research questionnaire template

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. Funding for the survey comes from the Department of Veterans Affairs (VA). 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. After all, the research process is an important part of the survey, and a questionnaire is a tool that benefits the process. Would you be willing to do the following additional activities? VA should develop appropriate safeguards to protect information from misuse and disclosure [SP][ Prompt twice] Q25 Now that you�ve had a chance to think more about the Genomic Medicine Program [INSERT LINK TO IMAGE], do you think it should be done? I worry the program would take dollars away from other health care provided at the VA. Participating would be completely voluntary. Please let us know if there is anything we should change in the survey to make the questions easier to understand. Research Questionnaire Template Net Promoter Score Questionnaire Template, Non-profit Organization Information Template, U.S. Part of the consent form would describe how your samples and information would be used. Funding for the survey comes from the Department of Veterans Affairs (VA). Do you agree or disagree with the following statements? Specifically, answers obtained through closed-ended questions with multiple choice answer options are analyzed using quantitative methods and they may involve pie … Download Questionnaire Template … Contents. 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. 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. A short summary of this paper. [SP] Q32 Do you belong to a Veteran Service Organization (VSO)? [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 complied feedback data help a particular government or a private company to research & locate certain consumer problems and help to implement the powerful result- oriented policies for the same. Dear Customer,Good day! The VA should be allowed to use this information to determine if a veteran gets particular disability benefits or not. 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. [Display] The Genomic Medicine Program Many diseases result from a mix of genetics, environment, and lifestyle. In this case the participant could not be identified or contacted. Questionnaires can be classified as both, quantitative and qualitative method depending on the nature of questions. 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. The participant could not be given information about their individual samples, and new medical information from their medical records could not be added to the database. A respondent answers each question depending on the instruction given. [MP] Q30 Please tell us about your military experience. [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. &. . Through this brief survey, your answers will be helpful in enhancing our services and meeting your needs. QuestionPro is the leading survey and research platform to conduct customer satisfaction surveys. It is important to use genetic information about a person to contain health care costs. Your response will only be used for survey purposes. Whether you’re hoping to measure brand awareness, test a product/concept, or understand your target market better, we have a variety of market research survey templates you can customize to your industry. Download Free PDF. PDF. hB� aJ 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. Whether a person agreed to participate or not would not affect his or her health care in the VA. 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. Customer Success Story Questionnaire Template Ask your customers how they use your product – … 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. (For example, Veterans of Foreign Wars, Disabled Veterans of America) Yes No [SP] [prompt twice] Q34 Do you have a service-connected medical condition? [INSERT LINKS THROUGHOUT SURVEY TO BELOW IMAGE WHERE NOTED AS �(INSERT LINK TO IMAGE�)] [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 Step Three: Research Using the Genomic Medicine Database The goal is to have a research database at the VA that contains the genetic and medical information of hundreds of thousands of veterans. [Grid � SP] YesNo Did you ever serve in a combat or war zone? [Display] If you decided to participate in the Genomic Medicine Program [INSERT LINK TO IMAGE], you would be asked to sign a consent form. I would be concerned about the government having my samples and information. Market Research Survey Template Discover new insights for your market fit. Use the links to move more easily between the table of contents and the questionnaire sections. Yes No Not sure [SP] Q46 Have you ever participated in medical research? Download Questionnaire Template 02. Here is our collection of 33 Free Questionnaire Templates (Word), Download Questionnaire Template 01. Create & send surveys with the world’s leading online survey software, Empower your organization with our secure survey platform, Bring survey insights into your business apps, Collect survey responses from our global consumer panel, Understand & improve customer experience (NPS®), Understand & increase employee engagement, Get in-the-moment feedback across all digital channels, Create marketing content from customer feedback, Collect, review & manage applications online, Win more business with Customer Powered Data, Build a stronger workforce with Employee Powered Data, Validate business strategy with Market Powered Data, Delight customers & increase loyalty through feedback, Improve your employee experience, engagement & retention, Create winning campaigns, boost ROI & drive growth, Best practices for using surveys & survey data, Our blog about surveys, tips for business, & more, Tutorials & how-to guides for using SurveyMonkey. Closed questions structure the answer by only allowing responses which fit into pre-decided categories. Questionnaire templates can help you to plan and format your survey, but there are a lot to choose between. Think of it as a kind of written interview that follows a fixed scheme to ensure that data remains accurate. Easily Editable & … ;� ' 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)? This database would be used by VA researchers to better understand diseases and disorders affecting veterans. You can send out our templates as is, choose separate variables, add additional questions, or customize our questionnaire templates to fit your needs. YesNo [RANDOMIZE LIST] Researchers in other health-related government agencies Researchers in academic or medical centers in the United States Researchers in U.S. pharmaceutical companies Researchers in academic or medical centers in other countries [Grid � SP] Q21 (PCP - Q41) In thinking about all of the types of research that could be done, do you think research on the following should be allowed or prohibited? I worry the program would not be able to recruit participants from all segments of the VA population. h�V� aJ h�V� CJ OJ QJ ^J aJ hOk[ h�V� 5�hOk[ hOk[ 5�h�:� 5�\� hB� 5�\� h�V� 5�\� hB� h�V� ( 8 9 z { | � � � / � � � > ? 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. This kind of general study finding would be published in a medical journal. It would be illegal for law enforcement to get my information. This program would involve developing a database of blood samples, genetic information, and medical information of veterans who get health care through 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 . However, a key could be kept in a secure place linking the name and number. Free PDF. [SP] Q43 Have you ever volunteered for a project or activity that benefits veterans? Another option is not to keep a key linking the participant�s name to their number. Available in A4 & US Sizes. Download PDF Package. Is there information from VA medical records that you think should NOT be included in the Genomic Medicine Program [INSERT LINK TO IMAGE]database? You can check out the specific format that ought to be followed when formulating questions that can be … [SP] Q17 PCP - Q42) In thinking about the consent you would give, would you prefer to: Give your permission at the beginning of the study for all approved research projects Select categories of research (for example, cancer or diabetes) up front that you would or would not want your samples and information used for Be asked for permission to use your samples and information for each research project as it comes up [Grid � SP] Q19 (PCP - Q44) Do you think the following types of researchers outside of the VA should be able to use the Genomic Medicine Program [INSERT LINK TO IMAGE] database and samples? Customer Satisfaction Survey Template Great for honing in on specific things to improve. Researchers using the database would only see the number and would not be able to identify the participant. [Display] Lastly, we would like to ask a few questions about you, your service in the military, your health and the health care services you receive through the VA. [MP] Q28 Please indicate each of the eras in which you served. If an individual agreed to participate, he or she would sign a consent form. To figure out how genes, environment, and lifestyle interact to cause disease, a large number of people need to be studied. Strongly AgreeAgreeDisagreeStrongly Disagree [Select one] I would want to know all of my individual research results. • If the questionnaire has been requested of you by AMAS, hit the “Email” button at the Step Two: What Participation Would Involve After signing the consent form, a blood sample would be collected. There would be serious consequences for researchers who violate my research agreement. 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. Research questionnaires can be tricky to make, so here is a guide to help you in making an effective and detailed research questionnaire. Yes No Don�t know [IF �YES� in Q34 show Q35] [SP] Q35 What is your service-connected rating? The VA would like to do this kind of research and is considering a project called the Genomic Medicine Program. Definitely yes Probably yes Probably no Definitely no [SP] [Prompt twice] Q26 (PCP - Q50) Based on what you know today, would you participate in the Genomic Medicine Program [INSERT LINK TO IMAGE] if you were asked? 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. I think the program is important to do. It also describes the different types of questionnaires and the question types that are used in these questionnaires. Political Identification Questionnaire. Before, during, and after your product or service launch, market research is invaluable to get the insights you need to create and improve what you offer. Instantly Download Free Market Research Questionnaire Template, Sample & Example in PDF, Microsoft Word (DOC), Apple Pages Format. This research would therefore adopt a positivist approach as credible data can just be derived through quantitative analysis of phenomena observed (… [Display] Assume you were asked to participate in the Genomic Medicine Program [INSERT LINK TO IMAGE] For the next several questions, please answer as if you were thinking about participating. An individual participant�s research result would be the information about whether that person had the specific genetic, environmental, or lifestyle risk factor. If your company and research allows it, make this even more personal. There would be a research agreement signed by researchers and participants. [Display] Thank you for agreeing to take this survey. E. Technology. I would not want any of my individual research results. Thank you for your time. Definitely yes Probably yes Probably no Definitely no [Display] The next questions ask about how information from genomic research might be used. Research questionnaires are usually printed to a large number of respondents in a certain area. 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. All of the answers you provide in this survey will be kept confidential. This survey will take about 20 minutes to complete. I suspect that the VA is doing this research already. 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? 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? In your research process, you should first come up with a research question. This paper. 2.1 What Kinds of Surveys Work Best? 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. Very importantSomewhat importantNot very importantNot important at all [RANDOMIZE LIST] It would be illegal for insurers and employers to get my information. Ask the right questions with JotForm. Strongly agreeAgreeDisagreeStrongly disagree [RANDOMIZE LIST] Participating would make me feel like I was helping veterans. Download Full PDF Package. Thinking about this topic, do you have any comments you would like to share? Use 123 Form Builder's ready-to-go template, build on it and then share it with your mentees. Then, choose the type of questions that you want to include, and come up with succinct, straightforward questions to gather … A person has a genetic test and finds out that they have this variant. The genetic and medical information would be coded so researchers would not be able to identify individual participants. Q � � � � � � � � � � � � � � � � � � � � � � � � � ! • If certain sections of the questionnaire do not apply to your organizational activities, leave them blank. Download PDF. [can you change the text for qf1 as follows] QF1. 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 [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? $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. A research questionnaire is a type of questionnaire intended for research purposes. Do you believe you were ever exposed to environmental hazards such as Agent Orange, chemical warfare agents, ionizing radiation, or other potentially toxic substances? [SP] Q15 (PCP - Q39) Assume you had agreed to participate and the research is not conducted in a certified laboratory so individual research results [INSERT LINK TO TEXT] will not be returned to participants. Whether you’re conducting research or gathering feedback, our free questionnaire templates will help you get the answers you need. Quickly Customize. A research questionnaire is a productive survey which is used for accumulating response regarding any particular research work. No identifying information will be provided to the Genetics and Public Policy Center or the VA.

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