Form #10 Form #10 Deliberative Experience Survey

Attachment F: Deliberative Experience
Survey

Attachment F: Deliberative Experience Survey

Form Approved
OMB No. XXXX-XXXX
Exp. Date XX/XX/20XX

DRAFT COMMUNITY FORUM
DELIBERATIVE EXPERIENCE SURVEY INSTRUMENT AND
SOURCE OF SURVEY ITEMS

Public reporting burden for this collection of information is estimated to average 15 minutes per
response, the estimated time required to complete the survey. 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: AHRQ Reports Clearance
Officer Attention: PRA, Paperwork Reduction Project (0935-0176) AHRQ, 540 Gaither Road, Room #
5036, Rockville, MD 20850.

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Attachment F: Deliberative Experience Survey

DRAFT
COMMUNITY FORUM
DELIBERATIVE EXPERIENCE SURVEY INSTRUMENT
SURVEY INSTRUCTIONS

♦ You should only fill out this survey if you have been selected to participate in the
Community Forum project. Do not fill out this survey if you will not participate in this project.
♦ Answer all the questions by checking the box to the left of your answer.

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Attachment F: Deliberative Experience Survey

Community Forum Deliberative Experience Survey
Please answer the questions in this survey about your experience in the
deliberative session.
1. People in the group respected my opinions.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

2. People in the group really listened to each other.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

3. Even when people disagreed, they respected each others' opinions.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

4. There was too much disagreement in my group.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

5. Some people in the group spoke a lot more than others.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly
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Attachment F: Deliberative Experience Survey

6. Some people in the group spoke too much.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

7. Some people in the group barely spoke at all.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

8. I spoke as much as I wanted to in the group.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

9. By the end of the discussion I understood why people held certain
beliefs that were different than mine.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

10. The discussion led me to change some of my opinions.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

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Attachment F: Deliberative Experience Survey

11. People gave reasons to support their opinions.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

12. Attending the discussion today was a good use of my time.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

13. I would participate in activities like this in the future.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

14. More events like this should be held as a way of getting the views of
people throughout the country.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

15. How much did the group discussions affect your opinions on the
issues?
1 
2 
3 

Not at all
A little bit
A lot

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Attachment F: Deliberative Experience Survey

16. How much did the educational materials affect your opinion on the
issues?
1 
2 
3 

Not at all
A little bit
A lot

17. How much did the sessions with the experts affect your opinion on
the issues?
1
2
3
4






Not at all
A little bit
A lot
There were no experts

18. How did you feel during the group discussions?
1
2
3
4






Not at all interested
Not very interested
Somewhat interested
Very interested

19. How did you feel during the presentations?
1
2
3
4






Not at all interested
Not very interested
Somewhat interested
Very interested

20. I think the recommendations made by the group will influence how
research findings are used.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

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Attachment F: Deliberative Experience Survey

21. The event was well organized.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

22. There was enough time to fully discuss all the relevant issues.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

1
2
3
4

23.





I understood what I was asked to do throughout the discussion group.
Disagree strongly
Disagree
Agree
Agree Strongly

1
2
3
4

24. The facilitator sometimes tried to influence the group with his or her
own opinions.
 Disagree strongly
 Disagree
 Agree
 Agree Strongly
25. I could tell that the facilitator favored some positions over others.

1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

1
2
3
4

26.





The facilitator made sure that all opinions were considered.
Disagree strongly
Disagree
Agree
Agree Strongly

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Attachment F: Deliberative Experience Survey

27. The facilitator encouraged everyone to have their say.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

28. The information presented was clear and easy to understand.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

29. There was so much information it was difficult to absorb it all.
Disagree strongly
Disagree
Agree
Agree Strongly

1
2
3
4






1
2
3
4

30. I understood the issues well enough to participate as much as I
wanted to.
 Disagree strongly
 Disagree
 Agree
 Agree Strongly
31. The materials presented all sides of the issues.

1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

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Attachment F: Deliberative Experience Survey

32. The experts provided credible information.
1
2
3
4
5







Disagree strongly
Disagree
Agree
Agree Strongly
There were no experts

33. The purpose of the event was clear.
1
2
3
4






Disagree strongly
Disagree
Agree
Agree Strongly

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