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Older Adults and Social Determinants of Health
Program Evaluation
We appreciate your participation in our continuing education activity. Your responses to this anonymous survey w
ill allow us to improve our program offerings and services. Thank you for your time.
*
1.
What is your primary professional
discipline
?
(Required.)
Medicine
Rehab Therapy (PT/OT/SLP)
Nursing
Social Work
Pharmacy
Other
*
2.
Please list all professional license/certificate/degree(s) you hold:
(Required.)
EVALUATION OF TRAINING:
Please use the scale below to rate the efficacy of the learning objectives, the presenters, and the instructional format:
1 = Totally ineffective, wouldn't recommend
2 = Somewhat ineffective, at least one serious deficiency
3 = Somewhat effective, acceptable but not outstanding
4 = Effective, meets high standards, would recommend
5 = Highly effective, among the best
*
3.
Rate the relationship between activity content to stated learning objective:
(Required.)
1
2
3
4
5
Describe social determinants of health (SDOH) for older adults.
1
2
3
4
5
Examine SDOH and its impact on older adult’s health.
1
2
3
4
5
Discuss strategies to address SDOH with older adults.
1
2
3
4
5
*
4.
Rate the effectiveness of the presenter(s)
(Required.)
1
2
3
4
5
a. Presentation Style
1
2
3
4
5
b. Knowledge of Subject
1
2
3
4
5
c. Quality of Material
1
2
3
4
5
d. Practical applicability or relevance of topic
1
2
3
4
5
*
5.
Please rate the effectiveness of teaching strategies:
(Required.)
1
2
3
4
5
Effectiveness of teaching strategies:
1
2
3
4
5
*
6.
What was the most significant thing(s) you learned?
(Required.)
*
7.
In your work with older adults, do you intent to implement at least one practice improvement learned as a result of this activity?
(Required.)
Yes
No
N/A
If yes, please describe:
RETROSPECTIVE ASSESSMENT:
Use the following scale to rate your perceived level of
confidence
in the topics listed below BEFORE the
training
an AFTER the training.
Scale
: 1= not at all confident, 2= somewhat confident, 3= mostly confident 4= fully
confident
*
8.
How confident were/are you in your ability to:
(Required.)
Before
After
a. Describe social determinants of health (SDOH) for older adults.
1
2
3
4
1
2
3
4
b. Examine SDOH and its impact on older adult’s health.
1
2
3
4
1
2
3
4
c. Discuss strategies to address SDOH with older adults.
1
2
3
4
1
2
3
4
9.
Please feel free to share any additional comments and suggestions. Your feedback is extremely valuable to us.
10.
Please indicate what type of continuing education credit you are looking to obtain:
Nursing
Social Work
Licensed Mental Health Counselor
Certificate of attendance
11.
If you would like a Certificate of Completion/ Continuing Ed please complete the information below:
Name and Title
Organization
State
Email Address
