Client Satisfaction Survey

Evaluating Locally-Developed HIV Prevention Interventions for African-American MSM in Los Angeles

Attachment 3f Client Satisfaction Survey Change

Client Satisfaction Survey

OMB: 0920-0913

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Form Approved:

OMB No. 0920-0913

Expiration Date: 01/31/2015


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:






Anonymous sex

1

2

3

4

N/A

Meeting partners on the Internet

1

2

3

4

N/A

Sexual guidelines/standards/timeframes

1

2

3

4

N/A

Safe sex negotiation

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?


  • Icebreaker

  • Session scenarios

  • Group interaction/ discussions

  • HIV prevention information

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

Least favorite part(s) of the session?

  • Icebreaker

  • Session scenarios

  • Group interaction/ discussions

  • HIV prevention information

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

How would you improve the session?


  • Make session longer

  • Make session shorter

  • More group discussion

  • Less group discussion

  • Better facilitator

  • More space

  • Other_______________


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:






Developing Healthy Friendships

1

2

3

4

N/A

Developing Healthy Intimate Gay Relationships

1

2

3

4

N/A

Discussing HIV status

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?


  • Session scenario

  • Group interaction/ discussions

  • HIV prevention information

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

Least favorite part(s) of the session?


  • Session scenario

  • Group interaction/ discussions

  • HIV prevention information

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

How would you improve the session?


  • Make session longer

  • Make session shorter

  • More group discussion

  • Less group discussion

  • Better facilitator

  • More space

  • Other_______________


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:






HIV and STIs in young Black MSM

1

2

3

4

N/A

Information on HIV, gonorrhea, syphilis, and herpes

1

2

3

4

N/A

HIV risk reduction strategies

1

2

3

4

N/A

Personal Action Plans

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?


  • Group interaction/ discussions

  • True or False Game

  • HIV/STI information

  • HIV risk-reduction strategies

  • Personal action plan

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

Least favorite part(s) of the session?

  • Group interaction/ discussions

  • True or False Game

  • HIV/STI information

  • HIV risk-reduction strategies

  • Personal action plan

  • Facilitator interaction with participants

  • Meeting new people

  • Other_______________

How would you improve the session?


  • Make session longer

  • Make session shorter

  • More group discussion

  • Less group discussion

  • Better facilitator

  • More space

  • Other_______________

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?




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