Skip to content
Askalot

← All Healthcare templates

Questionnaire template

Patient Education Needs

Assesses what patients understand about their condition, where they get information, how they prefer to learn and their barriers.

Preview

Healthcare · Patient. All Healthcare templates

Questions in this template

About You

  1. Thank you for helping us. Your answers show us what information patients need about their health and how best to provide it.

  2. Which age group are you in?

    Choose one from a list:

    • Under 18
    • 18-24
    • 25-34
    • 35-44
    • 45-54
    • 55-64
    • 65 or older

  3. What is your gender?

    Choose one:

    • Female
    • Male
    • Another gender
    • Prefer not to say

What You Know Now

  1. In your own words, what do you know about your current health condition?

    Open answer

  2. Which parts of your condition or its treatment are hardest for you to make sense of?

    Open answer

Where You Find Information

  1. Where do you usually look for information about your condition? Select all that apply.

    Choose any that apply:

    • Internet
    • My doctor
    • Nurse or pharmacist
    • Books or leaflets
    • Friends and family
    • Other
    • I don't look for information

  2. Which of these sources do you trust most?

    Condition: Shown when at least one source is used

    Choose one:

    • Internet
    • My doctor
    • Nurse or pharmacist
    • Books or leaflets
    • Friends and family
    • Other

How You Like to Learn

  1. Which ways of receiving health information suit you best? Select all that apply.

    Choose any that apply:

    • A conversation with a health professional
    • Printed leaflets
    • Videos
    • Websites or apps
    • Group classes

  2. How much detail do you want about your condition?

    Choose one:

    • Just the essentials
    • A moderate amount
    • As much detail as possible

What Gets in the Way

  1. What makes it difficult for you to learn about your condition?

    Open answer

  2. Does each of the following make it harder for you to learn about your health?

    • Not having enough time
    • Medical terms that are hard to follow
    • Difficulty getting hold of information
    • How unwell I feel
    • Low motivation

    For each row: choose one:

    • Yes
    • Not sure
    • No