Piloting the Patient Engagement Quality Guidance
First Evaluation Form

Introduction

Thank you for using/ testing/ piloting the Patient Engagement Quality Guidance (PEQG)!

This is a first feedback form to be filled in for projects in the planning or ongoing projects that enter the piloting process.

We appreciate your feedback on how you use the PEQG in order to learn two main things:

1) how useful it is for you in the patient engagement (PE) context, and

2) what is the impact achieved when using the PE Quality Guidance compared to situations where PE Quality Guidance would not have been used in the past.

By filling out this feedback form (and others in the process) you will help us improve the usability of the PE Quality Guidance and gather valuable input on how we can increase the impact the PE Quality Guidance has in PE activities.

PROCESS AND MATERIAL

If you haven't yet registered your project as a piloting project, please do so first, so that we receive basic information about your project. Only then continue to this feedback form.

Link to registration form: https://www.surveymonkey.com/r/PEQG-piloting-registration

Link to the Piloting manual: https://patientfocusedmedicine.org/peqg/Piloting-Manual.pdf

DATA:
Your data will be shared within the PFMD team during the piloting period and will be kept for the improvement work of PEQG. As agreed in the piloting registration, your feedback will be consolidated and used in the final report of the piloting period.

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* 1. Name of the project

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* 2. Name and Organisation of Respondent

Name

Organisation

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* 3. What expectations do you have for the PE Quality Guidance ?

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* 4. How did you use the PE Quality Guidance with your project partners ?

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* 5. How relevant is each of the 7 Quality Criteria to this project in your opinion? [rank the value (from 1 not relevant to 4 highly relevant]

	1 - Not at all relevant	2 - Slightly relevant	3 - Relevant	4 - Highly relevant
Shared Purpose	Shared Purpose 1 - Not at all relevant	Shared Purpose 2 - Slightly relevant	Shared Purpose 3 - Relevant	Shared Purpose 4 - Highly relevant
Respect and Accessibility	Respect and Accessibility 1 - Not at all relevant	Respect and Accessibility 2 - Slightly relevant	Respect and Accessibility 3 - Relevant	Respect and Accessibility 4 - Highly relevant
Representativeness of Stakeholders	Representativeness of Stakeholders 1 - Not at all relevant	Representativeness of Stakeholders 2 - Slightly relevant	Representativeness of Stakeholders 3 - Relevant	Representativeness of Stakeholders 4 - Highly relevant
Roles and Responsibilities	Roles and Responsibilities 1 - Not at all relevant	Roles and Responsibilities 2 - Slightly relevant	Roles and Responsibilities 3 - Relevant	Roles and Responsibilities 4 - Highly relevant
Capacity and Capability for Engagement	Capacity and Capability for Engagement 1 - Not at all relevant	Capacity and Capability for Engagement 2 - Slightly relevant	Capacity and Capability for Engagement 3 - Relevant	Capacity and Capability for Engagement 4 - Highly relevant
Transparency in Communication and Documentation	Transparency in Communication and Documentation 1 - Not at all relevant	Transparency in Communication and Documentation 2 - Slightly relevant	Transparency in Communication and Documentation 3 - Relevant	Transparency in Communication and Documentation 4 - Highly relevant
Continuity and Sustainability	Continuity and Sustainability 1 - Not at all relevant	Continuity and Sustainability 2 - Slightly relevant	Continuity and Sustainability 3 - Relevant	Continuity and Sustainability 4 - Highly relevant

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* 6. Is the PE Quality Guidance easy to understand ?

Yes

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* 7. If the answer to question 6 is no, what can we improve?

Language used or phrasing

More description/explanation

More multiple choice options

Other (please specify)

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* 8. Tick the box if the PE Quality Guidance:

helped you reflect on how to set up of your initiative

helped you to plan and integrate patient engagement in your initiative

helped in other way. Please tell us more!

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* 9. What challenges did you experience when filling out the PE Quality Guidance tool (if any)?

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* 10. At this stage, how likely is it that you would recommend the PE Quality Guidance to others? (0-10 scale)

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 1. Name of the project

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* 2. Name and Organisation of Respondent

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* 3. What expectations do you have for the PE Quality Guidance ?

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* 4. How did you use the PE Quality Guidance with your project partners ?

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* 5. How relevant is each of the 7 Quality Criteria to this project in your opinion? [rank the value (from 1 not relevant to 4 highly relevant]

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* 6. Is the PE Quality Guidance easy to understand ?

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* 7. If the answer to question 6 is no, what can we improve?

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* 8. Tick the box if the PE Quality Guidance:

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* 9. What challenges did you experience when filling out the PE Quality Guidance tool (if any)?

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* 10. At this stage, how likely is it that you would recommend the PE Quality Guidance to others? (0-10 scale)

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* 11. Any experience, specific comments, thoughts or feedback you would like to share with us after completing the PE Quality Guidance?