30820 Q VAMyHealth 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson

E-Government Website Customer Satisfaction Surveys

30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson.xlsx

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Welcome and Thank You Text
Model Questions
Current CQs
CQs (09-27-2021)


Sheet 1: Welcome and Thank You Text






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.












































































Sheet 2: Model Questions

Model Name VA - My HealtheVet Mobile

Red & Strike-Through: Delete
Model ID I0pRF5sUZBwwcMZREtAZkg4C

Underlined & Italicized: Re-order
Partitioned Yes (2MQ)

Pink: Addition
Date


Blue: Reword






Label Element Questions Label Satisfaction Questions Label Future Behaviors

Look and Feel (1=Poor, 10=Excellent, Don't Know)
Satisfaction
Likelihood to Return (1=Not Very Likely, 10=Very Likely)
Look and Feel - Appeal Please rate the visual appeal of this site. Satisfaction - Overall What is your overall satisfaction with this site?
(1=Very Dissatisfied, 10=Very Satisfied)
Return How likely are you to return to this site in the next 12 months?
Look and Feel - Balance Please rate the balance of graphics and text on this site. Satisfaction - Expectations How well does this site meet your expectations?
(1=Falls Short, 10=Exceeds)

Recommend (1=Not Very Likely, 10=Very Likely)
Look and Feel - Readability Please rate the readability of the pages on this site. Satisfaction - Ideal How does this site compare to your idea of an ideal website? (1=Not Very Close, 10=Very Close) Recommend How likely are you to recommend this site to someone else?

Site Performance (1=Poor, 10=Excellent, Don't Know)


Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Loading Please rate how quickly pages load on this site.

Trust - Level MHV Please rate your level of trust in My HealtheVet.
Site Performance - Consistency Please rate the consistency of speed from page to page on this site.


Trust (1=Not at all Trustworthy, 10=Very Trustworthy)
Site Performance - Completeness Please rate how completely the page content loads on this site.

Trust - Level VA Please rate your level of trust in the VA.

Navigation (1=Poor, 10=Excellent, Don't Know)


Use Web Channel Over Others (1=Very Unlikely, 10=Very Likely)
Navigation - Organized Please rate how well the site is organized.

Use Web Channel Over Others How likely are you to use this site rather than seeking information from other sources?
Navigation - Options Please rate the options available for navigating this site.



Navigation - Layout Please rate how well the site layout helps you find what you need.




Site Information (1=Poor, 10=Excellent, Don't Know) o


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

VA - My HealtheVet Mobile

Red & Strike-Through: Delete




Mobile I0pRF5sUZBwwcMZREtAZkg4C
Underlined & Italicized: Re-order



Yes (2MQ)

Pink: Addition



5/11/2020

Blue: Reword











QIDs Meta Tags Skip From Question Text Answer Choices Skip To Required
Y/N
Type Special Instructions CQ Label
RUS0456741

What is your age range? Under 20
N Drop down, select one
ANAge




20-29








30-39








40-49








50-59








60-69








70-79








80 or older




SBD9167Q011

What is your gender? Male
N Radio button, one-up vertical
ANGender




Female




PAT0503418

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 QQ







Tennessee RR







Texas SS







Utah TT







Virginia UU







Vermont VV







Washington WW







Wisconsin XX







West Virginia YY







Wyoming ZZ



PAT0503580
A Which Medical Center in Alaska do you visit? Anchorage - Alaska VA Healthcare System
Y Radio button, one-up vertical Skip Logic Alaska
PAT0503581
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




PAT0503582
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




PAT0503583
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




PAT0503584
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




PAT0503559
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




PAT0503585
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




PAT0503560
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
PAT0503561
I Which Medical Center in Delaware do you visit? Wilmington - Wilmington VA Medical Center
Y Radio button, one-up vertical Skip Logic Delaware
PAT0503562
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




PAT0503563
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




PAT0503564
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
PAT0503565
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




PAT0503566
N Which Medical Center in Idaho do you visit? Boise VA Medical Center
Y Radio button, one-up vertical Skip Logic Idaho
PAT0503567
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




PAT0503568
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




PAT0503569
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




PAT0503570
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




PAT0503571
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




PAT0503592
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




PAT0503593
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




PAT0503586
V Which Medical Center in Maine do you visit? Augusta - Togus VA Medical Center
Y Radio button, one-up vertical Skip Logic Maine
PAT0503587
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




PAT0503588
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




PAT0503589
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)




PAT0503590
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




PAT0503878
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
PAT0503879
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




PAT0503880
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
PAT0503881
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
PAT0503882
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
PAT0503883
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




PAT0503910
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
PAT0503911
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




PAT0503912
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




PAT0503913
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




PAT0503914
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




PAT0503915
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




PAT0503916
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




PAT0503917
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
PAT0503918
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
PAT0503919
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




PAT0503920
QQ 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




PAT0503921
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




PAT0503922
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




PAT0503923
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
PAT0503924
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




PAT0503925
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
PAT0503926
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




PAT0503884
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




PAT0503885
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




PAT0503886
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




PAT0503389

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
PAT0503390
In general, how would you rate your overall health? Excellent
Y Radio button, one-up vertical ANHealth




Very Good








Good








Fair








Poor




PAT0503391
How did you hear about upgrading your Advanced to Premium Account? Newsletter
Y Radio button, one-up vertical Referral




VA Flyers, brochures








Someone personally contacted me








Health care team/provider








Caregiver








Family member








My HealtheVet coordinator








Other








Not applicable




PAT0503432

How frequently do you visit the My HealtheVet web site? First time
Y Radio button, one-up vertical
ANMHVFreq




Daily or more than once a day








About once a week








About once a month








About every 6 months








Less than every 6 months








Not sure/Do not recall




PAT0503433 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



PAT0503416
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


Anchor Answer Choice
PAT0503417

What is the main improvement that you would suggest for the My HealtheVet web site?

N Text area, no char limit
ENDRequest


Have you tracked your health information under the ‘Track Health’ section in My HealtheVet? Yes
Y Radio button, one-up vertical
Track Health




No








Not sure






Have you used the new ‘Shared Vitals’ section of Track Health in My HealtheVet? Yes AAA Y Radio button, one-up vertical Skip Logic Group* Vitals Use




No








Not sure






AAA Which health information have you tracked using ‘Shared Vitals’? (Please select all that apply) Blood pressure
Y Checkbox, one-up vertical Skip Logic Group* Vitals Info Tracked




Heart rate


Randomize




Body weight








Body temperature








Pain








Blood sugar








Cholesterol (Lipids Profile)








Pulse oximetry








I have not tracked my Vitals in My HealtheVet


Anchor Answer Choice


Have you discussed any of the health information below from the Shared Vitals feature of My HealtheVet with your care provider? (Please select all that apply) Blood pressure
Y Checkbox, one-up vertical Randomize Vitals Discuss CP




Heart rate








Body weight








Body temperature








Pain








Blood sugar








Cholesterol (Lipids Profile)








Pulse oximetry








I have not tracked my Vitals in My HealtheVet


Anchor Answer Choice


What other type of health information would you like share with your provider using the Shared Vitals feature? (Please select all that apply) Activity level (e.g., steps, exercise)
N Checkbox, one-up vertical Randomize Vitals Share CP




Breathing difficulty








Sleep quality








Mood (e.g., depression, anxiety)








Overall well-being








Alcohol use, tobacco use, and/or substance use








Wellness goals








Immunizations








Allergies








Symptoms related to traumatic brain injury






How has the use of the ‘Vitals’ feature of My HealtheVet impacted you? (Please select all that apply) Increased understanding of your health condition
N Checkbox, one-up vertical Randomize Vitals Impact




Increased engagement with your own health








Improved monitoring the health of yourself or a loved one








Improved overall quality of care








Improved patient/physician communication








Improved accuracy of your medical record








Improved your satisfaction with your care in the VA








None of the above


Anchor Answer Choice

Sheet 4: CQs (09-27-2021)

VA - My HealtheVet Mobile

Red & Strike-Through: Delete




Mobile

Underlined & Italicized: Re-order



Yes (2MQ)

Pink: Addition



5/11/2020

Blue: Reword











QIDs Meta Tags Skip From Question Text Answer Choices Skip To Required
Y/N
Type Special Instructions CQ Label
RUS0456736

How likely is it that you will get a COVID-19 vaccine? Definitely would not get vaccine
Y Radio button, one-up vertical
Likely get vaccine




Probably would not get vaccine








Unsure








Probably would get vaccine








Very likely








Already received COVID vaccine




RUS0456737

Which of the following are reasons that you would get a COVID-19 vaccine? (Check all that apply) It would be the best way to prevent me from getting COVID-19
Y Checkbox, one-up vertical
Why would get vaccine




It would be the best way to prevent others from getting COVID-19







So I would not have to worry about infecting other people








I have a health condition that makes me more at risk from COVID-19








If my doctor recommended it








It is a way that I can contribute to ending the COVID-19 pandemic








So life can go back to the way it was before the pandemic








Drug companies were careful to ensure the saftey of their vaccines




RUS0456738

Which of the following are reasons that you would not get the COVID-19 vaccine? (check all that apply) I'm concerned about immediate side effects from the vaccine
Y Checkbox, one-up vertical
Why would not get vaccine




I'm worried I'll get COVID-19 from the vaccine








I do not think I'll get COVID-19








I do not think I'll get very sick if I get COVID-19








I am worried about side effects from the vaccine that might occur in the future







I do not think the vaccine will work very well








I intend to get pregnant, am pregnant or am breastfeeding








You have to get 2 shots about one month apart for the vaccine to work








The COVID-19 outbreak in the U.S. is not as serious as some people say it is







I will not have time to get the vaccine








I am allergic to vaccines








I do not like needles








It is against my religious or philosophical beliefs








I am concerned about how quickly the vaccines were developed




RUS0456739

Please select up to 3 sources of information from the list below that you trust the most to provide correct information about COVID‑19? (check up to 3 sources) Your faith leader
Y Checkbox, one-up vertical Select up to 3 choices Info source




People you go to work or school with or other people you know








News on the radio, TV, online, or in the newspapers








Your contacts on social media








The U.S. government








The U.S. Coronavirus Task Force








The Veterans Health Administration








Science experts like Dr. Anthony Fauci








State and local government








Veterans groups/organizations








Local VA leaders








Local community organizations




RUS0456740

How safe do you feel the current COVID-19 vaccines are? Very Unsafe
Y Radio button, one-up vertical
How safe vaccine




Unsafe








Neither safe or unsafe








Safe








Very Safe




RUS0456741

What is your age range? Under 20
N Drop down, select one
ANAge




20-29








30-39








40-49








50-59








60-69








70-79








80 or older




SBD9167Q011

What is your gender? Male
N Radio button, one-up vertical
ANGender




Female




RUS0456742

What is your race/ethnicity? (check all that apply) White
Y Checkbox, one-up vertical
Race/Ethnicity




Black or African American








Native American or American Indian








Asian/Pacific Islander








Multi-racial








Hispanic or Latino








Prefer not to answer







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


In general, how would you rate your overall health? Excellent
Y Radio button, one-up vertical ANHealth




Very Good








Good








Fair








Poor






How did you hear about upgrading your Advanced to Premium Account? Newsletter
Y Radio button, one-up vertical Referral




VA Flyers, brochures








Someone personally contacted me








Health care team/provider








Caregiver








Family member








My HealtheVet coordinator








Other








Not applicable







How frequently do you visit the My HealtheVet web site? First time
Y Radio button, one-up vertical
ANMHVFreq




Daily or more than once a day








About once a week








About once a month








About every 6 months








Less than every 6 months








Not sure/Do not recall





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





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


Anchor Answer Choice



What is the main improvement that you would suggest for the My HealtheVet web site?

N Text area, no char limit
ENDRequest



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 QQ






Tennessee RR






Texas SS






Utah TT






Virginia UU






Vermont VV






Washington WW






Wisconsin XX






West Virginia YY






Wyoming ZZ





A Which Medical Center in Alaska do you visit? Anchorage - Alaska VA Healthcare System
Y Radio button, one-up vertical Skip Logic Alaska


B Which Medical Center in Alabama do you visit? Birmingham - Birmingham VA Medical Center
Y Radio button, one-up vertical Skip Logic Alabama




Montgomery - Central Alabama Veterans Health Care System








Tuscaloosa - Tuscaloosa VA Medical Center








Tuskegee - Central Alabama Veterans Health Care System






C Which Medical Center in Arkansas do you visit? Fayetteville - Veterans Health Care System of the Ozarks
Y Radio button, one-up vertical Skip Logic Arkansas




Little Rock - Central Arkansas Veterans Healthcare System








North Little Rock - Central Arkansas Veterans Healthcare System






D Which Medical Center in Arizona do you visit? Phoenix - Phoenix VA Health Care System
Y Radio button, one-up vertical Skip Logic Arizona




Prescott - Northern Arizona VA Health Care System








Tucson - Southern Arizona VA Health Care System






E Which Medical Center in California do you visit? Fresno - VA Central California Health Care System
Y Radio button, one-up vertical Skip Logic California




Livermore - VA Palo Alto Health Care System








Loma Linda - VA Loma Linda Healthcare System








Long Beach - VA Long Beach Healthcare System








Los Angeles - VA Greater Los Angeles Healthcare System








Mather - VA Northern California Health Care System








Menlo Park - VA Palo Alto Health Care System








Palo Alto - VA Palo Alto Health Care System








San Diego - VA San Diego Healthcare System








San Francisco - San Francisco VA Medical Center






F Which Medical Center in Colorado do you visit? Denver - VA Eastern Colorado Health Care System
Y Radio button, one-up vertical Skip Logic Colorado




Grand Junction - Grand Junction VA Medical Center






G Which Medical Center in Connecticut do you visit? Newington - VA Connecticut Healthcare System
Y Radio button, one-up vertical Skip Logic Connecticut




West Haven - VA Connecticut Healthcare System






H Which Medical Center in District of Columbia do you visit? Washington DC - Washington DC VA Medical Center
Y Radio button, one-up vertical Skip Logic DC


I Which Medical Center in Delaware do you visit? Wilmington - Wilmington VA Medical Center
Y Radio button, one-up vertical Skip Logic Delaware


J Which Medical Center in Florida do you visit? Bay Pines - Bay Pines VA Healthcare System
Y Radio button, one-up vertical Skip Logic Florida




Miami - Miami VA Healthcare System








Gainesville - North Florida / South Georgia VA Healthcare System








Lake City - North Florida / South Georgia VA Healthcare System








Orlando - Orlando VA Medical Center








Tampa - James A. Haley Veterans' Hospital








West Palm Beach - West Palm Beach VA Medical Center






K Which Medical Center in Georgia do you visit? Augusta - Charlie Norwood VA Medical Center
Y Radio button, one-up vertical Skip Logic Georgia




Decatur - Atlanta VA Medical Center








Dublin - Carl Vinson VA Medical Center






L Which Medical Center in Hawaii do you visit? Honolulu - VA Pacific Islands Health Care System
Y Radio button, one-up vertical Skip Logic Hawaii


M Which Medical Center in Iowa do you visit? Des Moines - VA Central Iowa Health Care System
Y Radio button, one-up vertical Skip Logic Iowa




Iowa City - Iowa City VA Medical Center






N Which Medical Center in Idaho do you visit? Boise VA Medical Center
Y Radio button, one-up vertical Skip Logic Idaho


O Which Medical Center in Illinois do you visit? Chicago - Jesse Brown VA Medical Center

Radio button, one-up vertical
Illinois




Danville - VA Illiana Health Care System








Hines - Edward Hines Jr. VA Hospital








Marion - Marion VA Medical Center








North Chicago – Captain James A. Lovell Federal Healthcare Center






P Which Medical Center in Indiana do you visit? Fort Wayne - VA Northern Indiana Health Care System
Y Radio button, one-up vertical Skip Logic Indiana




Indianapolis - Richard L. Roudebush VA Medical Center








Marion - VA Northern Indiana Health Care System






Q Which Medical Center in Kansas do you visit? Leavenworth - VA Eastern Kansas Health Care System
Y Radio button, one-up vertical Skip Logic Kansas




Topeka - VA Eastern Kansas Health Care System








Wichita - Robert J. Dole VA Medical Center






R Which Medical Center in Kentucky do you visit? Lexington - Lexington VA Medical Center (Cooper Division)
Y Radio button, one-up vertical Skip Logic Kentucky




Lexington - Lexington VA Medical Center (Leestown Division)








Louisville - Louisville VA Medical Center






S Which Medical Center in Louisiana do you visit? New Orleans - Southeast Louisiana Veterans Health Care System
Y Radio button, one-up vertical Skip Logic Louisiana




Pineville - Alexandria VA Medical Center








Shreveport - Overton Brooks VA Medical Center






T Which Medical Center in Massachusetts do you visit? Bedford - Edith Nourse Rogers Memorial Veterans Hospital
Y Radio button, one-up vertical Skip Logic Massachusetts




Brockton - VA Boston Healthcare System








Jamaica Plain - VA Boston Healthcare System








Leeds – Central Western Massachusetts Health Care System








West Roxbury - VA Boston Healthcare System






U Which Medical Center in Maryland do you visit? Baltimore - VA Maryland Health Care System
Y Radio button, one-up vertical Skip Logic Maryland




Perry Point - Perry Point VA Medical Center






V Which Medical Center in Maine do you visit? Augusta - Togus VA Medical Center
Y Radio button, one-up vertical Skip Logic Maine


W Which Medical Center in Michigan do you visit? Ann Arbor - VA Ann Arbor Healthcare System
Y Radio button, one-up vertical Skip Logic Michigan




Battle Creek - Battle Creek VA Medical Center








Detroit - John D. Dingell VA Medical Center








Iron Mountain - Oscar G. Johnson VA Medical Center








Saginaw - Aleda E. Lutz VA Medical Center






X Which Medical Center in Minnesota do you visit? Minneapolis - Minneapolis VA Medical Center
Y Radio button, one-up vertical Skip Logic Minnesota




St. Cloud - St. Cloud VA Medical Center






Y Which Medical Center in Missouri do you visit? Columbia - Harry S. Truman Memorial VA Medical Center
Y Radio button, one-up vertical Skip Logic Missouri




Kansas City - Kansas City VA Medical Center








Poplar Bluff - John J. Pershing VA Medical Center








St. Louis - St. Louis VA Medical Center (Jefferson Barracks Division)








St. Louis - St. Louis VA Medical Center (John Cochran Division)






Z Which Medical Center in Mississippi do you visit? Biloxi - VA Gulf Coast Veterans Health Care System
Y Radio button, one-up vertical Skip Logic Mississippi




Jackson - G.V. (Sonny) Montgomery VA Medical Center






AA Which Medical Center in Montana do you visit? Fort Harrison - VA Montana Health Care System
Y Radio button, one-up vertical Skip Logic Montana


BB Which Medical Center in North Carolina do you visit? Asheville - Asheville VA Medical Center
Y Radio button, one-up vertical Skip Logic North Carolina




Durham - Durham VA Medical Center








Fayetteville - Fayetteville VA Medical Center








Salisbury - W.G. (Bill) Hefner VA Medical Center






CC Which Medical Center in North Dakota do you visit? Fargo - Fargo VA Medical Center
Y Radio button, one-up vertical Skip Logic North Dakota


DD Which Medical Center in Nebraska do you visit? Omaha - VA Nebraska-Western Iowa Health Care System
Y Radio button, one-up vertical Skip Logic Nebraska


EE Which Medical Center in New Hampshire do you visit? Manchester - Manchester VA Medical Center
Y Radio button, one-up vertical Skip Logic New Hampshire


FF Which Medical Center in New Jersey do you visit? East Orange - VA New Jersey Health Care System
Y Radio button, one-up vertical Skip Logic New Jersey




Lyons - VA New Jersey Health Care System






GG Which Medical Center in New Mexico do you visit? Albuquerque - New Mexico VA Health Care System
Y Radio button, one-up vertical Skip Logic New Mexico


HH Which Medical Center in Nevada do you visit? Las Vegas - VA Southern Nevada Healthcare System

Radio button, one-up vertical
Nevada




Reno - VA Sierra Nevada Health Care System






II Which Medical Center in New York do you visit? Albany - Samuel S. Stratton VA Medical Center
Y Radio button, one-up vertical Skip Logic New York




Batavia - VA Western New York Healthcare System








Bath - Bath VA Medical Center








Bronx - James J. Peters VA Medical Center








Brooklyn - VA NY Harbor Healthcare System








Buffalo - VA Western New York Healthcare System








Canandaigua - Canandaigua VA Medical Center








Castle Point - VA Hudson Valley Health Care System








Montrose - VA Hudson Valley Health Care System








New York - VA NY Harbor Healthcare System - Manhattan Campus








Northport - Northport VA Medical Center








Syracuse - Syracuse VA Medical Center






JJ Which Medical Center in Ohio do you visit? Chillicothe - Chillicothe VA Medical Center
Y Radio button, one-up vertical Skip Logic Ohio




Cincinnati - Cincinnati VA Medical Center








Cleveland - Louis Stokes VA Medical Center








Columbus - Chalmbers P. Wylie Ambulatory Care Center








Dayton - Dayton VA Medical Center






KK Which Medical Center in Oklahoma do you visit? Muskogee - Jack C. Montgomery VA Medical Center
Y Radio button, one-up vertical Skip Logic Oklahoma




Oklahoma City - Oklahoma City VA Medical Center






LL Which Medical Center in Oregon do you visit? Roseburg - VA Roseburg Healthcare System
Y Radio button, one-up vertical Skip Logic Oregon




Portland - Portland VA Medical Center






MM Which Medical Center in Pennsylvania do you visit? Altoona - James E. Van Zandt VA Medical Center
Y Radio button, one-up vertical Skip Logic Pennsylvania




Butler - VA Butler Healthcare System








Coatesville - Coatesville VA Medical Center








Erie - Erie VA Medical Center








Lebanon - Lebanon VA Medical Center








Philadelphia - Philadelphia VA Medical Center








Pittsburgh - VA Pittsburgh Healthcare System (Highland Drive Division)








Pittsburgh - VA Pittsburgh Healthcare System (University Drive Division)








Pittsburgh - VA Pittsburgh Healthcare System (H.J. Heinz Progressive Care Center)








Wilkes-Barre - Wilkes-Barre VA Medical Center






NN Which Medical Center in Puerto Rico do you visit? San Juan - VA Caribbean Healthcare System
Y Radio button, one-up vertical Skip Logic Puerto Rico


OO Which Medical Center in Rhode Island do you visit? Providence - Providence VA Medical Center
Y Radio button, one-up vertical Skip Logic Rhode Island


PP Which Medical Center in South Carolina do you visit? Charleston - Ralph H. Johnson VA Medical Center
Y Radio button, one-up vertical Skip Logic South Carolina




Columbia - Wm. Jennings Bryan Dorn VA Medical Center






QQ Which Medical Center in South Dakota do you visit? Fort Meade - VA Black Hills Health Care System
Y Radio button, one-up vertical Skip Logic South Dakota




Hot Springs - VA Black Hills Health Care System








Sioux Falls - Sioux Falls VA Medical Center






RR Which Medical Center in Tennessee do you visit? Memphis - Memphis VA Medical Center
Y Radio button, one-up vertical Skip Logic Tennessee




Mountain Home - Mountain Home VA Medical Center








Murfreesboro - Tennessee Valley Healthcare System








Nashville - Tennessee Valley Healthcare System






SS Which Medical Center in Texas do you visit? Amarillo - Amarillo VA Health Care System
Y Radio button, one-up vertical Skip Logic Texas




Big Spring - West Texas VA Health Care System








Dallas - VA North Texas Health Care System








El Paso - El Paso VA Health Care System








San Antonio - South Texas Veterans Health Care System








Temple - Central Texas Veterans Health Care System








Bonham - VA North Texas Health Care System








Houston - Michael E. DeBakey VA Medical Center








Kerrville - Kerrville VA Medical Center








Waco - Central Texas Veterans Health Care System






TT Which Medical Center in Utah do you visit? Salt Lake City - VA Salt Lake City Health Care System
Y Radio button, one-up vertical Skip Logic Utah


UU Which Medical Center in Virginia do you visit? Hampton - Hampton VA Medical Center
Y Radio button, one-up vertical Skip Logic Virginia




Richmond - Hunter Holmes McGuire VA Medical Center








Salem - Salem VA Medical Center






VV Which Medical Center in Vermont do you visit? White River Junction - White River Junction VA Medical Center
Y Radio button, one-up vertical Skip Logic Vermont


WW Which Medical Center in Washington do you visit? Seattle - VA Puget Sound Health Care System
Y Radio button, one-up vertical Skip Logic Washington




Tacoma - VA Puget Sound Health Care System (American Lake Division)








Spokane - Spokane VA Medical Center








Walla Walla - Jonathan M. Wainwright Memorial VA Medical Center






XX Which Medical Center in Wisconsin do you visit? Madison - William S. Middleton Memorial Veterans Hospital
Y Radio button, one-up vertical Skip Logic Wisconsin




Milwaukee - Clement J. Zablocki Veterans Affairs Medical Center








Tomah - Tomah VA Medical Center






YY Which Medical Center in West Virginia do you visit? Beckley - Beckley VA Medical Center
Y Radio button, one-up vertical Skip Logic West Virginia




Clarksburg - Louis A. Johnson VA Medical Center








Huntington - Huntington VA Medical Center








Martinsburg - Martinsburg VA Medical Center






ZZ Which Medical Center in Wyoming do you visit? Cheyenne - Cheyenne VA Medical Center
Y Radio button, one-up vertical Skip Logic Wyoming




Sheridan - Sheridan VA Medical Center




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