NORTH AMERICAN EDUCATION PROGRAM

PROGRAM OUTCOME SURVEY

In an effort to make future North American Education Programs as useful as possible to you and others, we inviteyour opinion about the program you recently attended. Your feedback will help staff design and improve programs to best meet the needs of people living with MS. Please return this survey at the end of this programor visit complete online. Thank you for taking the time to provide your feedback.

  1. What is your relationship to MS?

a. ___ Person with MS e. ___ Healthcare provider

b. ___ Spouse/Partnerf. ___ Other, please describe

c. ___ Family member/friend

  1. Approximately how long have you (or the person you care about) been diagnosed with MS?
  1. __ Less than two yearsc. __ 5-10 years
  2. __ 2–5yearsd. __ More than 10 years
  1. Was this a:___ Chapter-sponsored program (i.e. annual meeting, research symposium, etc.)
    ___ Self-help Group meeting

4. Please respond to the following statements by checking the box most descriptive of your response.

As a result of attending this program….. /

Strongly Agree

/ Agree / Disagree / Disagree
Strongly / No opinion
Don’t Know
I have a better understanding of the different factors that can complicate medical decision making.
I have a better understanding of why it’s important to start disease modifying treatment and manage symptoms.
I have a better understanding of why treatments options vary so greatly for people with primary progressive MS.
I have a better understanding of how to interpret benefits and risks for treatment and disease management options.
I learned about different choices I can make, including nutrition and exercise, that have a long term impact on disease management.
  1. I plan to discusstreatment and lifestyle choices with a member of my healthcare team.

It was worthwhile attending this program.

5. In what way do you think this program might impact your quality of life? ______

______

6. Additional comments or suggestions? ______

7. What topics would be of interest for future North American Education Programs? ______

8. Age: ______9. Gender: ___ Female___ Male 10. City/State: ______

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