4 Evaluation

4/3/2007

OMB No.:0925-XXXX and Expiration Date: XX/XX/2010
Appendix D
Post Focus Group Evaluation

Thank you for participating in today’s discussion. We would like to ask you a few questions
about your experiences in today’s discussion. Your responses will be used by the research team
to help improve upon future focus group discussions. Your responses will only be used by the
research team and will not be shared with other participants.
Please indicate below your level of agreement with each of the following statements.

Strongly
Disagree
1.

The questions asked
today were easy to
understand.

2.

Everyone had a
chance to participate
in today’s discussion.

3.

I was able to voice my
opinion whenever I
wanted to.

4.

The discussion today
helped me remember
the activities of daily
life in the 1950s.

5.

I enjoyed
participating in
today’s discussion.

6.

I understood the
purpose of today’s
discussion.

Disagree

Neither
Agree nor
Disagree

Agree

Strongly
Agree

_____________________________________________________________________________________________
Public reporting burden for this collection 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (xxxx-xxxx). Do not return the completed form to this address.
Appendix D - KAZ Post_FocusGroup_Evaluation_Apr2

4/3/2007

OMB No.:0925-XXXX and Expiration Date: XX/XX/2010

7. Please indicate below how satisfied you were with each of the following aspects of
today’s discussion.

Dissatisfied

a.

Starting and Ending on Time

b.

Room Temperature

c.

Seating

d.

Food and Drinks Provided

Neither
Satisfied nor
Dissatisfied

Satisfied

8. Is there anything we could improve about today’s discussion?

_____________________________________________________________________________________________
Public reporting burden for this collection 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 208927974, ATTN: PRA (xxxx-xxxx). Do not return the completed form to this address.
Appendix D - KAZ Post_FocusGroup_Evaluation_Apr2