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Questionnaire
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Questionnaire
UT Questionnaire
Dementia-Friendly Public Experience Survey
Purpose: We are looking to understand how we can improve the experience and quality of life for people living with dementia and their carers when out in public and visiting shops. Our aim is to banish the stigma of Dementia. Please tick or write your answers. You may answer on behalf of someone or with support.
About You (Optional)
I am a person living with dementia
I am a carer/guardian/family member
Other
General Experience
What do you find most challenging when going out in public or to shops?
(Required)
Crowds
Noise
Confusing layout
Finding toilets/seats
Communicating with staff
What helps you feel safe and comfortable when out in public? (Short answer)
(Required)
Are there any types of places you avoid? If yes, why?
Yes (Please explain why in box below)
No
Why I Avoid Certain Places
What makes a place or shop feel welcoming to you?
Do you prefer going out at a certain time of day?
Morning
Afternoon
Lunch Time
Evening
No preference
Other
Communication and Staff Interaction
How can staff better communicate with you?
Would it help if staff wore badges showing they are dementia-aware?
Yes
No
Not Sure
Have you ever felt confused or misunderstood in a shop or public place?
Yes (Please describe what would help in the box below)
No
What would have helped when you felt confused or misunderstood?
Navigation and Layout
Is it easy to find your way around shops and public areas?
Yes
No (Please describe what would help in the box below)
What would help make navigation easier?
What changes to layout or signage would make shopping easier?
Sensory Environment
Do loud noises, bright lights, or crowds cause stress?
Yes
No
Sometimes
Would you benefit from quiet or sensory-friendly shopping hours?
Yes
No
Not Sure
Facilities and Accessibility
How important are the following? (Rate 1 = Not important, 5 = Very important)
Access to toilets
1
2
3
4
5
Places to sit/rest
1
2
3
4
5
Clear signs/directions
1
2
3
4
5
Do you feel there are enough dementia-friendly facilities in public spaces?
Yes
No
Not Sure
Technology and Payment
Do you find it difficult to use self-checkouts or card machines?
Yes
No
Sometimes
Would it help to have a dementia/carer-friendly checkout option?
Yes
No
Not Sure
Support and Planning
Would printed guides or online maps of dementia-friendly places be useful?
Yes
No
Would you like support such as a “dementia buddy” or help in public spaces?
Yes
No
Maybe
Inclusion and Respect
Have you ever felt excluded or treated differently because of dementia?
Yes
No
Maybe
If you answered 'Yes' What could improve this?
What would help you feel more confident and independent when going out?