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Cultural Survey

1.Please indicate the following areas that you would like additional information or education to improve your professional practice based on interest or changing demographics in your community. (check all that apply)
2.What is your current healthcare profession?
3.How many years have you been in current role?
4.How many years have you been in healthcare?
5.What is your age group?
6.What is your current practice setting?
7.Have you attended a course focused on cultural congruence (competence) in the past 12 months?
8.How confident do you feel in your knowledge base when it comes to providing culturally congruent care for diverse populations?
9.Do you believe that biases and limitations exist in healthcare?
10.Do you believe that you have biases and limitations?
11.Do you believe that health care disparities exist?
12.How confident do you feel when interviewing clients of different cultural backgrounds to learn about their values and beliefs?
13.How knowledgeable do you feel about ways cultural factors may influence the care you provide when thinking about clients of different cultural backgrounds?
14.Would you attend educational/informational sessions to promote culturally congruent care in the state of Wisconsin?
15.Please answer the following in regards to distance education, or modes other than in-person programs.
I have participated
I would participate
Journal Club
Powerpoint slides
Case studies
Videos
Computer based training
16.What region of the state of Wisconsin best represents your practice area?
There is a map showing the regions at http://www.travelwisconsin.com/maps_guides.aspx if that could be shown as a reference picture.
17.Anything additional you would want us to know topic suggestions for education:
18.How would you best describe yourself? (check all that apply)
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