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How We View Dementia

1.	Age
	Under 30 30-39 40-49 50-59 60-69 70-79 80-89 90+
2.	Gender
	Male Female
3.	How are you affected by dementia? Check all that apply.
	I have been diagnosed with dementia I have or have had a family member diagnosed with dementia I am living with someone who has dementia I'm a caregiver I'm a health professional (MD/RN/OT/Pharmacist/etc.) I'm a researcher/professor My line of work deals with geriatrics/gerontology My life has not been touched personally by dementia
4.	Select three emotions you felt while watching the video.
	Depressed Anxious Disturbed Angry Frustrated Lighthearted Annoyed Amused Joyous Hopeful Neutral/Nothing Specific Other
4.1.	Other emotion:

5.	Select three words that best describe what you saw.
	Dramatic Heartwarming Heartbreaking Comforting Enjoyable Boring Painful Entertaining Educational Eye opening Other
5.1.	Other descriptive word.

6.	Did you find what you watched to be a useful way to explore or educate yourself on dementia?
	Not at all Somewhat For the most part, yes Definitely
7.	Did the video hold your attention?
	Not at all Somewhat Yes, but I lost track in a few places Yes, I was easily able to follow along
8.	Do you think humour is appropriate in videos of subject matter such as the one you watched?
	Never in this kind of a situation As long as the humour is tasteful Yes, but it depends on the context (please explain below). More please, life is all about ups and downs, humour and sadness, it reflects reality
8.1.	What context?

9.	Would you have preferred to read about dementia rather than watch videos?
	Yes No
9.1.	Why/Why not?

10.	Was the format of the video you watched interesting or could there have been another way to portray the information?
	Yes No
10.1.	Why/Why Not?

11.	What did you like about what you watched?

12.	What didn't you like about what you watched?

13.	What could make what you watched more appealing?

14.	Who would you recommend this piece to? Check all that apply.
	Dementia patients Family members of dementia patients Caregivers Medical and health professionals Those who aren't familiar with dementia
15.1.	Tell us how strongly you can relate and understand the emotions and feelings portrayed in these videos in comparison to your own experiences.
	Can't relate to many of the stories or anecdotes at all There are some aspects that are similar to my experiences but not many There are many similarities in the video that I experience or have experienced I can closely relate to the subject matter, the feelings and emotions that are portrayed
15.1.1.	Tell us how the emotions and stories you watched related to your own experiences in caregiving for someone with dementia.

15.2.	Do you feel that sharing stories is an important part of caring for people with dementia?
	Yes No
15.2.1.	Why/Why not?

15.3.	What do you think publishing memoirs about personal struggles with dementia?
	It's distasteful to share personal trials and tribulations It is a tedious to view It's a good resource to have Thank goodness we have authors willing to share their stories!
15.4.	Do you feel these video are an accurate portrayal of life for the caregivers, family and for the person who has the disease?
	Not in the slightest Only slightly Yes, somewhat accurate Extremely accurate
15.4.1.	Why/Why not?

15.5.	Do you think it would be beneficial for you as a caregiver to watch more videos about dementia?
	No, I deal with it enough No, I'm not very interested Yes, occasionally I love to, I find it therapeutic and educational
15.5.1.	Other thoughts?

16.1.	Did this video accurately portray the events and experiences of dementia patients you treat?
	Not at all similar A few similarities Quite similar Very similar
16.1.1.	How is it similar or how is it not at all accurate?

16.2.	Did this video accurately portray the events and experiences of any research you've studied?
	Not at all similar A few similarities Quite similar Very similar
16.2.1.	How is it similar or how is it not at all accurate?

16.3.	Are these types of case stories useful to your profession?
	Yes No
16.3.1.	Why/Why Not?

16.4.	Your work deals mainly with...
	The social symptoms of dementia The biological symptoms of dementia Other
16.4.1.	Please elaborate.

16.5.	Sharing personal stories such as those in the video is...
	Not very helpful to me Somewhat helpful to me Quite helpful An excellent resource for me
17.1.	Were you disturbed by the subject matter and the experiences portrayed in the video?
	Yes, I feel that the subject of dementia is unpleasant I did find myself feeling somewhat uncomfortable I was interested in the people and the subject matter I was not at all uncomfortable and empathized with the emotions and experiences
17.2.	How much do you know about dementia?
	Very little I might be able to recognize some signs and symptoms of dementia I understand somewhat how it affects families I can completely understand and empathize with the effects of dementia on individuals and families
17.3.	After watching do you think you might become more aware dementia signs and symptoms?
	Yes No
17.3.1.	Why/Why not?

17.4.	Before watching, were you alert for signs that you or a loved one is developing dementia?
	Yes No
17.4.1.	Why/Why Not?

17.5.	After watching the video, will your attitude toward dementia change?
	Yes No
17.5.1.	Why/Why Not?

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