IIHE Research, Diabetes Survey 10/98

	Diabetes Survey
IIHE \| Research \| Diabetes Survey

INTRODUCTION

Hello, my name is Dr. _______________ from Henry Ford Medical Center at East Jefferson.

Is (patient’s name) home? Yes No

(If the answer is NO, then you say, "Thank you very much for your time. Good-by.")

We are doing a Diabetes Survey, which will only take a few minutes. May I ask you a few questions.

(If the answer is YES:)

Are you a diabetic? Yes No

(If the answer is No, then say, "Thank you very much; that is all I need to know. Good-by.)

QUESTIONS

How long have you been diabetic? years

Tell me what you think are the important ways to manage or control your diabetes?

(As you ask this open question, continue to ask, "Anything Else?" until the patient cannot think of anything else. Do not give the options below at this point. This data is being ranked by the question that follows.)

Diet Yes No Not mentioned

Exercise Yes No Not mentioned

Oral medication or Insulin Yes No Not mentioned

Stress reduction Yes No Not mentioned

Know How Yes No Not mentioned

Other Yes No Not mentioned

Other Yes No Not mentioned

Other Yes No Not mentioned

Other Yes No Not mentioned

Other Yes No Not mentioned

Typically doctors recommend (any reasonable ways they mention plus) diet, oral medications or insulin, exercise, and stress reduction.

Which do you think is MOST important?

diet oral medications or insulin exercise stress reduction

Which is NEXT MOST important?

diet oral medications or insulin exercise stress reduction

Then, of this list: diet, oral medications or insulin, exercise, and stress reduction which is LEAST important?

diet oral medications or insulin exercise stress reduction

Where do you get most of your information about the dietary or nutritional management of your diabetes?

In this next question, we are going to ask you to rate how likely you are to get information about your diabetic diet from the following sources. On the scale of one to ten, ten being the most and one being the least, tell me how likely you are to get information on diabetic diet from each of the following sources?

Magazines and books Yes No Not Mentioned Rating:

Health Food Yes No Not Mentioned Rating:

Friends or family Yes No Not Mentioned Rating:

Wt. Loss (i.e. Weight Watchers, Medical Weight Loss Clinic, etc.) Yes No Not Mentioned Rating:

Support Yes No Not Mentioned Rating:

American Diabetes Assoc. Yes No Not Mentioned Rating:

Dietician Yes No Not Mentioned Rating:

Medical Support Yes No Not Mentioned Rating:

Nurses Yes No Not Mentioned Rating:

Doctors Yes No Not Mentioned Rating:

Other Yes No Not Mentioned Rating:

Other   Yes No Not Mentioned Rating:

Other   Yes No Not Mentioned Rating:

Other   Yes No Not Mentioned Rating:

Other   Yes No Not Mentioned Rating:

How well do you think you manage or control your diabetes, very poorly, poor, average, well, or very well?

Very poorly Poorly Average Well Very well = 5

Those are all the questions we have. Thank you very much for your time.

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Diet	Yes	No	Not mentioned
Exercise	Yes	No	Not mentioned
Oral medication or Insulin	Yes	No	Not mentioned
Stress reduction	Yes	No	Not mentioned
Know How	Yes	No	Not mentioned
Other	Yes	No	Not mentioned
Other	Yes	No	Not mentioned
Other	Yes	No	Not mentioned
Other	Yes	No	Not mentioned
Other	Yes	No	Not mentioned

Magazines and books	Yes	No	Not Mentioned	Rating:
Health Food	Yes	No	Not Mentioned	Rating:
Friends or family	Yes	No	Not Mentioned	Rating:
Wt. Loss (i.e. Weight Watchers, Medical Weight Loss Clinic, etc.)	Yes	No	Not Mentioned	Rating:
Support	Yes	No	Not Mentioned	Rating:
American Diabetes Assoc.	Yes	No	Not Mentioned	Rating:
Dietician	Yes	No	Not Mentioned	Rating:
Medical Support	Yes	No	Not Mentioned	Rating:
Nurses	Yes	No	Not Mentioned	Rating:
Doctors	Yes	No	Not Mentioned	Rating:
Other	Yes	No	Not Mentioned	Rating:
Other	Yes	No	Not Mentioned	Rating:
Other	Yes	No	Not Mentioned	Rating:
Other	Yes	No	Not Mentioned	Rating:
Other	Yes	No	Not Mentioned	Rating: