H2S ADVISORS’ RELATIONAL SKILLS QUESTIONNAIRE

Please do not write your name on this form. It is completely anonymous and confidential. Your Help2Change Advisor really appreciates your honest feedback.

The Advisor will not know who has said what, but will see the overall results to help improve the service he/she provides.

Please READ EACH STATEMENT CAREFULLY. Your response for each comment can range from 1(Poor) to 5(Excellent), depending on how well you rate your Advisor’s performance.

FOR EACH COMMENT, PLEASE CIRCLE ONE NUMBER ON EACH LINE

Poor / Fair / Good / Very
Good / Excellent
1 / My overall satisfaction with this Advisor is … / 1 / 2 / 3 / 4 / 5
2 / The welcome the Advisor gave me was … / 1 / 2 / 3 / 4 / 5
3 / I would rate the Advisor’s ability to really listen to me as… / 1 / 2 / 3 / 4 / 5
4 / The Advisor’s explanation of things to me was … / 1 / 2 / 3 / 4 / 5
5 / The extent to which I felt reassured by the Advisor was … / 1 / 2 / 3 / 4 / 5
6 / My confidence in this Advisor’s ability is … / 1 / 2 / 3 / 4 / 5
7 / The opportunity the Advisor gave me to express my concerns or fears was … / 1 / 2 / 3 / 4 / 5
8 / The respect shown to me by this Advisor was … / 1 / 2 / 3 / 4 / 5
9 / The amount of time given to me by this Advisor was … / 1 / 2 / 3 / 4 / 5
10 / This Advisor’s consideration of my personal progress in doing the Help2Slim programme was … / 1 / 2 / 3 / 4 / 5
11 / The Advisor’s concern for me as a person was … / 1 / 2 / 3 / 4 / 5
12 / The recommendation I would give my friends about this Advisor would be … / 1 / 2 / 3 / 4 / 5

Adapted from Greco.M.et al.(2001) The Doctor’s Interpersonal Skills Questionnaire (DISQ)

Thank you for your help

PLEASE PUT THIS SHEET INTO THE ENVELOPE PROVIDED. SEAL THE ENVELOPE AND RETURN IT TO YOUR ADVISOR.