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Feedback Survey on Public Programs and Services for Persons With Disabilities by Cuso International and Global Affairs Canada
1.
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
2.
How do you identify your gender?
Male
Female
Non-Binary
3.
What is your current socio-economic status?
Low income
Lower-middle income
Middle income
Upper-middle income
High income
4.
Which of the following best describes your ethnicity?
Afro-Caribbean
Black
Indian
Afro Indian
Mixed
Asian
Other (please specify)
5.
How do you identify regarding your ability?
I have no disabilities
I have a physical disability
I have a cognitive or mental health condition
I have a sensory disability (e.g., visual or hearing)
I have a chronic illness
Prefer not to say
6.
Which country are you participating from?
Grenada
St. Lucia
St. Vincent
Dominica
7.
Do you or someone know use (or have you tried to use) any specialized services or support programs related to disability in the last 12 months?
Yes, I used a service.
Yes, I know of someone who used a service
Yes, I (or someone) tried but was unable to use a service.
No, I did not (nor do I know of anyone) who use or tried to use a service.
8.
What type of public support service or resource did you (or someone you know) seek?
Counseling or mental health services
Emergency shelter or safe housing
Legal support or advocacy
Medical services (e.g., treatment for injuries)
Support groups or community resources
Reporting or law enforcement services
Financial assistance or job training
Educational resources
Other (please specify)
9.
How easy or difficult was it for you to physically access the service location (e.g., building entrance, washrooms, waiting areas)?
Very Easy
Easy
Neither Easy nor Difficult
Difficult
Very Difficult / I was unable to physically access the location.
The service was provided remotely (e.g., phone, online).
10.
If you or someone you know needed an accommodation (like sign language interpretation, Easy Read materials, or physical assistance), was it provided effectively?
Yes, it was effective.
It was provided, but it was not effective.
No, it was needed but not provided.
I did not need or request an accommodation.
11.
If you or someone you know encountered a barrier (e.g., attitude, cost, distance, inaccessibility) to using a service, what was the biggest barrier?
Physical Inaccessibility (e.g., stairs, no ramp/elevator)
Cost/Affordability
Staff Attitudes/Lack of Understanding
Distance/Lack of Accessible Transport
Communication Barrier (e.g., lack of sign language, unclear information)
I did not encounter any significant barrier.
12.
Based on your experience, how satisfied are you (or someone you know) with the overall quality of disability-specific services available in your community?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
13.
How would you rate your overall quality of life?
Very poor
Poor
Fair
Good
Very good
Excellent