||||
| Kerrville - Kerrville VA Medical Center | |||||||||
| Waco - Central Texas Veterans Health Care System | |||||||||
| TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Y | Radio button, one-up vertical | Skip Logic | Utah | |||
| UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Virginia | |||
| Richmond - Hunter Holmes McGuire VA Medical Center | |||||||||
| Salem - Salem VA Medical Center | |||||||||
| VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Vermont | |||
| WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Y | Radio button, one-up vertical | Skip Logic | Washington | |||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | |||||||||
| Spokane - Spokane VA Medical Center | |||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | |||||||||
| XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Wisconsin | |||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | |||||||||
| Tomah - Tomah VA Medical Center | |||||||||
| YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | West Virginia | |||
| Clarksburg - Louis A. Johnson VA Medical Center | |||||||||
| Huntington - Huntington VA Medical Center | |||||||||
| Martinsburg - Martinsburg VA Medical Center | |||||||||
| ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Wyoming | |||
| Sheridan - Sheridan VA Medical Center | |||||||||
| Which of the following social media tools have you used? (Check all that apply) | A | Y | Checkbox, one-up vertical | Skip Logic | Social Media | ||||
| B | |||||||||
| Google+ | |||||||||
| YouTube | |||||||||
| Blogs | |||||||||
| Podcasts | |||||||||
| Other | |||||||||
| None | |||||||||
| A | Do you follow 'Veterans Health' on Facebook? | Yes | Y | Radio button, one-up vertical | Skip Logic | SM_Facebook | |||
| No | |||||||||
| Not sure | |||||||||
| B | Do you follow 'Veterans Health' on Twitter? | Yes | Y | Radio button, one-up vertical | Skip Logic | SM_Twitter | |||
| No | |||||||||
| Not sure | |||||||||
| Were you aware that you can subscribe to receive the My HealtheVet bi-weekly newsletter by email? | Yes | A, B, C | Y | Radio button, one-up vertical | Skip Logic | Newsletter | |||
| No | |||||||||
| A | Have you subscribed to receive the My HealtheVet update newsletter by email? | Yes | Y | Radio button, one-up vertical | Skip Logic | Subscribe | |||
| No | |||||||||
| B | On a scale of 1 to 10, generally how useful is the information that you receive in the My HealtheVet update newsletter? | 1= Not at all useful | Y | Scale, no don't know | Skip Logic | Newsletter Useful | |||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10= Very useful | |||||||||
| C | Please share any additional comments about the My HealtheVet bi-weekly newsletter. | N | Text area, no char limit | OE_Newsletter | |||||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do not recall | |||||||||
| JIB0149304 | 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 | 12mosAccessVAMedRecords | ||||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| JIB0149305 | 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 | OE_Topics | |||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | 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 | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
Sheet 5: CQs (3-26-18)
| Model Name | VA - My HealtheVet V2 | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes (2MQ) | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | 6/19/2015 | Blue: Reword | ||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | |||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | Anchor Answer Choice | |||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | |||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | BB | ||||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | |||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders | |
| No | |||||||||
| Not sure | |||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | ||
| No | |||||||||
| Not sure | |||||||||
| I tried to access my VA Health Summary, but was unable to view it | |||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare | |
| No | |||||||||
| Not sure | |||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | ||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | Mutually Exclusive | ||||||||
| Other | DD | ||||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | |||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | |||
| Daily or more than once a day | A | ||||||||
| About once a week | A | ||||||||
| About once a month | A | ||||||||
| About every 6 months | A | ||||||||
| Less than every 6 months | A | ||||||||
| Not sure/Do not recall | |||||||||
| JIB0139511 | A | Did you notice any changes to the My HealtheVet website during your visit today? | Yes | B,C,D | Y | Radio button, one-up vertical | Skip Logic Group* | Theme Redesign Notice | |
| No | |||||||||
| JIB0139516 | B | Please tell us whether you agree or disagree with the following statements about the new My HealtheVet website: The new look and feel is visually pleasing. |
1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Look and Feel | ||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Strongly Agree | |||||||||
| Don't know | |||||||||
| JIB0139517 | C | The new design of the homepage made it easier to find the information I was looking for. | 1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Easier Find | ||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Strongly Agree | |||||||||
| Don't know | |||||||||
| JIB0139518 | D | The new design is an improvement over the previous design. | 1=Strongly Disagree | 1 | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Improvement | |
| 2 | 1 | ||||||||
| 3 | 1 | ||||||||
| 4 | 1 | ||||||||
| 5 | 1 | ||||||||
| 6 | 2 | ||||||||
| 7 | 2 | ||||||||
| 8 | 2 | ||||||||
| 9 | 2 | ||||||||
| 10=Strongly Agree | 2 | ||||||||
| Don't know | |||||||||
| JIB0139519 | 1 | Please tell us why you think the new design is not an improvement over the previous design. | N | Text area, no char limit | Skip Logic Group* | OE_Theme Redesign Not Improvement | |||
| JIB0139523 | 2 | Please tell us why the new design is an improvement over the previous design. | N | Text area, no char limit | Skip Logic Group* | OE_Theme Redesign Improvement | |||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I entered my username and/or password incorrectly | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | F | ||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| RUS0186524 | F | What type of information was unavailable (please be as specific as possible without entering any personal information)? | N | Text area, no char limit | Skip Logic Group* | OE_Log In Info Unavailable | |||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | ||||||||
| Partially | B | ||||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | Randomize | ||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | Anchor Answer Choice | |||||||
| Do you receive medical care from a VA medical center? | Yes | AAA | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | |||
| No | |||||||||
| AAA | In which state do you receive medical care? | Do not have a primary medical center | Y | Drop down, select one | Skip Logic Group* | State | |||
| Alaska | A | ||||||||
| Alabama | B | ||||||||
| Arkansas | C | ||||||||
| Arizona | D | ||||||||
| California | E | ||||||||
| Colorado | F | ||||||||
| Connecticut | G | ||||||||
| District of Columbia | H | ||||||||
| Delaware | I | ||||||||
| Florida | J | ||||||||
| Georgia | K | ||||||||
| Hawaii | L | ||||||||
| Iowa | M | ||||||||
| Idaho | N | ||||||||
| Illinois | O | ||||||||
| Indiana | P | ||||||||
| Kansas | Q | ||||||||
| Kentucky | R | ||||||||
| Louisiana | S | ||||||||
| Massachusetts | T | ||||||||
| Maryland | U | ||||||||
| Maine | V | ||||||||
| Michigan | W | ||||||||
| Minnesota | X | ||||||||
| Missouri | Y | ||||||||
| Mississippi | Z | ||||||||
| Montana | AA | ||||||||
| North Carolina | BB | ||||||||
| North Dakota | CC | ||||||||
| Nebraska | DD | ||||||||
| New Hampshire | EE | ||||||||
| New Jersey | FF | ||||||||
| New Mexico | GG | ||||||||
| Nevada | HH | ||||||||
| New York | II | ||||||||
| Ohio | JJ | ||||||||
| Oklahoma | KK | ||||||||
| Oregon | LL | ||||||||
| Pennsylvania | MM | ||||||||
| Puerto Rico | NN | ||||||||
| Rhode Island | OO | ||||||||
| South Carolina | PP | ||||||||
| South Dakota | |||||||||
| Tennessee | RR | ||||||||
| Texas | SS | ||||||||
| Utah | TT | ||||||||
| Virginia | UU | ||||||||
| Vermont | VV | ||||||||
| Washington | WW | ||||||||
| Wisconsin | XX | ||||||||
| West Virginia | YY | ||||||||
| Wyoming | ZZ | ||||||||
| A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | |||
| B | Which Medical Center in Alabama do you visit? | Birmingham - Birmingham VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Alabama | |||
| Montgomery - Central Alabama Veterans Health Care System | |||||||||
| Tuscaloosa - Tuscaloosa VA Medical Center | |||||||||
| Tuskegee - Central Alabama Veterans Health Care System | |||||||||
| C | Which Medical Center in Arkansas do you visit? | Fayetteville - Veterans Health Care System of the Ozarks | Y | Radio button, one-up vertical | Skip Logic | Arkansas | |||
| Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| North Little Rock - Central Arkansas Veterans Healthcare System | |||||||||
| D | Which Medical Center in Arizona do you visit? | Phoenix - Phoenix VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Arizona | |||
| Prescott - Northern Arizona VA Health Care System | |||||||||
| Tucson - Southern Arizona VA Health Care System | |||||||||
| E | Which Medical Center in California do you visit? | Fresno - VA Central California Health Care System | Y | Radio button, one-up vertical | Skip Logic | California | |||
| Livermore - VA Palo Alto Health Care System | |||||||||
| Loma Linda - VA Loma Linda Healthcare System | |||||||||
| Long Beach - VA Long Beach Healthcare System | |||||||||
| Los Angeles - VA Greater Los Angeles Healthcare System | |||||||||
| Mather - VA Northern California Health Care System | |||||||||
| Menlo Park - VA Palo Alto Health Care System | |||||||||
| Palo Alto - VA Palo Alto Health Care System | |||||||||
| San Diego - VA San Diego Healthcare System | |||||||||
| San Francisco - San Francisco VA Medical Center | |||||||||
| F | Which Medical Center in Colorado do you visit? | Denver - VA Eastern Colorado Health Care System | Y | Radio button, one-up vertical | Skip Logic | Colorado | |||
| Grand Junction - Grand Junction VA Medical Center | |||||||||
| G | Which Medical Center in Connecticut do you visit? | Newington - VA Connecticut Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Connecticut | |||
| West Haven - VA Connecticut Healthcare System | |||||||||
| H | Which Medical Center in District of Columbia do you visit? | Washington DC - Washington DC VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | DC | |||
| I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | |||
| J | Which Medical Center in Florida do you visit? | Bay Pines - Bay Pines VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Florida | |||
| Miami - Miami VA Healthcare System | |||||||||
| Gainesville - North Florida / South Georgia VA Healthcare System | |||||||||
| Lake City - North Florida / South Georgia VA Healthcare System | |||||||||
| Orlando - Orlando VA Medical Center | |||||||||
| Tampa - James A. Haley Veterans' Hospital | |||||||||
| West Palm Beach - West Palm Beach VA Medical Center | |||||||||
| K | Which Medical Center in Georgia do you visit? | Augusta - Charlie Norwood VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Georgia | |||
| Decatur - Atlanta VA Medical Center | |||||||||
| Dublin - Carl Vinson VA Medical Center | |||||||||
| L | Which Medical Center in Hawaii do you visit? | Honolulu - VA Pacific Islands Health Care System | Y | Radio button, one-up vertical | Skip Logic | Hawaii | |||
| M | Which Medical Center in Iowa do you visit? | Des Moines - VA Central Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Iowa | |||
| Iowa City - Iowa City VA Medical Center | |||||||||
| N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | |||
| O | Which Medical Center in Illinois do you visit? | Chicago - Jesse Brown VA Medical Center | Radio button, one-up vertical | Illinois | |||||
| Danville - VA Illiana Health Care System | |||||||||
| Hines - Edward Hines Jr. VA Hospital | |||||||||
| Marion - Marion VA Medical Center | |||||||||
| North Chicago – Captain James A. Lovell Federal Healthcare Center | |||||||||
| P | Which Medical Center in Indiana do you visit? | Fort Wayne - VA Northern Indiana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Indiana | |||
| Indianapolis - Richard L. Roudebush VA Medical Center | |||||||||
| Marion - VA Northern Indiana Health Care System | |||||||||
| Q | Which Medical Center in Kansas do you visit? | Leavenworth - VA Eastern Kansas Health Care System | Y | Radio button, one-up vertical | Skip Logic | Kansas | |||
| Topeka - VA Eastern Kansas Health Care System | |||||||||
| Wichita - Robert J. Dole VA Medical Center | |||||||||
| R | Which Medical Center in Kentucky do you visit? | Lexington - Lexington VA Medical Center (Cooper Division) | Y | Radio button, one-up vertical | Skip Logic | Kentucky | |||
| Lexington - Lexington VA Medical Center (Leestown Division) | |||||||||
| Louisville - Louisville VA Medical Center | |||||||||
| S | Which Medical Center in Louisiana do you visit? | New Orleans - Southeast Louisiana Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Louisiana | |||
| Pineville - Alexandria VA Medical Center | |||||||||
| Shreveport - Overton Brooks VA Medical Center | |||||||||
| T | Which Medical Center in Massachusetts do you visit? | Bedford - Edith Nourse Rogers Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Massachusetts | |||
| Brockton - VA Boston Healthcare System | |||||||||
| Jamaica Plain - VA Boston Healthcare System | |||||||||
| Leeds – Central Western Massachusetts Health Care System | |||||||||
| West Roxbury - VA Boston Healthcare System | |||||||||
| U | Which Medical Center in Maryland do you visit? | Baltimore - VA Maryland Health Care System | Y | Radio button, one-up vertical | Skip Logic | Maryland | |||
| Perry Point - Perry Point VA Medical Center | |||||||||
| V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | |||
| W | Which Medical Center in Michigan do you visit? | Ann Arbor - VA Ann Arbor Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Michigan | |||
| Battle Creek - Battle Creek VA Medical Center | |||||||||
| Detroit - John D. Dingell VA Medical Center | |||||||||
| Iron Mountain - Oscar G. Johnson VA Medical Center | |||||||||
| Saginaw - Aleda E. Lutz VA Medical Center | |||||||||
| X | Which Medical Center in Minnesota do you visit? | Minneapolis - Minneapolis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Minnesota | |||
| St. Cloud - St. Cloud VA Medical Center | |||||||||
| Y | Which Medical Center in Missouri do you visit? | Columbia - Harry S. Truman Memorial VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Missouri | |||
| Kansas City - Kansas City VA Medical Center | |||||||||
| Poplar Bluff - John J. Pershing VA Medical Center | |||||||||
| St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division) | |||||||||
| St. Louis - St. Louis VA Medical Center (John Cochran Division) | |||||||||
| Z | Which Medical Center in Mississippi do you visit? | Biloxi - VA Gulf Coast Veterans Health Care System | Y | Radio button, one-up vertical | Skip Logic | Mississippi | |||
| Jackson - G.V. (Sonny) Montgomery VA Medical Center | |||||||||
| AA | Which Medical Center in Montana do you visit? | Fort Harrison - VA Montana Health Care System | Y | Radio button, one-up vertical | Skip Logic | Montana | |||
| BB | Which Medical Center in North Carolina do you visit? | Asheville - Asheville VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Carolina | |||
| Durham - Durham VA Medical Center | |||||||||
| Fayetteville - Fayetteville VA Medical Center | |||||||||
| Salisbury - W.G. (Bill) Hefner VA Medical Center | |||||||||
| CC | Which Medical Center in North Dakota do you visit? | Fargo - Fargo VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | North Dakota | |||
| DD | Which Medical Center in Nebraska do you visit? | Omaha - VA Nebraska-Western Iowa Health Care System | Y | Radio button, one-up vertical | Skip Logic | Nebraska | |||
| EE | Which Medical Center in New Hampshire do you visit? | Manchester - Manchester VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New Hampshire | |||
| FF | Which Medical Center in New Jersey do you visit? | East Orange - VA New Jersey Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Jersey | |||
| Lyons - VA New Jersey Health Care System | |||||||||
| GG | Which Medical Center in New Mexico do you visit? | Albuquerque - New Mexico VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | New Mexico | |||
| HH | Which Medical Center in Nevada do you visit? | Las Vegas - VA Southern Nevada Healthcare System | Radio button, one-up vertical | Nevada | |||||
| Reno - VA Sierra Nevada Health Care System | |||||||||
| II | Which Medical Center in New York do you visit? | Albany - Samuel S. Stratton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | New York | |||
| Batavia - VA Western New York Healthcare System | |||||||||
| Bath - Bath VA Medical Center | |||||||||
| Bronx - James J. Peters VA Medical Center | |||||||||
| Brooklyn - VA NY Harbor Healthcare System | |||||||||
| Buffalo - VA Western New York Healthcare System | |||||||||
| Canandaigua - Canandaigua VA Medical Center | |||||||||
| Castle Point - VA Hudson Valley Health Care System | |||||||||
| Montrose - VA Hudson Valley Health Care System | |||||||||
| New York - VA NY Harbor Healthcare System - Manhattan Campus | |||||||||
| Northport - Northport VA Medical Center | |||||||||
| Syracuse - Syracuse VA Medical Center | |||||||||
| JJ | Which Medical Center in Ohio do you visit? | Chillicothe - Chillicothe VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Ohio | |||
| Cincinnati - Cincinnati VA Medical Center | |||||||||
| Cleveland - Louis Stokes VA Medical Center | |||||||||
| Columbus - Chalmbers P. Wylie Ambulatory Care Center | |||||||||
| Dayton - Dayton VA Medical Center | |||||||||
| KK | Which Medical Center in Oklahoma do you visit? | Muskogee - Jack C. Montgomery VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Oklahoma | |||
| Oklahoma City - Oklahoma City VA Medical Center | |||||||||
| LL | Which Medical Center in Oregon do you visit? | Roseburg - VA Roseburg Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Oregon | |||
| Portland - Portland VA Medical Center | |||||||||
| MM | Which Medical Center in Pennsylvania do you visit? | Altoona - James E. Van Zandt VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Pennsylvania | |||
| Butler - VA Butler Healthcare System | |||||||||
| Coatesville - Coatesville VA Medical Center | |||||||||
| Erie - Erie VA Medical Center | |||||||||
| Lebanon - Lebanon VA Medical Center | |||||||||
| Philadelphia - Philadelphia VA Medical Center | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division) | |||||||||
| Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center) | |||||||||
| Wilkes-Barre - Wilkes-Barre VA Medical Center | |||||||||
| NN | Which Medical Center in Puerto Rico do you visit? | San Juan - VA Caribbean Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Puerto Rico | |||
| OO | Which Medical Center in Rhode Island do you visit? | Providence - Providence VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Rhode Island | |||
| PP | Which Medical Center in South Carolina do you visit? | Charleston - Ralph H. Johnson VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | South Carolina | |||
| Columbia - Wm. Jennings Bryan Dorn VA Medical Center | |||||||||
| Which Medical Center in South Dakota do you visit? | Fort Meade - VA Black Hills Health Care System | Y | Radio button, one-up vertical | Skip Logic | South Dakota | ||||
| Hot Springs - VA Black Hills Health Care System | |||||||||
| Sioux Falls - Sioux Falls VA Medical Center | |||||||||
| RR | Which Medical Center in Tennessee do you visit? | Memphis - Memphis VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Tennessee | |||
| Mountain Home - Mountain Home VA Medical Center | |||||||||
| Murfreesboro - Tennessee Valley Healthcare System | |||||||||
| Nashville - Tennessee Valley Healthcare System | |||||||||
| SS | Which Medical Center in Texas do you visit? | Amarillo - Amarillo VA Health Care System | Y | Radio button, one-up vertical | Skip Logic | Texas | |||
| Big Spring - West Texas VA Health Care System | |||||||||
| Dallas - VA North Texas Health Care System | |||||||||
| El Paso - El Paso VA Health Care System | |||||||||
| San Antonio - South Texas Veterans Health Care System | |||||||||
| Temple - Central Texas Veterans Health Care System | |||||||||
| Bonham - VA North Texas Health Care System | |||||||||
| Houston - Michael E. DeBakey VA Medical Center | |||||||||
| Kerrville - Kerrville VA Medical Center | |||||||||
| Waco - Central Texas Veterans Health Care System | |||||||||
| TT | Which Medical Center in Utah do you visit? | Salt Lake City - VA Salt Lake City Health Care System | Y | Radio button, one-up vertical | Skip Logic | Utah | |||
| UU | Which Medical Center in Virginia do you visit? | Hampton - Hampton VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Virginia | |||
| Richmond - Hunter Holmes McGuire VA Medical Center | |||||||||
| Salem - Salem VA Medical Center | |||||||||
| VV | Which Medical Center in Vermont do you visit? | White River Junction - White River Junction VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Vermont | |||
| WW | Which Medical Center in Washington do you visit? | Seattle - VA Puget Sound Health Care System | Y | Radio button, one-up vertical | Skip Logic | Washington | |||
| Tacoma - VA Puget Sound Health Care System (American Lake Division) | |||||||||
| Spokane - Spokane VA Medical Center | |||||||||
| Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center | |||||||||
| XX | Which Medical Center in Wisconsin do you visit? | Madison - William S. Middleton Memorial Veterans Hospital | Y | Radio button, one-up vertical | Skip Logic | Wisconsin | |||
| Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center | |||||||||
| Tomah - Tomah VA Medical Center | |||||||||
| YY | Which Medical Center in West Virginia do you visit? | Beckley - Beckley VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | West Virginia | |||
| Clarksburg - Louis A. Johnson VA Medical Center | |||||||||
| Huntington - Huntington VA Medical Center | |||||||||
| Martinsburg - Martinsburg VA Medical Center | |||||||||
| ZZ | Which Medical Center in Wyoming do you visit? | Cheyenne - Cheyenne VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Wyoming | |||
| Sheridan - Sheridan VA Medical Center | |||||||||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do not recall | |||||||||
| JIB0149304 | 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 | 12mosAccessVAMedRecords | ||||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | |||
| View/pay my VA bills/copayments | Skip Logic Group* | ||||||||
| View a list of my VA health care providers and their contact information | |||||||||
| Use a mobile app for My HealtheVet | |||||||||
| Join an online forum to discuss health issues with other Veterans | |||||||||
| Advance check-in for my VA clinic visits | |||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||||
| Check to determine if my different medications are safe when taken together | |||||||||
| More online educational programs | |||||||||
| Other | A | ||||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | |||
| JIB0149305 | 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 | OE_Topics | |||||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | ||||
| Somewhat Dissatisfied | |||||||||
| Neither Satisfied Nor Dissatisfied | |||||||||
| Somewhat Satisfied | |||||||||
| Very Satisfied | |||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | 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 | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
Sheet 6: CQs (9-18-17)
| Model Name | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | Blue: Reword | ||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | ||
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | Anchor Answer Choice | ||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | ||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders |
| No | ||||||||
| Not sure | ||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | |
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | ||
| Daily or more than once a day | A | |||||||
| About once a week | A | |||||||
| About once a month | A | |||||||
| About every 6 months | A | |||||||
| Less than every 6 months | A | |||||||
| Not sure/Do not recall | ||||||||
| A | Did you notice any changes to the My HealtheVet website during your visit today? | Yes | B,C,D | Y | Radio button, one-up vertical | Skip Logic Group* | Theme Redesign Notice | |
| No | ||||||||
| B | Please tell us whether you agree or disagree with the following statements about the new My HealtheVet website: The new look and feel is visually pleasing. |
1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Look and Feel | ||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10=Strongly Agree | ||||||||
| Don't know | ||||||||
| C | The new design of the homepage made it easier to find the information I was looking for. | 1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Easier Find | ||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10=Strongly Agree | ||||||||
| Don't know | ||||||||
| D | The new design is an improvement over the previous design. | 1=Strongly Disagree | 1 | Y | Radio button, scale, has don't know | Skip Logic Group* | Theme Redesign Improvement | |
| 2 | 1 | |||||||
| 3 | 1 | |||||||
| 4 | 1 | |||||||
| 5 | 1 | |||||||
| 6 | 2 | |||||||
| 7 | 2 | |||||||
| 8 | 2 | |||||||
| 9 | 2 | |||||||
| 10=Strongly Agree | 2 | |||||||
| Don't know | ||||||||
| 1 | Please tell us why you think the new design is not an improvement over the previous design. | N | Text area, no char limit | Skip Logic Group* | OE_Theme Redesign Not Improvement | |||
| 2 | Please tell us why the new design is an improvement over the previous design. | N | Text area, no char limit | Skip Logic Group* | OE_Theme Redesign Improvement | |||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | F | |||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| F | What type of information was unavailable (please be as specific as possible without entering any personal information)? | N | Text area, no char limit | Skip Logic Group* | OE_Log In Info Unavailable | |||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | |||||||
| Partially | B | |||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Access my VA health records/Use the Blue Button or VA Health Summary | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | Anchor Answer Choice | ||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 6 months - less than 1 year | ||||||||
| 1-2 years | ||||||||
| More than 2 years | ||||||||
| Not sure/Do not recall | ||||||||
| JIB0149304 | 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 | 12mosAccessVAMedRecords | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | ||||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | ||
| JIB0149305 | 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 | OE_Topics | ||||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | |||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | 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 | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
Sheet 7: CQs (2-14-17)
| Model Name | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | Blue: Reword | ||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | ||
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | Anchor Answer Choice | ||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | ||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders |
| No | ||||||||
| Not sure | ||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | |
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | ||
| 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 | ||||||||
The new homepage's look and feel is visually pleasing. |
||||||||
| JAC0111141 | Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | ||||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | |||||||
| Partially | B | |||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) |
||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | Anchor Answer Choice | ||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 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 | 12mosAccessVAMedRecords | ||||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | ||||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | 
|
N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | |
| KFB04531 | 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 | OE_Topics | ||||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Y | Radio button, one-up vertical | OrgSat | ||||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | 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 | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
Sheet 8: CQs (11-1-16)
| Model Name | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | Blue: Reword | ||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| STE0129852 | For which of the following reasons did you visit the site today? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | ||
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | Anchor Answer Choice | ||||||
| STE0129853 | C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | ||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| STE0129854 | B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders |
| No | ||||||||
| Not sure | ||||||||
| STE0129855 | B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | |
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | Skip Logic Group* | ANMHVFreq | ||
| Daily or more than once a day | A | |||||||
| About once a week | A | |||||||
| About once a month | A | |||||||
| About every 6 months | A | |||||||
| Less than every 6 months | A | |||||||
| Not sure/Do not recall | ||||||||
| A | Did you notice any changes to the My HealtheVet homepage during your visit today? | Yes | B,C,D,E | Y | Radio button, one-up vertical | Skip Logic Group* | Redesign Notice | |
| No | ||||||||
| B | Please tell us whether you agree or disagree with the following statements about the new My HealtheVet homepage: The new homepage's look and feel is visually pleasing. |
1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Redesign Look and Feel | ||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10=Strongly Agree | ||||||||
| Don't know | ||||||||
| C | The new homepage made it easier to determine which section I needed to navigate to. | 1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Redesign Easier Nav | ||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10=Strongly Agree | ||||||||
| Don't know | ||||||||
| D | The new layout of the homepage made it easier to find the information I was looking for. | 1=Strongly Disagree | Y | Radio button, scale, has don't know | Skip Logic Group* | Redesign Easier Find | ||
| 2 | ||||||||
| 3 | ||||||||
| 4 | ||||||||
| 5 | ||||||||
| 6 | ||||||||
| 7 | ||||||||
| 8 | ||||||||
| 9 | ||||||||
| 10=Strongly Agree | ||||||||
| Don't know | ||||||||
| E | The new homepage design is an improvement over the previous design. | 1=Strongly Disagree | 1 | Y | Radio button, scale, has don't know | Skip Logic Group* | Redesign Improvement | |
| 2 | 1 | |||||||
| 3 | 1 | |||||||
| 4 | 1 | |||||||
| 5 | 1 | |||||||
| 6 | 2 | |||||||
| 7 | 2 | |||||||
| 8 | 2 | |||||||
| 9 | 2 | |||||||
| 10=Strongly Agree | 2 | |||||||
| Don't know | ||||||||
| 1 | Please tell us why you think the new homepage is not an improvement over the previous site. | N | Text area, no char limit | Skip Logic Group* | OE_Redesign Not Improvement | |||
| 2 | Please tell us why the new homepage is an improvement over the previous site. | N | Text area, no char limit | Skip Logic Group* | OE_Redesign Improvement | |||
| JAC0111141 | Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | ||||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | |||||||
| Partially | B | |||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) |
||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | Anchor Answer Choice | ||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 6 months - less than 1 year | ||||||||
| 1-2 years | ||||||||
| More than 2 years | ||||||||
| Not sure/Do not recall | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | ||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | |||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | 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 | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
Sheet 9: CQs (8-22-16)
| Model Name | VA - My HealtheVet V2 |
|
||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | ||||||
| Partitioned | Yes (2MQ) | Pink: Addition | ||||||
| Date | 6/19/2015 | Blue: Reword | ||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | 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) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Visit Reason | |||
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | Anchor Answer Choice | ||||||
| C | What else did you come to the site to do today? | N | Text area, no char limit | Skip Logic Group* | OE_Visit Reason | |||
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| B | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | B1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAwareVAproviders | |
| No | ||||||||
| Not sure | ||||||||
| B1 | Have you used My HealtheVet to access your VA Health Summary? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccessVAproviders | ||
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D, E, F, G, H, I, J, K | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
In the past 2 years, was there EVER a time when previous test results or your medical records from one organization were not available at the time of your scheduled medical care appointment at another organization? |
||||||||
If you had a choice, which of the following options would you most prefer when it comes to permission needed to have your VA health information shared electronically with community non-VA providers for medical care? |
||||||||
I am comfortable with my medical records being shared electronically between VA and community non-VA providers for treatment. |
||||||||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | ANMHVFreq | |||
| 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 | ||||||||
| JAC0111141 | Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | ||||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | ||
| No | B | |||||||
| Partially | A, B | |||||||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | Randomize | |||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) |
||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | Anchor Answer Choice | ||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 6 months - less than 1 year | ||||||||
| 1-2 years | ||||||||
| More than 2 years | ||||||||
| Not sure/Do not recall | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | ||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | |||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | 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 | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
Sheet 10: CQs (3-30-16)
| Model Name |
|
|||||||
| Model ID | Underlined & Italicized: Re-order | |||||||
| Partitioned | Pink: Addition | |||||||
| Date | Blue: Reword | |||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| JAC0111145 | B | How much time does it take for you to travel to the VA location where you receive care? | Less than 30 minutes | Y | Radio button, one-up vertical | Skip Logic Group* | VATravelTime | |
| 30-60 minutes | ||||||||
| 61-90 minutes | ||||||||
| 91 minutes to 2 hours | ||||||||
| Over 2 hours | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D, E, F, G, H, I, J, K | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
| JAC0111150 | E | Does VA pay for the care you receive from community non-VA providers? | Yes, VA pays for ALL of the care I receive from my community non-VA providers. | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACarePays | |
| Yes, VA pays for SOME of the care I receive from community non-VA providers. | ||||||||
| No, VA does NOT pay for any of the care I receive from community non-VA providers. | ||||||||
| Not sure | ||||||||
| JAC0111129 | F | Thinking about the past 2 years, when receiving care for a medical problem: In the past 2 years, was there EVER a time when previous test results or your medical records from one organization were not available at the time of your scheduled medical care appointment at another organization? |
Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsMRNA | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111149 | F | In the past 2 years, was there EVER a time when your health care provider(s) ordered a medical test that you felt was unnecessary because the test was ordered/completed by your other health care provider? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsUnnecTest | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111128 | F | In the past 2 years, was there EVER a time when you received information from your VA provider or community non-VA provider that conflicted? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsConflictInfo | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111127 | G | To coordinate your care, it is important for health information to be shared between all your healthcare providers. In some locations, VA has connected with non-VA health care organizations to share medical record information electronically for medical treatment. If you had a choice, which of the following options would you most prefer when it comes to permission needed to have your VA health information shared electronically with community non-VA providers for medical care? |
Share my VA information automatically unless I say not to share it | Y | Radio button, one-up vertical | Skip Logic Group* | SharePreference | |
| Share my VA information only after I provide my consent | ||||||||
| Share my VA information automatically in case of emergency, but otherwise do not share unless I provide consent | ||||||||
| JAC0111148 | H | Please indicate your agreement with the following statements: I am comfortable with my medical records being shared electronically between VA and community non-VA providers for treatment. |
Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareComfort | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111125 | H | I would like to use a mobile application (‘app’) or device to share my VA health information with community non-VA providers. | Strongly disagree | Radio button, one-up vertical | Skip Logic Group* | ShareMobile | ||
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111124 | H | I prefer that my VA providers and community non-VA providers are responsible for sharing my health information with each other (i.e., other than providing consent, I do not need to be involved in sharing my health information). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareConsentOnly | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111123 | H | There may be parts of my VA medical record that I would not want to share with community non-VA providers (and vice versa). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNotWanted | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | HH | |||||||
| Strongly agree | HH | |||||||
| JAC0111171 | HH | What types of information would you not want shared between providers if it was in your medical record? (Please select all that apply) | Lab test results | Y | Checkbox, one-up vertical | Skip Logic Group* | ShareNotTypes | |
| List of medical conditions | ||||||||
| Medications | ||||||||
| Mental health information (e.g., PTSD, depression) | ||||||||
| Alcohol or drug use information | ||||||||
| Military service information | ||||||||
| Reproductive health information | ||||||||
| HIV treatment or testing information | ||||||||
| Other | HH1 | |||||||
| JAC0111172 | HH1 | What other types of information would you not want shared between providers? | N | Text area, no char limit | Skip Logic Group* | OE_ShareNotTypes | ||
| JAC0111122 | H | I want to share my VA health information such as my medication list, or notes from medical visits, with family members or other informal care givers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareInformal | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111121 | H | I want to review my VA health information when meeting with my community non-VA providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNonVA | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111120 | H | I prefer to be the only one responsible for sharing information between my VA and community non-VA providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareResponsible | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111119 | H | I am confident that if my health information is available electronically to others for medical care, it will be secure and protected from being viewed by individuals that should not have access to my health information. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareSecure | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111118 | I | Are you aware of the “Connect Your Docs” or Virtual Lifetime Electronic Record (VLER) Health Information Exchange program where, with your consent, VA can share your VA medical record information with community non-VA partners? | Yes | I1 | Y | Radio button, one-up vertical | Skip Logic Group* | VLERaware |
| No | ||||||||
| Not sure | ||||||||
| JAC0111174 | I1 | How did you learn about “Connect your Docs”/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? (Please select all that apply) | Received information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERheard | |
| Learned about it from the My HealtheVet website | ||||||||
| Learned about it from the eBenefits website | ||||||||
| VA staff told me about it | ||||||||
| Learned about it from another Veteran | ||||||||
| Received information at a VA patient orientation | ||||||||
| Learned about it when enrolling for benefits | ||||||||
| Other | I12 | |||||||
| JAC0111153 | I12 | How else did you learn about "Connect your Docs"/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? | N | Text area, no char limit | Skip Logic Group* | OE_VLERheard | ||
| JAC0111173 | I1 | Are you aware that you can provide your consent/authorization online for the "Connect your Docs"/Virtual Lifetime Electronic Record (VLER) Health Information Exchange program through eBenefits? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERonline | |
| No | ||||||||
| Not sure | ||||||||
| I have not heard of eBenefits | ||||||||
| JAC0111152 | I1 | Have you ever provided your consent to participate in the “Connect your Docs”/Virtual Lifetime Electronic Record (VLER) Health Exchange program? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERParticipate | |
| No | I13 | |||||||
| Not sure | ||||||||
| JAC0111154 | I13 | Please share why you have not provided your consent. (Please select all that apply) | I do not know how to provide my consent for the program. | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERwhynoconsent | |
| I need to learn more about this program first. | ||||||||
| There are some parts of my medical record I do not want shared with others. | ||||||||
| I do not want my VA health information to be part of a health information exchange. | ||||||||
| I am not certain my health information is protected if it is part of a health information exchange. | ||||||||
| Other | I14 | |||||||
| JAC0111155 | I14 | Why else have you not provided your consent? | N | Text area, no char limit | Skip Logic Group* | OE_VLERwhynoconsent | ||
| JAC0111117 | J | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | JJ | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAware |
| No | ||||||||
| Not sure | ||||||||
| JAC0111156 | JJ | Have you used My HealtheVet to access your VA Health Summary? | Yes | JJ1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccess |
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111157 | JJ1 | How did you use your VA Health Summary? (Please select all that apply) | I saved it for my records | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryUsed | |
| I read it | ||||||||
| I printed it | ||||||||
| I shared it (or plan to share it) with my community non-VA health care provider | ||||||||
| I shared it (or plan to share it/review it) with my VA health care provider | ||||||||
| I shared it (or plan to share it) with my spouse, child, or other family member, friend, or informal caregiver | ||||||||
| Other | JJ2 | |||||||
| JAC0111182 | JJ2 | How else did you use your VA Health Summary? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryUsed | ||
| JAC0111146 | K | How would you like VA to provide more information about your options for health information exchange such as the "Connect the Docs" program or the VA Health Summary in My HealtheVet? (Please select all that apply) | Send information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryMoreInfo | |
| Include information on the My HealtheVet homepage | ||||||||
| Have my provider discuss these programs with me | ||||||||
| Have VA support staff provide me this information by phone | ||||||||
| Have VA support staff provide me this information at my next VA appointment | ||||||||
| Have Veterans educate me through Veteran Service Organizations or other Veteran outreach groups | ||||||||
| Provide information about this through a web link or through YouTube videos | ||||||||
| I am not interested in information about Connect Your Docs or the VA Health Summary | Mutually Exclusive | |||||||
| Other | KK | |||||||
| JAC0111158 | KK | How else would you like VA to provide more information about your options for health information exchange? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryMoreInfo | ||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | ANMHVFreq | |||
| 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 | ||||||||
| JAC0111140 | Please rate your ability in using the Internet: | Beginner or novice (just starting/don't use Internet much) | Y | Radio button, one-up vertical | InternetAbility | |||
| Intermediate (use the Internet for a few things) | ||||||||
| Advanced (frequently use Internet and search for information) | ||||||||
| JAC0111141 | Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | ||||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | A | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | |
| No | B | |||||||
| Partially | A, B | |||||||
| AML6198Q012 | A | Of the things you tried to do on the site today, what were you able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Accomplished | |
| Request a prescription refill | ||||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Wellness Reminders | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | |||||||
| AML6198Q013 | C | What other things were you able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_Accomplished | ||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | ||||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) |
||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Wellness Reminders | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | |||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 6 months - less than 1 year | ||||||||
| 1-2 years | ||||||||
| More than 2 years | ||||||||
| Not sure/Do not recall | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Receive a monthly email newsletter | ||||||||
| Receive notification of new content/features on the site | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | ||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | |||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | Y | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | 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 | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
| JAC0111136 | Which categories best describe you? (Please select all that apply) | White | N | Checkbox, one-up vertical | Race-Ethnicity | |||
| Hispanic, Latino(a), or Spanish origin | ||||||||
| Black or African American | ||||||||
| Asian | ||||||||
| American Indian or Alaska Native | ||||||||
| Middle Eastern or North African | ||||||||
| Native Hawaiian or other Pacific Islander | ||||||||
| Other race, ethnicity, or origin | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| JAC0111134 | Do you have (or have you ever had) any of the following health conditions? (Please select all that apply) | Arthritis of any kind (e.g., rheumatoid, osteoarthritis, degenerative arthritis) | N | Checkbox, one-up vertical | Skip Logic Group* | HealthConditions | ||
| Cancer of any kind | ||||||||
| Chronic pain | ||||||||
| Diabetes | ||||||||
| Heart problems (e.g., heart attack, coronary artery disease, heart failure) | ||||||||
| High cholesterol | ||||||||
| High blood pressure | ||||||||
| Lung problems (including asthma) | ||||||||
| Mental health/psychiatric condition (e.g., anxiety, depression, PTSD) | ||||||||
| Neurological disorders (e.g., stroke, Parkinson's disease, traumatic brain injury) | ||||||||
| Stomach/gastrointestinal problems | ||||||||
| Other | A | |||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| JAC0111135 | A | What other health condition do you or have you had? | N | Text area, no char limit | Skip Logic Group* | OE_HealthConditions | ||
Sheet 11: CQs (3-25-16)
| Model Name |
|
|||||||
| Model ID | Underlined & Italicized: Re-order | |||||||
| Partitioned | Pink: Addition | |||||||
| Date | Blue: Reword | |||||||
| QID | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | |
| National Guard/Reserve | A | |||||||
| Veteran | A | |||||||
| 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 | ||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | |
| Very Good | ||||||||
| Good | ||||||||
| Fair | ||||||||
| Poor | ||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111143 | B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | BB | |||||||
| JAC0111144 | BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||
| JAC0111145 | B | How much time does it take for you to travel to the VA location where you receive care? | Less than 30 minutes | Y | Radio button, one-up vertical | Skip Logic Group* | VATravelTime | |
| 30-60 minutes | ||||||||
| 61-90 minutes | ||||||||
| 91 minutes to 2 hours | ||||||||
| Over 2 hours | ||||||||
| JAC0111142 | C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D, E, F, G, H, I, J, K | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare |
| No | ||||||||
| Not sure | ||||||||
| JAC0111151 | D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |
| Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | ||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | ||||||||
| Home health care (e.g., visiting nurse, home health aide) | ||||||||
| Hospital-based care | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| Other | DD | |||||||
| JAC0111170 | DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||
| JAC0111150 | E | Does VA pay for the care you receive from community non-VA providers? | Yes, VA pays for ALL of the care I receive from my community non-VA providers. | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACarePays | |
| Yes, VA pays for SOME of the care I receive from community non-VA providers. | ||||||||
| No, VA does NOT pay for any of the care I receive from community non-VA providers. | ||||||||
| Not sure | ||||||||
| JAC0111129 | F | Thinking about the past 2 years, when receiving care for a medical problem: In the past 2 years, was there EVER a time when previous test results or your medical records from one organization were not available at the time of your scheduled medical care appointment at another organization? |
Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsMRNA | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111149 | F | In the past 2 years, was there EVER a time when your health care provider(s) ordered a medical test that you felt was unnecessary because the test was ordered/completed by your other health care provider? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsUnnecTest | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111128 | F | In the past 2 years, was there EVER a time when you received information from your VA provider or community non-VA provider that conflicted? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsConflictInfo | |
| No | ||||||||
| Not sure | ||||||||
| JAC0111127 | G | To coordinate your care, it is important for health information to be shared between all your healthcare providers. In some locations, VA has connected with non-VA health care organizations to share medical record information electronically for medical treatment. If you had a choice, which of the following options would you most prefer when it comes to permission needed to have your VA health information shared electronically with community non-VA providers for medical care? |
Share my VA information automatically unless I say not to share it | Y | Radio button, one-up vertical | Skip Logic Group* | SharePreference | |
| Share my VA information only after I provide my consent | ||||||||
| Share my VA information automatically in case of emergency, but otherwise do not share unless I provide consent | ||||||||
| JAC0111148 | H | Please indicate your agreement with the following statements: I am comfortable with my medical records being shared electronically between VA and community non-VA providers for treatment. |
Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareComfort | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111125 | H | I would like to use a mobile application (‘app’) or device to share my VA health information with community non-VA providers. | Strongly disagree | Radio button, one-up vertical | Skip Logic Group* | ShareMobile | ||
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111124 | H | I prefer that my VA providers and community non-VA providers are responsible for sharing my health information with each other (i.e., other than providing consent, I do not need to be involved in sharing my health information). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareConsentOnly | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111123 | H | There may be parts of my VA medical record that I would not want to share with community non-VA providers (and vice versa). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNotWanted | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | HH | |||||||
| Strongly agree | HH | |||||||
| JAC0111171 | HH | What types of information would you not want shared between providers if it was in your medical record? (Please select all that apply) | Lab test results | Y | Checkbox, one-up vertical | Skip Logic Group* | ShareNotTypes | |
| List of medical conditions | ||||||||
| Medications | ||||||||
| Mental health information (e.g., PTSD, depression) | ||||||||
| Alcohol or drug use information | ||||||||
| Military service information | ||||||||
| Reproductive health information | ||||||||
| HIV treatment or testing information | ||||||||
| Other | HH1 | |||||||
| JAC0111172 | HH1 | What other types of information would you not want shared between providers? | N | Text area, no char limit | Skip Logic Group* | OE_ShareNotTypes | ||
| JAC0111122 | H | I want to share my VA health information such as my medication list, or notes from medical visits, with family members or other informal care givers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareInformal | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111121 | H | I want to review my VA health information when meeting with my community non-VA providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNonVA | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111120 | H | I prefer to be the only one responsible for sharing information between my VA and community non-VA providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareResponsible | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111119 | H | I am confident that if my health information is available electronically to others for medical care, it will be secure and protected from being viewed by individuals that should not have access to my health information. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareSecure | |
| Disagree | ||||||||
| Neither agree nor disagree | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| JAC0111118 | I | Are you aware of the “Connect Your Docs” or Virtual Lifetime Electronic Record (VLER) Health Information Exchange program where, with your consent, VA can share your VA medical record information with community non-VA partners? | Yes | I1 | Y | Radio button, one-up vertical | Skip Logic Group* | VLERaware |
| No | ||||||||
| Not sure | ||||||||
| JAC0111174 | I1 | How did you learn about “Connect your Docs”/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? (Please select all that apply) | Received information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERheard | |
| Learned about it from the My HealtheVet website | ||||||||
| Learned about it from the eBenefits website | ||||||||
| VA staff told me about it | ||||||||
| Learned about it from another Veteran | ||||||||
| Received information at a VA patient orientation | ||||||||
| Learned about it when enrolling for benefits | ||||||||
| Other | I12 | |||||||
| JAC0111153 | I12 | How else did you learn about "Connect your Docs"/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? | N | Text area, no char limit | Skip Logic Group* | OE_VLERheard | ||
| JAC0111173 | I1 | Are you aware that you can provide your consent/authorization online for the "Connect your Docs"/Virtual Lifetime Electronic Record (VLER) Health Information Exchange program through eBenefits? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERonline | |
| No | ||||||||
| Not sure | ||||||||
| I have not heard of eBenefits | ||||||||
| JAC0111152 | I1 | Have you ever provided your consent to participate in the “Connect your Docs”/Virtual Lifetime Electronic Record (VLER) Health Exchange program? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERParticipate | |
| No | I13 | |||||||
| Not sure | ||||||||
| JAC0111154 | I13 | Please share why you have not provided your consent. (Please select all that apply) | I do not know how to provide my consent for the program. | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERwhynoconsent | |
| I need to learn more about this program first. | ||||||||
| There are some parts of my medical record I do not want shared with others. | ||||||||
| I do not want my VA health information to be part of a health information exchange. | ||||||||
| I am not certain my health information is protected if it is part of a health information exchange. | ||||||||
| Other | I14 | |||||||
| JAC0111155 | I14 | Why else have you not provided your consent? | N | Text area, no char limit | Skip Logic Group* | OE_VLERwhynoconsent | ||
| JAC0111117 | J | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | JJ | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAware |
| No | ||||||||
| Not sure | ||||||||
| JAC0111156 | JJ | Have you used My HealtheVet to access your VA Health Summary? | Yes | JJ1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccess |
| No | ||||||||
| Not sure | ||||||||
| I tried to access my VA Health Summary, but was unable to view it | ||||||||
| JAC0111157 | JJ1 | How did you use your VA Health Summary? (Please select all that apply) | I saved it for my records | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryUsed | |
| I read it | ||||||||
| I printed it | ||||||||
| I shared it (or plan to share it) with my community non-VA health care provider | ||||||||
| I shared it (or plan to share it/review it) with my VA health care provider | ||||||||
| I shared it (or plan to share it) with my spouse, child, or other family member, friend, or informal caregiver | ||||||||
| Other | JJ2 | |||||||
| JAC0111182 | JJ2 | How else did you use your VA Health Summary? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryUsed | ||
| JAC0111146 | K | How would you like VA to provide more information about your options for health information exchange such as the "Connect the Docs" program or the VA Health Summary in My HealtheVet? (Please select all that apply) | Send information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryMoreInfo | |
| Include information on the My HealtheVet homepage | ||||||||
| Have my provider discuss these programs with me | ||||||||
| Have VA support staff provide me this information by phone | ||||||||
| Have VA support staff provide me this information at my next VA appointment | ||||||||
| Have Veterans educate me through Veteran Service Organizations or other Veteran outreach groups | ||||||||
| Provide information about this through a web link or through YouTube videos | ||||||||
| I am not interested in information about Connect Your Docs or the VA Health Summary | Mutually Exclusive | |||||||
| Other | KK | |||||||
| JAC0111158 | KK | How else would you like VA to provide more information about your options for health information exchange? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryMoreInfo | ||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | ANMHVFreq | |||
| 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 | ||||||||
| JAC0111140 | Please rate your ability in using the Internet: | Beginner or novice (just starting/don't use Internet much) | Y | Radio button, one-up vertical | InternetAbility | |||
| Intermediate (use the Internet for a few things) | ||||||||
| Advanced (frequently use Internet and search for information) | ||||||||
| JAC0111141 | Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||
| No | ||||||||
| Not sure | ||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | |
| Advanced (A) | ||||||||
| Premium (authenticated or IPA’d)(P) | ||||||||
| Not sure | ||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site |
| No | ||||||||
| Not sure | ||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | |
| Yes, after more than one try | D | |||||||
| No, I was unable to log in | D | |||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | |
| I was unable to register | ||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | ||||||||
| I entered my username and/or password incorrectly | ||||||||
| Account was locked | ||||||||
| The answer to my security question was not accepted | ||||||||
| I received a site maintenance/error message | ||||||||
| After logging in, information was unavailable | ||||||||
| Website wasn't responding | ||||||||
| Other issue logging in | E | |||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | ||
| AML6198Q011 | Did you accomplish what you wanted to in My HealtheVet? | Yes | A | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | |
| No | B | |||||||
| Partially | A, B | |||||||
| AML6198Q012 | A | Of the things you tried to do on the site today, what were you able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Accomplished | |
| Request a prescription refill | ||||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) | ||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Wellness Reminders | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | C | |||||||
| AML6198Q013 | C | What other things were you able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_Accomplished | ||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | |
| Request a prescription refill | ||||||||
| Track the status of my prescription refill delivery | ||||||||
| View my medication history | ||||||||
| Use Secure Messaging to communicate with my VA health care team | ||||||||
| Use the Blue Button (Download My Data) |
||||||||
| View my VA Appointments | ||||||||
| Look up information about a health condition or medication | ||||||||
| View my lab or other test results | ||||||||
| View my VA Wellness Reminders | ||||||||
| View my VA Notes (written by my health care team) | ||||||||
| Enter my personal information (emergency contacts, etc.) | ||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | ||||||||
| Enter information about my non-VA medications or supplements | ||||||||
| Find a VA facility | ||||||||
| Find information about VA Health Benefits | ||||||||
| Find information about VA Benefits other than health benefits | ||||||||
| Use the Veterans Health Library | ||||||||
| Complete a HealtheLiving Assessment | ||||||||
| Other | D | |||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | ||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | |||
| 6 months - less than 1 year | ||||||||
| 1-2 years | ||||||||
| More than 2 years | ||||||||
| Not sure/Do not recall | ||||||||
| AML6198Q017 | 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 | MHV improve Health | |||
| Disagree | ||||||||
| Not sure | ||||||||
| Agree | ||||||||
| Strongly agree | ||||||||
| Not applicable | ||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | ||
| View/pay my VA bills/copayments | Skip Logic Group* | |||||||
| View a list of my VA health care providers and their contact information | ||||||||
| Use a mobile app for My HealtheVet | ||||||||
| Join an online forum to discuss health issues with other Veterans | ||||||||
| Advance check-in for my VA clinic visits | ||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | ||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | ||||||||
|
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||
| Check to determine if my different medications are safe when taken together | ||||||||
| More online educational programs | ||||||||
| Receive a monthly email newsletter | ||||||||
| Receive notification of new content/features on the site | ||||||||
| Other | A | |||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | ||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | |||
| Somewhat Dissatisfied | ||||||||
| Neither Satisfied Nor Dissatisfied | ||||||||
| Somewhat Satisfied | ||||||||
| Very Satisfied | ||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | ||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | N | Radio button, one-up vertical | Survey | |||
| No | ||||||||
| Don't recall | ||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | |||
| Desert Shield/Desert Storm | ||||||||
| Vietnam War | ||||||||
| Korean War | ||||||||
| World War II | ||||||||
| Peacetime Service | ||||||||
| Other | ||||||||
| Not Applicable | Mutually exclusive | |||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | |||
| 20-24 | ||||||||
| 25-29 | ||||||||
| 30-34 | ||||||||
| 35-39 | ||||||||
| 40-44 | ||||||||
| 45-49 | ||||||||
| 50-54 | ||||||||
| 55-59 | ||||||||
| 60-64 | ||||||||
| 65-69 | ||||||||
| 70-74 | ||||||||
| 75-79 | ||||||||
| 80-84 | ||||||||
| 85 or older | ||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | |||
| Female | ||||||||
| AML6198Q026 | Which of the following best describes the highest level of education you have completed? | Did not complete high school | Y | Radio button, one-up vertical | ANEduc | |||
| High school graduate | ||||||||
| Some college or vocational school | ||||||||
| College graduate | ||||||||
| Some postgraduate school | ||||||||
| Graduate or professional degree | ||||||||
| JAC0111136 | Which categories best describe you? (Please select all that apply) | White | N | Checkbox, one-up vertical | Race-Ethnicity | |||
| Hispanic, Latino(a), or Spanish origin | ||||||||
| Black or African American | ||||||||
| Asian | ||||||||
| American Indian or Alaska Native | ||||||||
| Middle Eastern or North African | ||||||||
| Native Hawaiian or other Pacific Islander | ||||||||
| Other race, ethnicity, or origin | ||||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| JAC0111134 | Do you have (or have you ever had) any of the following health conditions? (Please select all that apply) | Arthritis of any kind (e.g., rheumatoid, osteoarthritis, degenerative arthritis) | N | Checkbox, one-up vertical | Skip Logic Group* | HealthConditions | ||
| Cancer of any kind | ||||||||
| Chronic pain | ||||||||
| Diabetes | ||||||||
| Heart problems (e.g., heart attack, coronary artery disease, heart failure) | ||||||||
| High cholesterol | ||||||||
| High blood pressure | ||||||||
| Lung problems (including asthma) | ||||||||
| Mental health/psychiatric condition (e.g., anxiety, depression, PTSD) | ||||||||
| Neurological disorders (e.g., stroke, Parkinson's disease, traumatic brain injury) | ||||||||
| Stomach/gastrointestinal problems | ||||||||
| Other | A | |||||||
| Prefer not to answer | Mutually Exclusive | |||||||
| JAC0111135 | A | What other health condition do you or have you had? | N | Text area, no char limit | Skip Logic Group* | OE_HealthConditions | ||
Sheet 12: CQs (3-16-16)
| Model Name | VA - My HealtheVet V2 |
|
|||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes (2MQ) | Pink: Addition | |||||||
| Date | 6/19/2015 | Blue: Reword | |||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Radio button, one-up vertical | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | B, C | Y | Radio button, one-up vertical | Skip Logic Group* | ANFacilCare | |
| No | |||||||||
| Not sure | |||||||||
| B | What types of medical care do you receive from VA? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | VACareType | |||
|
Specialty care (e.g., cardiology, orthopedics, etc.) | ||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | |||||||||
| Other | BB | ||||||||
| BB | What other type of care do you receive from VA? | N | Text area, no char limit | Skip Logic Group* | OE_VACareType | ||||
| B | How much time does it take for you to travel to the VA location where you receive care? | Less than 30 minutes | Y | Radio button, one-up vertical | Skip Logic Group* | VATravelTime | |||
| 30-60 minutes | |||||||||
| 61-90 minutes | |||||||||
| 91 minutes to 2 hours | |||||||||
| Over 2 hours | |||||||||
| C | Do you get care from any health care providers in the community who are not part of VA (community non-VA providers)? | Yes | D, E, F, G, H, I, J, K | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACare | ||
| No | |||||||||
| Not sure | |||||||||
| D | What types of medical care do you receive from community non-VA providers? (Please select all that apply) | Primary care | Y | Checkbox, one-up vertical | Skip Logic Group* | NonVACareType | |||
| Specialty care (e.g., cardiology, orthopedics, etc.) | |||||||||
| Emergency care | |||||||||
| Behavioral health care (e.g., mental health, drug or alcohol treatment, PTSD, brain injury) | |||||||||
| Home health care (e.g., visiting nurse, home health aide) | |||||||||
| Hospital-based care | |||||||||
| Prefer not to answer | |||||||||
| Other | DD | ||||||||
| DD | What other type of care do you receive from community non-VA providers? | N | Text area, no char limit | Skip Logic Group* | OE_NonVACareType | ||||
| E | Does VA pay for the care you receive from community non-VA providers? | Yes, VA pays for ALL of the care I receive from my community non-VA providers. | Y | Radio button, one-up vertical | Skip Logic Group* | NonVACarePays | |||
| Yes, VA pays for SOME of the care I receive from community non-VA providers. | |||||||||
| No, VA does NOT pay for any of the care I receive from non-VA community providers. | |||||||||
| Not sure | |||||||||
| F | Thinking about the past 2 years, when receiving care for a medical problem: In the past 2 years, was there EVER a time when previous test results or your medical records from one organization were not available at the time of your scheduled medical care appointment at another organization? |
Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsMRNA | |||
| No | |||||||||
| Not sure | |||||||||
| F | In the past 2 years, was there EVER a time when your health care provider(s) ordered a medical test that you felt was unnecessary because the test was ordered/completed by your other health care provider? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsUnnecTest | |||
| No | |||||||||
| Not sure | |||||||||
| F | In the past 2 years, was there EVER a time when you received information from your VA provider or non-VA community provider that conflicted? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | 2yrsConflictInfo | |||
| No | |||||||||
| Not sure | |||||||||
| G | To coordinate your care, it is important for health information to be shared between all your healthcare providers. In some locations, VA has connected with non-VA health care organizations to share medical record information electronically for medical treatment. If you had a choice, which of the following options would you most prefer when it comes to permission needed to have your VA health information shared electronically with community non-VA providers for medical care? |
Share my VA information automatically unless I say not to share it | Y | Radio button, one-up vertical | Skip Logic Group* | SharePreference | |||
| Share my VA information only after I provide my consent | |||||||||
| Share my VA information automatically in case of emergency, but otherwise do not share unless I provide consent | |||||||||
| H | Please indicate your agreement with the following statements: I am comfortable with my medical records being shared electronically between VA and community non-VA providers for treatment. |
Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareComfort | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | I would like to use a mobile application (‘app’) or device to share my VA health information with community non-VA providers. | Strongly disagree | Radio button, one-up vertical | Skip Logic Group* | ShareMobile | ||||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | I prefer that my VA providers and community non-VA providers are responsible for sharing my health information with each other (i.e., other than providing consent, I do not need to be involved in sharing my health information). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareConsentOnly | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | There may be parts of my VA medical record that I would not want to share with community non-VA providers (and vice versa). | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNotWanted | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | HH | ||||||||
| Strongly agree | HH | ||||||||
| HH | What types of information would you not want shared between providers if it was in your medical record? (Please select all that apply) | Lab test results | Y | Checkbox, one-up vertical | Skip Logic Group* | ShareNotTypes | |||
| List of medical conditions | |||||||||
| Medications | |||||||||
| Mental health information (e.g., PTSD, depression) | |||||||||
| Alcohol or drug use information | |||||||||
| Military service information | |||||||||
| Reproductive health information | |||||||||
| HIV treatment or testing information | |||||||||
| Other | HH1 | ||||||||
| HH1 | What other types of information would you not want shared between providers? | N | Text area, no char limit | Skip Logic Group* | OE_ShareNotTypes | ||||
| H | I want to share my VA health information such as my medication list, or notes from medical visits, with family members or other informal care givers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareInformal | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | I want to review my VA health information when meeting with my non-VA community providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareNonVA | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | I prefer to be the only one responsible for sharing information between my VA and community non-VA providers. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareResponsible | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| H | I am confident that if my health information is available electronically to others for medical care, it will be secure and protected from being viewed by individuals that should not have access to my health information. | Strongly disagree | Y | Radio button, one-up vertical | Skip Logic Group* | ShareSecure | |||
| Disagree | |||||||||
| Neither agree nor disagree | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| I | Are you aware of the “Connect Your Docs” or Virtual Lifetime Electronic Record (VLER) Health Information Exchange program where, with your consent, VA can share your VA medical record information with community non-VA partners? | Yes | I1 | Y | Radio button, one-up vertical | Skip Logic Group* | VLERaware | ||
| No | I2 | ||||||||
| Not sure | |||||||||
| I2 | Would you like to learn more about the “Connect Your Docs” or the Virtual Lifetime Electronic Record (VLER) Health Exchange program? | Yes
|
Y | Radio button, one-up vertical | Skip Logic Group* | VLERlearnmore | |||
| No | |||||||||
| I1 | How did you learn about “Connect your Docs”/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? (Please select all that apply) | Received information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERheard | |||
| Learned about it from the My HealtheVet website | |||||||||
| Learned about it from the eBenefits website | |||||||||
| VA staff told me about it | |||||||||
| Learned about it from another Veteran | |||||||||
| Received information at a VA patient orientation | |||||||||
| Learned about it when enrolling for benefits | |||||||||
| Other | I12 | ||||||||
| I12 | How else did you learn about "Connect your Docs"/ Virtual Lifetime Electronic Record (VLER) Health Information Exchange program? | N | Text area, no char limit | Skip Logic Group* | OE_VLERheard | ||||
| I1 | Are you aware that you can provide your consent/authorization online for the "Connect your Docs"/Virtual Lifetime Electronic Record (VLER) Health Information Exchange program through eBenefits? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERonline | |||
| No | |||||||||
| Not sure | |||||||||
| I have not heard of eBenefits | |||||||||
| I1 | Have you ever provided your consent to participate in the “Connect your Docs”/Virtual Lifetime Electronic Record (VLER) Health Exchange program? | Yes | Y | Radio button, one-up vertical | Skip Logic Group* | VLERParticipate | |||
| No | I13 | ||||||||
| Not sure | |||||||||
| I13 | Please share why you have not provided your consent. (Please select all that apply) | I do not know how to provide my consent for the program. | Y | Checkbox, one-up vertical | Skip Logic Group* | VLERwhynoconsent | |||
| I need to learn more about this program first. | |||||||||
| There are some parts of my medical record I do not want shared with others. | |||||||||
| I do not want my VA health information to be part of a health information exchange. | |||||||||
| I am not certain my health information is protected if it is part of a health information exchange. | |||||||||
| Other | I14 | ||||||||
| I14 | Why else have you not provided your consent? | N | Text area, no char limit | Skip Logic Group* | OE_VLERwhynoconsent | ||||
| J | My HealtheVet offers VA patients the option to download a VA Health Summary using a feature called Blue Button. The VA Health Summary contains a summary of information from your VA medical record, such as medications, allergies, and recent lab test results. It can then be shared with others involved with your health care. Are you aware of the VA Health Summary? | Yes | JJ | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAware | ||
| No | |||||||||
| Not sure | |||||||||
| JJ | Have you used My HealtheVet to access your VA Health Summary? | Yes | JJ1 | Y | Radio button, one-up vertical | Skip Logic Group* | SummaryAccess | ||
| No | |||||||||
| Not sure | |||||||||
| I tried to access my VA Health Summary, but was unable to view it | |||||||||
| JJ1 | How did you use your VA Health Summary? (Please select all that apply) | I saved it for my records | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryUsed | |||
| I read it | |||||||||
| I printed it | |||||||||
| I shared it (or plan to share it) with my community non-VA health care provider | |||||||||
| I shared it (or plan to share it/review it) with my VA health care provider | |||||||||
| I shared it (or plan to share it) with my spouse, child, or other family member, friend, or informal caregiver | |||||||||
| Other | JJ2 | ||||||||
| JJ2 | How else did you use your VA Health Summary? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryUsed | ||||
| K | How would you like VA to provide more information about your options for health information exchange such as the "Connect the Docs" program or the VA Health Summary in My HealtheVet? (Please select all that apply) | Send information in the mail | Y | Checkbox, one-up vertical | Skip Logic Group* | SummaryMoreInfo | |||
| Include information on the My HealtheVet homepage | |||||||||
| Have my provider discuss these programs with me | |||||||||
| Have VA support staff provide me this information by phone | |||||||||
| Have VA support staff provide me this information at my next VA appointment | |||||||||
| Have Veterans educate me through Veteran Service Organizations or other Veteran outreach groups | |||||||||
| Provide information about this through a web link or through YouTube videos | |||||||||
| I am not interested in information about Connect Your Docs or the VA Health Summary | |||||||||
| Other | KK | ||||||||
| KK | How else would you like VA to provide more information about your options for health information exchange? | N | Text area, no char limit | Skip Logic Group* | OE_SummaryMoreInfo | ||||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Radio button, one-up vertical | ANMHVFreq | ||||
| 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 | |||||||||
| Please rate your ability in using the Internet: | Beginner or novice (just starting/don't use Internet much) | Y | Radio button, one-up vertical | InternetAbility | |||||
| Intermediate (use the Internet for a few things) | |||||||||
| Advanced (frequently use Internet and search for information) | |||||||||
| Do you have a DS Logon Premium account? | Yes | Y | Radio button, one-up vertical | DSLogonPremium | |||||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Radio button, one-up vertical | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Radio button, one-up vertical | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Radio button, one-up vertical | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Radio button, one-up vertical | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I entered my username and/or password incorrectly | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | |||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | A | Y | Radio button, one-up vertical | Skip Logic Group* | ANTaskAcc | |
| No | B | ||||||||
| Partially | A, B | ||||||||
| AML6198Q012 | A | Of the things you tried to do on the site today, what were you able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Accomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | ||||||||
| AML6198Q013 | C | What other things were you able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_Accomplished | |||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) |
|||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | ||||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | |||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do not recall | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | |||
| View/pay my VA bills/copayments | Skip Logic Group* | ||||||||
| View a list of my VA health care providers and their contact information | |||||||||
| Use a mobile app for My HealtheVet | |||||||||
| Join an online forum to discuss health issues with other Veterans | |||||||||
| Advance check-in for my VA clinic visits | |||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | |||||||||
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | ||||||||
| Check to determine if my different medications are safe when taken together | |||||||||
| More online educational programs | |||||||||
| Receive a monthly email newsletter | |||||||||
| Receive notification of new content/features on the site | |||||||||
| Other | A | ||||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | |||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | ||||
| Somewhat Dissatisfied | |||||||||
| Neither Satisfied Nor Dissatisfied | |||||||||
| Somewhat Satisfied | |||||||||
| Very Satisfied | |||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | N | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | Which of the following best describes the highest level of education you have completed? | Did not complete high school | Y | Radio button, one-up vertical | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
| Which categories best describe you? (Please select all that apply) | White | N | Checkbox, one-up vertical | Race-Ethnicity | |||||
| Hispanic, Latino(a), or Spanish origin | |||||||||
| Black or African American | |||||||||
| Asian | |||||||||
| American Indian or Alaska Native | |||||||||
| Middle Eastern or North African | |||||||||
| Native Hawaiian or other Pacific Islander | |||||||||
| Other race, ethnicity, or origin | |||||||||
| Prefer not to answer | |||||||||
| Do you have (or have you ever had) any of the following health conditions? (Please select all that apply) | Arthritis of any kind (e.g., rheumatoid, osteoarthritis, degenerative arthritis) | N | Checkbox, one-up vertical | Skip Logic Group* | HealthConditions | ||||
| Cancer of any kind | |||||||||
| Chronic pain | |||||||||
| Diabetes | |||||||||
| Heart problems (e.g., heart attack, coronary artery disease, heart failure) | |||||||||
| High cholesterol | |||||||||
| High blood pressure | |||||||||
| Lung problems (including asthma) | |||||||||
| Mental health/psychiatric condition (e.g., anxiety, depression, PTSD) | |||||||||
| Neurological disorders (e.g., stroke, Parkinson's disease, traumatic brain injury) | |||||||||
| Stomach/gastrointestinal problems | |||||||||
| Other | A | ||||||||
| Prefer not to answer | |||||||||
| A | What other health condition do you or have you had? | N | Text area, no char limit | Skip Logic Group* | OE_HealthConditions | ||||
Sheet 13: CQs (2-16-16)
| Model Name | VA - My HealtheVet V2 |
|
|||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes (2MQ) | Pink: Addition | |||||||
| Date | 6/19/2015 | Blue: Reword | |||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | Y | Drop down, select one | Skip Logic Group* | ANFacilCare | ||
| No | |||||||||
| Not Sure | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Drop down, select one | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Drop down, select one | ANMHVFreq | ||||
| 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 | |||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A, B | Y | Drop down, select one | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Drop down, select one | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | B | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Drop down, select one | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not Sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Drop down, select one | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I entered my username and/or password incorrectly | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | |||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | A | Y | Drop down, select one | Skip Logic Group* | ANTaskAcc | |
| No | B | ||||||||
| Partially | A, B | ||||||||
| AML6198Q012 | A | Of the things you tried to do on the site today, what were you able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Accomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | ||||||||
| AML6198Q013 | C | What other things were you able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_Accomplished | |||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) |
|||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | ||||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | |||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do Not Recall | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | |||
| View/pay my VA bills/copayments | Skip Logic Group* | ||||||||
| View a list of my VA health care providers and their contact information | |||||||||
| Use a mobile app for My HealtheVet | |||||||||
| Join an online forum to discuss health issues with other Veterans | |||||||||
| Advance check-in for my VA clinic visits | |||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | |||||||||
|
Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | ||||||||
| Check to determine if my different medications are safe when taken together | |||||||||
| More online educational programs | |||||||||
| Receive a monthly email newsletter | |||||||||
| Receive notification of new content/features on the site | |||||||||
| Other | A | ||||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | |||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | ||||
| Somewhat Dissatisfied | |||||||||
| Neither Satisfied Nor Dissatisfied | |||||||||
| Somewhat Satisfied | |||||||||
| Very Satisfied | |||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | N | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Drop down, select one | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | Which of the following best describes the highest level of education you have completed? | Did not complete high school | Y | Radio button, one-up vertical | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
Sheet 14: CQs (10-14-15)
| Model Name | VA - My HealtheVet V2 |
|
|||||||
| Model ID | 5d550oMNwYpxNB91gI9AAA4C | Underlined & Italicized: Re-order | |||||||
| Partitioned | Yes (2MQ) | Pink: Addition | |||||||
| Date | 6/19/2015 | Blue: Reword | |||||||
| QID | Meta Tags | Skip From | Question Text | Answer Choices | Skip To | Required Y/N |
Type | Special Instructions | CQ Label |
| AML6198Q001 | Which of the following best describes you? | Active duty | A | Y | Checkbox, one-up vertical | Skip Logic Group* Group* | ANRole | ||
| National Guard/Reserve | A | ||||||||
| Veteran | A | ||||||||
| 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 | |||||||||
| AML6198Q002 | A | Do you get care at a VA facility? | Yes | Y | Drop down, select one | Skip Logic Group* | ANFacilCare | ||
| No | |||||||||
| Not Sure | |||||||||
| AML6198Q003 | A | In general, how would you rate your overall health? | Excellent | Y | Drop down, select one | Skip Logic Group* | ANHealth | ||
| Very Good | |||||||||
| Good | |||||||||
| Fair | |||||||||
| Poor | |||||||||
| AML6198Q004 | How frequently do you visit the My HealtheVet web site? | First time | Y | Drop down, select one | ANMHVFreq | ||||
| 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 | |||||||||
| AML6198Q005 | Are you a registered user on the My HealtheVet web site? | Yes | A | Y | Drop down, select one | Skip Logic Group* | ANRegUser | ||
| No | |||||||||
| Not sure | |||||||||
| AML6198Q006 | A | Your member log in box now includes an icon for your account type. What type of My HealtheVet account do you have? | Basic (B) | Y | Drop down, select one | Skip Logic Group* | ANUserType | ||
| Advanced (A) | |||||||||
| Premium (authenticated or IPA’d)(P) | |||||||||
| Not sure | |||||||||
| AML6198Q007 | A | Did you try to log in to the My HealtheVet site today? | Yes | C | Y | Drop down, select one | Skip Logic Group* | Log Into Site | |
| No | |||||||||
| Not Sure | |||||||||
| AML6198Q008 | C | Were you able to log in successfully? | Yes, the first time I tried | Y | Drop down, select one | Skip Logic Group* | Log In Successfully | ||
| Yes, after more than one try | D | ||||||||
| No, I was unable to log in | D | ||||||||
| AML6198Q009 | D | Please tell us more about your experience logging in. (Please select all that apply) | My login information wasn't recognized/site would not accept my login information | Y | Checkbox, one-up vertical | Skip Logic Group* | Log In Experience | ||
| I was unable to register | |||||||||
| I forgot my username and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| I forgot my password and was unable to retrieve it (e.g., retrieval process did not work, I was not aware there was a retrieval process) | |||||||||
| Account was locked | |||||||||
| The answer to my security question was not accepted | |||||||||
| I received a site maintenance/error message | |||||||||
| After logging in, information was unavailable | |||||||||
| Website wasn't responding | |||||||||
| Other issue logging in | E | ||||||||
| AML6198Q010 | E | Please briefly tell us about your experience logging in. | N | Text area, no char limit | Skip Logic Group* | OE_Log In Experience | |||
| AML6198Q011 | Accomplish | Did you accomplish what you wanted to in My HealtheVet? | Yes | A | Y | Drop down, select one | Skip Logic Group* | ANTaskAcc | |
| No | B | ||||||||
| Partially | A, B | ||||||||
| AML6198Q012 | A | Of the things you tried to do on the site today, what were you able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | Accomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) | |||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | C | ||||||||
| AML6198Q013 | C | What other things were you able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_Accomplished | |||
| AML6198Q014 | B | Of the things you tried to do on the site today, what were you NOT able to do? (Please select all that apply) | Learn more about features that are available | Y | Checkbox, one-up vertical | Skip Logic Group* | NotAccomplished | ||
| Request a prescription refill | |||||||||
| Track the status of my prescription refill delivery | |||||||||
| View my medication history | |||||||||
| Use Secure Messaging to communicate with my VA health care team | |||||||||
| Use the Blue Button (Download My Data) |
|||||||||
| View my VA Appointments | |||||||||
| Look up information about a health condition or medication | |||||||||
| View my lab or other test results | |||||||||
| View my VA Wellness Reminders | |||||||||
| View my VA Notes (written by my health care team) | |||||||||
| Enter my personal information (emergency contacts, etc.) | |||||||||
| Enter data that I track myself such as weight, blood pressure, blood sugar, etc. | |||||||||
| Enter information about my non-VA medications or supplements | |||||||||
| Find a VA facility | |||||||||
| Find information about VA Health Benefits | |||||||||
| Find information about VA Benefits other than health benefits | |||||||||
| Use the Veterans Health Library | |||||||||
| Complete a HealtheLiving Assessment | |||||||||
| Other | D | ||||||||
| AML6198Q015 | D | What other things were you NOT able to do on the site today? | N | Text area, no char limit | Skip Logic Group* | OE_NotAccomplished | |||
| AML6198Q016 | How long have you been using My HealtheVet? | Less than 6 months | Y | Radio button, one-up vertical | PRYrsUse | ||||
| 6 months - less than 1 year | |||||||||
| 1-2 years | |||||||||
| More than 2 years | |||||||||
| Not sure/Do Not Recall | |||||||||
| AML6198Q017 | 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 | MHV improve Health | ||||
| Disagree | |||||||||
| Not sure | |||||||||
| Agree | |||||||||
| Strongly agree | |||||||||
| Not applicable | |||||||||
| AML6198Q018 | What additional services would you like to see on My HealtheVet? (Please select your top 3 choices) | Schedule or change my VA appointments | N | Checkbox, one-up vertical | Select up to 3 | Additional Services | |||
| View/pay my VA bills/copayments | Skip Logic Group* | ||||||||
| View a list of my VA health care providers and their contact information | |||||||||
| Use a mobile app for My HealtheVet | |||||||||
| Join an online forum to discuss health issues with other Veterans | |||||||||
| Advance check-in for my VA clinic visits | |||||||||
| Authorize sharing information I have stored in My HealtheVet with other people (e.g., family, caregiver) | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my VA health care team | |||||||||
| Authorize sharing information that I have stored in My HealtheVet with my Non-VA health care provider | |||||||||
| Check to determine if my different medications are safe when taken together | |||||||||
| More online educational programs | |||||||||
| Receive a monthly email newsletter | |||||||||
| Receive notification of new content/features on the site | |||||||||
| Other | A | ||||||||
| AML6198Q019 | A | What other additional services would you like to see on My HealtheVet? | N | Text area, no char limit | Skip Logic Group* | OE_Additional Services | |||
| AML6198Q020 | Considering all of your experiences to date, how satisfied are you with the My HealtheVet program overall? | Very Dissatisfied | Y | Radio button, one-up vertical | OrgSat | ||||
| Somewhat Dissatisfied | |||||||||
| Neither Satisfied Nor Dissatisfied | |||||||||
| Somewhat Satisfied | |||||||||
| Very Satisfied | |||||||||
| AML6198Q021 | What is the main improvement that you would suggest for the My HealtheVet web site? | N | Text area, no char limit | ENDRequest | |||||
| AML6198Q022 | Other than right now, have you completed this survey within the past 3 months? | Yes | N | Radio button, one-up vertical | Survey | ||||
| No | |||||||||
| Don't recall | |||||||||
| AML6198Q023 | Please indicate your military period(s) of service: | Global War on Terror (OEF/OIF/OND) | N | Checkbox, one-up vertical | ANMilServ | ||||
| Desert Shield/Desert Storm | |||||||||
| Vietnam War | |||||||||
| Korean War | |||||||||
| World War II | |||||||||
| Peacetime Service | |||||||||
| Other | |||||||||
| Not Applicable | Mutually exclusive | ||||||||
| AML6198Q024 | What is your age range? | Under 20 | N | Drop down, select one | ANAge | ||||
| 20-24 | |||||||||
| 25-29 | |||||||||
| 30-34 | |||||||||
| 35-39 | |||||||||
| 40-44 | |||||||||
| 45-49 | |||||||||
| 50-54 | |||||||||
| 55-59 | |||||||||
| 60-64 | |||||||||
| 65-69 | |||||||||
| 70-74 | |||||||||
| 75-79 | |||||||||
| 80-84 | |||||||||
| 85 or older | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Drop down, select one | ANGender | ||||
| Female | |||||||||
| AML6198Q026 | Which of the following best describes the highest level of education you have completed? | Did not complete high school | Y | Radio button, one-up vertical | ANEduc | ||||
| High school graduate | |||||||||
| Some college or vocational school | |||||||||
| College graduate | |||||||||
| Some postgraduate school | |||||||||
| Graduate or professional degree | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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