Lupus Foundation of America, Heartland Chapter Annual Survey 2016

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* 1. Optional: If you would like to be entered in a chance to win a $100 Amazon gift card, please complete this survey by November 1, 2016 and list your email address below:

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* 2. Please check the box that best represents who you are.

I am a person living with lupus

Caregiver

Family or Friend

Medical Professional

Other (please specify):

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* 3. What county do you live in?

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* 4. What state do you live in?

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* 5. Have you attended or participated in an educational program provided by the Heartland Chapter in the past?

Yes

Not Sure

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* 6. If yes, please rate the program(s) you attended.

	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied
Educational Workshop	Educational Workshop Not Satisfied	Educational Workshop Somewhat Satisfied	Educational Workshop Satisfied	Educational Workshop Very Satisfied
Educational Half-Day Conference	Educational Half-Day Conference Not Satisfied	Educational Half-Day Conference Somewhat Satisfied	Educational Half-Day Conference Satisfied	Educational Half-Day Conference Very Satisfied
Teleconference	Teleconference Not Satisfied	Teleconference Somewhat Satisfied	Teleconference Satisfied	Teleconference Very Satisfied
Summer Jam Youth Retreat	Summer Jam Youth Retreat Not Satisfied	Summer Jam Youth Retreat Somewhat Satisfied	Summer Jam Youth Retreat Satisfied	Summer Jam Youth Retreat Very Satisfied
Other (please list below)	Other (please list below) Not Satisfied	Other (please list below) Somewhat Satisfied	Other (please list below) Satisfied	Other (please list below) Very Satisfied

Other (please specify program):

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* 7. If you have not attended or participated in an educational program provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

Topics not of interest to me

Dates or times not convenient

Location not convenient

Lack of transportation

There isn't one in my area

I don't feel that I need the educational information

Other:

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* 8. Have you attended or participated in one of our lupus support groups?

Yes

Not Sure

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* 9. If yes, please rate your support group experience.

Not Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

Not Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

If your support group experience is unsatisfactory, please share with us the reason(s).

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* 10. If you have not attended or participated in a support group provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

Dates or times not convenient

Location not convenient

Lack of transportation

There isn't one in my area

I don't feel that I need a support group

Other:

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* 11. Have you attended or participated in one of our lupus exercise classes?

Yes

Not Sure

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* 12. If yes, please rate your exercise class experience.

Not Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

Not Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

If your exercise class experience is unsatisfactory, please share with us the reason(s).

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* 13. If you have not attended or participated in a lupus exercise class provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

Dates or times not convenient

Location not convenient

Lack of transportation

There isn't one in my area

I don't feel that I am able to exercise

I have no interest in the exercises offered

Other:

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* 14. What types of exercise classes might be of interest to you?

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* 15. Have you made any changes in your life as a result in participating in one of our educational programs, support groups or exercise programs?

Yes

Not Sure

If yes, please list one or two changes you have made.

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* 16. Has your participation in a Heartland Chapter educational program, support group or exercise program improved your quality of life?

Not at all

Somewhat

Yes

Not at all

Somewhat

Yes

If yes, please list one or two ways your quality of life has improved.

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* 17. Which days of the week and times would be best for you to attend an educational program, exercise class or support group?

Monday - Thursday evenings starting at 6:00 p.m.

Monday - Thursday evenings starting at 7:00 p.m.

Saturday mornings starting at 10:00 a.m.

Saturday mornings starting at 11:00 a.m.

Saturday afternoons

Other:

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* 18. Do you have any interest in participating in programs offered online?

Yes

I don't have a computer

Not Sure

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* 19. If yes, please indicate which online program(s) would be of interest to you. Please check all that apply.

Online Support Group

Online Chat Room

Live or taped educational webinar

Watch recorded programs online

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* 20. What topics would you be interested in learning more about through LFA-hosted educational programs? Please check all that apply.

Research updates

Mental/Emotional self care

Physical activities/exercise for people living with lupus

Medications and their effects

Controlling flares

How to talk about lupus with your family and friends

Pain Management

Women Issues and Lupus

Lupus symptom specifics

Other (please specify):

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* 21. What other types of programs or services could the Lupus Foundation provide that would be most helpful to you and/or your family & friends?

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* 22. Please indicate which social media site(s) you use:

Facebook

Twitter

Instagram

I don't use social media

Other (please specify):

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* 23. If you use social media, do you follow the Heartland Chapter?

Yes

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* 24. How often do you read our Lupus Foundation of America, Heartland Chapter e-newsletter?

Each time I receive it

Often

Not Often

Never

I don't receive your e-newsletter

What types of topics or information would you like to see in the e-newsletter?

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* 25. If you have contacted the Heartland Chapter for information, resources or assistance, what was the reason(s) for contacting us?

Lupus Information Packet

List of Physicians who treat Lupus

Community Resources

Program Information

Fundraising Information

Other (please specify):

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* 26. Was the information provided helpful?

Yes

Somewhat

If the information provided was not helpful, please share the reason(s).

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* 27. How do you prefer to receive information from the Heartland Chapter? Please check all that apply.

Mail

Social Media

Other (please specify):

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* 28. Please indicate the Heartland Chapter Fundraising event(s) you have participated in.

St. Louis Walk

Kansas City Walk

WolfRide

Purple Ball

Other (please specify):

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* 29. If you have not participated in a fundraising event, tell us why.

Not interested in fundraising

Not in my area

Wasn't aware of events

I don't feel like I know how or am comfortable with fundraising

Other:

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* 30. If you have volunteered with the Heartland Chapter, please rate your overall volunteer experience.

Excellent

Good

Fair

Poor

What recommendations do you have to improve your volunteer experience?

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* 1. Optional: If you would like to be entered in a chance to win a $100 Amazon gift card, please complete this survey by November 1, 2016 and list your email address below:

Question Title

* 2. Please check the box that best represents who you are.

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* 3. What county do you live in?

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* 4. What state do you live in?

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* 5. Have you attended or participated in an educational program provided by the Heartland Chapter in the past?

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* 6. If yes, please rate the program(s) you attended.

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* 7. If you have not attended or participated in an educational program provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

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* 8. Have you attended or participated in one of our lupus support groups?

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* 9. If yes, please rate your support group experience.

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* 10. If you have not attended or participated in a support group provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

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* 11. Have you attended or participated in one of our lupus exercise classes?

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* 12. If yes, please rate your exercise class experience.

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* 13. If you have not attended or participated in a lupus exercise class provided by the Heartland Chapter, please share with us the reason(s) you have not participated.

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* 14. What types of exercise classes might be of interest to you?

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* 15. Have you made any changes in your life as a result in participating in one of our educational programs, support groups or exercise programs?

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* 16. Has your participation in a Heartland Chapter educational program, support group or exercise program improved your quality of life?

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* 17. Which days of the week and times would be best for you to attend an educational program, exercise class or support group?

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* 18. Do you have any interest in participating in programs offered online?

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* 19. If yes, please indicate which online program(s) would be of interest to you. Please check all that apply.

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* 20. What topics would you be interested in learning more about through LFA-hosted educational programs? Please check all that apply.

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* 21. What other types of programs or services could the Lupus Foundation provide that would be most helpful to you and/or your family & friends?

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* 22. Please indicate which social media site(s) you use:

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* 23. If you use social media, do you follow the Heartland Chapter?

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* 24. How often do you read our Lupus Foundation of America, Heartland Chapter e-newsletter?

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* 25. If you have contacted the Heartland Chapter for information, resources or assistance, what was the reason(s) for contacting us?

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* 26. Was the information provided helpful?

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* 27. How do you prefer to receive information from the Heartland Chapter? Please check all that apply.

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* 28. Please indicate the Heartland Chapter Fundraising event(s) you have participated in.

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* 29. If you have not participated in a fundraising event, tell us why.

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* 30. If you have volunteered with the Heartland Chapter, please rate your overall volunteer experience.

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* 31. Please feel free to share any other suggestions or comments you may have.