Participant Evaluation

Critical Thinking and Cultural Affirmation: Evaluation of a Locally Developed HIV Prevention Intervention

Attachment 8 Participant Evaluation Forms

Participant Evaluation

OMB: 0920-0945

Document [docx]
Download: docx | pdf

Form Approved:

OMB No. 0920-

Expiration Date:




Critical Thinking and Cultural Affirmation (CTCA): Evaluation of a Locally Developed HIV Prevention Intervention




Attachment 8


Participant Evaluation Forms







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)



Cohort_____

B-ME Session 1 Participant Evaluation Form

HIV/AIDS in the Black community and health disparities


How satisfied were you with session 1? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 1 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Introduction of CTCA Purpose






  1. Black Male Health Statistics presentation









How would you rate the overall quality of each of the discussions you participated in during session 1?


Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Contributions of Non-US Persons to World History discussion






  1. Black Male Health Statistics discussion






  1. How do you Practice Valuing Black Life?: discussion









How would you rate the overall quality of each of the activities/exercises you did during session 1?


Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Introduction of CTCA Purpose






  1. CTCA Opening Circle






  1. Principles to Guide Group Dialogue reading






  1. Purpose and Goals of Session 1 reading






  1. Contributions of Non-US Persons to World History exercise






  1. Extraordinary Accomplishments made by Black People exercise






  1. How do you Practice Valuing Black Life?: exercise






  1. Closing Affirmation Circle

















  1. Was there anything about session1 that you did not like? How could we make it better?







  1. What did you like the best about session 1?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No



Cohort_____

B-ME Session 2 Participant Evaluation Form

Media and self-concept


How satisfied were you with session 2? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 2 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Session 2 Purpose and Goals presentation






  1. A Long & Mighty Walk: video clips






  1. A Girl Like Me: video clip






  1. Study shows how children view race bias: video clip






  1. Show me the dumb child: video clip







How would you rate the overall quality of each of the discussions you participated in during session 2?


Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Reflections of Session 1 - Lessons Learned discussion






  1. Black/African History - Video clips: A Long & Mighty Walk discussion






  1. The Living Timeline discussion






  1. Stereotype, Self-perception, Racism, Internalized oppression discussion






  1. Niggas Ain’t Shit discussion









How would you rate the overall quality of each of the activities/exercises you did during session 2?


Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Welcome and Opening Circle






  1. Reflections of Session 1 - Lessons Learned exercise






  1. Principles to Guide Group Dialogue reading






  1. The Living Timeline activity



















  1. Was there anything about session 2 that you did not like? How could we make it better?








  1. What did you like the best about session 2?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No



Cohort_____

B-ME Session 3 Participant Evaluation Form

The Strengths and Challenges Associated With Black/African American Cultures in the Successful Prevention of HIV


How satisfied were you with session 3? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 3 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Intra-Community Cultural Competence presentation






  1. Overview of Diverse Black Men at HIV Sexual Risk presentation






  1. Public On-Line Profiles exercise






  1. Compensatory “Manhood” Violent Names of Hip Hop Artists Presentation






  1. A Candid Debate on Black Manhood Video






  1. Important Points about HIV review






  1. Important Points about STDs review






  1. HIV risk and Substance Abuse review
















How would you rate the overall quality of each of the discussions you participated in during session 3?

Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Reflections of Session 2 discussion






  1. Intra-Community Cultural Competence discussion






  1. Construction of [Black] Manhood & Masculinity Discussion






  1. Your Connection/Relationship with Your Father discussion






  1. Compensatory “Manhood” Violent Names of Hip Hop Artists discussion






  1. A Candid Debate on Black Manhood discussion






  1. Behaviors that Put People at Risk for HIV and STD Infection Brainstorm






  1. Implications of Risky Behavior for the Individual and Community discussion







How would you rate the overall quality of each of the activities/exercises you did during session 3?

Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Opening Circle






  1. Construction of [Black] Manhood & Masculinity

Exercise






  1. Public On-Line Profiles exercise






  1. Hierarchy of Risk Questions and Exercise






  1. Personal Risk Assessment






  1. Goals and Barriers to Goals exercise






  1. Childhood Reflection Group Altar






  1. Closing Affirmation Circle









  1. Was there anything about session 3 that you did not like? How could we make it better?








  1. What did you like the best about session 3?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No





Cohort_____

B-ME Session 4 Participant Evaluation Form

Communication, Behavior, Self-Management and Coping



How satisfied were you with session 4? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 4 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Session 4 Purpose and Goals presentation






  1. Steps to Self-Love for Same-Gender Loving and Bisexual People review






  1. Proper Condom use and safer sex techniques demonstration






  1. Assertive Communication presentation






  1. The Top Ten Questions About HIV Tests: video






  1. Basic Facts About Condoms and Their Use in Preventing HIV Infection and Other STDs








How would you rate the overall quality of each of the discussions you participated in during session 4?


Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Reflections of Session 3 - Lessons Learned discussion






  1. Assertive Communication Role-play exercises discussion






  1. Coping Skills Role-play discussion








How would you rate the overall quality of each of the activities/exercises you did during session 4?


Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Welcome and Opening Circle






  1. Reflections of Session 3 - Lessons Learned exercise






  1. Principles to Guide Group Dialogue reading






  1. Proper Condom use and safer sex techniques practice






  1. Assertive Communication Role-play exercises






  1. Coping Skills Role-play exercises











  1. Was there anything about session 4 that you did not like? How could we make it better?








  1. What did you like the best about session 4?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No



Cohort_____

B-ME Session 5 Participant Evaluation Form

Benefits of Critical Thinking and Cultural Affirmation



How satisfied were you with session 5? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 5 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Session 5 Purpose and Goals presentation






  1. Applying Critical Thinking and Cultural Affirmation to the protection and preservation of Black Men: Review of topics presentation






  1. What is Critical Thinking; What is Cultural Affirmation presentation






  1. What are the benefits to Critical Thinking; What are the benefits to Cultural Affirmation presentation






  1. Good health from an African perspective presentation








How would you rate the overall quality of each of the discussions you participated in during session 5?


Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Reflections of Session 4 - Lessons Learned discussion








How would you rate the overall quality of each of the activities/exercises you did during session 5?


Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Welcome and Opening Circle






  1. Reflections of Session 4 - Lessons Learned exercise






  1. Principles to Guide Group Dialogue reading






  1. What is Critical Thinking; What is Cultural Affirmation exercise






  1. What are the benefits to Critical Thinking; What are the benefits to Cultural Affirmation exercise






  1. Logic Displacement and Behavioral Disorientation reading






  1. Selected Readings from the “Instructions of Ptahhotep” and Text of Antef











  1. Was there anything about session 5 that you did not like? How could we make it better?








  1. What did you like the best about session 5?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No



Cohort_____

B-ME Session 6 Participant Evaluation Form

Summary, Reflections and Praxis



How satisfied were you with session 6? (circle one)


1 2 3 4 5

Very dissatisfied Dissatisfied Neither Satisfied Very Satisfied


Use the following scale to rate the overall quality of this session. Check one.


1 2 3 4 5

Poor Fair Acceptable Good Excellent

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. How well prepared were the B-ME Session Leaders?






  1. How well was the activities/information presented?






  1. How well did the activities encourage your participation?






  1. How clearly were your questions answered?






  1. How clear were the session handouts?






  1. Was there enough time for discussions?









How would you rate the overall quality of each of the session 6 presentations?


Presentations

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Session 6 Purpose and Goals presentation






  1. Exploring what has been learned over the past 5 sessions presentation






  1. Review Through Action: Using the Nguzo Saba to Apply Learning presentation








How would you rate the overall quality of each of the discussions you participated in during session 6?


Discussions

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Reflections of Session 5 - Lessons Learned discussion






  1. Exploring: What has been learned over the past 5 sessions discussion






  1. Racial challenges in American are a thing of the past?: discussion






  1. (If time permitted) Continued exploration: What has been learned over the past 5 sessions discussion






  1. Review or skills and lessons in the context of the principles from the Nguzo Saba discussion






  1. Final thoughts about the sessions share-back discussion








How would you rate the overall quality of each of the activities/exercises you did during session 6?


Activities/Exercises

1

Poor

2

Fair

3

Acceptable

4

Good

5

Excellent

  1. Welcome and Opening Circle






  1. Reflections of Session 5 - Lessons Learned exercise






  1. Principles to Guide Group Dialogue reading






  1. What I Have Learned team exercise






  1. Selected Quotes and Proverbs worksheet exercise










  1. Was there anything about session 6 that you did not like? How could we make it better?








  1. What did you like the best about session 6?







  1. Something new I learned was:






  1. Did you have to take the subway, bus or any other form of paid transportation today?

Yes No


Page 24 of 24


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorFreeman, Arin (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2021-01-30
© 2024 OMB.report | Privacy Policy