Smoking Cessation Post-Training Survey

1. Smoking Cessation Post-Training Survey

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* 1. Please estimate the following:(answers must add up to 100%)

Percentage of the program information that was completely new to you

Percentage of the program information that you had been taught before but needed to review

Percentage of the program that you had been taught before and was an unnecessary review

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* 2. Enter a %:

What percentage of the program information do you expect to use when you work with patients?

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* 3. Before attending this class, had you provided tobacco cessation assistance to any patients?

Yes

If yes, How many patients did you assist with quitting in the past year?

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* 4. Please rate your level of counseling skills for each of the following:

	Poor	Fair	Good	Very Good	Excellent
Your overall ability to help patients quit using tobacco	Your overall ability to help patients quit using tobacco Poor	Your overall ability to help patients quit using tobacco Fair	Your overall ability to help patients quit using tobacco Good	Your overall ability to help patients quit using tobacco Very Good	Your overall ability to help patients quit using tobacco Excellent
Asking patients whether they use tobacco	Asking patients whether they use tobacco Poor	Asking patients whether they use tobacco Fair	Asking patients whether they use tobacco Good	Asking patients whether they use tobacco Very Good	Asking patients whether they use tobacco Excellent
Advising patients to quit using tobacco	Advising patients to quit using tobacco Poor	Advising patients to quit using tobacco Fair	Advising patients to quit using tobacco Good	Advising patients to quit using tobacco Very Good	Advising patients to quit using tobacco Excellent
Assessing patients’ readiness to quit	Assessing patients’ readiness to quit Poor	Assessing patients’ readiness to quit Fair	Assessing patients’ readiness to quit Good	Assessing patients’ readiness to quit Very Good	Assessing patients’ readiness to quit Excellent
Assisting patients with quitting	Assisting patients with quitting Poor	Assisting patients with quitting Fair	Assisting patients with quitting Good	Assisting patients with quitting Very Good	Assisting patients with quitting Excellent
Arranging follow-up counseling	Arranging follow-up counseling Poor	Arranging follow-up counseling Fair	Arranging follow-up counseling Good	Arranging follow-up counseling Very Good	Arranging follow-up counseling Excellent
BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco?	BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco? Poor	BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco? Fair	BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco? Good	BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco? Very Good	BEFORE attending the Rx for Change program, how would you have rated your overall ability to help patients quit using tobacco? Excellent

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* 5. How much confidence do you have in the following aspects of counseling patients to quit using tobacco?

	Not at All Confident	Not Very Confident	Moderately Confident	Very Confident	Extremely Confident
Know the appropriate questions to ask patients when providing tobacco cessation counseling?	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not at All Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Not Very Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Moderately Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Very Confident	Know the appropriate questions to ask patients when providing tobacco cessation counseling? Extremely Confident
Have the skills needed to counsel for an addiction?	Have the skills needed to counsel for an addiction? Not at All Confident	Have the skills needed to counsel for an addiction? Not Very Confident	Have the skills needed to counsel for an addiction? Moderately Confident	Have the skills needed to counsel for an addiction? Very Confident	Have the skills needed to counsel for an addiction? Extremely Confident
Can provide motivation to patients who want to quit?	Can provide motivation to patients who want to quit? Not at All Confident	Can provide motivation to patients who want to quit? Not Very Confident	Can provide motivation to patients who want to quit? Moderately Confident	Can provide motivation to patients who want to quit? Very Confident	Can provide motivation to patients who want to quit? Extremely Confident
Have the skills to monitor and assist patients throughout their quit attempt?	Have the skills to monitor and assist patients throughout their quit attempt? Not at All Confident	Have the skills to monitor and assist patients throughout their quit attempt? Not Very Confident	Have the skills to monitor and assist patients throughout their quit attempt? Moderately Confident	Have the skills to monitor and assist patients throughout their quit attempt? Very Confident	Have the skills to monitor and assist patients throughout their quit attempt? Extremely Confident
Have the skills to assist patients who seem to be in a hurry?	Have the skills to assist patients who seem to be in a hurry? Not at All Confident	Have the skills to assist patients who seem to be in a hurry? Not Very Confident	Have the skills to assist patients who seem to be in a hurry? Moderately Confident	Have the skills to assist patients who seem to be in a hurry? Very Confident	Have the skills to assist patients who seem to be in a hurry? Extremely Confident
Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation?	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not at All Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Not Very Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Moderately Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Very Confident	Have sufficient therapeutic knowledge of the pharmaceutical products for tobacco cessation? Extremely Confident
Know when a referral to a physician is appropriate?	Know when a referral to a physician is appropriate? Not at All Confident	Know when a referral to a physician is appropriate? Not Very Confident	Know when a referral to a physician is appropriate? Moderately Confident	Know when a referral to a physician is appropriate? Very Confident	Know when a referral to a physician is appropriate? Extremely Confident
Can create consumer awareness of why patients should be asked questions about tobacco use?	Can create consumer awareness of why patients should be asked questions about tobacco use? Not at All Confident	Can create consumer awareness of why patients should be asked questions about tobacco use? Not Very Confident	Can create consumer awareness of why patients should be asked questions about tobacco use? Moderately Confident	Can create consumer awareness of why patients should be asked questions about tobacco use? Very Confident	Can create consumer awareness of why patients should be asked questions about tobacco use? Extremely Confident
Can sensitively suggest tobacco cessation to patients who use tobacco?	Can sensitively suggest tobacco cessation to patients who use tobacco? Not at All Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Not Very Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Moderately Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Very Confident	Can sensitively suggest tobacco cessation to patients who use tobacco? Extremely Confident
Are able to provide adequate counseling when time is limited?	Are able to provide adequate counseling when time is limited? Not at All Confident	Are able to provide adequate counseling when time is limited? Not Very Confident	Are able to provide adequate counseling when time is limited? Moderately Confident	Are able to provide adequate counseling when time is limited? Very Confident	Are able to provide adequate counseling when time is limited? Extremely Confident
Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco?	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not at All Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Not Very Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Moderately Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Very Confident	Can help patients learn how to cope with situations or triggers that might lead them to relapse back to using tobacco? Extremely Confident
Can counsel patients who are not interested in quitting?	Can counsel patients who are not interested in quitting? Not at All Confident	Can counsel patients who are not interested in quitting? Not Very Confident	Can counsel patients who are not interested in quitting? Moderately Confident	Can counsel patients who are not interested in quitting? Very Confident	Can counsel patients who are not interested in quitting? Extremely Confident

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* 6. Do you think that participating in this class will increase:

	Definitely Yes	Probably Yes	Not Sure	Probably Not	Definitely Not
The number of patients that you counsel to quit using tobacco?	The number of patients that you counsel to quit using tobacco? Definitely Yes	The number of patients that you counsel to quit using tobacco? Probably Yes	The number of patients that you counsel to quit using tobacco? Not Sure	The number of patients that you counsel to quit using tobacco? Probably Not	The number of patients that you counsel to quit using tobacco? Definitely Not
The quality of counseling that you provide?	The quality of counseling that you provide? Definitely Yes	The quality of counseling that you provide? Probably Yes	The quality of counseling that you provide? Not Sure	The quality of counseling that you provide? Probably Not	The quality of counseling that you provide? Definitely Not

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* 7. Do you think that health professionals should be more or less active in:

	More Active	No Change is Needed	Less Active
Helping patients to quit using tobacco?	Helping patients to quit using tobacco? More Active	Helping patients to quit using tobacco? No Change is Needed	Helping patients to quit using tobacco? Less Active
Helping to prevent patients from starting to use tobacco?	Helping to prevent patients from starting to use tobacco? More Active	Helping to prevent patients from starting to use tobacco? No Change is Needed	Helping to prevent patients from starting to use tobacco? Less Active

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* 8. Do you believe that students at other health professional schools (e.g., medicine, pharmacy, dental, nutrition) would benefit from receiving the same, or similar, tobacco cessation training?

Yes

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* 9. What is your sex?

Male

Female

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* 10. What is your age?

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* 11. Which of the following best describes your race or ethnicity?

Hispanic

American Indian or Alaska Native

Asian

Native Hawaiian or other Pacific Islander

Black or African American

White

Other (please specify)

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* 12. Have you smoked 100 or more cigarettes in your lifetime?

Yes

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* 13. Which of the following best describes your tobacco use (cigarettes, cigars, hookah pipes, snuff, or chew)?

Use tobacco once or more a day

Use tobacco less than once a day

Used to use tobacco but quit

Experimented with tobacco a few times in the past

Never tried tobacco

If you used and quit, what year did you quit?

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* 14. About what percentage of the online tobacco cessation lectures did you complete (enter a value from 0%
to 100%)

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* 15. Did you complete a pre-training survey for this tobacco course?

Yes

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* 1. Please estimate the following:(answers must add up to 100%)

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* 2. Enter a %:

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* 3. Before attending this class, had you provided tobacco cessation assistance to any patients?

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* 4. Please rate your level of counseling skills for each of the following:

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* 5. How much confidence do you have in the following aspects of counseling patients to quit using tobacco?

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* 6. Do you think that participating in this class will increase:

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* 7. Do you think that health professionals should be more or less active in:

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* 8. Do you believe that students at other health professional schools (e.g., medicine, pharmacy, dental, nutrition) would benefit from receiving the same, or similar, tobacco cessation training?

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* 9. What is your sex?

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* 10. What is your age?

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* 11. Which of the following best describes your race or ethnicity?

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* 12. Have you smoked 100 or more cigarettes in your lifetime?

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* 13. Which of the following best describes your tobacco use (cigarettes, cigars, hookah pipes, snuff, or chew)?

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* 14. About what percentage of the online tobacco cessation lectures did you complete (enter a value from 0%to 100%)

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* 15. Did you complete a pre-training survey for this tobacco course?

* 14. About what percentage of the online tobacco cessation lectures did you complete (enter a value from 0%
to 100%)