Be Brain Powerful® Switzerland Pre-Survey

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Brain Health Survey - English Version (for other versions, visit www.womensbrainproject.com/be-brain-powerful-switzerland/)

Thank you for agreeing to participate in this survey about your health. The aim of the survey is to gather information about our community to better inform the programming and advocacy work that we do. We are not trying to sell anything, and we are only interested in your opinions and experiences. Your survey responses will be kept strictly confidential. Thank you for your time. For more information about the Be Brain Powerful® Switzerland campaign, visit www.womensbrainproject.com/be-brain-powerful-switzerland/

1. What is your age?

18 - 24

25 - 34

35 - 44

45 - 55

56 - 64

65 or older

Clear selection

2. Are you

Male

Female

Prefer not to answer

Clear selection

3. Please indicate where you live (contry, state/canton and zip code as applicable)

4. When it comes to making healthcare decisions, do you make decisions on behalf of the following? Choose all that apply.

Yourself

Partner/Spouse/Significant other

Child

Parent

Other family members (brother, sister, aunt, uncle grandparent, etc.)

None (someone else makes health decisions for me)

5. A caregiver is defined as someone who provides care to a friend or family member who needs support due to a serious illness, disability, or mental health issue. Do you provide unpaid caregiver services at least once a week to any of the following?

Parent

Spouse

Sister or brother

Child

Other relative

Friend or non-relative

You are not a caregiver

6. What are your top 3 health concerns for you or your loved ones? Choose one item for each column.

Alzheimer's disease

Cancer

Heart disease/stroke

Chronic pain

Diabetes

Inherited illnesses

Infectious diseases such as flu, pneumonia, or hospital-based infections

Mental health conditions, such as depresssion or anxiety

Opioid addiction

Substance abuse or misuse, such as alcohol or other drugs (excluding heroin or opioid-based pain relievers)

Other issue

Not sure

Clear selection

We use the phrase “brain health” to describe normal brain function, including processing and retaining information; performing logical thinking, judgement and perspective; storing and recalling memory; and the ability to concentrate.

7. How often is brain health a topic of conversation in your household?

Never have discussed

Rarely have discussed

Occasionally have discussed

Regularly discussed

Clear selection

8. To what extent do you agree or disagree with the following statements?

Agree Strongly

Agree Somewhat

Neither Agree Nor Disagree

Disagree Somewhat

Disagree Strongly

I am aware of preventive care/proactive measures that I can take to maintain or protect my brain health.

If I could ask my healthcare provider to measure my brain health to maintain or protect it, I would do so.

I’d be interested in learning more about measures of brain health as something to track and care for.

The health and performance of my brain as I age is something that worries me.

I interact/have interacted with family members who live with dementia.

Brain health is relevant only for older people.

Agree Strongly

Agree Somewhat

Neither Agree Nor Disagree

Disagree Somewhat

Disagree Strongly

I am aware of preventive care/proactive measures that I can take to maintain or protect my brain health.

If I could ask my healthcare provider to measure my brain health to maintain or protect it, I would do so.

I’d be interested in learning more about measures of brain health as something to track and care for.

The health and performance of my brain as I age is something that worries me.

I interact/have interacted with family members who live with dementia.

Brain health is relevant only for older people.

Clear selection

9. Do you take any steps to protect the brain health of your children?

Yes

I don't have any children

Clear selection

10. Which of the following have you done with or for your children? Choose all that apply.

Discussed how to try to avoid head injuries/concussion in sports and/or what to do if he/she thinks he/she has a head injury related to sports

Discussed threats to brain health like injury, drug and alcohol use

Limited overuse of electronics/screen time

Discussed the importance of staying healthy physically and mentally

Have had my child/children tested for learning challenges

None of these

11. Do you take steps to protect the brain health of your parents?

Yes

Parents are deceased

Clear selection

12. Which of the following have you done with or for your parents? Choose all that apply.

Encourage my parent(s) to play computer games designed for brain health

I don’t have to do anything; my parent(s) take(s) the initiative to keep his/her/their brain(s) healthy

Encourage my parent(s) to talk to their doctors about brain health

Would do more if I had more resources about brain health

Encourage my parent(s) to eat healthfully, sleep well, and/or engage socially

None of these

The last few questions are for classification purposes only.

13. What is the highest level of education that you have completed?

Less than high school

High school graduate, diploma, or equivalent (for example, GED)

Some college, no degree

Associate degree

Bachelor’s degree

Graduate or professional degree

Doctorate

Clear selection

14. Which of the following best describes your ethnicity?

African American or Black

Asian/Pacific Islander

Native American or American Indian

Caucasian or White

Hispanic or Latino

More than one ethnicity

Other

Prefer not to answer

Clear selection

15. What was your total annual household income during the past 12 months?

Less than $25,000

$25,000 - $34,999

$35,000 – $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 or more

Prefer not to answer

Clear selection

That concludes our survey. Thank you for your time.

Bonus: Would you like to be added to the WBP mailing list? No spam (promise!), and you can unsubscribe any time. If YES, please include your email address below. If NO, type in "NO" or leave blank.

Submit

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