The Icebreaker Flashcards are a set of cards that could enable people living with conditions to have a more active role in discussions with their HCP and take a step towards increased self-management. The cards could also facilitate discussion around embarrassing, stigmatized or ignored issues, helping people guide HCPs to topic that matter most to them.

You have shared the Icebreaker Flashcards with patients.

Thanks for providing feedback via a short questionnaire.

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* 1. You are a nurse from:

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* 2. How have you used the Flashcards? You can select more than one answer.

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* 3. How many patients have you shared the Flashcards with?

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* 4. Tell us more about the patients you have shared the Flashcards with: IF they have diabetes, what type of diabetes do they have? 

  0/none 1-5 patients 5-10 patients 10-15  patients 15-20 patients > 20 patients
Type 1
Type 2
Other chronic conditions

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* 5. Tell us more about the patients you have shared the Flashcards with: when have they been diagnosed ?

  1-5 patients 5-10 patients 10-15 patients 15-20 patients >20 patients
1-5 years ago
5-10 years ago
>10 years ago

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* 6. On a scale of 1 to 5, do you think the Flashcards were helpful to your patients to talk about their disease and difficult topics?  

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* 7. On a scale of 1 to 5, do you think your patients found the Flashcards helpful to address their healthcare concerns?  

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* 8. Do you think the Flashcards will support your patient’s intention to ______? (answer yes or no)

  YES NO
Quit smoking
Eat healthily
Be active
Improve his / her mood
Get pain relief
Reduce alcohol consumption
Improve sexual health
Think about the future       
Feel good
Sleep better

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* 9. Following this Flashcards session with patients, do you think your patient will take action to begin a behavior change?

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* 10. Please fell free to add any comments you might have

If you need to reach us, please contact us at contact@connecting-nurses.com

Thank you

T