The Somerville Foundation - Listening to you Question Title This survey will take you about 15 minutes to complete. It will help The Somerville Foundation to understand how we can best improve our services and communication to you. We will not share your personal details with anyone and really appreciate your help. Thank you. Question Title * 1. Are you completing this survey as a CHD Patient Carer of someone with a CHD Family / Friend of a CHD patient If you are completing this and do not have a CHD youself please answer only those questions you feel are appropriate. Thank you. Question Title * 2. A bit about you.. Name: Email Address: Question Title * 3. How old are you? 16 to 18 19 to 30 31 to 40 41 to 50 51 to 60 61 to 70 70+ Question Title * 4. How would you describe your ethnic origin? Question Title * 5. Are you male or female? Male Female Question Title * 6. Do you have any children that you usually care for? Yes No Question Title * 7. Do you have any other relatives that you usually care for? Yes No Question Title * 8. Do you describe yourself as Lesbian Gay Bisexual Trans-gendered Heterosexual Question Title * 9. Were you born with a heart condition? Yes No Question Title * 10. Do you consider yourself to have a disability? Yes No Now onto the real questions.... Question Title * 11. How do you feel about managing your CHD? Confident Mostly confident Sometimes not as confident as I’d like Mostly not as confident as I’d like Never confident Question Title * 12. Have you ever... Felt your CHD was not understood by health care professional treating you? Had to explain your CHD to a health care professional as they had not understood your notes? Been advised to have treatment you feel was inappropriate due to your CHD? Had to request antibiotic cover that you need having been refused due to NICE guidelines? Have you ever felt that your GP was not listening to you about your CHD? Have you ever received advice from your GP that contradicted advice from your GUCH specialist team? Have you ever felt that your cardiology care team were not listening to you? Did something else happen to you that you think we ought to know about, if so please explain? Question Title * 13. Would you find the following useful to help you manage your condition? CHD symptom tracker List of questions to ask your consultant and guidance on managing your cardiologist appointment List of questions to ask your GUCH nurse. List of questions to ask your travel insurance company and guidance on planning your holiday List of questions to ask your life insurance company. How to manage your mortgage company. When and how to get referred to an expert at a specialist GUCH centre? Guidance on how to communicate your CHD to GP, A&E, other NHS clinics, Private health clinics, Physios, alternative therapy providers. Guidance on how to communicate your CHD to your club, fitness class or gym. Guidance on managing fatigue and making the most of life Would any other tools or information help you? Please let us know Question Title * 14. Would you like guidance to help you to talk about your CHD to: Partner Child/ren Child’s School Other Family Friends Employer Colleagues Club Those you care for (if you do) Your carer (if you have one) Other (please specify) Question Title * 15. My biggest worry about my CHD is... Question Title * 16. My greatest barrier in life created by my CHD is... Question Title * 17. What would help you feel better about living with your CHD? Question Title * 18. What would help you think positively about living with your CHD? Question Title * 19. What other services would you like to see The Somerville Foundation develop to help you? Question Title * 20. How do you like to get your information? Mobile Website Mobile App Website on a PC Printed Newsletter Email Newsletter Leaflets Letters Question Title * 21. Where would you want to use this information? GPs A&E / Hospital appointments GUCH Clinics Work Whilst out and about At home Abroad / On Holiday Question Title * 22. Where do you like to learn more about CHD and support available? Reading in a quiet space on my own At a GUCH appointment At a GP surgery At the hospital (non-CHD) By talking to someone who understands how I feel By talking to someone who knows what my CHD is and how it affects me Searching the web Keeping it on paper for later Keeping a link for later Having it always on my mobile phone / smart phone Other (please specify) Question Title * 23. What should The Somerville foundation do more of? Question Title * 24. What should The Somerville foundation do less of? Question Title * 25. How likely would you be to recommend The Somerville Foundation to a friend or colleague affected by CHD? Unlikely to recommend I might recommend I would recommend but only if they needed help I would recommend without hesitation Question Title * 26. Would you be prepared to help fundraise for The Somerville Foundation? Yes Maybe No Question Title * 27. What would help you to fundraise on our behalf? Thank you very much for helping us to improve our services to you. Please don't forget to click the DONE button below. Question Title Done