* 1. What is your gender?

* 2. What is your age?

* 3. What is your current living situation?

* 4. Do you have internet access?

* 5. What is the highest level of school you have completed or the highest degree you have received?

* 6. Do you own:

* 7. How interested are you in using technology to assist in monitoring your health?

* 8. Do you use a tablet/laptop to communicate with:

* 9. Do you use a video program (Skype or facetime) to communicate with:

* 10. If you had access to a tablet/laptop, would you consider using it to communicate with:

* 11. Do you currently, or have you previously, used any health tracking technology (e.g., software applications, or Fitbit trackers)?

Comments:

* 12. If you have used any health tracking technology (e.g., software applications, or Fitbit trackers), did you feel like it changed your behavior?

* 13. Imagine you have a health issue that would benefit from professional monitoring (e.g., diabetes, atrial fibrillation), and that a technology exists that directly monitors and/or sends information to your health care professional. Please respond in the upcoming scenarios. 
Rate the following on a scale from “Agree to Disagree”  

     Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree
I would be comfortable using a dedicated device (e.g., heart monitor) to directly monitor my health.
I would be comfortable using a dedicated device to send information to my health care professional.
I have privacy concerns about using a dedicated device to directly monitor my health.
I have privacy concerns about using a dedicated device to send information to my health care professional.
I would be comfortable using software on a smart device (e.g., app on a tablet or smartphone) to directly monitor my health.
I would be comfortable using software on a smart device to send information to my health care professional.
I have privacy concerns about using software on a smart device to directly monitor my health.
I have privacy concerns about using software on a smart device to send information to my health care professional.
If I used a health monitor, I would like it to provide me with feedback about my status.
If I used a health monitor that sent information to my health care provider, I would like to review the information before it is sent to my health care provider.
I worry about negative consequences of my health care provider receiving information about health from a monitored device.
I believe a monitoring technology would help me to stick with the behavioral changes my health care professional recommends.

* 14. Do you have dysphagia (difficulty swallowing)

* 15. If you have dysphagia, have any of the following compensatory strategies been prescribed

* 16. If you have dysphagia, how often do you use safe eating strategies designed to reduce your risk of aspiration pneumonia

* 17. Is it difficult to always follow safe eating strategies

* 18. Would technology that helps you use safe eating strategies be useful?

* 19. If you had access to a device, would you be willing to turn on an iPad or other tablet application designed to help you follow safe eating strategies

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