Calendar User Feedback Survey

Consent

Introduction: The Regional Integrated Fall Prevention & Management Strategy, in collaboration with the Ontario Age-Friendly Community Outreach Initiative, is conducting surveys to get feedback on a 14-month calendar. The calendar was distributed throughout the South Eastern Ontario region to increase awareness of fall risk factors and services available in the region.

Purpose: The purpose of this survey is to collect feedback from users on how useful they found the calendar. We want to find out if it improved their awareness of some of the causes of falls and how to avoid them. We also want to find out if it increased their awareness of resources for older adults in their community.

Description of the survey procedures: If you agree to complete this survey, you will be asked to provide feedback on the 2017-2018 calendar. You will be asked to answer and elaborate on a series of questions regarding your opinions of the calendar. The survey should take approximately 20 minutes to complete.

Voluntary participation: Participation in this survey is completely voluntary. You may refuse to answer any questions or withdraw at any time without affecting your relationship with the investigators. In addition, you have the right to request that your feedback not be involved in the project.

Benefits of participation: Information collected in this survey may help community and health service providers understand how to better promote falls prevention information and participation in services. It will also support our ability to offer calendars in future years.

Risks of participation: There are no anticipated risks associated with participating in this survey.

Confidentiality: Information collected from this survey will only be accessible to investigators directly involved with the project. Data regarding calendar feedback may be shared with other stakeholders for the purpose of improving the calendars for future years but no personal information about participants will be shared.

Consent: By proceeding to the following question you agree to complete this survey and that you have read and understood the information provided above.

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* 1. Please provide the first 3 digits of your postal code

Postal Code

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* 2. Please select the options below which best describe you. You may select more than one.

Under 65 years of age

65-69 years of age

70-79 years of age

80-89 years of age

90+ years of age

Family caregiver of an older adult

Friend of an older adult

Informal caregiver of an older adult

Other (please specify)

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* 3. How would you describe the location of your home?

Rural (outside of a village)

Rural (inside of a village)

Urban (town)

Urban (city)

Other (please specify)

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* 4. How would you describe the type of housing that you live in?

House

Apartment/condominium

Retirement Community

Long Term Care

Other (please specify)

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* 5. Please select all that apply

This is the only calendar I use

I use this calendar in addition to another calendar

I have been using the calendar for less than a month

I have been using the calendar for 1-2 months

I have been using the calendar for more than 2 months

I do not use the calendar

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* 6. Do you think the calendar is a good way to provide fall prevention information?

Yes

Comments

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* 7. Please indicate which of the recommended websites you visited as a result of the calendar. You may select more than one.

www.agefriendlyontario.ca

www.fallprevention.southeasthealthline.ca

www.southeasthealthline.ca

www.cclt.ca

www.eatrightontario.ca/escreen

www.knowledgeisthebestmedicine.org

www.ontario.ca/page/find-family-doctor-or-nurse-practitioner

www.osteoporosis.ca

www.diabetes.ca

www.health.gov.on.ca/en/pro/program/adp/

www.cphcare.ca

www.von.ca

www.cphc.ca

healthcareathome.ca/southeast

www.kflapublichealth.ca

www.hpepublichealth.ca

www.healthunit.org

I don't know

None

Comments:

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* 8. Did you feel the pictures in the calendar were representative of your community?

Yes

Comments:

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* 9. Did you like the pictures in the calendar?

Yes

Comments:

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* 10. Please rate the following characteristics of the calendar.

	Needs Improvement	Fine	Good	Excellent
Print size	Print size Needs Improvement	Print size Fine	Print size Good	Print size Excellent
Calendar size	Calendar size Needs Improvement	Calendar size Fine	Calendar size Good	Calendar size Excellent
Calendar layout	Calendar layout Needs Improvement	Calendar layout Fine	Calendar layout Good	Calendar layout Excellent
Quality of pictures	Quality of pictures Needs Improvement	Quality of pictures Fine	Quality of pictures Good	Quality of pictures Excellent

Comments:

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* 11. Please rate the content of the calendar below.

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree
I learned something new from the calendar	I learned something new from the calendar Strongly Disagree	I learned something new from the calendar Disagree	I learned something new from the calendar Neither Agree or Disagree	I learned something new from the calendar Agree	I learned something new from the calendar Strongly Agree
The calendar inspired me to make a change	The calendar inspired me to make a change Strongly Disagree	The calendar inspired me to make a change Disagree	The calendar inspired me to make a change Neither Agree or Disagree	The calendar inspired me to make a change Agree	The calendar inspired me to make a change Strongly Agree
The calendar clearly outlines fall risk factors	The calendar clearly outlines fall risk factors Strongly Disagree	The calendar clearly outlines fall risk factors Disagree	The calendar clearly outlines fall risk factors Neither Agree or Disagree	The calendar clearly outlines fall risk factors Agree	The calendar clearly outlines fall risk factors Strongly Agree
The calendar clearly outlines ways to reduce risk of falling	The calendar clearly outlines ways to reduce risk of falling Strongly Disagree	The calendar clearly outlines ways to reduce risk of falling Disagree	The calendar clearly outlines ways to reduce risk of falling Neither Agree or Disagree	The calendar clearly outlines ways to reduce risk of falling Agree	The calendar clearly outlines ways to reduce risk of falling Strongly Agree

Comments:

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* 12. Have you or will you use the calendar for the following:

	I have	I have not	I plan to
Tracking Physical Activity	Tracking Physical Activity I have	Tracking Physical Activity I have not	Tracking Physical Activity I plan to
Tracking Falls or Near Falls	Tracking Falls or Near Falls I have	Tracking Falls or Near Falls I have not	Tracking Falls or Near Falls I plan to
Setting Goals	Setting Goals I have	Setting Goals I have not	Setting Goals I plan to

Comments:

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* 13. Select any of the recommendations from the calendar that you have tried or will try as a result of reading the calendar. You may select more than one.

How to get up from a fall

Drinking wisely

Hearing and vision tests

Home safety check

Healthy eating

Regular physical activity

Medication management

Regular check-up

Improving bone health

Participating in personally rewarding activities

Managing disease symptoms

Taking care of your feet

Inquiring about mobility aids

Staying active in the winter

None

Other comments

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* 14. Are you more likely to investigate fall prevention or other programming after reading the calendar?

Yes

Comments:

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* 15. Did the calendar increase your awareness of falls prevention or seniors programs and services?

Yes

Comments:

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* 16. Did you learn about programs and services you weren't previously aware of?

Yes

Please specify:

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* 17. Would you share this calendar with, or recommend this calendar to, a friend or family member?

Yes

Depends

Comments:

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* 18. Please select all that apply regarding your desire for a calendar in future years.

I would want one even if it contained advertisements

I would want one even if I had to pay a small fee (less than $3)

I would only want one if it contained extensive new content

I would want one even if it is very similar to the current one

I do not want one

Comments:

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* 19. What did you like most about the calendar?

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* 20. Is there anything missing or anything that should be changed about the calendar?

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* 21. If you would like to be entered in a draw to win a $50 gift card, please put your name and contact information below.

Name

Phone Number

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* 22. Please check the following box if you are willing to participate in follow-up questions regarding the survey/calendar.

Yes, you may contact me