Form 0920-1050 PHE Forum Survey

Attachment A: Survey Instrument

Form Approved

OMB 0920-1050

Exp. Date 6/30/2019

2018 Public Health Ethics Forum: Minority Elders and Healthy Aging

Thank you for attending the 2018 Public Health Ethics Forum "Minority Elders and Healthy Aging" sponsored by the Office of Minority Health and Health Equity at the Centers for Disease Control and Prevention (CDC) and the National Center for Bioethics in Research and Health Care at Tuskegee University. Please provide feedback by responding to the following questions. We will use your feedback to evaluate this event and assist in planning future activities. We will collect and report all responses anonymously. To assure your anonymity, please do not include sensitive or personally identifiable information (name, address, specific work title, etc.) in any written comments that you provide.

Q1 How did you attend this year's Public Health Ethics Forum?

• Attended in person (at the CDC campus)

• Viewed the forum online

• I did not attend this year's forum

Skip To: End of Survey If How did you attend this year's Public Health Ethics Forum? = I did not attend this year's forum

Q2 Overall, how would you rate the 2018 Public Health Ethics Forum?

• Excellent

• Very Good

• Good

• Fair

• Poor

Q3 The forum content addressed a gap in my knowledge.

• Strongly Agree

• Agree

• Neither agree nor disagree

• Disagree

• Strongly Disagree

Q4
Please rate how well the 2018 Public Health Ethics Forum met the stated learning objectives.

	1 = Not at all well	2	3	4	5	6	7=Extremely well	Not applicable
Describe the demographics and health status of minority elders in the U.S.
Understand ethical dilemmas in serving diverse elders.
Distinguish unique challenges confronted by healthy elders.
Implement a "care/relationship ethics" approach with minority elders.
Recognize and support resilience among minority elders.

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Q5
Please rate how effectively each session enhanced your knowledge of the topic presented.

	1 = Not at all effective	2	3	4	5	6	7 = Extremely effective	Not applicable/Did not attend
Opening Plenary: Dave Baldridge, BA
Panel: Thriving and aging with dignity (Councilman Chester Antone; Mamie H. Clemons, BS; Ms. Nadinne Cruz; Elias Segarra, JD; and moderator Rueben Warren, DDS, MPH, DrPH, MDiv)
Breakout Session A: The epidemiology of aging over the life course (TBD speaker, and discussant Lisa C. McGuire, PhD)
Breakout Session B: Ethical Dilemmas in Serving Diverse Elders (Becky A. Kurtz, JD, and discussant Jeffrey E. Hall, PhD, MA, MSPH, CPH)
Breakout Session C: Framing aging as a positive experience; Promoting a healthy mindset among minority elders (Riggins Earl, PhD, and discussant Heidi Holt, MPA)
Breakout Session D: Healthy aging and the built environment; Ethics of social policy and healthy aging (Chris Kochtitzky, MSP, and discussant Kathy Kinlaw, MDiv)
Closing Plenary: Catherine Alicia Georges, EdD, RN, FAAN

Q6 Please rate the overall quality of the posters and presentations presented by the students. (The students are bachelor's and master's degree candidates.)

• Excellent

• Very Good

• Good

• Fair

• Poor

• Not applicable/did not attend

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Q7
What aspects of the forum were most useful to you?

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Q8
What aspects of the forum were least useful to you?  

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Q9 As a result of the forum, how likely are you to change your beliefs or practices regarding minority elders or healthy aging?

• Very likely

• Somewhat likely

• Neither likely nor unlikely

• Somewhat unlikely

• Very unlikely

Q10 Please provide an example of how you hope to change your beliefs or practices as a result of the forum.

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Please answer the following questions which will help our office to better understand and serve our audiences.

Q11 Which of the following choices best describes your current role with the elderly? Select all that apply.

• I want to increase my knowledge about minority elders and healthy aging

• I work with or on behalf of the elderly as part of my professional role

• I develop or influence policy on behalf of the elderly

• I work primarily with minority elderly

• Other - Please specify ________________________________________________

Q12 Which one of the following choices best describes your current position?

• CDC employee, contractor, or fellow

• Other federal government employee, contractor, or fellow

• Academic/university employee (includes public and private colleges)

• County, state, or local government employee (excluding colleges or universities)

• Non-governmental, community, or other organization employee

• Student

• I am not currently in school or employed

• Other - Please specify ________________________________________________

Q13 What is your age?

• Less than 20 years

• 20 - 44 years

• 45 - 64 years

• 65 - 74 years

• 75 years and older

• Decline to respond

Q14 Which one of the following would you say best describes your race/ethnicity?

• American Indian or Alaskan Native

• Asian or Pacific Islander

• Black or African American, not of Hispanic origin

• Hispanic

• White, not of Hispanic origin

• Other (please describe) ________________________________________________

• Decline to respond

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Q15 Please use the space below to add additional comments or suggestions regarding the 2018 Public Health Ethics Forum.

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Thank you for completing this evaluation!

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: PRA (0920-1050).