Menopause Care Needs & Preferences Assessment
A patient-facing needs assessment capturing menopause symptom burden, care access barriers, and service preferences to inform care model design and resource prioritization.
샘플 질문
템플릿에 포함된 내용을 미리 확인해 보세요. 모든 질문은 설문 공개 전에 자유롭게 수정할 수 있습니다.
Which of the following best describes your current menopause status?
- Perimenopausal (periods changing, new symptoms)
- In menopause (12 months without a period)
- Postmenopausal
- Not sure
- Not experiencing menopause-related changes
- Prefer not to say
How familiar are you with menopause care options available in your area?
Which of the following symptoms have you experienced in the last 4 weeks? Select all that apply.
- Hot flashes or night sweats
- Sleep disruption or insomnia
- Mood changes (e.g., anxiety, irritability)
- Cognitive changes (e.g., brain fog, memory)
- Vaginal dryness or discomfort
- Low libido
- Joint or muscle pain
- Weight changes
- Headaches or migraines
- Other
- None of the above
- Prefer not to say
The next few questions ask about your most recent menopause-related care experience. If you have not received care, please select 'Not applicable' where available or skip ahead.
What makes it hard to get the menopause support you want? Select all that apply.
- Unsure where to seek care
- Hard to get appointments
- Cost or insurance coverage
- Limited local specialists
- Past negative experiences
- Stigma or discomfort discussing symptoms
- Transportation or childcare challenges
- Time constraints
- Privacy concerns
- Symptoms feel manageable without care
- Other (please specify)
- No barriers experienced
Overall, how satisfied are you with the menopause-related care and support you currently have access to?
Based on your responses in this survey, please share any additional thoughts about your menopause care experience, unmet needs, or what you wish existed to better support you.
Finally, a few questions about you to help us understand different perspectives. Your responses are confidential.
Thank you for completing this survey. Your responses will be kept confidential and used to improve menopause care services. We appreciate your time and openness.
Overall, how bothersome have your menopause-related symptoms been in the last 4 weeks?
How would you rate your most recent care provider's knowledge of menopause?
Rank the following sources from most to least preferred for getting menopause information.
- Primary care provider or OB-GYN
- Pharmacist
- Specialist menopause clinic
- Trusted health websites
- Support groups or communities
- Mobile app or digital program
How likely are you to recommend your current menopause care provider or service to a friend or family member experiencing menopause?
What is your age?
- 18–24
- 25–34
- 35–44
- 45–54
- 55–64
- 65+
- Prefer not to say
In the last 12 months, which types of support have you used for menopause symptoms? Select all that apply.
- Primary care clinician / GP
- OB-GYN / gynecology specialist
- Endocrinologist
- Nurse practitioner / physician assistant
- Pharmacist guidance
- Therapist / counselor
- Support group (online or in-person)
- Menopause-focused clinic or service
- Alternative or complementary practitioner (e.g., acupuncturist, naturopath)
- Self-care only (over-the-counter, lifestyle changes)
- I have not sought care for menopause symptoms
- Other (please specify)
- Prefer not to say
How well did you feel heard and understood during your most recent menopause-related appointment?
Rank the following service features from most to least important to you when choosing menopause care.
- Clinicians with menopause expertise
- Short wait times
- Clear, personalized care plan
- Insurance coverage and cost transparency
- Follow-up and ongoing check-ins
- Option for virtual and in-person visits
- Culturally responsive and inclusive care
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
How clear was the care plan or next steps you received after your most recent menopause-related visit?
What is your preferred appointment format for menopause care?
- In-person
- Video visit
- Phone
- Chat or asynchronous messaging
- No preference
What sex were you assigned at birth?
- Female
- Male
- Intersex
- Prefer not to say
Approximately how long did you wait from first seeking help to your first menopause-related appointment?
- Less than 1 week
- 1–2 weeks
- 3–4 weeks
- 1–2 months
- 3–6 months
- More than 6 months
- I have not sought a menopause-related appointment
- Don't remember
What is the most you would be willing to pay per month out-of-pocket for a menopause support program, if not covered by insurance?
- $0 — I would only use a free program
- $1–$25
- $26–$50
- $51–$100
- $101–$150
- $151–$200
- More than $200
- Not sure
Where do you currently live?
- United States
- Canada
- United Kingdom
- European Union
- Australia / New Zealand
- Other
- Prefer not to say
What is the highest level of education you have completed?
- High school or less
- Some college or vocational
- Bachelor's degree
- Postgraduate (master's or doctorate)
- Prefer not to say
What is your current employment status?
- Full-time
- Part-time
- Self-employed
- Unemployed and looking for work
- Homemaker / caregiver
- Student
- Retired
- Unable to work
- Prefer not to say
포함된 기능
AI 후속 질문
정형화된 설문이 놓치는 세부 내용을, 주관식 답변에 맞춰 AI가 심층 질문으로 끌어냅니다.
주의력 확인 장치
성의 없는 답변과 저품질 응답자를 걸러내는 내장 안전장치입니다.
AI가 작성한 문안
문구, 질문 순서, 분기 로직까지 AI가 연구 목표에 맞춰 작성합니다.
자동 리포트
응답이 모이면 주요 주제, 인용문, 이해하기 쉬운 요약이 자동으로 작성됩니다.
다른 서비스와 비교
다른 설문 도구의 가장 유사한 템플릿을 검토했습니다. 그 도구들이 잘하는 점과, 이 템플릿이 한발 더 나아가는 지점을 정리했습니다.
이 템플릿을 선택하는 이유
- Includes an AI follow-up interview that adapts to each respondent's own symptom and care-experience answers, going beyond fixed-choice questions to surface unstructured 'additional thoughts' patients wouldn't otherwise volunteer
- Covers the full care-journey arc in one instrument: symptom burden and bothersomeness, most recent provider experience (knowledge, being heard, clarity of care plan), wait times, cost willingness-to-pay, and ranked service/channel preferences
- Uses ranking questions to force-prioritize preferred information sources and service features, giving care-model designers clear trade-off data rather than just satisfaction scores
- Pairs quantitative opinion-scale and multiple-choice items with transparent, auditable AI prompts and an automated report, so teams can validate exactly how the qualitative follow-up was generated
Jotform
600+ Healthcare Assessment FormsThis is a broad category hub linking to hundreds of generic healthcare assessment forms, not a purpose-built menopause needs-assessment template. It's useful as a starting point for form building and customization but requires assembling the menopause-specific question set yourself. Good for teams who want drag-and-drop form design over a ready-to-field survey.
잘하는 점
- Large library of pre-built healthcare form templates to adapt
- Drag-and-drop form builder for quick customization
- Broad healthcare category coverage beyond menopause
아쉬운 점
- No menopause-specific needs assessment content out of the box
- Static form fields only — no adaptive AI follow-up probing on symptom or care-experience answers
- No built-in quality scoring or automated qualitative report generation
Typeform
Online Community Needs Assessment Survey TemplateA general-purpose community needs assessment template with Typeform's conversational form style, not tailored to menopause symptoms, care barriers, or clinical experience. It can be manually customized but starts from generic community-needs questions rather than menopause-specific content. Fielding-ready for broad needs assessments, but would need substantial rework for this use case.
잘하는 점
- Polished, conversational question flow that feels less clinical
- Flexible template structure adaptable to different needs-assessment contexts
- Established brand for consumer-friendly survey design
아쉬운 점
- No menopause-specific symptom, care-access, or provider-experience questions
- No adaptive AI interviewing — follow-up logic is limited to fixed branching, not open-ended probing
- No automated per-response quality scoring or transparent AI prompt documentation
QuestionPro
Healthcare Opinion Survey TemplateA generic healthcare opinion survey template covering general satisfaction and opinion questions, not specific to menopause care needs, symptom burden, or service design preferences. It's ready to field for broad healthcare opinion capture but lacks the condition-specific depth and journey-stage structure of a menopause needs assessment. Suitable as a general satisfaction pulse rather than a service-design planning tool.
잘하는 점
- Ready-to-field generic healthcare opinion survey
- Established survey platform with reporting and analytics tooling
- Broad applicability across healthcare topics
아쉬운 점
- No menopause-specific content on symptoms, care barriers, or service preferences
- Fixed-question format with no adaptive AI follow-up interview or voice AI option
- No transparent prompt methodology or automated qualitative synthesis report
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