Form 002 2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17
E-Government Website Customer Satisfaction Surveys
2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17.xlsx
2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17
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⚠️ Notice: This form may be outdated.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 (7-15-19)
CQs (3-13-19)
Overview
Welcome and Thank You TextModel Qsts v2
Current CQs
CQs (7-15-19)
CQs (3-13-19)
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 | 1/17/2020 | 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 | |||||||
| BUC0219864 | Do you receive medical care from a VA medical center? | Yes | A1 | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | ||
| No | |||||||||
| JHR6198Q142 | A1 | 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* | Time to travel to VA | ||
| Between 30-60 minutes | |||||||||
| Between 61-90 minutes | |||||||||
| Between 91 minutes to 2 hours | |||||||||
| Over 2 hours | |||||||||
| Don't know | |||||||||
| JHR6198Q143 | A1 | How would you describe the area where you live? | Urban (50,000 or more people) | Y | Radio button, one-up vertical | Skip Logic Group* | Describe area | ||
| Mid-size (between 10,000 – 49,999 people) | |||||||||
| Small Town (between 2,500-9,999 people) | |||||||||
| Rural and/or Frontier (2,499 or fewer people) | |||||||||
| Don't know | |||||||||
| BUC0219865 | A1 | 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 | ||||||||
| BUC0219866 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | ||
| BUC0219867 | 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 | |||||||||
| BUC0219868 | 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 | |||||||||
| BUC0219869 | 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 | |||||||||
| BUC0219870 | 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 | |||||||||
| BUC0219871 | 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 | |||||||||
| BUC0219872 | 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 | |||||||||
| BUC0219845 | 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 | ||
| BUC0219873 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | ||
| BUC0219874 | 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 | |||||||||
| BUC0219846 | 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 | |||||||||
| BUC0219875 | 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 | ||
| BUC0219847 | 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 | |||||||||
| BUC0219848 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | ||
| BUC0219876 | 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 | |||||||||
| BUC0219849 | 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 | |||||||||
| BUC0219877 | 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 | |||||||||
| BUC0219878 | 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 | |||||||||
| BUC0219879 | 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 | |||||||||
| BUC0219850 | 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 | |||||||||
| BUC0219851 | 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 | |||||||||
| BUC0219852 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | ||
| BUC0219880 | 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 | |||||||||
| BUC0219881 | 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 | |||||||||
| BUC0219853 | 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) | |||||||||
| BUC0219882 | 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 | |||||||||
| BUC0219854 | 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 | ||
| BUC0219855 | 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 | |||||||||
| BUC0219884 | 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 | ||
| BUC0219885 | 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 | ||
| BUC0219886 | 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 | ||
| BUC0219857 | 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 | |||||||||
| BUC0220022 | 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 | ||
| BUC0220023 | 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 | |||||||||
| BUC0220044 | 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 | |||||||||
| BUC0220045 | 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 | |||||||||
| BUC0220046 | 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 | |||||||||
| BUC0220047 | 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 | |||||||||
| BUC0220048 | 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 | |||||||||
| BUC0220049 | 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 | ||
| BUC0220050 | 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 | ||
| BUC0220051 | 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 | |||||||||
| BUC0220052 | 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 | |||||||||
| BUC0220053 | 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 | |||||||||
| BUC0220054 | 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 | |||||||||
| BUC0220056 | 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 | ||
| BUC0220058 | 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 | |||||||||
| BUC0220059 | 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 | ||
| BUC0220060 | 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 | |||||||||
| BUC0220061 | 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 | |||||||||
| BUC0220062 | 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 | |||||||||
| BUC0220063 | 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 | |||||||||
| 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 | |||||
| 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 | |||||||||
| Prefer not to respond | 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 | |||||||||
| Prefer not to respond | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| Prefer not to respond | |||||||||
| 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 | |||||||||
| Prefer not to respond | |||||||||
| When you receive prescription medications or supplies from the VA, there is paperwork and prescription labels attached to the package that includes the unique prescription number of the medication or supply item contained in the package. This may be in addition to the label on a bottle. | I read the paperwork for any new information. | N | Checkbox, one-up vertical | Skip Logic | Do with paperwork | ||||
| I save the paperwork for future reference. | |||||||||
| What do you usually do with this paperwork attached to the prescription medication or supply package? (please check all that apply) | I discard the paperwork | A | |||||||
| I do not receive prescription medications or supplies from the VA. | |||||||||
| None of the above | Mutually exclusive | ||||||||
| A | Why do you discard this paperwork comes with your medications or supplies? (please check all that apply) | I believe I already have the information I need to take my medications correctly. | N | Checkbox, one-up vertical | Skip Logic | Why discard paperwork | |||
| I can find any information I need about my medications in My HealtheVet. | |||||||||
| I shred the paperwork for privacy reasons, for example to avoid identity theft | |||||||||
| It’s a waste of paper | |||||||||
| It takes up too much space | |||||||||
| I have difficulty reading it | |||||||||
| None of the above | Mutually exclusive | ||||||||
| What do you usually do with the prescription container (bottle, box, etc.) that has the prescription label stuck to it? | I take my medications as prescribed out of the prescription container with the label | N | Radio button, one-up vertical | Skip Logic | Do with container | ||||
| I discard the prescription container with the label because I put my medication into another container (pill boxes, envelopes, etc.) | B | ||||||||
| I save the prescription container with the label for future reference or use. | |||||||||
| I do not receive prescription medications or supplies from the VA. | |||||||||
| None of the above | |||||||||
| B | Why do you discard the prescription and/or supply container with the label (please check all that apply)? | I believe I already have the information I need to take my medications correctly. | N | Checkbox, one-up vertical | Skip Logic | Why discard container | |||
| I store my medications in containers, like pill boxes, so I don’t need prescription container with the label | |||||||||
| I can find any information I need about my medications in My HealtheVet. | |||||||||
| I discard the prescription container with the label for privacy reasons, for example to avoid identity theft | |||||||||
| I’ve been on the prescription medication or supply for years so I don’t need it | |||||||||
| It’s takes up too much space | |||||||||
| It’s a waste of plastic, paper, etc.. | |||||||||
| I have difficulty reading it | |||||||||
| None of the above | Mutually exclusive | ||||||||
| Do you have a system for keeping track of the prescription numbers located on the paperwork and prescription or supply containers with the labels that you are currently taking/using? | Yes | C | N | Radio button, one-up vertical | Skip Logic | Have system for tracking numbers | |||
| No | |||||||||
| Don't know | |||||||||
| C | How do you keep track of the prescription numbers? | I look up my prescription number in My HealtheVet. | N | Radio button, one-up vertical | Skip Logic | How track numbers | |||
| I safe the paperwork included with the prescription medication or supply from VA. | |||||||||
| I save the prescription label from the prescription medication or supply packages or I save the packages themselves. | |||||||||
| I create my own paper or electronic record of the prescription numbers of my current VA Prescription medications or supplies. | |||||||||
| If I need a prescription number, I contact my VA provider or pharmacist. | |||||||||
| None of the above | |||||||||
Sheet 4: CQs (7-15-19)
| 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 |
| 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 | |||||||
| BUC0219864 | Do you receive medical care from a VA medical center? | Yes | A1 | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | ||
| No | |||||||||
| JHR6198Q142 | A1 | 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* | Time to travel to VA | ||
| Between 30-60 minutes | |||||||||
| Between 61-90 minutes | |||||||||
| Between 91 minutes to 2 hours | |||||||||
| Over 2 hours | |||||||||
| Don't know | |||||||||
| JHR6198Q143 | A1 | How would you describe the area where you live? | Urban (50,000 or more people) | Y | Radio button, one-up vertical | Skip Logic Group* | Describe area | ||
| Mid-size (between 10,000 – 49,999 people) | |||||||||
| Small Town (between 2,500-9,999 people) | |||||||||
| Rural and/or Frontier (2,499 or fewer people) | |||||||||
| Don't know | |||||||||
| BUC0219865 | A1 | 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 | ||||||||
| BUC0219866 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | ||
| BUC0219867 | 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 | |||||||||
| BUC0219868 | 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 | |||||||||
| BUC0219869 | 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 | |||||||||
| BUC0219870 | 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 | |||||||||
| BUC0219871 | 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 | |||||||||
| BUC0219872 | 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 | |||||||||
| BUC0219845 | 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 | ||
| BUC0219873 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | ||
| BUC0219874 | 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 | |||||||||
| BUC0219846 | 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 | |||||||||
| BUC0219875 | 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 | ||
| BUC0219847 | 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 | |||||||||
| BUC0219848 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | ||
| BUC0219876 | 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 | |||||||||
| BUC0219849 | 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 | |||||||||
| BUC0219877 | 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 | |||||||||
| BUC0219878 | 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 | |||||||||
| BUC0219879 | 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 | |||||||||
| BUC0219850 | 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 | |||||||||
| BUC0219851 | 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 | |||||||||
| BUC0219852 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | ||
| BUC0219880 | 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 | |||||||||
| BUC0219881 | 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 | |||||||||
| BUC0219853 | 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) | |||||||||
| BUC0219882 | 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 | |||||||||
| BUC0219854 | 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 | ||
| BUC0219855 | 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 | |||||||||
| BUC0219884 | 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 | ||
| BUC0219885 | 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 | ||
| BUC0219886 | 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 | ||
| BUC0219857 | 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 | |||||||||
| BUC0220022 | 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 | ||
| BUC0220023 | 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 | |||||||||
| BUC0220044 | 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 | |||||||||
| BUC0220045 | 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 | |||||||||
| BUC0220046 | 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 | |||||||||
| BUC0220047 | 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 | |||||||||
| BUC0220048 | 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 | |||||||||
| BUC0220049 | 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 | ||
| BUC0220050 | 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 | ||
| BUC0220051 | 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 | |||||||||
| BUC0220052 | 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 | |||||||||
| BUC0220053 | 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 | |||||||||
| BUC0220054 | 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 | |||||||||
| BUC0220056 | 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 | ||
| BUC0220058 | 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 | |||||||||
| BUC0220059 | 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 | ||
| BUC0220060 | 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 | |||||||||
| BUC0220061 | 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 | |||||||||
| BUC0220062 | 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 | |||||||||
| BUC0220063 | 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 | |||||||||
| 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 | |||||
| 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 | |||||||||
| Prefer not to respond | 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 | |||||||||
| Prefer not to respond | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| Prefer not to respond | |||||||||
| 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 | |||||||||
| Prefer not to respond | |||||||||
Sheet 5: CQs (3-13-19)
| 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 |
| 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 | |||||||
| BUC0219864 | Do you receive medical care from a VA medical center? | Yes | A1 | Y | Radio button, one-up vertical | Skip Logic Group* | Receive Care | ||
| No | |||||||||
| JHR6198Q142 | A1 | 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* | Time to travel to VA | ||
| Between 30-60 minutes | |||||||||
| Between 61-90 minutes | |||||||||
| Between 91 minutes to 2 hours | |||||||||
| Over 2 hours | |||||||||
| Don't know | |||||||||
| JHR6198Q143 | A1 | How would you describe the area where you live? | Urban (50,000 or more people) | Y | Radio button, one-up vertical | Skip Logic Group* | Describe area | ||
| Mid-size (between 10,000 – 49,999 people) | |||||||||
| Small Town (between 2,500-9,999 people) | |||||||||
| Rural and/or Frontier (2,499 or fewer people) | |||||||||
| Don't know | |||||||||
| BUC0219865 | A1 | 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 | ||||||||
| BUC0219866 | A | Which Medical Center in Alaska do you visit? | Anchorage - Alaska VA Healthcare System | Y | Radio button, one-up vertical | Skip Logic | Alaska | ||
| BUC0219867 | 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 | |||||||||
| BUC0219868 | 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 | |||||||||
| BUC0219869 | 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 | |||||||||
| BUC0219870 | 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 | |||||||||
| BUC0219871 | 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 | |||||||||
| BUC0219872 | 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 | |||||||||
| BUC0219845 | 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 | ||
| BUC0219873 | I | Which Medical Center in Delaware do you visit? | Wilmington - Wilmington VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Delaware | ||
| BUC0219874 | 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 | |||||||||
| BUC0219846 | 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 | |||||||||
| BUC0219875 | 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 | ||
| BUC0219847 | 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 | |||||||||
| BUC0219848 | N | Which Medical Center in Idaho do you visit? | Boise VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Idaho | ||
| BUC0219876 | 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 | |||||||||
| BUC0219849 | 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 | |||||||||
| BUC0219877 | 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 | |||||||||
| BUC0219878 | 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 | |||||||||
| BUC0219879 | 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 | |||||||||
| BUC0219850 | 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 | |||||||||
| BUC0219851 | 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 | |||||||||
| BUC0219852 | V | Which Medical Center in Maine do you visit? | Augusta - Togus VA Medical Center | Y | Radio button, one-up vertical | Skip Logic | Maine | ||
| BUC0219880 | 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 | |||||||||
| BUC0219881 | 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 | |||||||||
| BUC0219853 | 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) | |||||||||
| BUC0219882 | 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 | |||||||||
| BUC0219854 | 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 | ||
| BUC0219855 | 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 | |||||||||
| BUC0219884 | 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 | ||
| BUC0219885 | 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 | ||
| BUC0219886 | 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 | ||
| BUC0219857 | 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 | |||||||||
| BUC0220022 | 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 | ||
| BUC0220023 | 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 | |||||||||
| BUC0220044 | 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 | |||||||||
| BUC0220045 | 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 | |||||||||
| BUC0220046 | 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 | |||||||||
| BUC0220047 | 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 | |||||||||
| BUC0220048 | 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 | |||||||||
| BUC0220049 | 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 | ||
| BUC0220050 | 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 | ||
| BUC0220051 | 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 | |||||||||
| BUC0220052 | 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 | |||||||||
| BUC0220053 | 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 | |||||||||
| BUC0220054 | 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 | |||||||||
| BUC0220056 | 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 | ||
| BUC0220058 | 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 | |||||||||
| BUC0220059 | 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 | ||
| BUC0220060 | 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 | |||||||||
| BUC0220061 | 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 | |||||||||
| BUC0220062 | 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 | |||||||||
| BUC0220063 | 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 | |||||||||
| 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 | |||||
| In this next section, we are interested in learning about how Veterans use technology for their health and well-being. These next questions will focus on your experiences during the last 12 months. | A wearable activity tracker like a Fitbit or similar device. | A,B,C,D,F | Y | Checkbox,one-up vertical | SKip Logic | Technologies Used | |||
| In the last 12 months, which of the following technologies have you used? (Select all that apply.) | A smart watch like an Apple Watch, Garmin, Samsung or similar watch. | A,B,C,D,F | |||||||
| A patient portal similar to My HealtheVet through another health care provider or organization. | G,H | ||||||||
| A mobile application (app) to remind you to do health activities, track your weight or blood pressure, or access your health records, etc. | A,B,C,D,F | ||||||||
| Receiving text messaging on your phone to remind you of health care appointments, take medications, etc. | A,B,C,D,F | ||||||||
| A video or virtual visit with a health care provider (doctor, nurse, etc.), sometimes called an e-visit or telemedicine visit. | I, I3 | ||||||||
| A device in your home for your health care team to help monitor information such as blood pressure, weight, blood sugar, or other data for health conditions. | |||||||||
| A social media site or online group focused on health or a specific condition - for example, a Facebook support group, weight management discussion forum, or PatientsLikeMe, etc. | |||||||||
| Internet search for health information using Google search or health sites such as Health.net, WebMD, AARP or similar websites. | |||||||||
| Digital voice assistant speaker(s) such as Alexa, Echo, Google Home, or similar voice activated speaker for health or any other purpose. | J, K, L | ||||||||
| None of the above | Mutually Exclusive | ||||||||
| A | How often do you use wearable technologies, mobile apps, or text messaging to monitor your activity level or work toward your health goals? | Daily | Y | Radio button, one-up vertical | Skip Logic | Frequency wearables | |||
| 3 – 5 times a week | |||||||||
| Once a week | |||||||||
| Once a month | |||||||||
| Less than monthly | |||||||||
| Not sure | |||||||||
| JHR6198Q146 | B | How long have you used wearable technologies, mobile apps, or text messaging to monitor your activity level or work toward your health goals? | Less than 6 months | Y | Radio button, one-up vertical | Skip Logic | Length of time wearables | ||
| Between 6 months and a year | |||||||||
| More than a year | |||||||||
| Not sure | |||||||||
| JHR6198Q147 | C | How helpful are wearable technologies, mobile apps, or text messaging in helping you monitor activity or progress towards your health goals? | 1=Not at All Helpful | Y | Radio button, one-up vertical | Skip Logic | Helpfulness of wearables | ||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Extremely Helpful | |||||||||
| JHR6198Q148 | D | Are you using wearable technologies, mobile apps, or text messaging to help you manage specific health conditions such as diabetes, heart disease, your weight, etc.? | Yes | E | Y | Radio button, one-up vertical | Skip Logic | Manage health wearables | |
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q149 | E | For which health condition(s)? (Select all that apply.) | Obesity or Overweight | N | Checkbox,one-up vertical | Skip Logic | Health conditions wearables | ||
| High Blood Pressure | |||||||||
| Diabetes | |||||||||
| Lung Disease | |||||||||
| Heart Disease | |||||||||
| Musculoskeletal conditions (for example, arthritis) | |||||||||
| Chronic pain | |||||||||
| Mental Health Conditions | |||||||||
| Substance use disorder | |||||||||
| Prefer not to respond | |||||||||
| Other (Please specify.) | E1 | ||||||||
| JHR6198Q150 | E1 | Which other health condition? | N | Text field, <100 char | Skip Logic | OE_Heath conditions wearables | |||
| JHR6198Q151 | F | Did a health care provider recommend you use a wearable technology, mobile apps, or text messaging to helping you manage your specific health conditions? | Yes | Y | Radio button, one-up vertical | Skip Logic | Provider recommend wearable | ||
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q152 | G | How many other patient portals do you use that are NOT My HealtheVet? | 0 | Y | Radio button, one-up vertical | Skip Logic | Other portals used | ||
| 1 | |||||||||
| 2 | |||||||||
| 3 | |||||||||
| 4 or more | |||||||||
| Not sure | |||||||||
| JHR6198Q153 | H | Would you like the ability to manage your health information from My HealtheVet and your community portals in one online location? | Yes | Y | Radio button, one-up vertical | Skip Logic | Would like one portal | ||
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q154 | I | What organization provided your virtual or video visit(s) with a health care provider (doctor, nurse, etc.)? | VA | I1 | Y | Radio button, one-up vertical | Skip Logic | Virtual visit organization | |
| Community (non-VA) organization or provider | I2 | ||||||||
| Both VA and community (non-VA) organization or provider | I1, I2 | ||||||||
| Not sure | |||||||||
| JHR6198Q155 | I1 | Where were you when you received a video or virtual visit(s) with a health care provider from VA? (Select all that apply.) | At your home | Y | Checkbox, one- up vertical | Skip Logic | Where virtual visit VA | ||
| At a VA Medical Center and/or Community-Based Outpatient Clinic | |||||||||
| At another location | |||||||||
| Not sure | |||||||||
| JHR6198Q156 | I2 | Where were you when you received a video or virtual visit(s) with a health care provider from the community (non-VA) organization or provider? | At your home | Y | Checkbox, one- up vertical | Skip Logic | Where virtual visit non-VA | ||
| At the community (non-VA) organization | |||||||||
| At another location | |||||||||
| Not sure | |||||||||
| JHR6198Q157 | I3 | How satisfied are you with your video or virtual visits? | Very dissatisfied | Y | Radio button, one-up vertical | Skip Logic | Virtual visit satisfaction | ||
| Dissatisfied | |||||||||
| Neither satisfied nor dissatisfied | |||||||||
| Satisfied | |||||||||
| Very Satisfied | |||||||||
| JHR6198Q158 | J | For what have you used your digital voice assistant speaker(s) (Alexa, Echo, Google Home etc.)? (Select all that apply.) | Stream music or play radio stations | Y | Checkbox, one- up vertical | Voice assistant purpose | |||
| Access video features for entertainment or communicating with others | |||||||||
| Health (for example as a medication or appointment reminder) | |||||||||
| Online shopping and purchasing | |||||||||
| Ask web-based questions | |||||||||
| Set timers and alarms | |||||||||
| Control smart home devices with your voice | |||||||||
| Make calls to cell phone contacts | |||||||||
| Speak with others in your household | |||||||||
| Play games | |||||||||
| Other (Please specify.) | J1 | ||||||||
| JHR6198Q159 | J1 | For what other purpose have you used your digital voice assistant speaker(s)? | N | Text field, < 100 char | OE_Voice assistant purpose | ||||
| JHR6198Q160 | K | How concerned are you about privacy of your health information when using a digital voice assistant speaker for health-related tasks or questions? | 1=Not at all concerned | Y | Radio button, one- up vertical | Concern about health privacy info | |||
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| 5 | |||||||||
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| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Extremely concerned | |||||||||
| JHR6198Q161 | L | Would you like to be able to use your digital voice assistant speaker to do tasks within My HealtheVet or any VA mobile apps, such as scheduling an appointment or entering health data such as daily weight or blood pressure? | Yes | Y | Radio button, one- up vertical | Use voice assistant for tasks | |||
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q162 | Which device do you prefer to use to help you manage your health goals? | A smartphone | Y | Radio button, one- up vertical | Preferred device | ||||
| A tablet | |||||||||
| A personal computer | |||||||||
| A digital voice assistant speaker such as Echo, Alexa, or Google Home | |||||||||
| I have no preference | |||||||||
| JHR6198Q163 | How concerned are you about privacy and security when using technology for managing your health? | 1=Not at all concerned | Y | Radio button, one- up vertical | Concern about health privacy device | ||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10=Extremely concerned | |||||||||
| JHR6198Q164 | Have you discussed any of the technologies you use for managing your health with your health care team? | Yes | Y | Radio button, one- up vertical | Discussed technologies | ||||
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q165 | Of the technologies below, which are most effective in helping you monitor activity or progress towards your health goals? (Select up to three.) | A wearable activity tracker like a Fitbit, smart watch, or similar device | Y | Checkbox, one- up vertical | Allow no more than 3 choices | Technologies most effective monitor | |||
| A smart watch like an Apple Watch, Garmin, Samsung or similar watch. | |||||||||
| My HealtheVet, VA’s patient portal | |||||||||
| A patient portal through another health care provider or organization. | |||||||||
| A mobile application (app) to remind you to do health activities, track your weight or blood pressure, or access your health records, etc. | |||||||||
| Receiving text messaging on your phone to remind you of health appointments, take medications, etc. | |||||||||
| A video or virtual visit with a health care provider (doctor, nurse, etc.) sometimes called an e-visit or telemedicine visit | |||||||||
| A device in your home for your health care team to help monitor information such as blood pressure, weight, blood sugar, or other data for health conditions. | |||||||||
| A social media site or online group focused on health or a specific condition - for example, a Facebook support group, weight management forum, or PatientsLikeMe, etc. | |||||||||
| Internet search for health information using Google, Health.Net or WebMD, AARP, or similar websites | |||||||||
| Digital voice assistant speaker(s) such as Alexa, Echo, Google Home, or similar voice activated speaker for health. | |||||||||
| Other (Please specify.) | A | Skip logic group | |||||||
| JHR6198Q166 | A | Which other technology is most effective in helping you monitor activity or progress towards your health goals? | N | Text field, <100 char | Skip logic group | OE_Technologies most effective monitor | |||
| JHR6198Q167 | How likely are you to try new technologies on your own? | 1 = Not at all likely | Y | Radio button, one- up vertical | Likely to try new technologies | ||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10 = Very likely | |||||||||
| JHR6198Q168 | How do you learn about different technologies? (Select all that apply.) | On your own | Y | Checkbox, one-up vertical | How learn about technologies | ||||
| Spouse | |||||||||
| Children | |||||||||
| Health care staff | |||||||||
| Media (television, internet, etc.) | |||||||||
| Other (Please specify.) | |||||||||
| JHR6198Q169 | What other ways do you learn about different technologies? | N | Text field, <100 char | OE_How learn about technologies | |||||
| JHR6198Q170 | Do you regularly have access to high-speed internet services? | Yes | Y | Radio button, one-up vertical | High speed internet access | ||||
| No | |||||||||
| Don't know | |||||||||
| JHR6198Q171 | Does limited access to broadband internet (i.e. cable internet, high-speed internet) prevent you from using videoconferencing, wearable technologies, mobile apps, or text messaging to help you monitor activity or progress towards your health goals? | Yes | Y | Radio button, one-up vertical | Limited access prevents | ||||
| No | |||||||||
| Not sure | |||||||||
| JHR6198Q172 | Are you unable to use certain technologies such as text messaging or wearable activity trackers because they cost too much? | Yes | Y | Radio button, one-up vertical | Technologies cost | ||||
| No | |||||||||
| Not sure | |||||||||
| 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 | |||||||||
| Prefer not to respond | 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 | |||||||||
| Prefer not to respond | |||||||||
| AML6198Q025 | What is your gender? | Male | N | Radio button, one-up vertical | ANGender | ||||
| Female | |||||||||
| Prefer not to respond | |||||||||
| 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 | |||||||||
| Prefer not to respond | |||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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