Form Approved:
OMB No. 0920-XXXX
Expiration Date: 00/00/2014
Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles
Attachment 3f
Client Satisfaction Survey
Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)
SESSION 1 CLIENT SATISFACTION SURVEY
Group#: _______
Session #:1
Please rate how satisfied you were with the discussion of the following session topics. Use the following 4-point scale: 1=not at all satisfied; 2=somewhat satisfied; 3=satisfied; 4=very satisfied; N/A=topic not discussed
not at all satisfied very satisfied
Discussion of Session Topics: |
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Anonymous sex |
1 |
2 |
3 |
4 |
N/A |
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Legitimacy of internet dating |
1 |
2 |
3 |
4 |
N/A |
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Sexual guidelines/standards/timeframes |
1 |
2 |
3 |
4 |
N/A |
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Safe sex negotiation |
1 |
2 |
3 |
4 |
N/A |
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Please rate the facilitator on the following characteristics. Use the following 5-point scale: 1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree. |
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-------------------------------☺strongly disagree strongly agree |
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Facilitator(s): |
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Understands HIV prevention |
1 |
2 |
3 |
4 |
5 |
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Is an empowering facilitator |
1 |
2 |
3 |
4 |
5 |
||||||||
Relates to the participants |
1 |
2 |
3 |
4 |
5 |
||||||||
Is knowledgeable about the kinds of issues young Black gay men face in their lives |
1 |
2 |
3 |
4 |
5 |
Check all that apply for each question below
|
||
Favorite part(s) of the session?
|
Least favorite part(s) of the session?
|
How would you improve the session?
|
What aspect of this session will have the most impact on your life in general?
What did you learn today that will help you have healthier/safer sexual relationships?
How can we improve this session?
SESSION 2 CLIENT SATISFACTION SURVEY
Group#: _______
Session #:2
Please rate how satisfied you were with the discussion of the following session topics. Use the following 4-point scale: 1=not at all satisfied; 2=somewhat satisfied; 3=satisfied; 4=very satisfied; N/A=topic not discussed
not at all satisfied very satisfied
Discussion of Session Topics: |
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|
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Friendship |
1 |
2 |
3 |
4 |
N/A |
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Intimate relationships |
1 |
2 |
3 |
4 |
N/A |
||||||||
Partner HIV/AIDS status disclosure |
1 |
2 |
3 |
4 |
N/A |
||||||||
Trust/monogamy |
1 |
2 |
3 |
4 |
N/A |
||||||||
Publicly open male relationships |
1 |
2 |
3 |
4 |
N/A |
||||||||
|
|
|
|
|
|
||||||||
Please rate the facilitator on the following characteristics. Use the following 5-point scale: 1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree. |
|||||||||||||
-------------------------------☺strongly disagree strongly agree |
|||||||||||||
Facilitator(s): |
|
|
|
|
|
||||||||
Understands HIV prevention |
1 |
2 |
3 |
4 |
5 |
||||||||
Is an empowering facilitator |
1 |
2 |
3 |
4 |
5 |
||||||||
Relates to the participants |
1 |
2 |
3 |
4 |
5 |
||||||||
Is knowledgeable about the kinds of issues young Black gay men face in their lives |
1 |
2 |
3 |
4 |
5 |
Check all that apply for each question below
|
||
Favorite part(s) of the session?
|
Least favorite part(s) of the session?
|
How would you improve the session?
|
What aspect of this session will have the most impact on your life in general?
What did you learn today that will help you have healthier/safer sexual relationships?
How can we improve this session?
SESSION 3 CLIENT SATISFACTION SURVEY
Group#: _______
Session #:3
Please rate how satisfied you were with the discussion of the following session topics. Use the following 4-point scale: 1=not at all satisfied; 2=somewhat satisfied; 3=satisfied; 4=very satisfied; N/A=topic not discussed
not at all satisfied very satisfied
Discussion of Session Topics: |
|
|
|
|
|
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HIV transmission (sexual) |
1 |
2 |
3 |
4 |
N/A |
|||||||
HIV transmission (drugs) |
1 |
2 |
3 |
4 |
N/A |
|||||||
Risk reduction |
1 |
2 |
3 |
4 |
N/A |
|||||||
HIV testing |
1 |
2 |
3 |
4 |
N/A |
|||||||
|
|
|
|
|
|
|||||||
|
|
|
|
|
|
|||||||
Please rate the facilitator on the following characteristics. Use the following 5-point scale: 1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree; N/A=topic not discussed |
||||||||||||
-------------------------------☺strongly disagree strongly agree |
||||||||||||
Facilitator(s): |
|
|
|
|
|
|||||||
Understands HIV prevention |
1 |
2 |
3 |
4 |
5 |
|||||||
Is an empowering facilitator |
1 |
2 |
3 |
4 |
5 |
|||||||
Relates to the participants |
1 |
2 |
3 |
4 |
5 |
|||||||
Is knowledgeable about the kinds of issues young Black gay men face in their lives |
1 |
2 |
3 |
4 |
5 |
Check all that apply for each question below
|
||
Favorite part(s) of the session?
|
Least favorite part(s) of the session?
|
How would you improve the session?
|
What aspect of this session will have the most impact on your life in general?
What did you learn today that will help you have healthier/safer sexual relationships?
How can we improve this session?
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | gpo4 |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |