Survey on the analysis of target group needs in terms of cognitive challenges, skills and learning needs

Information and Consent

Please, read the following data management and protection policy and provide your explicit consent before moving to the survey content:

Thank you for choosing to spend 15 minutes of your time to participate in this study, which is undertaken in the interest of people older than 55 years.

The purpose of the study is to identify the challenges you face in terms of everyday cognitive skills and related training/learning opportunities and methods.

Participation is voluntary, your responses are confidential and will only be used for the purposes of the study. Your name is not required, and the completed questionnaire will be anonymous. If you would like to receive the results of this research by email, please give us your email address and we will get back to you after all the data will be collected and analysed (pre-estimated at early July 2019).

For your participation in this study you will be asked to give some data and information, which will be processed in accordance with the general Data Management and Protection Policy you can find here. Please, pay particular attention to your rights in relation with your personal data. Acting in the framework of our general policy, we provide the following specific information with regards to the collection and processing of data for the present study:

As a rule, we need your responses to the questions to make general conclusions about the situation in different countries with regards to the studied subjects and we do not have any interest in collecting data that will enable identification of an individual whatsoever. Therefore, no matter how you will provide your responses, i.e., filling-in printed versions of the questionnaire and handing it to project consultants offline or filling-in the dedicated online survey, we will take all measures to aggregate the data and achieve the highest degree of pseudonymization, before any analysis is performed on the data for extracting conclusions.

However, at the beginning of the data collection process, there are cases where the data you provide may give grounds for identification. For instance, you may provide your email address to receive the results of the study or have the chance of any different follow up with the team undertaking the study. If you fill-in the online version of the questionnaire, the system will record the IP address (internet protocol address) of the device through which you do the work. If you fill-in the offline version of the questionnaire and hand it over to a project consultant, that person may be able to identify you.

Please, note: the above-mentioned data will be kept ONLY during the data collection process, which will stop by end of July 2019. After that, all data that link your responses to your identity, will be deleted and the questionnaire content will undergo a fully anonymized processing. In other words, no human or the system collecting data, will be able to identify the individual that provided the responses. Your email or other contact details will be kept longer only if you give your explicit consent. The pseudonymized data will be kept for a period of 5 years for the needs of the project, ending at end of December 2023.

I provide my explicit consent for: *

	Yes	No
My participation in the aforementioned study and for the subsequent processing of the data and information I provide, as above described:
My email and other contact details I will provide to be kept so that you will be able to contact me and inform me of the progress of the project and future activities:
My email and other contact details I will provide to be kept so that you will be able to contact me and inform me of other projects you participate in, which are relevant to my line of business and profile:

Email address (optional):

Gender *

Female

Male

Age: *

55 - 60

61 - 65

66 - 70

71 - 75

76+

Do you face any health-related challenge(s)? *

Yes

I face the following health-related challenges:

Diabetes

Diagnosed with Dementia symptoms

Heart problem

Epilepsy

Visual problems (severe visual difficulty or blindness)

Hearing problems

Mobility problems

If other, please specify what kind of physical challenges?

For each type of digital devices listed below, please, choose the frequency you use them: *

	Every day	Few times per week	Few times per month	Never
Mobile phone
Smart phone (phone with touch screen)
Tablet
Laptop
e-Reader
Home PC

Memory Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
I find it easy to remember everyday things
I usually remember where I put my personal items (keys, phone, documents, etc.)
I usually remember events (important dates) or other information from the past
I find it easy to remember things planned for the future (appointments, shopping list, taking drugs, etc.)

Attention Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
I stay focused on task despite distractions
I stay focused on task for a sustained period of time (e.g. reading a long text)
I find it easy to do two things at the same time
I find it easy to stay concentrated when driving

Visual Perception Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
When I think about something, I can visualize it in images or scenarios
I can easily interpret maps
I can easily organize and interpret diagrams or charts

Reasoning and Planning Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
I find it easy to reason and form ideas
I find it easy to solve problems
I can easily plan or organize something for a specific topic

Processing Speed Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
I calculate my shopping bill quickly and accurately
I can react quickly and adapt to the environment
I can solve simple math problems in my head

Sequential Processing Capacities *

	No	I have difficulties very often	I have difficulties sometimes	Yes	I don't know
I can put things in order when thinking
It is easy for me to plan activities and events step by step

Please, rate the importance of each statement: *

	Not important	Maybe it’s useful	It’s important	Very important
I find it easy to use my smart phone
I can read the newspapers on the Internet
I use my email to communicate with my family members or friends
I use tools like Skype, Messenger, etc. to communicate with family and friends
I use Facebook, Twitter, Instagram or other social media
I use my phone/tablet/PC to edit photos & videos and save them for future reference
I use my devices to submit my Tax declaration or other governmental declarations through the Internet
I shop through the Internet
I check the status of my bank account through the Internet
I manage my electronic health record or I consult my health insurance through the Internet

Please, rate the appropriateness of the methods below, to learn new technologies: *

	No	I don’t know	It’s a good idea	Yes
I find it easier to learn during face-to-face group lessons.
I find it easier to learn during face-to-face private lesson.
I find it easier to attend courses through the Internet.
I like learning through face to face classes combined with Internet sources.
I find it easier to learn by interaction with family members or friends.
I find it easier to learn from peers.

During my free time I like: *

	Yes	No
Playing mind games (Sudoku, crosswords, etc.)
Playing board games (Scrabble, cards, Monopoly, etc.)
Playing chess or backgammon
Learning new things via books, movies, performances, etc.
Going out with my friends and planning activities

If other, please specify: