HIS Lifestyle Guide Survey - Issue #0 (August)

Thank you for taking the time to provide feedback on the draft version of the HIS Lifestyle Guide. Following are 7 questions concerning the design, content, and usefulness of the Guide. Some questions ask you to use a ratings scale while others are open-ended and allow you to comment in your own words. There are also a few demographic questions at the end of the survey to let us know who is accessing the Guide and who is responding to our survey.

The entire survey should take only about 10 minutes to complete.

Thank you again for your help..

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* 1. Considering the look and overall design of the draft HIS Lifestyle Resource Guide, please rate the Guide in terms of its appeal/attractiveness using the following 4-point scale:

Very Unattractive/Unappealing

Unattractive/Unappealing

Attractive/Appealing

Very Attractive/Appealing

Don't Know/Refused

If you would like to provide detail on your rating of the Guide's attractiveness, please use the space below.

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* 2. Considering now the different images and graphics in the Guide, to what extent do you think they are reflective of the community and are relatable?

Very Unrelatable/Unreflective

Unrelatable/Unreflective

Relatable/Reflective

Very Relatable/Reflective

Don't Know/Refused

If you would like to provide detail on your rating of the Guide's graphics and images, please use the space below.

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* 3. Considering now the content in the draft HIS Lifestyle Resource Guide, please rate the Guide in terms of how interesting/informative the information it contained was to you using the following 4-point scale:

Very Uninteresting/Uninformative

Uninteresting/Uninformative

Interesting/Informative

Very Interesting/Informative

Don't Know/Refused

If you would like to provide detail on your rating of the Guide's informational and interest value, please use the space below.

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* 4. Following is a list of the featured articles in the draft HIS Lifestyle Guide. Please rank order them from the most interesting/useful to the least interesting/useful. 1 = most useful/interesting; 6 = least useful/interesting

A Call to Action for Chicago's House/Ball Community

New Website for Chicago Black Gay Men's Caucus

Healthy is Sexy's Physical Health Cooperative

Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts

Economics and Black Gay Men

Can We Text?

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* 5. Each of the featured articles in the Guide provided a link for you to follow-up and provide feedback and/or obtain further information. Using the ratings scale below, please indicate for each article the likelihood you will follow-up using the contact information provided.

	Very Unlikely	Unlikely	Likely	Very Likely	Already Followed-up
New Website for Chicago Black Gay Men's Caucus	New Website for Chicago Black Gay Men's Caucus Very Unlikely	New Website for Chicago Black Gay Men's Caucus Unlikely	New Website for Chicago Black Gay Men's Caucus Likely	New Website for Chicago Black Gay Men's Caucus Very Likely	New Website for Chicago Black Gay Men's Caucus Already Followed-up
Healthy is Sexy's Physical Health Cooperative	Healthy is Sexy's Physical Health Cooperative Very Unlikely	Healthy is Sexy's Physical Health Cooperative Unlikely	Healthy is Sexy's Physical Health Cooperative Likely	Healthy is Sexy's Physical Health Cooperative Very Likely	Healthy is Sexy's Physical Health Cooperative Already Followed-up
A Call to Action for Chicago's House/Ball Community	A Call to Action for Chicago's House/Ball Community Very Unlikely	A Call to Action for Chicago's House/Ball Community Unlikely	A Call to Action for Chicago's House/Ball Community Likely	A Call to Action for Chicago's House/Ball Community Very Likely	A Call to Action for Chicago's House/Ball Community Already Followed-up
Economics and Black Gay Men	Economics and Black Gay Men Very Unlikely	Economics and Black Gay Men Unlikely	Economics and Black Gay Men Likely	Economics and Black Gay Men Very Likely	Economics and Black Gay Men Already Followed-up
Can We Text?	Can We Text? Very Unlikely	Can We Text? Unlikely	Can We Text? Likely	Can We Text? Very Likely	Can We Text? Already Followed-up
Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts	Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts Very Unlikely	Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts Unlikely	Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts Likely	Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts Very Likely	Black Gay/Bisexual Men in the Crosshairs of State Budget and Medicaid Cuts Already Followed-up

If you would like to provide detail on your rating of the likelihood you would use each service, please use the space below.

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* 6. The HIS Lifestyle Guide provides a list of resources showing where black gay/bisexual men can receive culturally sensitive health care services. Overall, how helpful/useful did you find the resource guide?

Very Unhelpful

Unhelpful

Helpful

Very Helpful

Don't Know/Refused

If you would like to provide detail on your rating of the helpfulness of the Guide's list of culturally sensitive resources, please use the space below.

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* 7. For each of the resources listed at the end of the Guide, contact information is provided for you to inquire about services or to make an appointment. Using the ratings scale below, please indicate for each type of resource listed, how likely it is you will contact one of the providers in that service category for information or to make an appointment.

	Very Unlikely	Unlikely	Likely	Very Likely	Already Contacted
Health and Wellness	Health and Wellness Very Unlikely	Health and Wellness Unlikely	Health and Wellness Likely	Health and Wellness Very Likely	Health and Wellness Already Contacted
Medical and Health Centers	Medical and Health Centers Very Unlikely	Medical and Health Centers Unlikely	Medical and Health Centers Likely	Medical and Health Centers Very Likely	Medical and Health Centers Already Contacted
STD/HIV Screening and Support Services	STD/HIV Screening and Support Services Very Unlikely	STD/HIV Screening and Support Services Unlikely	STD/HIV Screening and Support Services Likely	STD/HIV Screening and Support Services Very Likely	STD/HIV Screening and Support Services Already Contacted
Substance Abuse and Treatment	Substance Abuse and Treatment Very Unlikely	Substance Abuse and Treatment Unlikely	Substance Abuse and Treatment Likely	Substance Abuse and Treatment Very Likely	Substance Abuse and Treatment Already Contacted

If you would like to provide detail on your rating of the likelihood you will contact one of the agencies listed in each resource category, please use the space below.

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* 8. Please use the space below to provide any additional information/feedback about the HIS Lifestyle Guide that you think will help us improve the design, content or usefulness of the Guide.

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* 9. To help us understand who we are reaching with the HIS Lifestyle Guide, the next few questions ask for some demographic information. Please indicate your age in years:

Age:

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* 10. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 11. What is your race/ethnicity (check all that apply)?

African-American/Black

Hispanic/Latino

White/Caucasian

Asian/Pacific Islander

Native American/Alaskan Native

Middle Eastern

Other (please specify)

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* 12. Do you think of yourself as:

Gay or "same sex loving"

Bisexual

Heterosexual or "straight"

Other (please specify)