Service User Monitoring Information
Answers marked with a * are required.
1.
Service User Monitoring Information
Our aim is that all people who use our services can do so equally easily and secure the quality of outcomes which are important to them. So that we can make sure we reach that aim, it is essential that we listen to what you, the service user, tells us about your actual experiences when using our services, think carefully about what you have told us and look hard at what changes we can make which delivers the aim – that you can use our services equally easily and get the same quality of outcome as everyone else.
For some people in Scotland, we recognise that some services are not easy to access nor do they provide the same quality of outcome. So that we can ensure that we can identify the barriers which cause these problems, we are asking you to take some time to provide us with a profile of who you are. In this way we can use your critical feedback to positively change the design of services for the benefit of all the other people in Scotland who share your particular needs.
By our working together in this way we can ensure that our services become equally accessible to all the people living in Scotland, irrespective of their background or circumstances, and that the quality of the health outcome for them is the same as that for everyone else.
None of the information you provide will be shared with anyone else. It will be handled in the strictest confidence and we will only use it when added to all the other feedback results we get to work out if there are patterns and trends we need to react to. For example, people with visual impairments may regularly tell us that a particular colour we use in the design of a web page makes it difficult for them to read what is said there. We would then want to check with say the Royal National Institute for the Blind about what colour is better and redesign that page and any others affected. In this way we would constantly revise and change to ensure that access and use is equal for all.
Please choose one option from each of the sections listed below to build your profile.
Your Age
Up to 15
16 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 - 74
75 - 84
85 - 94
95 +
Prefer not to say
Disability
The Disability Discrimination Act 1995 (DDA) protects disabled people from discrimination. The DDA defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) and has an adverse effect on the person’s ability to carry out normal day-to-day activities.
Do you consider yourself to have a disability according to the terms given in the DDA?
Yes
No
Prefer not to say
If you have answered yes, please indicate the type of impairment which applies to you (by clicking next to it below). People may experience more than one type of impairment, in which case click in all the types that apply. If your disability does not fit any of these types, please click on Other.
Physical impairment, such as difficulty using your arms or mobility issues which means using a wheelchair or crutches
Sight impairment, such as being blind or having a serious visual impairment or
Hearing impairment, such as being deaf or having a serious hearing impairment.
Mental health condition, such as depression or schizophrenia
Learning disability, (such as Down’s syndrome or dyslexia) or cognitive impairment (such as autism or head-injury)
Long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
Other, such as disfigurement (specify below if you wish)
Your ethnic group
Prefer not to say
Asian, Asian British, Asian English, Asian Scottish, or Asian Welsh
Bangladeshi
Indian
Pakistani
Any other Asian background (specify below if you wish)
Black, Black British, Black English, Black Scottish, or Black Welsh
African
Caribbean
Any other Black background (specify below if you wish)
Chinese, Chinese British, Chinese English, Chinese Scottish, or Chinese Welsh, or other ethnic group
Chinese
Any other ethnic background (specify below if you wish)
Mixed
White and Asian
White and Black African
White and Black Caribbean
White and Chinese
Any other Mixed background (specify below if you wish)
White
British
English
Irish
Scottish
Welsh
Any other White background (specify below if you wish)
Your gender
Male (including trans man)
Female (including trans woman)
Other (e.g. androgyne person)
Prefer not to say
Your religion or belief
Which group below do you most identify with?
No religion or belief
Baha’i
Buddhist
Christian – Church of Scotland
Christian – Roman Catholic
Christian – Other
Hindu
Jain
Jewish
Muslim
Sikh
Any other religion or belief (specify if you wish)
Prefer not to say
Your sexual orientation
Bisexual
Gay man
Gay woman / lesbian
Heterosexual / straight
Other (specify below if you wish)
Prefer not to say
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