FWP Post Survey- JAN 2024 cohort 1
1.
First and Last Name:
2.
Participant I.D
3.
Email Address:
4.
I have a primary health care provider and I am...
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
5.
If obtaining health insurance was needed, I was able to receive assistance
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
6.
I have more knowledge surrounding who my primary healthcare provider is
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
7.
As a result of this program, I have increased/improved my health care with my primary care doctor.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8.
As a result of this program, I am able to communicate better with my primary care doctor.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
9.
My understanding of medical information has improved since starting this program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
10.
The device was helpful to me to track my progress and health.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
11.
I currently have internet services and was able to complete the Zoom sessions each week
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
12.
I have reliable, consistent means of transportation?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
13.
I am able to purchase adequate groceries and household supplies each month
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
14.
I am able to pay for your utilities each month
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
15.
What would be considered a normal blood pressure reading?
130/80
120/80
110/88
100/80
16.
Carbohydrates can be another way to reference…
Beans and seeds
Protein
Grains
Whey
17.
Hypertension often refers to…
High cholesterol
High Blood pressure
Liver Disease
Diabetes
18.
What is the recommended number of minutes of physical activity needed per week?
130 minutes per week
125 minutes per week
150 minutes per week
250 minutes per week
19.
Can you think of one reason why physical activity is so important?
20.
What is your current weight?
21.
In the last 16 weeks have you been diagnosed with any chronic health conditions? Check all that apply.
Hypertension/High Blood Pressure
Diabetes
Musculoskeletal Conditions
Other (please specify)
22.
During this program I learned new ways to improve my physical fitness.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
23.
How many minutes of physical activity do you currently get per week?
0-30 minutes per week
30-60 minutes per week
60-90 minutes per week
90-120 minutes per week
120-150 minutes per week
More than 150 minutes per week
24.
In the last 30 days, how many days per week do you participate in intentional exercise such as walking fast, jogging, dancing, swimming, biking, or other similar activities that increased your heart rate?
0 days per week
1 day per week
2 days per week
3 days per week
4 days per week
5+ days per week on average
25.
As a result of this program, I believe my nutrition habits have improved.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
26.
As a result of this program, I feel more confident navigating the grocery store to find healthier food options.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
27.
I have gained self-awareness and am able to better assess how certain foods and beverages affect my body in a positive way since starting this program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
28.
I understand and can discuss healthy grains and how to consume them.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
29.
My ability to read and understand food labels has improved.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
30.
The one-on-one sessions with the registered dietician were valuable to me.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
31.
I understand and can discuss healthy fats and how to consume them.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
32.
I understand and can discuss proteins and how to consume them.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
33.
In the last 30 days, on average, how many times a day did you eat fruit?
0 servings per day
1-2servings per day
3-4 servings per day
5 or more servings per day
34.
In the last 30 days, on average, how many times a day did you eat vegetables?
0 servings per day
1-2 servings per day
3-4 servings per day
5+ servings per day
35.
During this program I found the well-being discussions helpful in dealing with my own challenges.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
36.
I learned well-being coping strategies in this program that are helping me to develop a healthier lifestyle.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
37.
As a result of this program, I would recommend counseling for someone who is trying to lose weight/control diabetes/eat healthier.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
38.
The Family Wellness Program provided what was promised.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
39.
The material was presented in an organized, understandable fashion.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
40.
My overall feeling of health and well-being improved due to the Family Wellness Program.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
41.
Please feel free to share any comments or suggestions on your overall experience in the program