2 Participant Outcome Survey

ATTACHMENT A
CREATIVE FORCES COMMUNITY ENGAGEMENT PROGRAM
PARTICIPANT OUTCOMES SURVEY PILOT TEST INSTRUMENTS
PARTICIPANT OUTCOME SURVEY
SURVEY INTRODUCTION
This voluntary survey is part of a pilot study of a Participant Outcomes Survey for the Creative Forces®:
NEA Military Healing Arts Network Community Arts Engagement Grant Program. The National
Endowment for the Arts and its cooperator, Mid-America Arts Alliance, are interested in learning more
about the experiences and needs of the people who participate in Creative Forces community arts
programs. The pilot study data will be used to evaluate and improve the survey. We are very interested
in your experience and ideas, and we hope you will share your real thoughts.
Your survey access code is unique to this survey. When you use this link, your responses are entered
into a database. The database does not include your name, but it links the responses you make on the
survey at the beginning and end of the program. Only the program research team have access to the
database and responses. The connection between you and the unique link is kept in a separate,
password protected file that only the researchers can access. Your responses to this survey will be kept
fully confidential and will combined with all other survey responses with no identifying information.
No one associated with this program, the National Endowment for the Arts, and the Mid-America Arts
Alliance will be able to see your survey or even know whether you participated in this study. Your
answers will be combined with the answers from other participants in Creative Forces programs. While
the researchers will keep your information confidential, there are some risks of data breeches when
sending information over the internet that are beyond the control of the researchers. Your responses to
this survey will in no way impact the outcome of any present or future grant applications, contract
proposals, or cooperative agreement proposals with the National Endowment for the Arts or MidAmerica Arts Alliance.
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control
number. The OMB control number for this survey is OMB No. XXXX-XXXX (expires XX/XX/XXXX). The time
required to provide responses to the survey questions is estimated to be approximately 10 minutes.
Please contact Debra Holden, Ph.D., of Veritas Management Group at
[email protected] if you have questions about this pilot study or the National
Endowment for the Arts at [email protected] if you have any questions regarding the estimated time
burden or any other aspect of this data collection. If you have any questions about your rights as a
participant in the study, you may contact Solutions IRB (the body that oversees our protection of study
participants) at (855) 226-4472 or [email protected].
You should also know that:

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•
•
•

•
•
•
•
•

You must be 18 or older to take this survey.
All information collected through this study will be kept in a locked office and/or on a password
protected computer.
You can choose whether to be part of this pilot test. If you decide to be part of it, you may
withdraw at any time without any consequences. The researcher will delete all information,
including your contact information and any data you may have already provided. If you wish to
withdraw, you can contact Debra Holden, Ph.D., of Veritas Management Group at
[email protected].
Your participation in the Creative Forces program will not be impacted by whether or not you
choose to complete the survey.
You may skip any question or stop participating at any time.
There are no benefits to you for participating in this survey. You will not receive any
compensation for responding to the survey.
There are no risks expected with participation in this survey, although it is possible that some
people may experience discomfort when answering questions about making art, how connected
they feel to others, and how they handle challenges.
The database with access codes will be permanently deleted at the end of the project on August
31, 2023.

By completing this survey, you are consenting to participate in this study.
*Please feel free to print or save a copy of this form for your records.*

SURVEY
Section I- Let’s start by finding out about your health and well-being.
Very
Poor
poor
1. How would you rate your quality of life?

Very
dissatisfied

2. How satisfied are you with your health?

Dissatisfied

Neither
poor nor
good

Good

Very
good

Neither
satisfied nor
dissatisfied

Satisfied

Very
satisfied

Section II- We’d also like to know how often you have participated recently in these types of events:
1. In the past 30 days, approximately how many total hours have you been involved in any of your
group’s activities (including events or meetings)?
o Less than 1 hour total
o 1 to 3 hours total
o 4 to 5 hours total
o 6 to 9 hours total
o 10 or more hours total
o There have been no activities for me to be involved in during the past 30 days
2. When I attended meetings or events in the past 30 days, I took part in the activities.
o Very often
o Often
o Occasionally
o Rarely

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o
o
o

Never
I attended no meetings or events in the past 30 days
The group held no meetings or events in the past 30 days

Section III- For the next set of questions, we want to understand the extent to which you’ve
participated in arts and creativity activities in the past and how you have found it affects you
and/or your life. For this survey, arts engagement refers to a range of receptive to
participatory arts engagement including attending, viewing or listening to works of art, as well
as performing or making art. Examples include watching a performance, viewing an exhibition,
painting a picture, writing or performing a song, etc. Please indicate for each item the extent to
which you agree or disagree with each.
Strongly
Disagree

1. Through arts engagement, I:
a. Understand myself better.
b. Understand the things that matter most to
me.
c. Feel understood by others.
d. Understand others better.
e. Feel more connected to the civilian
community.
f. Feel connected to the civilian community.
g. I am able to take chances in a safe,
supportive environment.
h. Learn and improve creative skills.
2. Arts engagement improves my physical health.
3. Arts engagement has a positive effect on my
relationships with family or close friends.
4. I enjoy getting lost in the process of engaging
with the arts.
5. My concentration improves when I’m fully
absorbed in the arts.
6. Being absorbed in the arts enables me to clarify
thoughts or ideas I didn’t fully understand
before.
7. I am optimistic and hopeful about the future.
8. I am grateful for people or opportunities in my
life.
9. I am proud of myself.
10. I am kind and understanding towards myself
when I am going through a hard time.
11. I am open minded to trying new experiences.
12. I approach life with excitement and energy.
13. I have purpose in my life.

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Disagree

Mixed or
Neither
Agree nor
Disagree

Agree

Strongly
Agree

14. I have personal goals that I am working on
achieving.
15. I have a sense of direction in my life.
16. I am working towards a common goal with
other people.
17. I feel part of something bigger than myself.
18. My role in my family, work, or community is a
positive source of self-worth and connection to
others.
19. I put time and effort into helping others.
20. I feel a sense of belonging to a larger
community.
21. I feel connected to my local community.
22. I participate in leadership activities that
increase my sense of purpose.
23. I participate in community service activities that
increase my sense of purpose.
24. I feel like a leader in my community.
25. I tend to bounce back quickly after hard times.
26. I have a hard time making it through stressful
events.
27. It does not take me long to recover from a
stressful event.
28. It is hard for me to snap back when something
bad happens.
29. I usually come through difficult times with little
trouble.
30. I tend to take a long time to get over set-backs
in my life.

For the next 6 questions, there are only four rating
choices for assessing the quality of your close
relationships and how well you feel supported.
31. There are people I can depend on to help me if I
really need it.
32. I have close relationships that provide me with
a sense of emotional security and well-being.
33. There is someone I could talk to about
important decisions in my life.
34. I have relationships where my competence and
skill are recognized.
35. I feel part of a group of people who share my
attitudes and beliefs.

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Strongly
Disagree

Disagree

Agree

Strongly
Agree

36. There are people I can count on in an
emergency.
Section IV- Please respond to just a few more questions about you.
1. Which best describes you? (check all that apply)

o Service Member

o Veteran





Active Duty
National Guard
Reserve



Retiree

o Spouse/Partner of a Service Member or Veteran

o

o
o
o
o
o

 Active Duty Service Member
 National Guard/Reserve
 Veteran
Other Family Member of a Service Member or Veteran
 Active Duty
 National Guard/Reserve
 Veteran
Caregiver for a
 Service Member
 Veteran
Health care worker serving military-connected populations
Civilian
Other ________
Prefer not to say

2. What is your age?

o
o
o
o
o

18-24 years
25-44 years
45- 64 years
65 years or older

3. Which best describes you? (check all that apply)
o
American Indian or Alaskan Native
o
Asian
o
Black or African American
o
Hispanic or Latino
o
Native Hawaiian or other Pacific Islander
o
White
o
Prefer not to say
4. Do you identify as:
o Female
o Male
o Prefer not to say

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One final question: We want to make it easy to take this survey. What recommendations do you
have? Please consider the whole process: how you learned about the survey, the emailed
instructions, using the access code, and completing the survey electronically, etc. Please also indicate
which device you used to take the survey.
5. To take this survey, I used a:
o
Desktop computer
o
Tablet
o
Phone
o
Other
Feedback: [500 character limit]

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PARTICIPANT OUTCOMES SURVEY INVITATION
You are invited to take part in a pilot study of a Participant Outcomes Survey for the Creative Forces®:
NEA Military Healing Arts Network Community Arts Engagement Grant Program. The survey is for
people who participate in Creative Forces community arts programs. It will help the National
Endowment for the Arts and its cooperator, Mid-America Arts Alliance, understand the experiences of
the participants, so we can ensure the programs are meaningful. The survey is voluntary and
confidential.
We ask participants to take the survey two times: at the beginning of the program and after they have
had a chance to experience the program. The survey takes about 10 minutes to complete.
To access the survey, please use this link. It is unique to you and to the survey. Please keep it
confidential.
Your unique link to the survey: _____________________
When you use this link, your responses are entered into a database. The database does not include your
name, but it links the responses you make on the survey at the beginning and end of the program. Only
the program researchers) have access to the database. The connection between you and the link is kept
in a separate, password protected file. Only the researchers can access the file. However, there are
some risks of data breaches when sending information over the internet that are outside the control of
the researchers.
No one associated with this program, the National Endowment for the Arts, and the Mid-America Arts
Alliance will be able to see your survey or even know whether you participated in this study. Your
answers will be combined with the answers from other participants in Creative Forces programs. While
the researchers will keep your information confidential, there are some risks of data breeches when
sending information over the internet that are beyond the control of the researchers. Your responses to
this survey will in no way impact the outcome of any present or future grant applications, contract
proposals, or cooperative agreement proposals with the National Endowment for the Arts or MidAmerica Arts Alliance.
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid Office of Management and Budget (OMB) control
number. The OMB control number for this survey is OMB No. XXXX-XXXX (expires XX/XX/XXXX). The time
required to provide responses to the survey questions is estimated to be approximately 10 minutes.
Please contact Debra Holden, Ph.D., of Veritas Management Group at
[email protected] or the National Endowment for the Arts at [email protected] if
you have any questions regarding the estimated time burden or any other aspect of this data collection.
If you have any questions about your rights as a participant in the study, you may contact Solutions IRB
(the body that oversees our protection of study participants) at (855) 226-4472
or [email protected].
You should also know that:

7

•
•
•

•
•
•
•
•

You must be 18 or older to take this survey.
All information collected through this study will be kept in a locked office and/or on a password
protected computer.
You can choose whether to be part of this pilot test. If you decide to be part of it, you may
withdraw at any time without any consequences. The researcher will delete all information,
including your contact information and any data you may have already provided. If you wish to
withdraw, you can contact Debra Holden, Ph.D., of Veritas Management Group at
[email protected].
Your participation in the Creative Forces program will not be impacted by whether or not you
choose to complete the survey.
You may skip any question or stop participating at any time.
There are no benefits to you for participating in this survey. You will not receive any
compensation for responding to the survey.
There are no risks expected with participation in this survey, although it is possible that some
people may experience discomfort when answering questions about making art, how connected
they feel to others, and how they handle challenges.
The database with access codes will be permanently deleted at the end of the project on August
31, 2023.

*Please feel free to print or save a copy of this information for your records.

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