GRAAHI Website Usage Evaluation

Your feedback is considered very valuable to us and your input is considered confidential.

For each statement, please rate your knowledge of this subject before today’s experience and after today’s experience on a scale of 1 – 5 with 1 being “no knowledge” and 5 being “very knowledgeable”.

1. I know the difference between health disparities and health care disparities
BEFORE website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
AFTER website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
2. I know at least 3 factors that contribute to health disparities.
BEFORE website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
AFTER website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
3. I know the leading cause of death in the African American population.
BEFORE website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
AFTER website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
4. I recognize what I can do to help make health equaility a reality.
BEFORE website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable
AFTER website experience
No Knowledge
Limited Knowledge
Somewhat Knowledgeable
Average Amount of Knowledge
Very Knowledgeable

Customer Satisfaction
5. Did you explore GRAAHI's website?
Yes: No:
6. Was GRAAHI's website easy to use?
Yes: No:
If not, what suggestions can you give us?
7. Did you find the available information in the website useful?
Yes: No:
If not, what additional information would be useful to you?
8. What suggestions would you make to improve your experience using the website?

Please fill out the following information for our records:
1) I am:
Male
Female
2) Age:    
3) Race/Ethnicity
Caucasian/White
African American/Black
Asian
Pacific Islander
Hispanic/Latino
Native American
Multi Racial:
Other:
4) Home zip code:
5) Do you have a place where you get regular medical care (like a doctor or a clinic?)
No Yes If Yes, name the doctor or clinic:
6) What kind of insurance do you have?
Medicare
 Medicaid
Self Pay or No Insurance
Private/Employer (Such as Blue Cross, Priority Health, Grand Valle
Other:
    

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