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CATCH My Breath Teacher Survey
The aim of the CATCH My Breath Teacher Survey is to assess teachers’ opinions of the CATCH My Breath Program including its proposed applicability, compatibility, and effectiveness. The survey is filled out by the individual (i.e. teacher, tobacco educator, etc.) whom teaches the CATCH My Breath Program. The survey should be filled out after teaching the CATCH My Breath sessions and should take approximately 10-15 minutes to complete.
1.
Please complete:
Your Title/Position:
Your School/Organization's Name:
Grade level(s) where sessions were taught:
Subject where sessions were taught:
Number of sessions taught (there are 4 sessions):
Approximate number of students reached:
2.
Please select your level of agreement with each statement based on your evaluation of the CATCH My Breath (CMB) sessions.
***Select N/A if you did not use that particular resource/component.***
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
I feel confident in my ability to teach the CMB sessions.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The CMB sessions are culturally appropriate.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The CMB sessions are age appropriate.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The worksheets/handouts associated with the CMB sessions were good.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The Powerpoint slides associated with the CMB sessions were helpful.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The Peer Group Facilitator component of the CMB sessions went well.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The additional resources (i.e. Teacher 411) provided sufficient background information for teaching the CMB sessions.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
3.
Did you complete any CATCH My Breath training prior to teaching the CATCH My Breath sessions?
Yes
No
If not, can you please tell us why? (Ex: didn't have time)
4.
If you completed a CATCH My Breath training, did you feel it was a helpful resource for teaching the program?
Yes, it was helpful.
It was somewhat helpful.
No, it was not helpful.
I did not attend a training prior to teaching CMB.
Please provide any additional comments.
5.
Did you teach the sessions using Peer Group Facilitators?
Peer Group Facilitators are students who helped teach the sessions by leading small group discussions with their peers.
Yes
No
If not, can you please tell us why?
6.
If you taught the sessions using Peer Group Facilitators (PGF), did you train the PGF prior to teaching Session 1?
I did not use PGF
Yes, I trained the PGF
No, I did not train the PGF
If you did not train the PGF, can you please tell us why? (Ex: didn't have time)
7.
If you taught the sessions using Peer Group Facilitators (PGF), did you conduct regular check-ins with the PGF throughout the program?
I did not use PGF
Yes, I conducted regular check-ins with the PGF
No, I did not conduct regular check-ins with the PGF
If you did not conduct regular check-ins with the PGF, can you please tell us why? (Ex: didn't have time)
8.
Were you able to teach all four CATCH My Breath sessions?
Yes
No
If not, can you please tell us why? (Ex: didn't have time)
9.
Were you able to teach/complete the sessions in the suggested amount of instruction time ( approx. 40 minutes)?
Yes
No
If not, how long did the sessions take?
10.
How many weeks did it take you to teach the sessions?
Choose the answer that best matches your timeline.
1 week
2 weeks
3-4 weeks
5-6 weeks
More than 6 weeks
11.
How was your experience
interacting
with the CATCH.org platform?
Very difficult
A little difficult
Neutral
A little easy
Very easy
12.
Do you have any suggestions on how to improve the CATCH.org platform?
Please enter suggestions below
.
13.
How engaged were your students in the sessions?
Not engaged
A little engaged
Very engaged
14.
How helpful were the instructions for the sessions?
Not helpful
A little helpful
Very helpful
15.
What improvements would you make to the sessions and/or the CATCH My Breath program as a whole (to include the teacher resources and other supplemental materials)?
16.
Please provide any additional feedback or comments.
17.
May we contact you regarding your feedback? If so, please provide your contact information.
Name:
Email:
Thank you for teaching the CATCH My Breath program and completing this survey!
