Client Satisfaction Survey

Form Approved:

OMB No. 0920-0913

Expiration Date: XX/XX/XXXX

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 (0920-0913)

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

For each question below, rate your top 3 favorite parts, least favorite parts and areas you would like to improve (e.g. 1=Most favorite, 2=Second favorite, and 3=Third favorite)
Top 3 Favorite part(s) of the session? __Icebreaker __Session scenarios __Group interaction/ discussions __HIV prevention information __Facilitator interaction with participants __Meeting new people __Other_______________	3 Least favorite part(s) of the session? __Icebreaker __Session scenarios __Group interaction/ discussions __HIV prevention information __Facilitator interaction with participants __Meeting new people __Other_______________	Top 3 ways you would 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

For each question below, rate your top 3 favorite parts, least favorite parts and areas you would like to improve (e.g. 1=Most favorite, 2=Second favorite, and 3=Third favorite)
Top 3 Favorite part(s) of the session? __Session scenario __Group interaction/ discussions __HIV prevention information __Facilitator interaction with participants __Meeting new people __Other_______________	3 Least favorite part(s) of the session? __Session scenario __Group interaction/ discussions __HIV prevention information __Facilitator interaction with participants __Meeting new people __Other_______________	Top 3 ways you would 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

For each question below, rate your top 3 favorite parts, least favorite parts and areas you would like to improve (e.g. 1=Most favorite, 2=Second favorite, and 3=Third favorite)
Top 3 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_______________	3 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_______________	Top 3 ways you would 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?