Be Brain Powerful® Switzerland Pre-Survey
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?
Clear selection
2. Are you
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.
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?
6. What are your top 3 health concerns for you or your loved ones? Choose one item for each column.
#1
#2
#3
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?
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.
Clear selection
9. Do you take any steps to protect the brain health of your children?
Clear selection
10. Which of the following have you done with or for your children? Choose all that apply.
11. Do you take steps to protect the brain health of your parents?
Clear selection
12. Which of the following have you done with or for your parents? Choose all that apply.
The last few questions are for classification purposes only.
13. What is the highest level of education that you have completed?
Clear selection
14. Which of the following best describes your ethnicity?
Clear selection
15. What was your total annual household income during the past 12 months?
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.
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