Dementia Module 1 Survey

When answering the questions below, please consider the module, toolbox, and other module materials presented.

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 with "Up the Pyramid" before and after Completing Module 1?

	Strongly Disagree	Disagree	Neither	Agree	Strongly Agree
Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia.	Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Strongly Disagree	Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Disagree	Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Neither	Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Agree	Before taking the Introduction to Dementia Skills training, I was aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Strongly Agree
After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia.	After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Strongly Disagree	After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Disagree	After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Neither	After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Agree	After taking the Introduction to Dementia Skills training, I am aware that as we climb the Pyramid of survival, security, belonging, esteem and fulfillment, quality of life increases when care for people with dementia. Strongly Agree

Question Title

* 3. Please rate your level of knowledge before and after completing Module 1.

	Slightly knowledgeable	Moderately knowledgeable	Very knowledgeable
Before taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia	Before taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Slightly knowledgeable	Before taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Moderately knowledgeable	Before taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Very knowledgeable
After taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia	After taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Slightly knowledgeable	After taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Moderately knowledgeable	After taking the Introduction to Dementia Skills training, at what level would you rate your knowledge of caring for people with dementia Very knowledgeable

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?