すべてのテンプレート
Healthcare & Clinical

Health Data Sharing Trust & Privacy Preferences Survey

Measures patient comfort, consent preferences, and privacy concerns when sharing health data across providers, insurers, and digital health tools. Ideal for healthcare organizations, privacy teams, and compliance officers seeking to understand patient attitudes toward data sharing.

設問の例

テンプレートの内容をプレビューできます。すべての設問は公開前に自由に編集できます。

全21問・約10分
Q01
メッセージ

Welcome to this research survey on health data sharing preferences. This survey takes approximately 10 minutes to complete. Your participation is entirely voluntary, and you may stop at any time. There are no right or wrong answers — we are simply interested in your honest opinions. All responses are confidential, will be anonymized, and reported only in aggregate for internal research purposes. By continuing, you acknowledge that you have read and understood this information.

Q02
選択式

In the last 12 months, have you visited any health professional (e.g., doctor, nurse, therapist)?

  • Yes
  • No
Q03
選択式

In the last 12 months, which of the following health or wellness tools have you used? Select all that apply.

  • Fitness/activity tracker (e.g., Fitbit, Apple Watch)
  • Nutrition or calorie app
  • Symptom checker or health chatbot
  • Medication reminder app
  • Telemedicine/virtual care platform
  • Patient portal (e.g., MyChart)
  • Sleep tracking app/device
  • Mental health app
  • Other (please specify)
  • None of the above
Q04
オピニオンスケール

How comfortable or uncomfortable are you with sharing your health information with medical providers?

スケール: 1 – 7
最小:Very uncomfortable最大:Very comfortable
Q05
オピニオンスケール

How comfortable or uncomfortable are you with sharing your health data with fitness or wearable apps (e.g., Fitbit, Apple Health)?

スケール: 1 – 7
最小:Very uncomfortable最大:Very comfortable
Q06
ランク付け

Please rank the following types of health data from most comfortable to least comfortable to share.

  1. Basic profile (age, sex)
  2. Step counts/activity minutes
  3. Heart rate or sleep data
  4. Medication list
  5. Lab results
  6. Mental health notes or assessments
  7. Genetic/ancestry data
ドラッグして順位を付ける
Q07
AIインタビュー

Based on your responses throughout this survey, please share any additional thoughts or feelings about how your health data is shared. What concerns, if any, stand out most to you?

Q08
プルダウン

What is your age?

  • 18–24
  • 25–34
  • 35–44
  • 45–54
  • 55–64
  • 65+
  • Prefer not to say
Q09
メッセージ

Thank you for completing this survey! Your responses have been recorded and will be used in aggregate to improve health data sharing practices. If you have any questions about this research, please contact the research team.

Q10
選択式

During your most recent visit to a health professional, how did you share information with your provider? Select all that apply.

  • Spoke in person
  • Filled out paper forms
  • Phone call
  • Email
  • Online portal
  • Synced data from a wearable or app
  • Other (please specify)
  • I don't recall
Q11
オピニオンスケール

How comfortable or uncomfortable are you with sharing your health data with patient portals (e.g., MyChart)?

スケール: 1 – 7
最小:Very uncomfortable最大:Very comfortable
Q12
オピニオンスケール

How important or unimportant is it to you to control who can access your health data?

スケール: 1 – 7
最小:Very unimportant最大:Very important
Q13
選択式

Which best describes your gender?

  • Man
  • Woman
  • Non-binary
  • Prefer to self-describe
  • Prefer not to say
Q14
オピニオンスケール

How comfortable or uncomfortable are you with sharing your health information with your health insurer?

スケール: 1 – 7
最小:Very uncomfortable最大:Very comfortable
Q15
オピニオンスケール

How comfortable or uncomfortable are you with sharing your health data with telemedicine or virtual care platforms?

スケール: 1 – 7
最小:Very uncomfortable最大:Very comfortable
Q16
選択式

Which of the following would most increase your willingness to share health data with a new app or service? Select up to two.

  • Clear explanation of how my data will be used
  • Ability to delete my data at any time
  • Knowing data is stored in my country
  • Endorsement by my doctor or health system
  • Independent security certification
  • Option to share anonymized data only
  • Other (please specify)
Q17
選択式

Do you currently have health insurance coverage?

  • Yes
  • No
  • Prefer not to say
Q18
選択式

In the last 12 months, have you shared any health data directly with your health insurer?

  • Yes — through claims only
  • Yes — via a wellness program
  • Yes — by connecting an app or device
  • Not sure
  • No
Q19
プルダウン

In which region do you currently live?

  • Africa
  • Asia
  • Europe
  • North America
  • South America
  • Oceania
  • Prefer not to say
Q20
プルダウン

What is the highest level of education you have completed?

  • Less than high school
  • High school or equivalent
  • Some college/Associate
  • Bachelor's degree
  • Graduate or professional degree
  • Trade/Vocational
  • Prefer not to say
Q21
選択式

What is your current employment status?

  • Employed full time
  • Employed part time
  • Self-employed
  • Student
  • Homemaker
  • Unemployed
  • Retired
  • Prefer not to say

含まれる機能

  • AIによる深掘り

    自由回答に合わせてAIが追加で質問し、固定のフォームでは拾えない具体的な内容を引き出します。

  • 注意確認設問

    急いだ回答や質の低い回答者を除外する仕組みを標準で備えています。

  • AIが作成する設問文

    文言、設問の順序、条件分岐をAIが調査の目的に合わせて作成します。

  • 自動レポート

    回答が集まると、テーマ、引用、わかりやすい要約が自動で作成されます。

他ツールとの比較

ほかのアンケートツールで最も近いテンプレートを調べました。それぞれの優れている点と、このテンプレートがさらに踏み込んでいる点をまとめています。

このテンプレートを選ぶ理由

  • Uses a series of opinion-scale questions to quantify comfort sharing health data across distinct contexts (primary care providers, fitness/wellness apps, patient portals, telehealth), not just a single generic comfort rating.
  • Includes a ranking question asking respondents to order health data types from most to least comfortable to share, surfacing relative sensitivity rather than isolated yes/no consent.
  • Adds an AI follow-up interview at the end that adaptively probes respondents' own stated concerns and preferences, generating qualitative depth a static form cannot capture.
  • Captures demographic and coverage variables (age, gender, insurance status, region, education, employment) so compliance and privacy teams can segment trust attitudes by population.

SurveySparrow

Patient Consent Form Template

This is a functional patient consent form for authorizing treatment or data use, not a survey designed to measure attitudes toward health data sharing. It's fielding-ready as a form, but it collects signatures/agreement rather than exploring comfort levels, concerns, or trade-offs. Relevant only as an adjacent healthcare-data document, not a comparable attitudes/preferences instrument.

優れている点

  • Ready-to-use, healthcare-specific consent template within a broader form/survey builder
  • Likely supports standard customization and mobile-friendly completion
  • Part of a larger library of healthcare templates, easing adoption for clinics

物足りない点

  • Captures binary consent/agreement rather than graded comfort levels, ranked preferences, or reasons behind privacy concerns
  • No adaptive AI follow-up to explore why a patient is or isn't comfortable sharing specific data types
  • No per-response quality scoring or transparent prompt methodology for the questions asked

よくあるご質問

「Health Data Sharing Trust & Privacy Preferences Survey」テンプレートにはどのような設問が含まれていますか?

すぐに使える設問が21問含まれており、最初の設問は次のとおりです:「Welcome to this research survey on health data sharing preferences. This survey takes approximately 10 minutes to comple…」・「In the last 12 months, have you visited any health professional (e.g., doctor, nurse, therapist)?」・「In the last 12 months, which of the following health or wellness tools have you used? Select all that apply.」。すべての設問は上でプレビューでき、自由に編集できます。

このアンケートの回答にはどのくらい時間がかかりますか?

回答者は通常、21問を約10分で回答し終えます。

テンプレートは編集できますか?

はい。公開前であれば、すべての設問、選択肢、順序を編集できます。設問の追加や削除のほか、調査の目的に合わせた作り直しをAIエディターに依頼することもできます。

このテンプレートは無料で使えますか?

はい。エディターで開けば、すぐに編集を始められます。お試しにアカウントは不要で、無料プランでアンケートを公開できます。

公開の準備はできましたか?

このテンプレートをエディターで開いてみてください。最初の回答者が目にする前に、すべてを自由に変更できます。

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