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  1. Surveys
  2. 2010
  3. November
  4. P
  5. Pre-survey Session 1.
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Which task(s) in your daily routine are you having the most difficulty with? (Check all that apply)
 
Cooking
 
Driving
 
Social activities
 
Self-Care
 
Other ______________
 
 
 
How confident are you when performing these tasks?
 
Extremely confident
 
Confident
 
Not sure
 
Somewhat confident
 
Not confident
 
 
 
How fearful are you of being injured while performing these task(s)?
 
Extremely Afraid
 
Mostly Afraid
 
Somewhat Afraid
 
Slightly Afraid
 
Not Afraid at All
 
 
 
What is your highest level of education?
 
High School
 
Attended College
 
Undergraduate Degree
 
Graduate School
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
How helpful was the information you received?
 
Extremely helpful
 
Helpful
 
Somewhat helpful
 
Unsure
 
Not helpful
 
 
 
Would you recommend this session to someone?
 
Yes
 
No
 
Maybe
 
 
 
How likely are you to use any of the strategies discussed in the session?
 
Extremely likely
 
Likely
 
Not sure
 
Unlikely
 
Extremely unlikely
 
 
 
How would you rate the topics discussed in the session?
 
Poor
 
Below Average
 
Average
 
Good
 
Excellent
 
 
 
As a result of this session, how confident do you feel now in participating in your daily activities?
 
Extremely confident
 
Confident
 
Not sure
 
Somewhat confident
 
Not confident
 
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