Pre-screener

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* 1. Contact Information

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* 2. In what country do you live?

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* 3. What is your age?

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* 4. Which of the below genders do you most closely identify with?

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* 5. Which of the following best describes your racial or ethnic heritage?

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* 6. Do you have interest in discussing your health and your experience with healthcare services?

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* 7. Are you currently living with any of the following health conditions?

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* 8. If you indicated that you are currently living with Diabetes. How recently were you diagnosed?

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* 9. Do you have a primary care provider?

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* 10. When it comes to managing your health, to what extent would you agree with the statements below?

  1. Strongly disagree 2 3 4 5. Strongly agree
I don’t regularly schedule preventative care appointments with my doctor(s)
I rarely take my medications as prescribed by my doctor(s)
If I start to feel sick, I seek medical care only when symptoms become urgent
I don’t have a great understanding of how health insurance and healthcare work for me
I don’t have trusted doctors and care providers

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* 11. How would you describe your health insurance coverage?

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* 12. Which of the following insurance providers are you insured by?

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* 13. Which of the following would you consider your primary pharmacy provider? (i.e. pharmacy that you use for recurring prescriptions, where you typically fill new prescriptions, or where you tend to purchase over-the-counter medicines or other healthcare products)

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* 14. In the past six months, which of the following healthcare services have you used?

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* 15. Which provider did you receive those services from?

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* 16. What is your current employment status?

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* 17. What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.

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* 18. Which of the following best describes your household income (including any social security income)?

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* 19. How would you describe your household?

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* 20. How would you best describe where you live?

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* 21. In the past six months, have you participated in any focus groups or other market research studies?

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* 22. Please answer the following statements on a scale of 1 = strongly disagree to 5 = strongly agree:

  1 = strongly disagree 2 3 4 5 = strongly agree
I do not invest in my own health.
I am not physically active.
Covid has had little effect on my life.
My current care providers (e.g. doctors, dentists, therapists) do not meet my expectations.
I do not have sufficient access to care (e.g. insurance, proximity to healthcare providers).
Healthcare is inaccessible to me because of cost.
I am not comfortable with new technology.

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