MILK Screening/Workshop- Participant Follow up Survey

Question Title

1. I attended the following screening/workshop of MILK

Screening/Workshop Date:

Host Organization:

Question Title

2. Please enter your name (**Optional. You can respond to this survey anonymously.)*

First Name

Last Name

Question Title

3. Country:

Question Title

4. Email address:

Question Title

5. I attended the event in my capacity as (choose one that applies the most):

A parent

A peer supporter/advocate

A student

A teacher

A health practitioner/professional

A paid staff member

A volunteer

General interest

Question Title

6. Age:

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

7. After the screening/workshop of MILK my awareness and understanding of birth and infant feeding issues was:

Greatly deepened

Deepened a little bit

I didn’t learn anything knew

Question Title

8. The scene/theme I appreciated the most in the film was:

Question Title

9. The one thing that impacted me the most in the film was:

Question Title

10. Did you attend the post-screening workshop?

Yes

Only some of it

Question Title

11. The workshop gave me more confidence to prepare my family for emergencies.

True

Not True

Clear

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

Question Title

12. The workshop gave me more confidence to work as a health care provider in emergency situations.

True

Not True

Clear

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

Question Title

13. Tell us about the most important or interesting thing you learned about emergencies.

Question Title

14. The screening/workshop gave me more confidence in the decisions I make about feeding my family.

Yes

Please elaborate

Question Title

15. Tell us how the workshop increased your knowledge or confidence about feeding your family.

Question Title

16. Is there anything you were expecting to learn that you didn’t?

Yes

Please elaborate

Question Title

17. What did you learn from the post-screening/workshop discussion and activities? Can you elaborate?

Question Title

18. The screening/workshop event has inspired me to become an advocate for maternal-child health or play a new role in supporting and improving maternal-child health in my community.

Yes

Please elaborate

Question Title

19. If you could implement one specific change in the way maternal-child health is addressed in your community what would that be? Please elaborate.

Question Title

20. Would you recommend the film to someone you know?

Yes

MILK Screening/Workshop- Participant Follow up Survey

Question Title

* 1. I attended the following screening/workshop of MILK

Question Title

* 2. Please enter your name (*Optional. You can respond to this survey anonymously.)

Question Title

* 3. Country:

Question Title

* 4. Email address:

Question Title

* 5. I attended the event in my capacity as (choose one that applies the most):

Question Title

* 6. Age:

Question Title

* 7. After the screening/workshop of MILK my awareness and understanding of birth and infant feeding issues was:

Question Title

* 8. The scene/theme I appreciated the most in the film was:

Question Title

* 9. The one thing that impacted me the most in the film was:

Question Title

* 10. Did you attend the post-screening workshop?

Question Title

* 11. The workshop gave me more confidence to prepare my family for emergencies.

Question Title

* 12. The workshop gave me more confidence to work as a health care provider in emergency situations.

Question Title

* 13. Tell us about the most important or interesting thing you learned about emergencies.

Question Title

* 14. The screening/workshop gave me more confidence in the decisions I make about feeding my family.

Question Title

* 15. Tell us how the workshop increased your knowledge or confidence about feeding your family.

Question Title

* 16. Is there anything you were expecting to learn that you didn’t?

Question Title

* 17. What did you learn from the post-screening/workshop discussion and activities? Can you elaborate?

Question Title

* 18. The screening/workshop event has inspired me to become an advocate for maternal-child health or play a new role in supporting and improving maternal-child health in my community.

Question Title

* 19. If you could implement one specific change in the way maternal-child health is addressed in your community what would that be? Please elaborate.

Question Title

* 20. Would you recommend the film to someone you know?

Question Title

* 21. Any other comments about the film or the event you would like to share with us? Please elaborate.

Question Title

* 22. Can we share your written responses?

1. I attended the following screening/workshop of MILK

2. Please enter your name (**Optional. You can respond to this survey anonymously.)*

3. Country:

4. Email address:

5. I attended the event in my capacity as (choose one that applies the most):

6. Age:

7. After the screening/workshop of MILK my awareness and understanding of birth and infant feeding issues was:

8. The scene/theme I appreciated the most in the film was:

9. The one thing that impacted me the most in the film was:

10. Did you attend the post-screening workshop?

11. The workshop gave me more confidence to prepare my family for emergencies.

12. The workshop gave me more confidence to work as a health care provider in emergency situations.

13. Tell us about the most important or interesting thing you learned about emergencies.

14. The screening/workshop gave me more confidence in the decisions I make about feeding my family.

15. Tell us how the workshop increased your knowledge or confidence about feeding your family.

16. Is there anything you were expecting to learn that you didn’t?

17. What did you learn from the post-screening/workshop discussion and activities? Can you elaborate?

18. The screening/workshop event has inspired me to become an advocate for maternal-child health or play a new role in supporting and improving maternal-child health in my community.

19. If you could implement one specific change in the way maternal-child health is addressed in your community what would that be? Please elaborate.

20. Would you recommend the film to someone you know?

21. Any other comments about the film or the event you would like to share with us? Please elaborate.

22. Can we share your written responses?