Public Health Nutrition Education Impact Survey
Help us evaluate the effectiveness of our nutrition education program by sharing your experience and feedback.
Participant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age Group
*
Please Select
Under 18
18-24
25-34
35-44
45-54
55-64
65 or older
Gender
*
Female
Male
Non-binary/Third gender
Prefer not to say
Other
Highest Level of Education Completed
*
Please Select
Primary School
High School
Associate Degree
Bachelor's Degree
Master's Degree or higher
How would you rate your knowledge of nutrition before and after attending the education program?
*
Rows
Before Program
After Program
Very Poor
1
2
Poor
3
4
Average
5
6
Good
7
8
Excellent
9
10
How often do you practice the following healthy nutrition behaviors?
*
Rows
Before Program
After Program
Eat vegetables daily
Never
Rarely
Sometimes
Often
Always
Never
Rarely
Sometimes
Often
Always
Limit sugary drinks
Never
Rarely
Sometimes
Often
Always
Never
Rarely
Sometimes
Often
Always
Read nutrition labels
Never
Rarely
Sometimes
Often
Always
Never
Rarely
Sometimes
Often
Always
Choose whole grains
Never
Rarely
Sometimes
Often
Always
Never
Rarely
Sometimes
Often
Always
Control portion sizes
Never
Rarely
Sometimes
Often
Always
Never
Rarely
Sometimes
Often
Always
How satisfied are you with the nutrition education program?
*
1
2
3
4
5
Which topics did you find most useful? (Select all that apply)
Balanced diet principles
Meal planning
Reading food labels
Healthy cooking methods
Managing special diets (e.g., diabetes, hypertension)
Other
On a scale of 1 to 10, how likely are you to recommend this nutrition education program to others?
*
Not at all likely
1
2
3
4
5
6
7
8
9
Extremely likely
10
1 is Not at all likely, 10 is Extremely likely
Please share any additional comments or suggestions to improve our nutrition education program.
Submit Survey
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