Paediatric Diabetes Survey We want to improve our services provided to you and would like your feedback about your experience. Question Title * 1. Do you find hours of clinic convenient? If not, please provide details about your preference. Convenient Somewhat convenient Not very convenient Other (please specify) Question Title * 2. How long do you have to travel to attend a diabetes appointment? Less than 30 minutes Less than 60 minutes More than 1 hour Question Title * 3. Please let us know what you think about the way we currently run your diabetes appointment: Like to see all staff together and tell my story once Would prefer to see each staff member separately (nurse, dietitian, Paediatrician, social worker) Other (please specify) Question Title * 4. We provided you a manual when your child was first diagnosed and wonder if it is something you used. In the beginning We use it all the time We never look at it Only use it for specific concerns Other (please specify) Question Title * 5. You had a crash course in diabetes when your child was first diagnosed. Are there things you wish to review again at an appointment with the nurse, dietitian or social worker? No, I feel well informed No, I don't think it will help Yes, I would like to meet to talk about food Yes, I would like to meet to talk about exercise Yes, I would like to meet to talk about parenting Yes, I would like to meet to talk about insulin dose adjustment Yes, I would like to meet to talk about new technology Other (please specify) Question Title * 6. Would you like an evening group information session on any of the following? Yes No Research Research Yes Research No Food Food Yes Food No Adjusting insulin Adjusting insulin Yes Adjusting insulin No Insulin pump Insulin pump Yes Insulin pump No Continuous Glucose Monitoring Continuous Glucose Monitoring Yes Continuous Glucose Monitoring No Financial & Tax Information Financial & Tax Information Yes Financial & Tax Information No Managing stress Managing stress Yes Managing stress No Parent support Parent support Yes Parent support No School Issues School Issues Yes School Issues No Question Title * 7. Do you meet with teachers every fall to inform them about your child's diabetes? Yes No Other (please specify) Question Title * 8. There is a lot of work involved in diabetes management. Please share how you do things. Independant Parent and Child together Parent supervises Call Diabetes Nurse Do not do this Testing blood sugar Testing blood sugar Independant Testing blood sugar Parent and Child together Testing blood sugar Parent supervises Testing blood sugar Call Diabetes Nurse Testing blood sugar Do not do this Recording or looking at readings to decide if dose change is needed Recording or looking at readings to decide if dose change is needed Independant Recording or looking at readings to decide if dose change is needed Parent and Child together Recording or looking at readings to decide if dose change is needed Parent supervises Recording or looking at readings to decide if dose change is needed Call Diabetes Nurse Recording or looking at readings to decide if dose change is needed Do not do this Carb counting Carb counting Independant Carb counting Parent and Child together Carb counting Parent supervises Carb counting Call Diabetes Nurse Carb counting Do not do this Injecting insulin or bolus your pump Injecting insulin or bolus your pump Independant Injecting insulin or bolus your pump Parent and Child together Injecting insulin or bolus your pump Parent supervises Injecting insulin or bolus your pump Call Diabetes Nurse Injecting insulin or bolus your pump Do not do this Insulin plan for illness Insulin plan for illness Independant Insulin plan for illness Parent and Child together Insulin plan for illness Parent supervises Insulin plan for illness Call Diabetes Nurse Insulin plan for illness Do not do this Testing for ketones Testing for ketones Independant Testing for ketones Parent and Child together Testing for ketones Parent supervises Testing for ketones Call Diabetes Nurse Testing for ketones Do not do this Question Title * 9. Who else helps with your diabetes care (others who do injections or supervises bolus)? Babysitter Grandparent(s) School Nurse Other (please specify) Question Title * 10. What is your experience with Glucagon? (Select all that apply to you). Have kit and it is not expired Feel comfortable using Don't feel comfortable using Glucagon kit Have expired kit and do not plan to replace it Know how to use minidose Glucagon for vomiting and low sugar Don't know about minidose Glucagon for vomiting and low sugar Question Title * 11. What methods do you use to count carbohydrates? Guess Look at label Beyond the basics poster Food scale Apps I don't do it Other (please specify) Question Title * 12. How important is healthy eating? Very important Somewhat important Not important Other (please specify) Question Title * 13. How are you and your family coping with Diabetes? Feel we are coping well with diabetes as a family, although it is a lot of work Feel we are not coping well and wish we had more support from clinic staff to help us What help can we offer to help support you? Question Title * 14. Have you applied for disability tax credit? Yes No Question Title * 15. Any final comments or suggestions on how we can improve your experience? Next
