Questionnaire: 1st Draft
- Less than 65
- 65 - 70
- 71 - 75
- 76 - 80
- 81 - 85
- 86 - 90
- Over 90
2. Which of the following best describes your current living situation?
- Live alone
- Live with partner/spouse
- Live with family
- Live in shelter accommdation
- Live in a care home
3. How important do you consider your independence to be?
- Very important/vital
- Quite important
- No preference
- Not important
- Not at all important
4. On an average week, how often to you leave your home?
- Never
- Once a week
- 2-3 times a week
- 4-5 times a week
- Everyday
- More than once a day
5. Which of the following best describes your current family situation? (Please tick all that apply)
a)
- No family
- Partner/spouse
b)
- Parent(s)
- Sibling(s) (with of without chilren/grandchildren)
- 1-2 children (with of without grandchildren)
- 3-4 children (with or without grandchildren)
- 5+ children (with or without grandchildren)
(If you have not ticked anything in section b, please skip questions 6-8)
6. Where does your family live? (Please tick all that apply)
- Within the same genral area (walking distance)
- Within 2-10 miles
- Within 11-30 miles
- Within 31-60 miles
- In the UK
- Outside the UK
7. Which family members live the closest to you?
- Parent(s)
- Sibling(s)
- Children
8. Which of the following best decribes how often you see your family?
- Never
- Once a year
- Once every 6 months
- Once every 3 months
- Once a month
- Once a fortnight
- Once a week
- Everyday
9. Do you worry that if you have an accident at home, you would be unable to get help?
- Yes
- No
10. If there was a device that existed to help you improve with your day to day life, would you like to have it in your home and use it?
- Yes
- No
(If you have ticked no, please ingore the rest of the questions)
11. Which of the following functions of a device would help you retain your independence in your own home? (Please tick all that apply)
- Personal alarm/panic button
- Automatic lighting systems
- Automatic opening/closing curtains
- Shopping home delivery service
- Reminders service for important events
- Fire sensors with automatic appliance shut off
- Fire sensors with sprinkler system
- Gas/carbon monoxide detectors
- Automatic cooker shut off when leaving home
12. Which of the following best describes your mobility in your home?
- I use a walking frame
- I use a walking stick
- I use a wheelchair and I am not able to walk
- I walk unaided but not far
- I walk completely unaided
13. If you live in a home with stairs, do you use a stair lift?
- Yes
- No
14. Are there any other additional suggestions/concerns/comments you would like to contribiute?
NB: This is only a draft version of the questionnaire and only features the content. The finalised questionnaire for distribution will be a word processing document.
Labels: questionnaire
posted by Koulle at 8:49:00 pm
3 Comments:
Only while I've been filling this in for my persona have I noticed some points:
Q8 - the final two options are 'once a week' and then 'everyday'. I think an intermediate 'several times a week' would probably make the question better.
I'm also now wondering if questions 9 and 10 are too sharply defined with 'yes' and 'no'. Maybe we should add in 'Not sure' or 'depends' and allow the users to elaborate. From the point of view of my persona, 'yes' and 'no' just don't feel like easy or suitable answers.
For question 8, I've put down a couple of options because my persona has 2 children...
Although we've all looked at the questionnaire, its only because we're actually filling it out that these problems have come up. Perhaps for the next one we fill out a draft as a test to see if it works?
This questionnaire is only a draft as stated but I can make the suggested revisions if you would like?
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