E-Health Survey

Question Title

* 1. What is your age?

25 to 44

45 to 60

Question Title

* 2. Do you currently have medical aid (insurance)?

Yes, I do

No, I do not

Question Title

* 3. Do you make use of private healthcare facilities

Yes, I do

No, I do not

Question Title

* 4. How do you make appointments?

Telephone / Cellphone

Online

Other (please specify)

Question Title

* 5. Do you own a smartphone or tablet (device)?

Yes

Question Title

* 6. Do you access any of the following online?

Symptom checker

Self diagnosis

Alternative medication lookup

Dr. Locator

Dr. Appointment

Scripting or medicaiton orders

If “No” to more that 2 of the above would you prefer to do any of these online?

Question Title

* 7. During the past year, were you prescribed a medicine but were unable to get it?

Yes

With some delay

Question Title

* 8. In what language do you prefer to speak with your doctor

English

Afrikaans

Other (please specify)

	Not Important	Less Important	Important	Very Important
Book Change and cancel appointments online	Book Change and cancel appointments online Not Important	Book Change and cancel appointments online Less Important	Book Change and cancel appointments online Important	Book Change and cancel appointments online Very Important
Receive reminders	Receive reminders Not Important	Receive reminders Less Important	Receive reminders Important	Receive reminders Very Important
Refill prescriptions online	Refill prescriptions online Not Important	Refill prescriptions online Less Important	Refill prescriptions online Important	Refill prescriptions online Very Important
Communicate with providers via secure email	Communicate with providers via secure email Not Important	Communicate with providers via secure email Less Important	Communicate with providers via secure email Important	Communicate with providers via secure email Very Important
Access medical records electronically	Access medical records electronically Not Important	Access medical records electronically Less Important	Access medical records electronically Important	Access medical records electronically Very Important
Have full access to your medical records	Have full access to your medical records Not Important	Have full access to your medical records Less Important	Have full access to your medical records Important	Have full access to your medical records Very Important
Flexibility of seeing a doctor out of town with your medical history available	Flexibility of seeing a doctor out of town with your medical history available Not Important	Flexibility of seeing a doctor out of town with your medical history available Less Important	Flexibility of seeing a doctor out of town with your medical history available Important	Flexibility of seeing a doctor out of town with your medical history available Very Important
Having your chronic meds delivered to you periodically	Having your chronic meds delivered to you periodically Not Important	Having your chronic meds delivered to you periodically Less Important	Having your chronic meds delivered to you periodically Important	Having your chronic meds delivered to you periodically Very Important
Quick access to medical assistance	Quick access to medical assistance Not Important	Quick access to medical assistance Less Important	Quick access to medical assistance Important	Quick access to medical assistance Very Important

Not
Important

Less
Important

Important

Very Important

Book Change and cancel appointments online

Book Change and cancel appointments online Not
Important

Book Change and cancel appointments online Less
Important

Book Change and cancel appointments online Important

Book Change and cancel appointments online Very Important

Receive reminders

Receive reminders Not
Important

Receive reminders Less
Important

Receive reminders Important

Receive reminders Very Important

Refill prescriptions online

Refill prescriptions online Not
Important

Refill prescriptions online Less
Important

Refill prescriptions online Important

Refill prescriptions online Very Important

Communicate with providers via secure email

Communicate with providers via secure email Not
Important

Communicate with providers via secure email Less
Important

Communicate with providers via secure email Important

Communicate with providers via secure email Very Important

Access medical records electronically

Access medical records electronically Not
Important

Access medical records electronically Less
Important

Access medical records electronically Important

Access medical records electronically Very Important

Have full access to your medical records

Have full access to your medical records Not
Important

Have full access to your medical records Less
Important

Have full access to your medical records Important

Have full access to your medical records Very Important

Flexibility of seeing a doctor out of town with your medical history available

Flexibility of seeing a doctor out of town with your medical history available Not
Important

Flexibility of seeing a doctor out of town with your medical history available Less
Important

Flexibility of seeing a doctor out of town with your medical history available Important

Flexibility of seeing a doctor out of town with your medical history available Very Important

Having your chronic meds delivered to you periodically

Having your chronic meds delivered to you periodically Not
Important

Having your chronic meds delivered to you periodically Less
Important

Having your chronic meds delivered to you periodically Important

Having your chronic meds delivered to you periodically Very Important

Quick access to medical assistance

Quick access to medical assistance Not
Important

Quick access to medical assistance Less
Important

Quick access to medical assistance Important

Quick access to medical assistance Very Important

Question Title

* 1. What is your age?

Question Title

* 2. Do you currently have medical aid (insurance)?

Question Title

* 3. Do you make use of private healthcare facilities

Question Title

* 4. How do you make appointments?

Question Title

* 5. Do you own a smartphone or tablet (device)?

Question Title

* 6. Do you access any of the following online?

Question Title

* 7. During the past year, were you prescribed a medicine but were unable to get it?

Question Title

* 8. In what language do you prefer to speak with your doctor

Question Title

* 9. How do you personally evaluate the importance of the following aspects of coordinated care?