9 Satistfaction Questionaire

Attachment 14: SATISFACTION QUESTIONAIRE
Web-based Skills Training for SBIRT (Screening Brief Intervention and Referral to Treatment)
August 2011

OMB # 0925-XXX
Expiration Date xx/xxxx

Public reporting burden for this collection of information is estimated to average less than
4 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. Each time the assessment is completed, it is expected to be
completed in a single sitting. 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 20892‐
7974, ATTN: PRA (0925‐xxxx*). Do not return the completed form to this address.

Experimental Condition
Core Curriculum and Basics of Motivational Counseling Evaluation/Satisfaction Questions
Thank you for using the SBIRT-PC web training
program. Please answer the following questions
regarding the content of this module, your answers
will help us improve our materials and determine
their effectiveness.

Strongly
Disagree
Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

The content of this module was appropriate for me and
my profession.
The content in this module will help me in my clinical
practice.
I would recommend this module to my colleagues.
The content of the module was complete and thorough.
Way too A little
Not quite Not at all
Just right
much
too much
enough
enough
The amount of content in the module was:

Strongly
Disagree
Disagree

Neither
Agree or
Disagree

Strongly
Disagree
Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

Did not
read or
view the
cases

Agree

Strongly
Agree

Did not
read or
view the
cases

The cases in this module were realistic.

If they did NOT seem realistic, why not?

If you did not use the cases, why not?

The cases enhanced my ability to learn the
material.

If the cases did NOT enhance your ability to learn the material, why not?

Please share any other suggestions for changes or improvements to this module. If none, please enter "none."

Overall Training Program Evaluation/Satisfaction Questions
Thank you for using the SBIRT-PC web training
program. Please answer the following questions,
your answers will help us improve our materials
and determine their effectiveness.

Strongly
Disagree

Neither
Disagree Agree or
Disagree

Disagree

Neither
Agree or
Disagree

Disagree

Neither
Agree or
Disagree

Agree

Strongly
Agree

Strongly
Agree

Did not
use the
Quick
Links

Strongly
Agree

Did not
listen to
the
audios

The program was easy to use.
The program was visually appealing.
It was easy to navigate and get around in the program.
The program ran smoothly and did not stop working or
stall during the time I was using it.
I enjoyed using the program.
The material was easy to read and understand.
I would recommend this training to my colleagues.

Strongly
Disagree

Agree

The Quick Links were useful.

Strongly
Disagree

Agree

The audio components of the program
worked well.
Strongly
Disagree

Disagree

Neither
Agree or
Disagree

Agree

Did not
Strongly
watch the
Agree
videos

Neutral

Very
favorable

The video components of the program
worked well.
Very
unfavorable
My overall impression of the program is:

Which of the Quick Links Resources would you use in your practice? (check all that apply)
ASSIST+ Screening Tool
Paper Screening Tools
Resources for your patients (pamphlets/reading material, etc.)
Resources for your practice (educational material, quick reference charts, etc.)
Additional Training Suggestions
Reimbursement Information
None
Did not look at the Quick Links resources
What material did you find most interesting, helpful, or relevant to your daily practice?

Were there any topics not covered that would you have liked to see? If so, which ones?

Please share any other suggestions for changes or improvements. If none, please enter "none."

Control Condition
Course evaluation/satisfaction questions
Thank you for using the SBIRT-PC training
program. Please answer the following questions,
your answers will help us improve our materials
and determine their effectiveness.

Strongly
Disagree

Neither
Disagree Agree or
Disagree

Way too
much

A little Just right Not quite Not at all
too much
enough enough

Agree

Strongly
Agree

The program was easy to use.
The program was visually appealing.
It was easy to navigate and get around in the program.
The program ran smoothly and did not stop working or
stall during the time I was using it.
I enjoyed using the program.
The material was easy to read and understand.
I would recommend this training to my colleagues.
The content of this training was appropriate for me and
my profession.
The content in this training will help me in my clinical
practice.
The content of the training was complete and
thorough.

The amount of content in the training was:

Very
unfavorable

Neutral

My overall impression of the program is:

What material did you find most interesting, helpful, or relevant to your daily practice?

Very
favorable

Were there any topics not covered that would you have liked to see? If so, which ones?

Please share any other suggestions for changes or improvements. If none, please enter "none."

Thanks again for your participation and feedback!