“It is important to know what you think about the Home Telehealth program. Please answer the following eight questions. The OMB survey approval number is 2900-0766. ”
**Notes:
1. The numbers in parentheses are how the response will be scored in the database.
1. My care coordinator explains things in a way that is easy to understand.
· Always (1)
· Usually (2)
· Sometimes (3)
· Never (4)
2. The information provided by my care coordinator has helped me manage my health problem(s).
· Strongly Agree (1)
· Agree (2)
· Disagree (3)
· Strongly Disagree (4)
3. Over the past 3 months, my home telehealth equipment works:
· Always (1)
· Usually (2)
· Sometimes (3)
· Never (4)
4. My home telehealth equipment is easy to use.
· Strongly Agree (1)
· Agree (2)
· Disagree (3)
· Strongly Disagree (4)
5. I have made changes in the way I take care of myself as a result of the VA home telehealth program.
· Strongly Agree (1)
· Agree (2)
· Disagree (3)
· Strongly Disagree (4)
6. When I have questions, I am able to contact my care coordinator during business hours.
· Always (1)
· Usually (2)
· Sometimes (3)
· Never (4)
7. Using the VA home telehealth program has made a positive difference in my health.
· Strongly Agree (1)
· Agree (2)
· Disagree (3)
· Strongly Disagree (4)
8. I would recommend a home telehealth program to others.
· Strongly Agree (1)
· Agree (2)
· Disagree Strongly (3)
· Disagree (4)