Dementia Module 3 Survey

Question Title

* 1. What is your role in working with persons with dementia?

Family caregiver

Certified Family Home Provider

Case manager, care coordinator

Direct care worker

Health care provider

First responder

Community business

Other (please specify)

Question Title

* 2. What was your level of awareness of the Describe, Investigate, Create and Evaluate (DICE) tool before and after completing Dementia Module 3?

	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia.	Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Strongly Disagree	Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Disagree	Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Neither	Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Agree	Before taking the Preparing for Communication dementia skills training, I was aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Strongly Agree
After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia.	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Strongly Disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Disagree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Neither	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Agree	After taking the Providing Safe and Comfortable Care dementia skills training, I am aware of the Describe, Investigate, Create and Evaluate (DICE) tool used to help understand nonverbal behavior when providing care for a person with dementia. Strongly Agree

Question Title

* 3. Please rate your ability to understand the needs of a person with dementia Before and After taking Module 3.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them.	Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them. Strongly disagree	Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them. Disagree	Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them. Neither agree nor disagree	Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them. Agree	Before taking the Preparing for Communication dementia skills training, I feel I could understand the needs of a person with dementia when providing care to them. Strongly agree
After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them.	After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them. Strongly disagree	After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them. Disagree	After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them. Neither agree nor disagree	After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them. Agree	After taking the Preparing for Communication dementia skills training, I feel I can understand the needs of a person with dementia when providing care to them. Strongly agree

Question Title

* 4. How likely are you to use the information presented in this module?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?

Question Title

* 5. How likely are you to recommend this module to others?

Not likely

Somewhat likely

Likely

Very likely

Not likely

Somewhat likely

Likely

Very likely

Comments?