Students’ survey
Dear Diabetescured Users,
Why should you fill in the questionnaire?
- we will send to you a little present (your mailling address is: ……. ),
- we will inform you about the results,
(write if you are not interested in a present ……. and/or results:
…….),
- you will help to students,
- you will help to understand the needs of diabetes patients.
Your personal data and your e-mail or mail addresses will NOT be used by a
third part - they will be used in this survey ONLY.
Fill in the questionnaire if you have some experience with internet shoping.
You are welcome to add your comments to any question.
Put asterix ( * ) in gap ( __ ). For example: if you mean "Yes" write
"Yes:_*_" instead of "Yes:__".
1. Are any kind of diabetes supplies reimbursed for you?
- Yes:__
- No:__
2. How many boxes of blood glucose test strips (50 strips in box) do you buy
for your o w n money per year?
- 0 - everything is reimbursed:__
- 1-3:__
- 4-5:__
- 6 or more:__
3. How much do you spend for insulin per year?
- $ 0 - everything is reimbursed:__
- $ 0 - I do not use insulin:__
- $ 1-50:__
- $ 51-200:__
- $ 201-500:__
- $ 501 and more:__
4. What glucometer do you use:
- Accu-Chek Active: __
- Glucotrend: __
- Dex: __
- Esprit: __
- MediSense Precision QID, Card or Pen : __
- MediSense Optium: __
- OneTouch Basic:__
- Another: __________
5. Blood test result is displayed in your glucometer in:
- mmol/l:__
- mg/dl:__
7. How important the following things are when buying on the Internet? The
most important one mark as no. 1, one of the lowest importance mark as no.
6:
- Wide assortment: __
- Low price: __
- Safe credit card data transmission: __
- Quick delivery of goods purchased: __
- Possibility to speak via phone with a seller: __
- Nice web site’s design: __
8. Lets imagine that you buy test strips for 29 USD at e-shop X. What is the
price limit at e-shop Y under which your change your mind and become
customer of that cheaper e-shop Y?
- $ 28: __
- $ 26-27: __
- $ 23-25: __
- $ 20-22: __
- $ 19 or less: __
9. If you buy test strips on the Internet: how many test strips boxes of 50
strips do you buy at single order?
- 1-2: __
- 3-4: __
- 5-7: __
- 8-10:__
- 11 and more:__
10. If you buy not only test strips on the Internet: what is the persentage
you spend to test strips?
- 0-20 %: __
- 21-50 %: __
- 51-100 %: __
11(a). Would you buy in an e-shop like this: test strip prices are lower 10
% than in another e-shops + you must wait 7 days for the delivery + you must
pay 11 USD for the delivery + the sender (seller) is small and not known
company located abroad + credit card data are transmitted via PayPal (as via
a safe and known company).
- Yes, I would buy: __
- Maybe I would buy: __
- Maybe I would not buy: __
- No, I would not buy: __
11(b). The same question as above 11(a), but the price is 25 % lower (not
10%).
- Yes, I would buy: __
- Maybe I would buy: __
- Maybe I would not buy: __
- No, I would not buy: __
12. Write your e-mail address there ……. if you want to receive a www
address of such a diabetes e-shop.
13. What delivery option of goods purchased would you select:
- Quick (2-3 days) but expencive ($ 37) delivery: __
- Slow (7 days) but cheap ($ 11) delivery: __
14. If you bought on the Internet you would pay by:
- Credit (or debit) card:__
- Check (cheque):__
- Using PayPal:__
- You will send money through the bank to e-shop’s account:__
- Another:__________
15. About PayPal:
- I do not know what PayPal is:__
- I trust PayPal as safe money transfer solution:__
- I have an account in PayPal:__
16. What words would you entered to a search engine if you were looking for
some diabetes e-shop?
- __________, __________, __________,__________, …
17. What type of diabetes are you ill with?
- Type I: __
- Type II: __
18. What is your age?
- Up to 18: __
- 19-30: __
- 31-50: __
- 51-70: __
- 71 and more: __
19. What country are you living in?
- _____________
Thank you very much.
Victor
Vilnius University
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