Acceptability Survey by Site - PHMC

Development and Testing of an HIV Prevention Intervention

Targeting Black Bisexually-Active Men

Attachment 3D

Acceptability Survey by Site

Form Approved

OMB No. 0920-XXXX

Expiration Date:

3D.1 PHMC: Acceptability/Feasibility Assessment

Session feedback Session # ------------

Please give us your honest opinion of today’s session. Date ----------------

Seal your completed form in the envelope and place in the box

at the receptionist desk.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
The session achieved my expected results
I felt comfortable with the counselor
The amount of information was about right
The information presented was interesting
The information was applicable
The discussion was useful to me
The session motivated me
The facilitator seemed to be knowledgeable
The verbal pact with the life coach was important and appropriate

My overall rating of the session Very good Very poor

5 4 3 2 1

Please tell us what you liked and what was particularly useful in this session.

Please tell us what you didn’t like or topics that didn’t apply to you.

What changes would you suggest?

Form Approved

OMB No. 0920-XXXX

Expiration Date:

3D.2: NOVA: Acceptability/Feasibility Assessment

1. The information provided in the sessions was useful.

2. I am likely to use information that I learned in the program to make changes in my life.

3. Information given in the sessions can easily be applied to real life.

4. It was difficult to follow the information presented in each session.*

5. I felt comfortable talking to the group leaders.

6. The program addressed issues faced by young people like me.

7. The examples used by the interventionists were not relevant.*

8. The interventionists seemed to be well-informed.

9. I would recommend this program to my friends.

10. The material presented in the program was easy to understand.

11. The interventionists were easy to understand.

12. The handouts and other written materials were difficult to read.*

13. How could we improve this program? (open ended)

14. What topics do you think would be helpful to add to the program? (open ended)

15. How hard was it to keep appointment sessions?

16. What were some things that made it difficult to attend the sessions? "Check all those that apply"

16l. If other please specify: (open ended)

17.  What are some things that we can do to make it easier for someone to attend their sessions?  "Please list as many…(open ended)

18. My friends would participate in this program if offered.

19. Three sessions were too many sessions.*

20. This is a program that I will recommend to my friends.

Items 1-12; 18-20 use a 5 point Likert scale (strongly agree – strongly agree) (3 = neutral)

Item 15 uses a 5 point Likert scale (very difficult – not difficult at all)  

Item 16 (items to choose: didn’t have transportation, I was tired, I was in another city, etc.)   

This assessment measures: 1) the usability of the content and material; 2) user-friendliness of the presentation, delivery format, and facilitator; 3) credibility of the examples used; 4) participant ratings of the competence, credibility, and empathy of the facilitator, and 5) comprehensibility and readability of the content.  Participants will also rate how easy or hard it was to attend the sessions and the barriers to attendance. So, the higher the score, the more acceptability (*Starred/highlighted items that will need to be reverse coded).

Form Approved

OMB No. 0920-XXXX

Expiration Date:

3D.3 CSU: Acceptability/Feasibility Assessment

Overall Session Evaluation

Date___________ Intervention Location __________

Facilitator: _____________ Co Facilitator: ____________

Facilitator Introduction: Thanks for participating. We would like you now to fill out an evaluation about the program and about us. Please be honest. This will help us to improve the program and to improve our work with future groups.

Number of regular MILE sessions that you completed: ___

Number of make-up MILE sessions that you completed: ___

1: Which parts of the sessions will you be most able to apply to your everyday life?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

2: Approximately how many of the sessions provided you with useful skills and information that you could use in your everyday life? __________ (0 to 6). What parts of these sessions were the most useful?

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

3: Did this project leave you feeling more empowered to make better decisions regarding your sexual activities?

Extremely Very Somewhat A little Not at all

4: Compared to when you started the group, how willing are you to take the necessary steps to live a healthier life?

Extremely Very Somewhat A little Not at all

5: Actually using what I learned in the project (i.e., diet, safer sex, communication, and exercise) is unrealistic in my daily life.

Very true Somewhat true A little true Not at all true

6: Would you be willing to share the project with other men and encourage them to attend?

Yes Not Really No

7: Which topics and exercises aided you the most in gaining a better understanding of some of your unhealthy decision making? ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

8: What was your overall rating of the facilitators?

Excellent Very Good Good Fair Poor

9: Are there ways in which the facilitators could perform better? Please be specific and indicate if your comments apply to just one of the facilitators.

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

10: What was your overall rating of the MILE program?

Excellent Very Good Good Fair Poor

11: How do you think the MILE program could be improved?

__________________________________________________________________________________________________________________________________________________________________________________________________________________

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