;� ' P \ z� �^ �^ �n@��� �\ 2d � b� b n 4 � 0 # �� � � ,e 0 � � z� � \ �� � s` � =a � �q �a t Ab i s` s` s` � � \l � s` s` s` # �c �c �c �c p p p D@ �\ p p p �\ p p p � � � � � � ���� Veterans Health Care Survey April 2008 -Questionnaire- ASSESSING VETERANS� ATTITUDES ABOUT THE GENOMIC MEDICINE PROGRAM [SCREENING QUESTION] [prompt] S1 Have you ever received health or psychological care through the Department of Veterans Affairs (VA)? Definitely yes Probably yes Probably no Definitely no [Display] The next questions ask about how information from genomic research might be used. Available in A4 & US Sizes. Strongly agreeAgreeDisagreeStrongly disagree [RANDOMIZE LIST] Participating would make me feel like I was helping veterans. It contains a set of questions along with multiple answer choices. Note: For all following questions, please link �this program�, �the program�, �The Genomic Medicine Program�, and �the genomic medicine program� to an HTML page showing the text above. The QRZ Family Restaurant is dedicated to improving customer satisfaction. Research is a broad term to classify and hence a questionnaire prepared related to any such purpose has to be constructed with proper questions relevant to the work. I would not want any of my individual research results. Well you’re in the right place! You can send out our templates as is, choose separate variables, add additional questions, or customize our questionnaire templates to fit your needs. To develop a questionnaire for research, identify the main objective of your research to act as the focal point for the questionnaire. Through this brief survey, your answers will be helpful in enhancing our services and meeting your needs. Individual research results are generally not returned to research participants, unless the research is conducted in a laboratory certified to give medical results. The genetic and medical information would be coded so researchers would not be able to identify individual participants. You can check out the specific format that ought to be followed when formulating questions that can be … In this case the participant could not be identified or contacted. Do you want to write a survey questionnaire, but need a little guidance on the right questions to use? [Display] Thank you for agreeing to take this survey. Our sample survey examples—or customizable survey templates that span every use case, can allow you to overcome writer’s block and help you identify the questions you want to ask the most. Use 123 Form Builder's ready-to-go template, build on it and then share it with your mentees. The category can be restricted to as few as two options, i.e., dichotomous (e.g., 'yes' or 'no,' 'male' or 'female'), or include quite complex lists of alternatives from which the respondent can choose (e.g., polytomous).Closed questions can also provide ordinal data (which can be ranked). Download Questionnaire Template 02. Political Identification Questionnaire. Your participation will help us to understand the attitudes and opinions of veterans regarding the proposed Genomic Medicine Program [INSERT LINK TO IMAGE]. Another option is not to keep a key linking the participant�s name to their number. Give your brand a face. [SP] Q43 Have you ever volunteered for a project or activity that benefits veterans? Very importantSomewhat importantNot very importantNot important at all [RANDOMIZE LIST] It would be illegal for insurers and employers to get my information. I think the program is important to do. A questionnaire is defined a market research instrument that consists of questions or prompts to elicit and collect responses from a sample of respondents. Strongly AgreeAgreeDisagreeStrongly Disagree [Select one] I would want to know all of my individual research results. [MP] Q30 Please tell us about your military experience. Ultimately, the style, the questions and the strategies involved are going to be decided by the purpose of the survey. It is important to use genetic information about a person to contain health care costs. The VA would like to do this kind of research and is considering a project called the Genomic Medicine Program. There would be a research agreement signed by researchers and participants. This article enlists 21 questionnaire templates along with samples and examples. [Grid � SP] Q8 (PCP - Q31) In deciding whether or not to participate, how important would the following be to you? Customer Success Story Questionnaire Template Ask your customers how they use your product – … Specifically, answers obtained through closed-ended questions with multiple choice answer options are analyzed using quantitative methods and they may involve pie … If a person decided at a later time that they no longer wanted to have their genetic and medical information in the database, they could have them removed. I do not care if I get any individual research results. Customer evaluation survey templates. Whether you’re conducting research or gathering feedback, our free questionnaire templates will help you get the answers you need. Would you be willing to do the following additional activities? . Research questionnaires are usually printed to a large number of respondents in a certain area. A questionnaire is only effective if its questions bring in results that help you answer an overarching research question. QuestionPro is the leading survey and research platform to conduct customer satisfaction surveys. The results of the genetic testing would go into a database along with information from that person�s VA medical record. This customer questionnaire template presents various questions like awareness about the company, knowledge about the company website, online purchase details, promptness in delivery of goods purchased through online, improvement related to packing and product and satisfaction levels. Would you be more or less likely to participate in the Genomic Medicine Program [INSERT LINK TO IMAGE],? Our likert scale templates will enable you to easily and accurately design questionnaires that will be specific to your subject and those that are likert scale compatible. The social realm of banks and graduates where this research relies exists externally and aren’t associated with the investigator hence they could be measured through objective methods instead of being deduced subjectively through reflection, sensation or intuition (Easterby-Cruz, 2002). I worry the program would not be able to recruit participants from all segments of the VA population. Quickly Customize. I suspect that the VA is doing this research already. 2.1 What Kinds of Surveys Work Best? A research questionnaire template, as the name depicts, is a ready to use questionnaire consisting of different questions in order to record the feedback of the people. gd�V� Very importantSomewhat importantNot very importantNot important at all [RANDOMIZE LIST] Monetary compensation for my time [If (1-3) Show Q9, Else Q10] Receiving information about my health Knowing what kind of research is being done using the database Knowing who to go to with a question or complaint Having my privacy protected Having a mechanism to change my mind and withdraw my sample and information at a later time [SP] Q9 (PCP - Q32) What is the lowest amount you would require to participate? Contents. The rest of the sample would be stored for future research. Think of it as a kind of written interview that follows a fixed scheme to ensure that data remains accurate. [SP] Q32 Do you belong to a Veteran Service Organization (VSO)? ; 3 Questionnaire Examples . In case you have any questions regarding the survey, please call Johnny Smith at 123-456-7890. Definitely yes Probably yes Probably no Definitely no [Grid � SP] Q6 (PCP - Q24) When thinking about the Genomic Medicine Program [INSERT LINK TO IMAGE], do you agree or disagree with the following statements? Strongly agreeAgreeDisagreeStrongly disagree [RANDOMIZE LIST] A research database of genetic and medical information on veterans would lead to improved treatments, cures, or lives saved for veterans. A person has a genetic test and finds out that they have this variant. Researchers plan effective questionnaires and reach to … [Display] Individual Research Results Researchers studying all of the samples and information together may find that a certain genetic, environmental, or lifestyle factor is related to a specific disease. After all, the research process is an important part of the survey, and a questionnaire is a tool that benefits the process. We are seeking to understand the opinions of veterans who receive health care through the VA. Download Free PDF. A research questionnaire is a type of questionnaire intended for research purposes. The survey is being done by the Genetics and Public Policy Center at Johns Hopkins University. Our pre-written survey templates make it easy to pick through a series of questions, understand the difference between open questions and closed questions, build your survey, and start collecting data in minutes. 3.1 Choosing Your Template By The Questions Your Survey Asks; 3.2 Choosing Your Questions Carefully; 4 Questionnaire Samples. Conclude mentoring sessions with a qualitative research survey. Market Research Survey Template Discover new insights for your market fit. No identifying information will be provided to the Genetics and Public Policy Center or the VA. Strongly agree Agree Disagree Strongly Disagree Combine Q43, 45, and 46 into a grid, place after Q44. World War II Between WWII and the Korean Conflict During the Korean Conflict Between the Korean Conflict and the Vietnam Era During the Vietnam Era Between Vietnam Era and the Gulf War During the Gulf War Between the Gulf War and Operation Enduring Freedom/Operation Iraqi Freedom During Operation Enduring Freedom/Operation Iraqi Freedom [NUM BOX, RANGE 1-40] Q29 In total, how many years did you serve on active duty? Researchers who are interested in studying disorders that affect veterans could apply to use the information in the database. In thinking about individual research results, [INSERT LINK TO TEXT], which would you prefer? • If certain sections of the questionnaire do not apply to your organizational activities, leave them blank. The purpose of the survey is to collect opinions from veterans who get health care through the VA about a research project being considered by the VA. Plus, by looking through an example of a survey, you’ll get a sense for the question types you can use, how you can order the questions, and the ways you can apply survey logic. Yes No Not sure [SP] Q46 Have you ever participated in medical research? Please complete the questionnaire below. [RANDOMIZE LIST] HIV infection or AIDS diagnosis Mental illness information Cancer diagnosis Diagnosis of posttraumatic stress disorder (PTSD) Reproductive history Sexual behavior Social security number Sexual trauma Drug and alcohol history None of the above [INSERT LINKS THROUGHOUT SURVEY TO BELOW TEXT WHERE NOTED AS �(INSERT LINK TO TEXT�)] Note: please link �individual research results� to an HTML screen with the following text. This program would involve developing a database of blood samples, genetic information, and medical information of veterans who get health care through the VA. Yes No Not sure [SP] Q44 (PCP - Q10) Have you donated blood in the past five years? Attached is a meal coupon good for 3 months as a token of our good will. Funding for the survey comes from the Department of Veterans Affairs (VA). This paper. Use this template: We personally want to thank YOU for every second invested in our research. [Display] The Genomic Medicine Program Many diseases result from a mix of genetics, environment, and lifestyle. An individual participant�s research result would be the information about whether that person had the specific genetic, environmental, or lifestyle risk factor. Download Full PDF Package. [SP] Q12 Should a key [INSERT LINK TO Q11 INTRO DISPLAY] be kept linking the participant�s name to their number? $0 $1-50 $51-100 $101-250 $251-500 More than $500 [Grid � SP] Q10 (PCP - Q28) Participants in the program [insert link to program] would be asked to give a blood sample for genetic research and give permission for their medical records to be put into the database. [Grid � SP] Q7 (PCP - Q25) When thinking about participating in the program, [INSERT LINK TO IMAGE] do you agree or disagree with the following statements? This kind of general study finding would be published in a medical journal. 8 9 { | � � � � � � � � � � ( > � f g h i j ���������������ſ��Ţ����pdpQp� %j hk* h�V� CJ OJ QJ UaJ hss� CJ OJ QJ aJ j h�V� CJ OJ QJ UaJ *j h�V� CJ OJ QJ UaJ mH nH u h�V� CJ OJ QJ aJ h�}� CJ OJ QJ ^J aJ ht� h�V� aJ Strongly AgreeAgreeDisagreeStrongly Disagree [RANDOMIZE LIST] The VA should be allowed to use this information to determine if a veteran gets particular health care benefits or not. Instantly Download Free Market Research Questionnaire Template, Sample & Example in PDF, Microsoft Word (DOC), Apple Pages Format. A respondent answers each question depending on the instruction given. With over 50 expert-designed survey templates, we offer the most advanced tools to measure your Customer Satisfaction … DOCX. [Display] If you decided to participate in the Genomic Medicine Program [INSERT LINK TO IMAGE], you would be asked to sign a consent form. Less than a quarter Between a quarter and a half Between a half and 99% I get all of my health care through the VA [SP] Q39 Do you agree or disagree with the following statement: I am satisfied with the health care that I receive through the VA. [Display] Show the schema INCLUDEPICTURE "../../Documents%20and%20Settings/jscott/Local%20Settings/jscott/Local%20Settings/dmcbride.INTERSURVEY/Desktop/Local%20Settings/Temp/Local%20Settings/Local%20Settings/jscott/Local%20Settings/Temp/XPgrpwise/Documents%20and%20Settings/Local%20Settings/DOCUME~1/SWILLI~1/LOCALS~1/Temp/XPgrpwise/IMAGE_1.jpeg" \* MERGEFORMAT How the Genomic Medicine Program would work: Step One: Who Would Participate Veterans from all over the country who receive health care through the VA would be invited to participate. If your company and research allows it, make this even more personal. Download PDF Package. This would allow the participant to be identified and contacted if needed, and would allow new information from a participant�s medical record to be added to the database. Net Promoter Score Questionnaire Template, Non-profit Organization Information Template, U.S. The next question relates to whether or not a key should be kept linking a participant�s name and number. academic performance research questionnaire sample. Yes No Don�t know [IF �YES� in Q34 show Q35] [SP] Q35 What is your service-connected rating? Participating would be completely voluntary. A questionnaire can be explained as a data collection tool consisting of a series of questions in printed form for the purpose of gathering required information or data from particular group of people or respondents. A research questionnaire is a tool that consists of a series of standardized questions with the intent of collecting information from a sample of people. ��ࡱ� > �� � � ���� � � � � � � � � ���������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� %` �� gK bjbjN�N� 9� ,� ,� �B n �� �� �� � � � � � \ \ \ p �\ �\ �\ 8 �\ � �] $ p # h �^ ( �^ �^ �^ �^ s` s` s` � � � � � � � $ � h � � � \ �c Q` " s` �c �c � � � �^ �^ a � �q �q �q �c � � 0 �^ \ �^ � �q �c � �q �q DefinitelyProbablyProbably notDefinitely not [Randomize order of first FOUR responses and second six responses � don�t repeat header] Spend a half-day at a VA facility near you to get a physical examination Have follow-up exams over time [have this response always following the previous] Get X-rays Agree to have medical records from the health care you get outside of the VA added to the database Answer detailed questions about your psychological and emotional health Wear an environmental monitoring device such as a pedometer for a week Have researchers come to your home to collect information, such as environmental samples Keep a diet and exercise journal for one week Be contacted by either phone or e-mail periodically to find out about your current health [Q11 INTRO DISPLAY SCREEN] Hyperlink references to linking or a key to this screen When a participant�s sample and their genetic and medical information go into the Genomic Medicine Program [INSERT LINK TO IMAGE] database, his or her name would be removed and replaced with a number. &. Research Hypotheses. Customize your online questionnaire with our drag-and-drop Form Builder. Your response will only be used for survey purposes. Download Questionnaire Template … Plus, by looking through an example of a survey, you’ll get a sense for the question types you can use, how you can order the questions, and the ways you can apply survey logic . How else can a sample survey help you? I would be less likely to participate It would not make a difference to me I would be more likely to participate Q14 (PCP - Q38C) Assume you had agreed to participate, and that the research is done in a certified laboratory. Thinking about this topic, do you have any comments you would like to share? Questionnaires can be classified as both, quantitative and qualitative method depending on the nature of questions. Researchers using the database would only see the number and would not be able to identify the participant. 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