Survey - Kauai Agency on Elderly Affairs

ADRC User Survey 1

Please give us your feedback about the ADRC website. Mahalo!

On a scale from one to five, how helpful did you find this website?

1 - Not at all
2 - A little
3 - Somewhat
4 - Very
5 - Extremely

On a scale from one to five, how difficult was it for you to navigate this website?

1 - Not at all
2 - A little
3 - Somewhat
4 - Very
5 - Extremely

How did you locate this website?

a. Used a search engine (such as Google)
b. Saw it advertised in the media
c. Heard from friends
d. Heard from a health care or social service professional
e. Other

Overall, how would you rate your satisfaction with the ADRC Hawaii website?

1 - Not at all
2 - A little
3 - Somewhat
4 - Very
5 - Extremely

Would you recommend this website to a friend or member of your family?

Yes
No

(Optional) Did you contact this website for yourself? Or are you a family caregiver or professional service provider?

a. Self
b. Caregiver
c. Professional
d. Other
e. Prefer not to answer

(Optional) What is your gender?

(Optional) What is your gender?
a. Male
b. Female
c. Prefer not to answer

(Optional) What is your age?

Under 18 years old
18 to 54
55 to 59
60 to 74
75 to 84
85 years and older
Prefer not to answer

(Optional) What is your ethnicity?

Asian
Caucasian/White
Hispanic or Latino
Native Hawaiian or Pacific Islander
African-American/Black
American Indian or Alaska Native
Other
Prefer not to answer

(Optional) Do you or someone you are caring for have a disability which requires assistance with one or more of the following activities: walking, dressing, bathing, toileting, feeding and transferring from sitting to standing?

Yes
No
Prefer not to answer

Kauai ADRC

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