Health Care Decision Makers

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* 1. What is your first and last name?

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* 2. What is your phone number?

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* 3. What is your email address?

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* 4. What is your age?

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* 5. Do you or anyone in your household currently work in any of the following industries or have worked in them in the past 5 years?

Marketing

Market Research

Online Advertising/Digital Marketing

Advertising/PR

Journalism/Media/News/Blogging

Health Insurance

Hospital or Medical Practice

Hospitality

Food or Beverage Company

None of the above

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* 6. Do you currently live in PA?

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* 7. When it comes to health care and health insurance decisions in your household, would you say?

I am the primary health care decision maker

I share the responsibility equally with someone else

Someone else in my household is the primary health care decision maker

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* 8. Do you currently have health insurance coverage?

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* 9. To your knowledge, does your insurance allow you to go to Allegheny Health Network? (AHN)

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* 10. How do you obtain your current primary health insurance coverage?

Through your current employer

Through your spouse's current or former employer

Through COBRA

Through a health insurance Exchange or online marketplace (Obamacare)

Purchased from a broker

Purchased directly from a health insurance company

Through Medicare or Medicare Advantage plan

From the Veteran's Administration, TRICARE, or CHAMPUS

Through Medicaid (includes Medical Assistance, ACCESS, BEST Healthcare, Unison, Gateway, Three River's)

Some other way

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* 11. Other than Medicare coverage provided by the government, do you have any other health insurance such as Medicare Supplement, Medicare Advantage or Medigap plan or health insurance provided through an employer

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* 12. If you answered previously that you are on Medicare, what is the name of your primary health insurance company (that is the company that provides your Medicare Plan)?

AARP

Aetna

Cigna

Gelsinger Health Plan

Highmark Blue Cross Blue Shield

Humana

UnitedHealthcare/UHC

UPMC Health Plan

Some other brand

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* 13. Please review the list of healthcare systems below and indicate all those that you are aware of

Allegheny Health Network (AHN)

UPMC

Lake Erie College of Osteopathic Medicine (LEMCOM)

Excela Health System (EHS)

Heritage Valley Health System (HVHS)

None of the above

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* 14. Have you or any member of your household used any AHN affillated physicians, hospitals, or health care facilities in the past 2 years?

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* 15. If you answered yes that you used an AHN affiliated facilities in the past 2 years, for whom did it get use for?

Yourself

Child under 18 in my household

Other members of my household

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* 16. In general, how would you rate your overall health now?

Excellent

Very Good

Good

Fair

Poor

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* 17. For each of the following types of visits, approximately how many total visits/stays, did you and any household member that you accompanied make to each of the following in the last 12 months

	0- no visits	1 visit	2 visits	3-4 visits	5-6 visits	7-9 visits	10+ visits	Don't know
A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics)	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 0- no visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 1 visit	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 2 visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 3-4 visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 5-6 visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 7-9 visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) 10+ visits	A primary care physician's office (including family medicine internal medicine, general medicine, pediatrics) Don't know
An emergency room	An emergency room 0- no visits	An emergency room 1 visit	An emergency room 2 visits	An emergency room 3-4 visits	An emergency room 5-6 visits	An emergency room 7-9 visits	An emergency room 10+ visits	An emergency room Don't know
An Urgent care or walk-in clinic	An Urgent care or walk-in clinic 0- no visits	An Urgent care or walk-in clinic 1 visit	An Urgent care or walk-in clinic 2 visits	An Urgent care or walk-in clinic 3-4 visits	An Urgent care or walk-in clinic 5-6 visits	An Urgent care or walk-in clinic 7-9 visits	An Urgent care or walk-in clinic 10+ visits	An Urgent care or walk-in clinic Don't know
A specialist office (including orthopedics, cardiologist, dermatologist, etc.)	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 0- no visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 1 visit	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 2 visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 3-4 visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 5-6 visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 7-9 visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) 10+ visits	A specialist office (including orthopedics, cardiologist, dermatologist, etc.) Don't know
A hospital stay where you were admitted as an overnight patient	A hospital stay where you were admitted as an overnight patient 0- no visits	A hospital stay where you were admitted as an overnight patient 1 visit	A hospital stay where you were admitted as an overnight patient 2 visits	A hospital stay where you were admitted as an overnight patient 3-4 visits	A hospital stay where you were admitted as an overnight patient 5-6 visits	A hospital stay where you were admitted as an overnight patient 7-9 visits	A hospital stay where you were admitted as an overnight patient 10+ visits	A hospital stay where you were admitted as an overnight patient Don't know
A hospital, but on an outpatient basis, where you were not admitted for an overnight stay	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 0- no visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 1 visit	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 2 visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 3-4 visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 5-6 visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 7-9 visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay 10+ visits	A hospital, but on an outpatient basis, where you were not admitted for an overnight stay Don't know
Telehealth visit	Telehealth visit 0- no visits	Telehealth visit 1 visit	Telehealth visit 2 visits	Telehealth visit 3-4 visits	Telehealth visit 5-6 visits	Telehealth visit 7-9 visits	Telehealth visit 10+ visits	Telehealth visit Don't know

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* 18. To ensure we have a good cross-section of the population, which of the following best describes your total household income before taxes

Under $10k

$10-25K

$25-50k

$50-75k

$75-100k

$100-150k

Over $150k

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* 19. Now I'm going to read you a list of statements that may or may not describe you personally. Please rate how well each statement describes you on a scale of 1 to 10, where a 1 means it does not describe you at all and a 10 describes you completely

	1	2	3	4	5	6	7	8	9	10
If asked to describe something I know about, I can usually do it in detail	If asked to describe something I know about, I can usually do it in detail 1	If asked to describe something I know about, I can usually do it in detail 2	If asked to describe something I know about, I can usually do it in detail 3	If asked to describe something I know about, I can usually do it in detail 4	If asked to describe something I know about, I can usually do it in detail 5	If asked to describe something I know about, I can usually do it in detail 6	If asked to describe something I know about, I can usually do it in detail 7	If asked to describe something I know about, I can usually do it in detail 8	If asked to describe something I know about, I can usually do it in detail 9	If asked to describe something I know about, I can usually do it in detail 10	If asked to describe something I know about, I can usually do it in detail
I'm uncomfortable talking with others, especially if I haven't met them before	I'm uncomfortable talking with others, especially if I haven't met them before 1	I'm uncomfortable talking with others, especially if I haven't met them before 2	I'm uncomfortable talking with others, especially if I haven't met them before 3	I'm uncomfortable talking with others, especially if I haven't met them before 4	I'm uncomfortable talking with others, especially if I haven't met them before 5	I'm uncomfortable talking with others, especially if I haven't met them before 6	I'm uncomfortable talking with others, especially if I haven't met them before 7	I'm uncomfortable talking with others, especially if I haven't met them before 8	I'm uncomfortable talking with others, especially if I haven't met them before 9	I'm uncomfortable talking with others, especially if I haven't met them before 10	I'm uncomfortable talking with others, especially if I haven't met them before
Others would describe me as having a strong sense of self	Others would describe me as having a strong sense of self 1	Others would describe me as having a strong sense of self 2	Others would describe me as having a strong sense of self 3	Others would describe me as having a strong sense of self 4	Others would describe me as having a strong sense of self 5	Others would describe me as having a strong sense of self 6	Others would describe me as having a strong sense of self 7	Others would describe me as having a strong sense of self 8	Others would describe me as having a strong sense of self 9	Others would describe me as having a strong sense of self 10	Others would describe me as having a strong sense of self
I do not see myself as naturally creative	I do not see myself as naturally creative 1	I do not see myself as naturally creative 2	I do not see myself as naturally creative 3	I do not see myself as naturally creative 4	I do not see myself as naturally creative 5	I do not see myself as naturally creative 6	I do not see myself as naturally creative 7	I do not see myself as naturally creative 8	I do not see myself as naturally creative 9	I do not see myself as naturally creative 10	I do not see myself as naturally creative
I like to reflect about thigs in order to make new discoveries about myself	I like to reflect about thigs in order to make new discoveries about myself 1	I like to reflect about thigs in order to make new discoveries about myself 2	I like to reflect about thigs in order to make new discoveries about myself 3	I like to reflect about thigs in order to make new discoveries about myself 4	I like to reflect about thigs in order to make new discoveries about myself 5	I like to reflect about thigs in order to make new discoveries about myself 6	I like to reflect about thigs in order to make new discoveries about myself 7	I like to reflect about thigs in order to make new discoveries about myself 8	I like to reflect about thigs in order to make new discoveries about myself 9	I like to reflect about thigs in order to make new discoveries about myself 10	I like to reflect about thigs in order to make new discoveries about myself
I have trouble expressing my thoughts and feelings	I have trouble expressing my thoughts and feelings 1	I have trouble expressing my thoughts and feelings 2	I have trouble expressing my thoughts and feelings 3	I have trouble expressing my thoughts and feelings 4	I have trouble expressing my thoughts and feelings 5	I have trouble expressing my thoughts and feelings 6	I have trouble expressing my thoughts and feelings 7	I have trouble expressing my thoughts and feelings 8	I have trouble expressing my thoughts and feelings 9	I have trouble expressing my thoughts and feelings 10	I have trouble expressing my thoughts and feelings
I consider myself very articulate	I consider myself very articulate 1	I consider myself very articulate 2	I consider myself very articulate 3	I consider myself very articulate 4	I consider myself very articulate 5	I consider myself very articulate 6	I consider myself very articulate 7	I consider myself very articulate 8	I consider myself very articulate 9	I consider myself very articulate 10	I consider myself very articulate

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* 20. Do you have daily access to a computer with high-speed internet access? By computer, we mean a traditional laptop or desktop machine, NOT a tablet or mobile device.

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* 21. On average, how often do you use the internet?

I'm pretty much always online

More than once a day

Once a day

A few times a week

Once a week

Less than once a week

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* 22. This study will require you to watch videos with sound and rate the videos using your computer mouse. Do you have working speakers and a working mouse on your computer?

Health Care Decision Makers

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* 1. What is your first and last name?

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* 2. What is your phone number?

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* 3. What is your email address?

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* 4. What is your age?

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* 5. Do you or anyone in your household currently work in any of the following industries or have worked in them in the past 5 years?

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* 6. Do you currently live in PA?

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* 7. When it comes to health care and health insurance decisions in your household, would you say?

Question Title

* 8. Do you currently have health insurance coverage?

Question Title

* 9. To your knowledge, does your insurance allow you to go to Allegheny Health Network? (AHN)

Question Title

* 10. How do you obtain your current primary health insurance coverage?

Question Title

* 11. Other than Medicare coverage provided by the government, do you have any other health insurance such as Medicare Supplement, Medicare Advantage or Medigap plan or health insurance provided through an employer

Question Title

* 12. If you answered previously that you are on Medicare, what is the name of your primary health insurance company (that is the company that provides your Medicare Plan)?

Question Title

* 13. Please review the list of healthcare systems below and indicate all those that you are aware of

Question Title

* 14. Have you or any member of your household used any AHN affillated physicians, hospitals, or health care facilities in the past 2 years?

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* 15. If you answered yes that you used an AHN affiliated facilities in the past 2 years, for whom did it get use for?

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* 16. In general, how would you rate your overall health now?

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* 17. For each of the following types of visits, approximately how many total visits/stays, did you and any household member that you accompanied make to each of the following in the last 12 months

Question Title

* 18. To ensure we have a good cross-section of the population, which of the following best describes your total household income before taxes

Question Title

* 19. Now I'm going to read you a list of statements that may or may not describe you personally. Please rate how well each statement describes you on a scale of 1 to 10, where a 1 means it does not describe you at all and a 10 describes you completely

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* 20. Do you have daily access to a computer with high-speed internet access? By computer, we mean a traditional laptop or desktop machine, NOT a tablet or mobile device.

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* 21. On average, how often do you use the internet?

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* 22. This study will require you to watch videos with sound and rate the videos using your computer mouse. Do you have working speakers and a working mouse on your computer?

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* 23. Do you currently have a working webcam on your computer that you are comfortable recording yourself with?