1. About Your Child...

These questions are gathering some basic information about your child with CF as well as identifying the areas you might be having trouble with. By the end of this class, you will have new ways to handle many of these issues.

Question Title

1. In order for us to match up your pre- and post class surveys, we need you to pick a code name. My code name is:

Question Title

2. What best describes your child's medical adherence? (check one box for each item)

  All of the time Most of the time Some of the time Not much of the time
Pancreatic Enzymes
Nutrition
Breathing Treatments
Airway Clearance
Exercise

Question Title

3. What is the most common reason for your child's non- adherence?

  Forgetting Resistant behavior Don't see value in it Financial Issues Not Enough Time Embarrassment Need more training/ education Tastes Bad Side Effects
Pancreatic Enzymes
Nutrition
Breathing Treatments
Airway Clearance
Exercise

Question Title

4. Please select the best response for each question:

  Strongly Disagree Disagree Agree Strongly Agree
My child complies with medical requirements without my reminding, lecturing or coercion.
I have the parenting skills I need to handle my child’s behavioral and emotional issues.
I feel supported and understood by others in regards to our family’s healthcare challenges.
Despite our challenges, I am hopeful about the future. I can handle it!

Question Title

5. Overall, the grade I would give my child on his/her self-care performance is (A,B,C,D,F):

Question Title

6. The grade I would give myself on my response to my child’s performance is (A,B,C,D,F):

Question Title

7. My child is: ____________ years old.

Question Title

8. My biggest parenting challenge is:

Question Title

9. I hope to learn:

T