Professional Documents
Culture Documents
On
Mobile-Health Applications for the Efficient
Delivery of Health Care Facility to People: - A
survey on Woodland RPG
at
Submitted by
Bishal Roy
MBA (MAJOR- MARKETING, MINOR- FINANCE)
UNIVERSITY ROLL: 96/MBA/180016
CLASS ROLL: 16
REGISTRATION: 120-1113-0025-18
DEPARTMENT: MBA (Semester – IV)
UNIVERSITY OF CALCUTTA
CONTACT: 8961187463
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Declaration
X
Bishal Roy
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Acknowledgement
My thanks are due to all who have directly or indirectly helped me in preparing
this project report. However, I accept the sole responsibility for any possible
error of omission and would be extremely grateful to the readers of this project
report if they bring such mistakes to my notice.
Thank You
X
Mr. Joydeep Das
General Manager, Business Analytics And In...
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Preface
India is a developing nation with second largest populated country in the world.
Two thirds of India’s population is living in rural areas. Demographic and
environmental alteration in India is expanding, the already existing high burden
of communicable, non-communicable and emerging infectious diseases. In
recent years India has made progress in improving overall health care sector.
Barriers like large geographical area, high population density, lack of transport
facilities, inadequate nutrition, illiteracy and poverty directly impacts in
achieving good quality healthcare. Healthcare delivery requires an urgent need
in health care delivering with enabling referral systems with information
communication technology applications.
Over the past decades, mHealth has seen a significant progress and is mainly
due to the growing usage of mobile phones. Presently, the number of mobile
subscribers worldwide is expected to have extended over 7 billion, of which 1
billion are smartphones with mobile broadband connections. Almost all
developed and some developing countries have mobile penetration greater than
100%. The expectations are high for mHealth for both developed and
developing regions in the world. According to the Economist Intelligence Unit
(2012), mHealth can escalate access to care in emerging markets and transform
the developed world’s costly healthcare burden into less expensive, prevention-
based and patient-focused systems. Healthcare system in India is ripe for
innovation. The capability of the healthcare system to deliver care is unlikely to
meet both the demands of the growing urban middle and upper classes, or the
needs of the urban and rural poor. About 75% of healthcare costs paid out-
ofpocket create a consumer-driven market capable of fast change. Using
technology to enable greater access to care at a lower price point is critical.
In this project I have studied to analyze the Mobile-Health applications for the
efficient delivery of health care facility to people and also their pros-cons and
consumer’s perception towards mHealth apps of Woodlands Multi-Specialty
Hospital Limited. I attempted to provide some information about their
mHealth(MyWoodlands) app.
I would be delighted to receive reader’s comment which might prove to be
valuable for my further studies and also which will help me to gain further
knowledge.
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Table of contents
4. Company Profile
Company History
Vision Mission
Achievements accolades, Ratings
Other details
Service/product profile
SWOT Analysis
Marketing Mix
5. Features and Marketing of MyWoodlands app
6. Literature Review
7. Research Methodology
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11. Conclusion
12. Bibliography
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CHAPTER-1
Introduction
Woodlands Hospital is as old as India herself. Ever since its inception,
Woodlands Hospital have nursed a dream of becoming one of the leading
healthcare provider of free India by providing global standards with advanced
technology.
In 1947, we began as a tertiary care unit. And today, we've grown much larger
to become a Multispecialty hospital. Over the years, our global quality of
treatment has enabled us to become the hospital of trust for patients not only of
Kolkata and eastern India, but also of neighbouring countries.
In its 70+ year long journey, it have touched millions of lives and with that, also
the dream it nursed. Woodlands is part of the large and diversified business
conglomerate RP-SG group.
Statutory Compliance:
Bio-Medical Waste is not be mixed with any other waste. The collected
waste is temporarily stored in a designated Bio-Medical Waste room.
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CHAPTER-2
Objective
The aim of this paper is to provide a comprehensive review of existing research
that supports the evidence of using mHealth applications in healthcare
industries. I am
To check out technology trends within the healthcare mobile app industry (IoT, AI,
Blockchain, etc.)
To check out design, healthcare app development, and monetization tips for
MyWoodlands app
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CHAPTER-3
A recent joint report by PwC and the Confederation of Indian Industries (CII)
states that mHealth is expected to be crucial in making healthcare accessible
in India. Also, it has the potential to save the country $0.8-1 billion annually.
It is time for the healthcare ecosystem to explore various mHealth apps,
device integration, and sensor technology seriously and start benefitting from
it.
Entrepreneur India spoke to few start-ups in India to know how mHealth can
change India's healthcare space. mHealth is a huge opportunity for the
healthcare market as well as people in India.
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CHAPTER-4
Company Profile
Sometime in the early forties, British Companies realised the need of good
healthcare services for their families.
Accordingly they opened a company called “East India Clinic Ltd” on 23rd
October 1946 East India Clinic started 2 nursing homes in Elgin Road in 1947
and started his journey.
East India Clinic Ltd was shifted to Woodlands Nursing Home. The name
Woodlands was derived from the name of the Palace.
The setup of Elgin Road as well as the pharmacy in Russel Street were closed
immediately after the opening of the Woodlands Nursing Home.
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The name of East India Clinic Limited got changed to Woodlands Hospital and
Medical Research Centre Limited in the year 1994 and thereafter to Woodlands
Medical Centre Limited in the year 2004.
QUALITY POLICY:
Woodlands Hospital, Kolkata, is established with the purpose of providing
international standards of healthcare. We are further committed to achieve
patient centric care, clinical excellence and safety of patients, their relatives and
staff with the aid of trained medical, non-medical and paramedical
professionals.
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AWARDS, ACCOLADES, CERTIFICATION
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Patients get services by credential Medical& Support staff.
Rights of patients are respected and protected
Patient satisfaction is regularly evaluated
Accreditation provides an objective system of empanelment by
insurance and other third parties. Accreditation provides access to
reliable and certified information on facilities, infrastructure and
level of care.
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Woodlands Hospital received this certification for meeting
the following standards-
High patient care standards
Benchmarking global standards
Effective competency building
Consistently positive treatment outcomes.
Services offered
The Hospital has a well equipped Diagnostic center. It consists of 12
lead ECG, Colour Doppler, 128 slice dual source dual energy CT Scan
and 3 Tesla MRI facility. It offers Cardiac Stress Tests, Holter
Monitoring Pulmonary Function Tests, Echocardiogram,
Mammography, CT/USG Guided FNAC, Special Imaging and
EEG/EMG.
The hospital offers Cardiac health Check Up, Executive Health Check
Up; Health Screening Schemes I, II & III; Customized Corporate
Diagnostics; Renal, Hepatic, Cardiovascular and Urological &
Gastrointestinal Test Packages.
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There are Intensive Therapy Unit, Intensive Cardiac care Unit, Critical
care Unit, Neo-natal Intensive Therapy Unit and Special Care Units.
Procedures like Laparoscopies, Lithotripsy, URS / Uroslometry,
Cystoscopy & Allied Procedures, Cardiotocography; Burn, Trauma &
other cosmetic treatment and Smile Correction are carried out.
The Hospital provides 24-hour service.
It consists of a Blood Bank. It offers Dialysis, Imaging and Emergency
Intervention services.
The Hospital provides outpatient as well as in-patient care. It treats
and cures a wide range of maladies and complicated.
SWOT Analysis
STRENGTHS WEAKNESSES
Highly qualified and Limited presence
experienced doctors High costs
Patient care Security measures are not that
Focus on continuous strong.
improvement Lack of research & development
Quality Accreditations facilities.
Corporate Tie-ups.
More than 786 reputed doctors
associated with the organisation
OPPORTUNITIES THREATS
Growing health concerns Presence of cut-throat competition
Underdeveloped healthcare in healthcare sector
availability Prohibitive healthcare costs
Medical Tourism Unknown potential epidemics.
New approaches of treating Salary competition between
diseases with the help of organic hospitals.
therapies
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Strengths:
Highly qualified and experienced doctors – the doctors and
facilities are what make a hospital good. This is something that is
readily available in Woodlands Hospital. Every single appointed
doctor is highly qualified with impeccable experience which
ensures that you are in good hands and not just callous ones. This
is what segregates this hospital from the sea of other hospitals.
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corporate like IBM, NHPC,IOCL etc which is one of the strengths
to capitalize on.
Weaknesses:
Limited presence – At present only providing services in
Kolkata with one and only branch.
High Costs -Even with the world-class services that they
provide, they charge a hefty amount of money which is not
always affordable by the common people. This is why this
hospital is not always the first option for the ordinary
people, even with the kind of services that they provides.
Opportunities:
Growing health concerns: With more and more
information available over the Internet, people are highly
conscious of their health today. They are also aware that
after 40 they need to keep track of the signals that their
body gives them. This is making people approach
specialists even for small ailments providing a plethora
of opportunities for hospitals.
Underdeveloped healthcare availability – India is that
third world country that is evolving in terms of hospitals
and healthcare. This is definitely one of the main reasons
which account for positive opportunities for the Apollo
Hospitals. The lesser amount of developed healthcare
service providers around the country pose as one of the
best opportunities for this hospital.
Medical Tourism: India is popular globally not just for
the quality of its healthcare but also for the quality of the
professionals who provide them. The nurses of India are
wanted globally for the prowess. The healthcare facilities
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in India are also relatively cheaper. All this makes India
a prime target for medical tourism.
Threats:
Competition –With the advancing technology and newer
medical interventions, several hospitals are evolving with
their services as well. This is one of the primary threats
that Woodlands Hospital might encounter in the coming
future. Newer technologies are being added and most of
the high-end hospitals are incorporating the same into
their services to be able to successfully serve people with
their added and advanced services. This is one of those
threats that this establishment might face along the way.
Services
Services are the non-physical, intangible parts of our economy, as opposed to
goods, which we can touch or handle.
Services, such as banking, education, medical treatment, and transportation
make up the majority of the economies of the rich nations. They also represent
most of the emerging nations’ economies.
Services are different from tangible goods.
They are:
Intangible (have no fixed existence)
Inseparable (Cannot be separated from its provider)
Not stored (Cannot be stored in a warehouse or anytime before the actual
performance)
Perishable (Perishes as soon as the work is done)
Heterogeneous (result in different experience to different users)
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The Services Marketing Mix
Extending the 4Ps
The services marketing mix is an extension of the 4Ps framework. The essential
elements of product, promotion, price and place remain but three additional
elements – people, physical evidence and process are included to the 7Ps mix.
The need for the extension is due to the high degree of direct contact between
service providers and its customers, the highly visible nature of the service
process, and the simultaneity of the production and consumption.
Although it is possible to discuss people, physical evidence and process within
the 4P framework (for example, people can be considered part of the product
offering), this extension allows for a more thorough analysis of the marketing
elements necessary for successful services marketing.
Product
In the case of services, the “product” is intangible, heterogeneous and
perishable. Moreover, its production and consumption are inseparable. Hence,
there is scope for customizing the offering as per customer requirements, and
the actual customer encounter therefore assumes particular significance.
However, too much customization would compromise the standard delivery of
the service and adversely affect its quality. Therefore, particular care has to be
taken in designing the service offering.
Pricing
Pricing of services is tougher than pricing of goods. While the latter can be
priced easily by taking into account the raw material costs, in the case of
services there are attendant costs– such as labour and overhead costs–that also
need to be factored in. A restaurant not only has to charge for the cost of the
food served but also has to calculate a price for the ambiance provided.
Place
Since service delivery is concurrent with its production and cannot be stored or
transported, the location of the service product assumes importance. Service
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providers have to give special thought as to where the service is provided. A
fine dining restaurant is better located in a busy, upscale market as opposed to
the outskirts of a city. A holiday resort is better situated in the countryside away
from the rush and noise of a city. Promotion Since a service offering can be
easily replicated, promotion becomes crucial in differentiating a service offering
in the mind of the consumer. Service providers offering identical services such
as airlines or banks and insurance companies invest heavily in advertising their
services. This is crucial in attracting customers in a segment where the services
providers have nearly identical offerings.
People
People are a defining factor in a service delivery process, since a service is
inseparable from the person providing it. A restaurant is known as much for its
food as for the service provided by its staff. The same is true of banks and
department stores. Consequently, customer service training for staff has become
a top priority for many organizations today. Process The process of service
delivery is crucial since it ensures that the same standard of service is repeatedly
delivered to the customers. Most companies have a service blue print which
provides the details of the service delivery process, often going down to even
defining the service script and the greeting phrases to be used by the service
staff. Physical Evidence Since services are intangible in nature, most service
providers strive to incorporate certain tangible elements into their offering to
enhance customer experience. Many hair salons have well designed waiting
areas, often with magazines and plush sofas for patrons to read and relax while
they await their turn. Similarly, restaurants invest heavily in their interior design
and decorations to offer a tangible and unique experience to their guests.
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CHAPTER-5
Features and Marketing of MyWoodlands app
Features of the app:
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This is the Homepage of MyWoodlands app where users can Book doctors’
appointments, Book for test, Book health check-ups, Book an ambulance and
also can track their health and see their results through the app.
Users can select the date, time and doctor and can book directly from the app.
There is no need to call or go there and make an appointment.
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Users can book health check-ups and can compare it with other health check-up
packages to determine which are good for them.
Users can track their health status through this app.
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For medical emergency, user can directly call for an ambulance from the app.
This is a great feature where user don’t have to waste their time on finding
numbers, here they can directly book ambulance form the app.
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App Marketing
Mobile apps are now an integral part of digital strategy, with well over 1 million apps in both
the Apple App Store and Google Play Store. Today, there is big competition in the mobile
app market and it became more challenging for the businesses to get their apps on the top. So
that mobile app marketing is very much important after the launch of an app.
App Marketing is a set of techniques with which your app can became visible to the users and
it will rank on the top in app store. It is the best way to interact with the users from the time
when they hear about your app to when they became your loyal customers. App marketing is
a great approach for the promotion of app using multi channels.
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These are some brochures for promoting MyWoodland app in Woodland
Hospital
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These are some advertisement on MyWoodlands app in the Hospital premises. Most recently
Woodlands hospital launched its own official app to make it more convenient for people to
connect and contact with Woodlands. The app was promoted extensively on social media
platforms and app stores all over.
The brochure contains Woodlands logo on the top cover and inside it contains the
features of the app.
The branding department designed an entire brochure to promote the app and make
people aware of its launch.
The colour and design of the app was done in a manner so that people get attracted
towards it.
With the help of the brochure, people will be able to book appointments, book tests,
book health check-up, book ambulance, doctors and reports.
Branding of the app was done on all the hospital lifts inside and out to generate
visibility.
A quick step instruction was also given at the back of the app to make it easier for
people to find it out and download.
The brand promotion through social media helped to attract people who use social
media regularly to stay connected with friends.
Whenever any event happens or any change in the app has to be done, the design and
layout of the app is done by the branding department.
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CHAPTER-6
Lierature Review
The literature on mobile technology’s effectiveness and desirability among learners is mixed.
While modern learners may be comfortable with technology, Ellaway et al3 found a disparity
in the value of mobile apps in clinical decision support (CDS, high) versus its value in
learning (lower, heterogenous). Previous work deploying a mobile app containing an
anesthesia calculator (CDS) and lectures (didactics) to residents and anesthesiologist assistant
students demonstrated substantially greater use of the CDS piece.4 Learners demonstrated a
preference for traditional educational modalities (lectures, intraoperative didactics) over
mobile apps for didactics (unpublished communication). We should modulate our excitement
for mobile technology as a driver of the “andragogical approach”; learners seem to want
educator engagement as much as educators want learner engagement. The role of mobile
technology in education is likely to be as nuanced as our learners themselves.
The future of mHealth will be driven less by the computational power of the devices and
more by advances in electronic medical record integration and cross-platform development of
just-in-time CDS tools. Detailed analytics will provide feedback in the app development
lifecycle. We applaud the authors for their summary of this rapidly changing landscape.
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CHAPTER-7
Research Methodology
After analysing the business requirement, myWoodlands app is proposing solution per needs:
The proposed mobile App can be downloaded from play store for Android users and
from app store for IOS users.
The proposed mobile App will allows users to find information & details about the
services offered by the hospital.
User can also log in to their profile and can update their profiles. If the registered
users are patients, they can view and pay their hospital bills anytime online.
The Admin will also have an option to push update and notifications on the user’s
mobile.
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End User Features
Admin / Monitoring Features
Admin Features
News, Update & New Program Notifications, Health Package Update
Upload content as per need
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CHAPTER-8
Data analysis and interpretation
Procedure
This study explored consumer’s perception and experience with health apps through
structured questionnaire. Questionnaire was made to analysis the consumer’s perception
about MyWoodlands app. The survey was conducted in Woodlands Hospital among the
patients or with customers. Survey was aimed to target 60 consumers, but I got responses
from 50 consumers which I interpreted and analysed to derive my objective of study.
Participants
70% of respondents were male & 30% female. Respondents were from the age group of
below 20, 20-30, 30- 40 and above 40 years. The majority of respondents were found within
the age bracket of 20-30 years. The respondent further had an education level: 32.4%
undergraduates, 39% graduates & 28.6% postgraduates with different socio economic
backgrounds. The respondent’s further sub classified under different categorizes as students,
health care professionals, government & private sector employee, businessman &
homemaker.
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Questionnaire was structured with closed ended questions in a simple language (English).
Questions were framed for consumer’s behaviour and perception towards mHeath apps
targeting mainly MyWoodlands app. Eleven questions were asked from sample population
which took time maximum 5 mins to fill survey.
Survey of questionnaire:
Distribution of questionnaire was done directly at the venue in Woodlands Hospital. Target
was randomly chosen sample population which includes college students, working
professionals, homemakers and old age people who are the customers/patients in the hospital.
Inclusion criteria
Consumers must have a smartphone
Consumers should have minimum 18 years of age. It was intended to involve
participants of broad age range to combine experiences of technology savvy younger
generation with the older generation
Any duration of use of the apps was valuable
Data analysis
Data from survey was collected and compiled for analysis. I used excel to compile survey
data and made graphs to compare the outcomes. Data was separated in two sections:
1. Questions related to demographics
2. Questions related to MyWoodlands app
Results were concluded on the basis of data analysis.
a) Demographic analysis
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Demographic Analysis
8000%
7000%
6000%
5000%
4000%
3000%
2000%
1000%
0%
In sample population we found that majority of responders are in age group of 20-30 and are
professionals and majority of them are postgraduate and private employees.
%of
Factors Subcategory Respondents
undergraduate 32.4
Education postgraduate 39
graduate 28.6
>18- 20 16.8
20- 30 68.6
Age 30-40 7.4
40-50 2.4
>50 4.8
<20k 13.9
20-30k 12.5
Monthly Income 30-40k 7.2
>40k 23.6
others 42.8
Government employees 14.3
Private employees 49.3
Business owner 21.9
Occupation Healthcare professionals 0.9
Homemaker 4.2
Students 2.8
Others 6.6
Table 2: Demographic Analysis
Response
Question Agre Neutra Disagre
no. Strongly agree e l e Strongly Disagree
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1 25 60 10 4 1
2 10 65 20 4 1
3 25 55 15 3 2
4 26 58 14 1 1
5 30 65 3 1 1
6 50 35 10 4 1
7 32 45 16 6 1
8 36 50 10 4 0
9 45 35 15 4 1
10 56 40 2 1 1
11 60 35 3 1 1
60%
50%
40%
30%
20%
10%
0%
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11
Chapter-9
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Findings and Suggestions
Findings
This study has established that health management with using an app requires constant
stimulation. There are many apps for health and wellness but this found that the most of the
consumers are not aware of health apps use
Among the participants these were the factors which were identified as following:
1. Age: Results of survey found that the responders from the age group of 20-30 years was
the active participants and aware of MyWoodlands app and utilize this app to track their health
as compared to any other age group. The reason being that these age group had highest no. of
smartphone adoption.
2. Income: This factor may or may not be influencing the affordability for buying a
smartphone with latest technology which will directly and indirectly related with the usage of
Health and wellness apps. Income would play major role as some of the apps are not free of
cost so it will act as a barrier but here MyWoodlands app is free to use for everyone.
3. Occupation: In sample population, major section is of young age to middle age group and
most of them are private sector employees which were found to be more tech savvy and keen
to use MyWoodlands app to track and monitor their health.
4. Education: It had a major impact on adoption of mHealth apps as the technology and
terminology requires basic knowledge, consumers who were not well educated is not
motivated towards these apps as compared to the one who is well educated and aware of
apps. Also it is tougher for the old age people to use this mHealth apps.
5. Awareness: Through survey we got to know that there is majority of sample population
who are not aware of MyWoodlands app, can help to manage their health themselves. Also,
lack of awareness and the lack of motivation are the major challenges in implementing Health
apps.
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Lack of time and effort: Through study it was found that continued use of app requires
time and effort and therefore people uninstall this app because they are not willing to spend
much time and efforts into it.
Lack of motivation: Majority of participants felt that continued use of this type of mHealth
app requires lot of dedication and motivation because after some time, its task becomes
tedious and boring.
Motivators
Information and personalised guidance: This feature is mostly preferred by the
participants as majority of consumers prefer MyWoodlands app for informational purpose and
booking doctors’ appointments.
Social competition: The major driver for the adoption of MyWoodlands app is peer reviews
and social competition. It can be seen as a driving force for younger generation if their family
and friends are using any such apps.
Reminders: This feature which is appreciated by most of the participants. It found to be
useful for those who were busy in their schedules.
Tracking for awareness and progress: From the study participants felt that they prefer
apps who helped them to measure their day to day activities. As many apps have in built
feature to track user’s activity like diet & exercise.
Suggestion
On the basis of qualitative analysis on consumers perception towards
MyWoodlands app it can be suggested to the Woodlands Multispeciality
Hospital that-
It needs to focus on awareness of the app.
The company needs to focus on engage with user more to let the users
know about benefit of the app.
Chapter-10
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Recommendation and Limitation
Recommendation
As per my great experience working in Woodland RPG dealing head to head
directly with the CFO, I do have some humble recommendations:-
1. The app is new hence it was better to first release it for the hospital staff like
a beta version to improve thier productivity.
2. Once the app is running without any issues and glitches then it should have
been made public via playstore .
3. The slow interface and lagging multiple attempts is very much hassled for the
user. Hence the IT team must get the lagging issue resolved by multiple updates
once in every week.
Limitation
The study has the following limitations-
Data privacy is a key concern where many users will not provide their
information
Users do need stable internet connection to use this app
Sometimes this mHealth app can produce inaccurate information.
Chapter-11
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Conclusion
This study found that healthy young adults were interested in using health apps
to support health- related behaviour change. Potential users expected health
apps to be accurate, secure, legitimate and able to record and track goals and
behaviours. They also expected health apps to require minimal effort to operate
and have the ability to acquire advice and information on the go. From the
perspective of health and fitness app developers as well as health educators or
researchers, it is important to understand what predicts or prevents health app
adoption and continued use so as to better design and promote them. The future
of mHealth depends on platform compatibility/availability, consumer attitude/
adoption, and regulatory action. mHealth market is niche or untapped market
and the obstacle is more of a marketing problem that requires more of scientific
evidence for measuring usability and accuracy of apps, users friendly platform
considering preferences, data privacy, and security. If these types of
applications successfully implemented in individuals lives with adaptable
healthcare infrastructure, there is boost in the productivity of health
management and significant reduction in healthcare costs.
Chapter-12
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Bibliography
1. www.woodlandshospital.com
2. www.ibef.org
3. www.olympiabenefits.com
4. www.scribd.com
5. Brochures
6. www.healthcaresuccess.com
7. www.thebrandingjournal.com
8. www.marketbusinessnews.com
9. www.feedough.com
Questionnaire
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1. Access to smart phone is seen as main driver for mHealth apps?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
2. Do you agree exercise, fitness, calorie counter and symptom checker are the widely downloaded or
preferred by MyWoodlands app?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
3. Do you agree the information provided by the MyWoodlands app is useful and reliable?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
5. Remote access to medical information, customized features and health tracker are the biggest
attraction for using MyWoodlands app?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
7. Convenience, cost, time & quality of service are the key benefits for using MyWoodlands app?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
9. Do you agree that MyWoodlands app have become a part of your day to day lifestyle?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
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11. Is lack of interest and lack of information are the barriers on adoption of MyWoodlands app?
a) Strongly agree b) Agree c) Neither agree nor disagree d) Disagree e) Strongly disagree
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