MDS Foundation Technology Use Survey MDS Foundation - MDS MANAGER Technology Use Survey Please take a minute to answer each question. Select the answer that best describes your feelings about each question by clicking on that response. OK Question Title * 1. I have been using MDS Manager I have never used MDS Manager Less than 4 weeks Between 4 weeks and 3 months Between 3 months and 6 months More than 6 months OK Question Title * 2. When were you diagnosed with MDS (Month/Year)? OK Question Title * 3. In what state or province do you live? State/Province ZIP/Postal Code Country OK Question Title * 4. In what year were you born? (enter 4-digit birth year; for example, 1976) OK Question Title * 5. What is your gender? Female Male OK Question Title * 6. What is the highest level of education you have completed? Did not complete high school Graduated from high school Some college Graduated from college Some graduate school Completed graduate school OK Question Title * 7. What is your approximate average household income? $0-$24,999 $25,000-$49,999 $50,000-$74,999 $75,000-$99,999 $100,000-$124,999 $125,000-$149,999 $150,000-$174,999 $175,000-$199,999 $200,000 and up OK Question Title * 8. Please indicate your IPSS-R Score 0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 >6 I don't know my IPSS-R Score OK Question Title * 9. I am currently receiving treatment for my MDS? Yes No OK Question Title * 10. I can get health information by myself. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 11. I have talked with my health care provider about participating in a clinical trial? Yes No OK Question Title * 12. I find mobile health applications useful in my daily life. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 13. Using mobile health applications helps me to accomplish things more quickly. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 14. Using mobile health applications increases my ability to manage my health. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 15. Using mobile health application is easy for me. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 16. It is easy for me to become skillful at using mobile health applications. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 17. My interactions with mobile health applications are clear and understandable Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 18. I find mobile health applications easy to use. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 19. I intend to continue using mobile health applications in the future. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 20. I will continue to use mobile health applications frequently Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 21. I will continue to use mobile health applications frequently Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree OK Question Title * 22. I will continue to use mobile health applications in my daily life. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 23. I have at least one health care provider who knows me well. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 24. I have at least one health care provider I can discuss my health problems with. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 25. I have the health care providers I need to help me work out what I need to do. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 26. I can rely on at least one health care provider. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 27. I spend quite a lot of time actively managing my health. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 28. I make plans for what I need to do to be healthy. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 29. Despite other things in my life, I make time to be healthy. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 30. I set my own goals about health and fitness. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 31. I can get access to several people who understand and support me. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 32. When I feel ill, the people around me really understand what I am going through. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 33. There are things I do regularly to make myself more healthy. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 34. I have at least one person who can come to medical appointments with me. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 35. If I need help, I have plenty of people I rely on. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 36. I have strong support from family and friends. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 37. I make sure that health care providers understand my health care needs. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 38. I have good discussions about my health with my health care providers. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 39. I discuss things with my health care provider until I understand all I need to. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 40. I feel able to discuss my health concerns with my health care provider. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 41. I ask healthcare providers questions to get the health information I need Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 42. I can find the right healthcare. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 43. I can get to see the health care provider I need to manage my health. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 44. I can decide which healthcare provider I need to see Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 45. I can make sure I find the right place to get the healthcare I need. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 46. I can find out what health care services I am entitled to. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 47. I can find information about health problems. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 48. I can get information about my health so I am up to date with the best information Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 49. I can get information from several different places. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 50. I can get health information in words I understand. Strongly disagree Disagree Neutral Agree Strongly agree Strongly disagree Disagree Neutral Agree Strongly agree OK Question Title * 51. Please offer any additional comments about your ability to manage your health OK Question Title * 52. I currently use a patient portal to access my health information from my health care provider Every day A few times a week About once a week A few times a month Once a month Less than once a month I do not use a patient portal OK Question Title * 53. I was able to install MDS Manager Easily without difficulty With some difficulty With much difficulty I was not able to install the application I decided not to install the application I did not try to install the application I have not used MDS Manager OK Question Title * 54. I was able to enter symptoms using the symptom tracker Easily without difficulty With some difficulty With much difficulty I was not able to enter symptoms using the symptom tracker I decided not to use the symptom tracker I have not used MDS manager OK Question Title * 55. I have shared my symptom information with my health care team Yes No OK Question Title * 56. I was able to access the Clinical Trials web page for the MDS Foundation using MDS manager Yes No I have not used MDS Manager OK Question Title * 57. I have discussed clinical trials with my health care team Yes No OK Question Title * 58. I have participated in a clinical trial Yes No Unsure OK Question Title * 59. I was able to access additional resources on the MDS Foundation web page using MDS manager Yes No I have not used MDS Manager OK Question Title * 60. I was able to access the Quick Tips on the MDS Foundation web page using MDS Manager Yes No I have not used MDS Manager OK Question Title * 61. I found the Quick Tips to be Extremely helpful Very helpful Somewhat helpful Not so helpful Not at all helpful I have not used MDS Manager OK Question Title * 62. I would like to learn more about MDS Manager and MDS Resources Yes No OK Question Title * 63. Please enter your email address if you would like more information about MDS Manager and MDS Foundation Resources. ZIP/Postal Code Email Address OK DONE