Needs Assessment for CF Education

Your healthcare team at the Toronto Adult CF Clinic wants to know what CF-related topics you are interested in learning more about. We also want to know what you think about the use of computer technology to access education. Please complete this short survey to help us better meet your needs!

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* 1. Please rate how interested you are in learning about the following CF-related topics:

	Very interested	Somewhat interested	Neutral	Not very interested	Not at all interested	I don't know
What is cystic fibrosis?	What is cystic fibrosis? Very interested	What is cystic fibrosis? Somewhat interested	What is cystic fibrosis? Neutral	What is cystic fibrosis? Not very interested	What is cystic fibrosis? Not at all interested	What is cystic fibrosis? I don't know
Medications: what do they do and how do they help	Medications: what do they do and how do they help Very interested	Medications: what do they do and how do they help Somewhat interested	Medications: what do they do and how do they help Neutral	Medications: what do they do and how do they help Not very interested	Medications: what do they do and how do they help Not at all interested	Medications: what do they do and how do they help I don't know
CF-related diabetes	CF-related diabetes Very interested	CF-related diabetes Somewhat interested	CF-related diabetes Neutral	CF-related diabetes Not very interested	CF-related diabetes Not at all interested	CF-related diabetes I don't know
How to cope with anxious moments	How to cope with anxious moments Very interested	How to cope with anxious moments Somewhat interested	How to cope with anxious moments Neutral	How to cope with anxious moments Not very interested	How to cope with anxious moments Not at all interested	How to cope with anxious moments I don't know
Physiotherapy & exercise	Physiotherapy & exercise Very interested	Physiotherapy & exercise Somewhat interested	Physiotherapy & exercise Neutral	Physiotherapy & exercise Not very interested	Physiotherapy & exercise Not at all interested	Physiotherapy & exercise I don't know
Nutrition	Nutrition Very interested	Nutrition Somewhat interested	Nutrition Neutral	Nutrition Not very interested	Nutrition Not at all interested	Nutrition I don't know
Digestive issues	Digestive issues Very interested	Digestive issues Somewhat interested	Digestive issues Neutral	Digestive issues Not very interested	Digestive issues Not at all interested	Digestive issues I don't know
Liver disease	Liver disease Very interested	Liver disease Somewhat interested	Liver disease Neutral	Liver disease Not very interested	Liver disease Not at all interested	Liver disease I don't know
Recognizing a CF ‘flare up’ and what to do	Recognizing a CF ‘flare up’ and what to do Very interested	Recognizing a CF ‘flare up’ and what to do Somewhat interested	Recognizing a CF ‘flare up’ and what to do Neutral	Recognizing a CF ‘flare up’ and what to do Not very interested	Recognizing a CF ‘flare up’ and what to do Not at all interested	Recognizing a CF ‘flare up’ and what to do I don't know
Pregnancy & fertility	Pregnancy & fertility Very interested	Pregnancy & fertility Somewhat interested	Pregnancy & fertility Neutral	Pregnancy & fertility Not very interested	Pregnancy & fertility Not at all interested	Pregnancy & fertility I don't know
Social assistance/drug coverage	Social assistance/drug coverage Very interested	Social assistance/drug coverage Somewhat interested	Social assistance/drug coverage Neutral	Social assistance/drug coverage Not very interested	Social assistance/drug coverage Not at all interested	Social assistance/drug coverage I don't know
Lung transplantation assessment process	Lung transplantation assessment process Very interested	Lung transplantation assessment process Somewhat interested	Lung transplantation assessment process Neutral	Lung transplantation assessment process Not very interested	Lung transplantation assessment process Not at all interested	Lung transplantation assessment process I don't know
Career planning	Career planning Very interested	Career planning Somewhat interested	Career planning Neutral	Career planning Not very interested	Career planning Not at all interested	Career planning I don't know

Other (please specify)

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* 2. How would you prefer to learn about CF-related topics? Rank your learning preference with 1 being most preferred and 5 being least preferred.

On your own, with access to online education modules

On your own, with paper handouts (ex. pamphlets, booklets)

One-on-one with a CF clinic team member in person

One-on-one with a CF clinic team member using a videoconferencing link on your computer (ex. Skype or Telemedicine)

In a group videoconference using your computer to link to a call that includes a CF team member and other CF patients (ex. Skype, GoTo Meeting)

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* 3. Have you used Skype, FaceTime, or other video-based communication tools before?

Yes

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* 4. Do you have access to a webcam with a microphone (for instance, computer, tablet, smart phone)?

Yes

Not sure

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* 5. What is your gender?

Male

Female

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* 6. What is your age?

18-24 years

25-34 years

35-44 years

45 years and older

Needs Assessment for CF Education

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* 1. Please rate how interested you are in learning about the following CF-related topics:

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* 2. How would you prefer to learn about CF-related topics? Rank your learning preference with 1 being most preferred and 5 being least preferred.

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* 3. Have you used Skype, FaceTime, or other video-based communication tools before?

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* 4. Do you have access to a webcam with a microphone (for instance, computer, tablet, smart phone)?

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* 5. What is your gender?

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* 6. What is your age?

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* 7. What are the first three digits of your postal code?

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* 8. If you have any additional comments, please feel free to write them here: