Inclusion Health Action in General Practice (IHAGP): evaluation

Appendix B: Patient Survey Questionnaire

Ask all

Section 1: About You

Q1. What is your age?

Single code

16-24

25-34

35-44

45-54

55-64

65+

Q2. What is your gender?

Multicode

Man

Woman

Non-binary

Transgender

Other

Prefer not to say

Q3. What is your postcode?

[Open text]

Q4. What is your ethnic group?

Choose ONE section from A to F, then tick ONE box which best describes your ethnic group or background.

Single code

White

Scottish

Other British

Irish

Polish

Gypsy / Traveller

Roma

Showman / Showwoman

Other white ethnic group

Mixed or multiple ethnic groups

Asian, Scottish Asian or British Asian

Pakistani, Scottish Pakistani or British Pakistani

Indian, Scottish Indian or British Indian

Bangladeshi, Scottish Bangladeshi or British Bangladeshi

Chinese, Scottish Chinese or British Chinese

Other

African, Scottish African or British African

Caribbean or Black

Other ethnic group

Arab, Scottish Arab or British Arab

Other, please write in:

Prefer not to say

Q5. Are you a refugee or person seeking asylum?

Single code

Yes

No

Q6. What is your main language?

Single code

English

Other, please write in:

Q7. How is your health in general?

Single code

Very good

Good

Fair

Bad

Very bad

Q8. Do you have any of the following, which have lasted, or are expected to last, at least 12 months? Please select all that apply.

Multicode

Deafness or partial hearing loss

Blindness or partial sight loss

Full or partial loss of voice or difficulty speaking (a condition that requires you to use equipment to speak)

Learning disability (a condition that you have had since childhood that affects the way you learn, understand information and communicate)

Learning difficulty (a specific learning condition that affects the way you learn and process information)

Developmental disorder (a condition that you have had since childhood which affects motor, cognitive, social and emotional skills, and speech and language)

Physical disability (a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, lifting or carrying)

Mental health condition (a condition that affects your emotional, physical and mental wellbeing)

Long-term illness, disease or condition (a condition, not listed above, that you may have for life, which may be managed with treatment or medication)

Other condition, please write in:

No condition

Q9. Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months? Please include problems related to old age and select all that apply

Multicode

Yes, limited a lot

Yes, limited a little

No

Ask all

Section 2: About your General Practice

Q10. What General Practice are you registered at?

Open text

Q11. Have any of the following made it hard for you to get care or support from your General Practice?

Multicode

Randomise

Lack of appointment availability

Opening hours don’t suit my needs

Lack of trust or understanding with staff

Not being able to speak with someone who knows me well

Not knowing what services are available

Language or communication barriers

My family or caring responsibilities

Transport or travel issues

Lack of access to or difficulty using technology

Not sure who to contact or how to get support

Lack of access to support/link worker

Lack of accessible materials or spaces

Lack of communication between staff

Difficulty knowing about or remembering appointments

No problems accessing services

Other (please specify):

Section 3: What Did You Experience?

Ask all

Q12. Have you experienced any of the following in the past year at your General Practice?

Multicode

Randomise order

My practice got in touch for a check-in, to offer support or arrange an appointment

My practice invited me to take part in an information session

I was given a longer appointment than usual (over 10 minutes) without asking for it

I took part in a health and wellbeing group or event through my practice

I was offered an appointment or information in a language other than English

Other (please specify):

Not sure (single code – fix to bottom) skip to Q14

None of the above (single code – fix to bottom) skip to Q14

Ask if Q12=A-F

Q13. Thinking about [pipe in experience from Q12], to what extent, if at all, was this helpful to you?

Single code

Rotate scale

Repeat for all Q12 selected

Very helpful

Somewhat helpful

Not at all helpful

Don’t know

Ask if Q12=A-F

Q14. And what would make this experience more helpful to you?

Repeat for all Q12 selected

[open text]

Section 4: Outcomes and Impact

Ask if Q12=A-F

Q15. What effect did [PIPE IN EXPERIENCE FROM Q12] have on the following:

Single code

Randomise

Repeat for all Q12 selected

Your health/wellbeing

Your understanding of your health condition(s)

Your confidence in managing your health

Your confidence in asking for support

Your trust in your General Practice team

Your confidence in your ability to receive support quickly or easily

Your connection with other people (e.g., through groups or sessions)

Other (please specify):

SCALE: Significantly increased, somewhat increased, remained the same, somewhat decreased, significantly decreased, don’t know

Ask all

Q16. And thinking about the last appointment you had at your General Practice, how much do you agree or disagree with the following statements?

I was listened to

I was given enough time

I was treated with compassion and understanding

I was able to ask questions if I wanted to

I understood the information I was given

The health professional checked I understood what I had been told

I was treated with dignity and respect

Scale: strongly agree, agree, neither agree nor disagree, disagree, strongly disagree

Ask all

Section 5: Final Reflections

Q17. Your General Practice is taking part in a project that provides people with extra support to help them with their health and wellbeing. To what extent, if at all, would you find the following actions helpful?

Single code Randomise

Staff in the practice receive training on a variety of topics that helps them better understand and support patients

The practice proactively reaches out to patients who have not been in touch for a while

Longer appointments are offered to patients who need them

The practice connects patients with groups and projects in the community to support health and wellbeing

The practice actively and openly asks patients about their experiences as a patient

Scale: very helpful, somewhat helpful, not at all helpful, don’t know

Q18. Is there anything that would improve your experience at your General Practice?

[Open text]

Q19. And is there anything else you’d like to share about your experience at your General Practice?

[Open text]