Diabetes Self-Management

You are invited to participate in a research project entitled “Diabetes Self-Management Education Program: Barriers to Access and Program Adherence” designed to analyze the most common barriers to accessing diabetes education programs as well as factors that decrease adherence to programs. The study is being conducted by Marcos A. Sanchez-Gonzalez, MD, PhD from Lake Erie College of Osteopathic Medicine (LECOM). This research is being conducted as part of the Masters in Health Administration thesis for Tricia Kim, OMSIV.

I will request that only those who are over the age of eighteen and who are or have been diagnosed with Type II diabetes to participate in the survey. The survey consists of 18 questions asking demographics, co-morbidities, and diabetes self-management education participation, which will take approximately 5 minutes to complete. The survey will not ask for your name or for any other information that could be used to identify you. In addition, SurveyMonkey will not record any electronic information that could be used to identify you. Participation is completely voluntary and there will be no penalty or loss of benefits if you choose to withdraw.

I appreciate your time and participation!

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* 1. What is your gender?

Female

Male

Other (specify)

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* 2. Which category below includes your age?

18-24

25-34

35-44

45-54

55-64

65 or older

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

Less than high school degree

High school degree or equivalent (e.g., GED)

Some college but no degree

Associate degree

Bachelor degree

Graduate degree

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* 4. How much total combined money did all members of your HOUSEHOLD earn last year?

$0 to $9,999

$10,000 to $24,999

$25,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $124,999

$125,000 to $149,999

$150,000 to $174,999

$175,000 to $199,999

$200,000 and up

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* 5. What is your race/ethnicity?

White

Black or African-American

American Indian or Alaskan Native

Asian

Native Hawaiian or other Pacific Islander

Hispanic/Latino

Some other race (please specify)

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* 6. Number of members in household (including self)

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* 7. Which of the following categories best describes your employment status?

Employed, working full-time

Employed, working part-time

Not employed, looking for work

Not employed, NOT looking for work

Retired

Disabled, not able to work

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* 8. What type of community do you live in?

Rural

Suburban

Urban

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* 9. Which of the following co-morbidities do you have? (check all that apply)

Hypertension (high blood pressure)

Hyperlipidemia (high cholesterol)

Coronary artery disease

Stroke

End-stage renal disease

Other (please specify)

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* 10. Have you ever been offered a diabetes education program upon first diagnoses of diabetes?

Yes, by my primary care doctor

Yes, by another healthcare professional (please specify)

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* 11. If you answered no to #10, has anyone ever told you about a diabetes education program?

Yes

N/A

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* 12. Do you currently or have you ever participated in a diabetes education program?

Yes, currently

Yes, previously and completed

Yes, previously but never completed

Never

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* 13. If you have been offered a program but never participated, why did you choose not to participate? (check all that apply)

N/A

Takes too much time

No way to get to classes/sessions

I was told I would have to pay

Program is too far away

Language barrier

Disability

I have no interest in learning about diabetes

I'm embarrassed to get help in learning about diabetes

Other (please specify)

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* 14. Would you consider participating in a program if you could attend sessions/obtain information online via smartphone apps, website videos, online chat?

Yes

Maybe

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* 15. Do you have access to the internet (i.e. home computer/laptop, work computer/laptop, smartphone, library, etc.)?

Yes, daily

Yes, 3-5 times a week

Yes, once a week

Yes, every other week

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* 16. Do you own a smartphone or tablet to be able to use health-related apps?

Yes

Diabetes Self-Management

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* 1. What is your gender?

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* 2. Which category below includes your age?

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

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* 4. How much total combined money did all members of your HOUSEHOLD earn last year?

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* 5. What is your race/ethnicity?

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* 6. Number of members in household (including self)

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* 7. Which of the following categories best describes your employment status?

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* 8. What type of community do you live in?

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* 9. Which of the following co-morbidities do you have? (check all that apply)

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* 10. Have you ever been offered a diabetes education program upon first diagnoses of diabetes?

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* 11. If you answered no to #10, has anyone ever told you about a diabetes education program?

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* 12. Do you currently or have you ever participated in a diabetes education program?

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* 13. If you have been offered a program but never participated, why did you choose not to participate? (check all that apply)

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* 14. Would you consider participating in a program if you could attend sessions/obtain information online via smartphone apps, website videos, online chat?

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* 15. Do you have access to the internet (i.e. home computer/laptop, work computer/laptop, smartphone, library, etc.)?

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* 16. Do you own a smartphone or tablet to be able to use health-related apps?

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* 17. If you did not start a program, what would make you most likely to participate in a diabetes education program?

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* 18. Is there anything else you would like to contribute to this survey regarding diabetes education programs or your understanding of your disease?