Assignment Five--Part One

Assignment Five--Part One

Short Survey of the Weight-Loss Support Group in Rural Saskatchewan

Original Version

November 20, 2009

Group Membership Survey



Janelle R. Christensen
University of Saskatchewan







In Partial Fulfilment of the Course:

ECUR 809.3 (01): Introduction to Program Evaluation

November 12, 2009

Introduction:

On the following four pages, there are several questions that ask you about you and your membership in the #### group to which you belong. The purpose of the survey is to obtain an overview of your perceptions of what it is like to belong to the group that you do. Your opinions will be used to help your group as a whole as you assist each other on your weight-loss journey. Please answer all questions as best you can. Only the program evaluator, namely Janelle Christensen, will see the results of the individual surveys. However, a summary of the results will be provided to your group once the course for which Janelle is completing this assignment has finished in December 2009.


How long have you been a member of ####? ______years and/or ______months



What was your main reason for joining #### when you initially joined the group?




What did you know about #### before becoming a member?




What kind of roles have you played in the last 3 months and before then in ####? (Circle YES or NO in each column for each item).


Past 3 Months
Before Then


a) Attend weekly meetings regularly

YES
NO
YES
NO
b) Talk at meetings (make comments, express ideas, etc.)

YES
NO
YES
NO
c) Help organize activities (other than meetings)

YES
NO
YES
NO
d) Participate in ####-related activities outside of meetings

YES
NO
YES
NO
e) Planned and lead one or more programs for a meeting

YES
NO
YES
NO

Group Functioning

1. What a group accomplishes is often dependent upon how the group functions. Think about the way your #### group works and how effective you think the group is in the following ways. Please rate each item from 1 (Low) to 5 (High) by circling the number that best describes your position. Circle U if you are uncertain or can’t answer.

Effectiveness of the group in:

Low Moderate High Uncertain

a) Listening to everyone’s perspective 1 2 3 4 5 U

b) Creating mutual respect, 1 2 3 4 5 U
understanding, and trust within the
group

c) Building a clear purpose (members 1 2 3 4 5 U
know what the purpose of the group is)

d) Providing effective leadership 1 2 3 4 5 U

e) Conducting meetings that accomplish 1 2 3 4 5 U
what is necessary

f) Carrying out planned actions 1 2 3 4 5 U

g) Orienting new members 1 2 3 4 5 U

h) Celebrating progress 1 2 3 4 5 U

i) Identifying and using members’ 1 2 3 4 5 U
skills and talents

j) Making decisions accepted by all 1 2 3 4 5 U
members

2. Please indicate your perceptions of the group using a 5-point scale from 1 (Infrequently) to 5 (All the time). Circle the number which best describes your position.

Infrequently Sometimes All the Time

a) My viewpoint is heard 1 2 3 4 5

b) I am viewed as a valued 1 2 3 4 5
member

c) I feel comfortable in the 1 2 3 4 5
group

d) I am satisfied with the 1 2 3 4 5
group’s progress




3. What is the most significant impact that membership in this group has had for you?










4. In your opinion, what could be done to improve the group’s effectiveness?
















Impact/Influence on Group Members

1. Your membership and participation in #### may have influenced your personal knowledge, beliefs, or skills. Please indicate this group’s IMPACT INFLUENCE ON YOU by rating each item below on a scale from 1 (low impact/influence) to 5 (high impact/influence. Circle the number which best describes your position. If you are uncertain/unsure about any of these effects, please circle U.

To what extent does the #### group to which you belong have an IMPACT/INFLUENCE on you with respect to:

Low Moderate High Uncertain

a) Your knowledge of portion control 1 2 3 4 5 U

b) Your understanding of serving sizes 1 2 3 4 5 U

c) Your understanding of others’ 1 2 3 4 5 U
perspectives

d) Your understanding of the 1 2 3 4 5 U
importance of support in the group

e) Your ability to read and understand 1 2 3 4 5 U
food labels

f) Your ability to monitor your own 1 2 3 4 5 U
behaviour, including food choices
and physical activity

g) Your knowledge of stress 1 2 3 4 5 U
management strategies and techniques



2. What is the greatest impact that being part of this specific #### has had upon YOU as an individual?







Thank you for your participation.