User Experience Survey Regional Clinical Plan
INSTRUCTIONS | This questionnaire will ask about your experience with the health resources found in your community.
With this questionnaire, we are trying to better understand if your experience met your expectations to receive help when you needed it.
Your answers will be treated confidentially.
PART 1: WHEN YOU NEEDED HELP
Think about one time you had to visit the nursing/hospital.
1.1 I needed help concerning *
1.2 I needed help concerning *
1.3 The health problem was concerning *
1.4 The Nurse was helpful when I called *
1.5 I had to go to the nursing/hospital between *
1.6 I knew where to go when I needed help *
1.7 I knew who to go to when I needed help *
1.8 I was afraid to go and seek help at the nursing/hospital *
1.9 I was told I would need to travel to get the health service needed *
1.9.1 I had to travel *
1.9.2 It bothered me travelling to get the service *
1.9.3 Someone was allowed to travel with me *
1.9.4 It helped to have someone with me *
PART 2: WHEN I WAS RECEIVING HELP AT THE NURSING/HOSPITAL
2.1 I met the right people that could help me *
2.2. I saw someone that could help me *
2.3. I had access to an interpreter *
2.4. They explained how they could help me, what they would do *
2.5 I felt I understood how they could help me, what they would do *
2.6 I felt comfortable to ask all my questions *
2.7 They made sure I understood the answers *
2.8 I felt I understood the answers *
2.9 I felt they considered my point of view *
2.10 I felt safe *
PART 3: WHEN I RETURNED HOME
3.1 When I returned home, my problem was solved *
3.2 I felt it was a good idea to go to the nursing/hospital *
3.3 I had to go back to the nursing/hospital shortly after because my problem was not solved *
3.4 I had to go back to the nursing/hospital for a follow up *
3.5 I frequently have to travel to the hospital for health treatment *
3.6 In general the help provided was *
PART 4: EDUCATION ON HELP ISSUES
4.1 When I have health issues, I ask my family rather than going to the hospital/clsc *
4.2 I learn about health issues *
Required
PART 5: GENERAL ACCESS
5.1 I feel I have good access to the health services in my community *
5.2 I feel I have access to the same health services than I would in other Nunavik Communities *
5.2.1 Comments about access in other Nunavik Communities
Your answer
5.3 I feel I have access to the same health services than elsewhere in the Province of Quebec *
5.3.1 Comments about access elsewhere
Your answer
PART 6 : ABOUT YOU
6.1 I am *
6.2 My age *
6.3 I feel that I am in good health *
6.4 I live in : *
6.5 I am a JBNQA beneficiary? *
PART 7: Additional comments
7.1 I would be interested to participate in an individual interview to talk more about the subject *
7.2 Do you have any other comments concerning your experience?
Your answer
To enter the contest:
Name
Your answer
Phone number
Your answer
Email address
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service