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UNM Health Hackathon Questionnaire
Thank you for participating in this informal survey. Please note that your information will be anonymized, and it will not be retained after the UNM Health Hackathon has ended.
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* Indicates required question
What is your age?
*
Under 25
25-40
41-65
Over 65
Prefer not to answer
What is your gender?
Female
Male
Prefer not to say
Other:
Clear selection
What is your level of vision loss?
Legally blind
Permanent partial loss of vision
Intermittent or temporary loss of vision
Color blindness or other
Other:
Clear selection
Do you use any mobility aids, such as a cane, guide dog, or an electronic aid?
Yes
No
Maybe
Clear selection
When did you start using a mobility aid?
MM
/
DD
/
YYYY
Do you have any other impairments that affect your ability to walk?
Yes
No
Maybe
Clear selection
What impairment(s) are you affected by? (Optional)
Your answer
In a typical week, how often do you travel alone outside of your house?
Once a week or less
1-3 times per week
More than 3 times per week
Clear selection
How often do you travel alone outside of your familiar routes?
Once a week or less
1-3 times per week
More than 3 times per week
Clear selection
Have you experienced any head-level accidents? (i.e., hitting your head against an unknown obstacle)
Yes
No
Maybe
Clear selection
Have any head-level accidents you experienced resulted in medical consequences (hospitalization, ER visits, home rest)?
Yes
No
Maybe
Clear selection
Please describe any head-level accidents you've experienced (What did you hit? In what circumstances did it occur?)
Your answer
Have any head-level accidents resulted in time lost (from work, school, appointments)?
Yes
No
Maybe
Clear selection
Have you ever changed your walking habits as a consequence of your head-level accident? (e.g., did it make you reluctant to walk in unfamiliar places)
Yes
No
Maybe
Clear selection
Have you experienced any difficulties using a white cane?
Yes
No
Maybe
Clear selection
What is the hardest part about using a cane?
Your answer
How often do you experience a problem using a cane?
Less than once per week
1-3 times per week
3 or more times per week
Clear selection
Have you tried adapting your cane to fix any problems you've experienced? If yes, what did you try, and what was the result?
Your answer
What don't you love about the solutions you've tried?
Your answer
What would be the ideal solution for you? (What features would you most like to have?)
Your answer
Would you be willing to pay for a solution that provides the assistance you have identified as necessary?
Yes
No
Maybe
Clear selection
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