Critical Health and Racial Literacy (CHRL) for PENs Pre-Training Survey

Introduction

The purpose of this survey is to gather baseline information about your knowledge and skills related to health issues in African, Caribbean, and Black (ACB) communities, as well as your motivations and goals for participating in the CHRL training program for Peer Equity Navigators (PENs). The survey should take only 5–10 minutes to complete. All responses will remain strictly confidential and will be used only for evaluation purposes.

Question Title

1. What is your age group? (Required.)

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Pefer not to answer

Question Title

2. What best describes your current gender identity? (Required.)

Woman

Man

Two-Spirit

Non-Binary, Genderqueer, Agender, or similar identity

Trans-Woman

Trans-Man

Prefer not to answer

Other gender identity (please specify)

Question Title

3. What category best describes you? (Required.)

Black (African, African Canadian, Afro-Caribbean descent)

East Asian (Chinese, Japanese, Korean, Taiwanese descent)

Latin American (Hispanic or Latin American descent)

Middle Eastern (Arab, Persian, West Asian descent (e.g Afghan, Egyptian, Iranian, Kurdish, Lebanese, Turkish))

South Asian (South Asian descent (e.g. Bangladesh, Indian, Indo-Caribbean, Pakistani, Sri Lankan))

Southeast Asian (Cambodian, Filipino, Indonesian, Thai, Vietnamese, Southeast Asian descent)

White (European descent)

Another race category (Includes values not described above)

Do not know (Not applicable)

Prefer not to answer (Not applicable)

Other origin (please specify)

Question Title

4. What is the highest level of school you have completed or the highest degree you have received? (Required.)

Less than high school degree

High school degree or equivalent

Some college but no degree

Community college or trade certificate

Bachelor degree

Graduate degree

Other (please specify)

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5. What is your current (or previous) occupation (Required.)

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6. In what sector(s) are you working?
Select all that apply (Required.)

Health

Social services

Community

Education

Other (please specify)

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7. Have you previously worked or volunteered in the ACB community? (Required.)

Yes

If yes, please describe

Question Title

8. Do you require any accomodation(s) in your training or work activities? (Required.)

Yes

If yes, please describe

Knowledge

Question Title

9. On a scale from 'none/very low' to 'very high', how would you assess your knowledge/understanding of the following areas (Required.)

	None/Very low	Low	Moderate	High	Very high
History of ACB communities in Canada	History of ACB communities in Canada None/Very low	History of ACB communities in Canada Low	History of ACB communities in Canada Moderate	History of ACB communities in Canada High	History of ACB communities in Canada Very high
Historical roots of racism in Canada	Historical roots of racism in Canada None/Very low	Historical roots of racism in Canada Low	Historical roots of racism in Canada Moderate	Historical roots of racism in Canada High	Historical roots of racism in Canada Very high
Health status and problems in ACB communities	Health status and problems in ACB communities None/Very low	Health status and problems in ACB communities Low	Health status and problems in ACB communities Moderate	Health status and problems in ACB communities High	Health status and problems in ACB communities Very high
Social Determinants of Health (SDoH)	Social Determinants of Health (SDoH) None/Very low	Social Determinants of Health (SDoH) Low	Social Determinants of Health (SDoH) Moderate	Social Determinants of Health (SDoH) High	Social Determinants of Health (SDoH) Very high
HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.)	HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.) None/Very low	HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.) Low	HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.) Moderate	HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.) High	HIV/AIDS prevention and care (e.g., ART, PrEP, testing, PEP, etc.) Very high
Lived experience of individuals with HIV/AIDS	Lived experience of individuals with HIV/AIDS None/Very low	Lived experience of individuals with HIV/AIDS Low	Lived experience of individuals with HIV/AIDS Moderate	Lived experience of individuals with HIV/AIDS High	Lived experience of individuals with HIV/AIDS Very high
Health literacy	Health literacy None/Very low	Health literacy Low	Health literacy Moderate	Health literacy High	Health literacy Very high
Critical health literacy	Critical health literacy None/Very low	Critical health literacy Low	Critical health literacy Moderate	Critical health literacy High	Critical health literacy Very high
Anti-oppressive practices in healthcare settings	Anti-oppressive practices in healthcare settings None/Very low	Anti-oppressive practices in healthcare settings Low	Anti-oppressive practices in healthcare settings Moderate	Anti-oppressive practices in healthcare settings High	Anti-oppressive practices in healthcare settings Very high
Unconscious bias and its impacts	Unconscious bias and its impacts None/Very low	Unconscious bias and its impacts Low	Unconscious bias and its impacts Moderate	Unconscious bias and its impacts High	Unconscious bias and its impacts Very high
Critical racial literacy	Critical racial literacy None/Very low	Critical racial literacy Low	Critical racial literacy Moderate	Critical racial literacy High	Critical racial literacy Very high
Cultural competence and safety in healthcare settings	Cultural competence and safety in healthcare settings None/Very low	Cultural competence and safety in healthcare settings Low	Cultural competence and safety in healthcare settings Moderate	Cultural competence and safety in healthcare settings High	Cultural competence and safety in healthcare settings Very high
Canada’s health care system	Canada’s health care system None/Very low	Canada’s health care system Low	Canada’s health care system Moderate	Canada’s health care system High	Canada’s health care system Very high
ACB community and public health stakeholder groups	ACB community and public health stakeholder groups None/Very low	ACB community and public health stakeholder groups Low	ACB community and public health stakeholder groups Moderate	ACB community and public health stakeholder groups High	ACB community and public health stakeholder groups Very high
Policies and practices to improve health equity	Policies and practices to improve health equity None/Very low	Policies and practices to improve health equity Low	Policies and practices to improve health equity Moderate	Policies and practices to improve health equity High	Policies and practices to improve health equity Very high
Where to access health resources to share with ACB communities	Where to access health resources to share with ACB communities None/Very low	Where to access health resources to share with ACB communities Low	Where to access health resources to share with ACB communities Moderate	Where to access health resources to share with ACB communities High	Where to access health resources to share with ACB communities Very high

Skills

Question Title

10. On a scale from 'none/very low' to 'very high', how would you assess your ability in the following areas (Required.)

	None/Very low	Low	Moderate	High	Very high
ACB community engagement	ACB community engagement None/Very low	ACB community engagement Low	ACB community engagement Moderate	ACB community engagement High	ACB community engagement Very high
Health promotion	Health promotion None/Very low	Health promotion Low	Health promotion Moderate	Health promotion High	Health promotion Very high
Asset-based community development	Asset-based community development None/Very low	Asset-based community development Low	Asset-based community development Moderate	Asset-based community development High	Asset-based community development Very high
Civic engagement (e.g., taking local action)	Civic engagement (e.g., taking local action) None/Very low	Civic engagement (e.g., taking local action) Low	Civic engagement (e.g., taking local action) Moderate	Civic engagement (e.g., taking local action) High	Civic engagement (e.g., taking local action) Very high
Working with individual/communities impacted by HIV	Working with individual/communities impacted by HIV None/Very low	Working with individual/communities impacted by HIV Low	Working with individual/communities impacted by HIV Moderate	Working with individual/communities impacted by HIV High	Working with individual/communities impacted by HIV Very high
Leadership	Leadership None/Very low	Leadership Low	Leadership Moderate	Leadership High	Leadership Very high
Advocacy	Advocacy None/Very low	Advocacy Low	Advocacy Moderate	Advocacy High	Advocacy Very high
Capacity-building (e.g., raising awareness, education)	Capacity-building (e.g., raising awareness, education) None/Very low	Capacity-building (e.g., raising awareness, education) Low	Capacity-building (e.g., raising awareness, education) Moderate	Capacity-building (e.g., raising awareness, education) High	Capacity-building (e.g., raising awareness, education) Very high
Implementing anti-racist policies, procedures and practices	Implementing anti-racist policies, procedures and practices None/Very low	Implementing anti-racist policies, procedures and practices Low	Implementing anti-racist policies, procedures and practices Moderate	Implementing anti-racist policies, procedures and practices High	Implementing anti-racist policies, procedures and practices Very high
Creating culturally safe spaces	Creating culturally safe spaces None/Very low	Creating culturally safe spaces Low	Creating culturally safe spaces Moderate	Creating culturally safe spaces High	Creating culturally safe spaces Very high

Motivation for Training

Question Title

11. Where did you first hear about the Critical Health and Racial Literacy training (CHRL for PENs) program?
Select all that apply. (Required.)

CO-CREATH Social media (Facebook, Twitter, LinkedIn, Instagram, etc.)

Company/organization website

Word of mouth

Email newsletter

Online advertisement

Flyer or poster

News article or blog post

Event or conference

Radio or podcast advertisement

Television advertisement

Educational institution (e.g., university, college, training center)

Professional association or group

Search engine results

Direct mail or brochure

Other (please specify)

Question Title

12. What motivated you to apply to the CHRL-PENs training program?
Select all that apply. (Required.)

Acquiring new skills or knowledge.

A workplace requirement.

Enhancing your resume or professional qualifications.

Gaining practical experience.

Seeking personal growth and self-improvement.

Contributing closing the health equity gap that you care about.

Achieving a certification.

Accessing new culturally competent resources.

Looking for a change in career or career advancement.

Enjoyment.

Other (please specify)

Question Title

13. How easy was it to apply to the program? (Required.)

Very difficult

Difficult

Neutral

Easy

Very easy

Very difficult

Difficult

Neutral

Easy

Very easy

Question Title

14. What are you hoping to achieve from participating in the program?
Select all that apply. (Required.)

Acquiring new skills or knowledge.

Enhancing your resume or professional qualifications.

Gaining practical experience.

Seeking personal growth and self-improvement.

Contributing closing the health equity gap that you care about.

Achieving a certification.

Accessing new culturally competent resources.

Looking for a change in career or career advancement.

Enjoyment.

Other (please specify)

Goals

Question Title

15. On a scale from 'strongly disagree' to 'strongly agree', how would you rate the following statements (Required.)

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
I have a clear understanding of the expectations of the training program	I have a clear understanding of the expectations of the training program Strongly disagree	I have a clear understanding of the expectations of the training program Disagree	I have a clear understanding of the expectations of the training program Neutral	I have a clear understanding of the expectations of the training program Agree	I have a clear understanding of the expectations of the training program Strongly agree
I have a clear understanding of the role of PENS as advocates and change makers in their communities	I have a clear understanding of the role of PENS as advocates and change makers in their communities Strongly disagree	I have a clear understanding of the role of PENS as advocates and change makers in their communities Disagree	I have a clear understanding of the role of PENS as advocates and change makers in their communities Neutral	I have a clear understanding of the role of PENS as advocates and change makers in their communities Agree	I have a clear understanding of the role of PENS as advocates and change makers in their communities Strongly agree
I understand my role to facilitate ACB community members access to health information	I understand my role to facilitate ACB community members access to health information Strongly disagree	I understand my role to facilitate ACB community members access to health information Disagree	I understand my role to facilitate ACB community members access to health information Neutral	I understand my role to facilitate ACB community members access to health information Agree	I understand my role to facilitate ACB community members access to health information Strongly agree

Critical Health and Racial Literacy (CHRL) for PENs Pre-Training Survey

Introduction

Question Title

* 1. What is your age group? (Required.)

Question Title

* 2. What best describes your current gender identity? (Required.)

Question Title

* 3. What category best describes you? (Required.)

Question Title

* 4. What is the highest level of school you have completed or the highest degree you have received? (Required.)

Question Title

* 5. What is your current (or previous) occupation (Required.)

Question Title

* 6. In what sector(s) are you working?Select all that apply (Required.)

Question Title

* 7. Have you previously worked or volunteered in the ACB community? (Required.)

Question Title

* 8. Do you require any accomodation(s) in your training or work activities? (Required.)

Question Title

* 9. On a scale from 'none/very low' to 'very high', how would you assess your knowledge/understanding of the following areas (Required.)

Question Title

* 10. On a scale from 'none/very low' to 'very high', how would you assess your ability in the following areas (Required.)

Question Title

* 11. Where did you first hear about the Critical Health and Racial Literacy training (CHRL for PENs) program?Select all that apply. (Required.)

Question Title

* 12. What motivated you to apply to the CHRL-PENs training program? Select all that apply. (Required.)

Question Title

* 13. How easy was it to apply to the program? (Required.)

Question Title

* 14. What are you hoping to achieve from participating in the program? Select all that apply. (Required.)

Question Title

* 15. On a scale from 'strongly disagree' to 'strongly agree', how would you rate the following statements (Required.)

1. What is your age group? (Required.)

2. What best describes your current gender identity? (Required.)

3. What category best describes you? (Required.)

4. What is the highest level of school you have completed or the highest degree you have received? (Required.)

5. What is your current (or previous) occupation (Required.)

6. In what sector(s) are you working?
Select all that apply (Required.)

7. Have you previously worked or volunteered in the ACB community? (Required.)

8. Do you require any accomodation(s) in your training or work activities? (Required.)

9. On a scale from 'none/very low' to 'very high', how would you assess your knowledge/understanding of the following areas (Required.)

10. On a scale from 'none/very low' to 'very high', how would you assess your ability in the following areas (Required.)

11. Where did you first hear about the Critical Health and Racial Literacy training (CHRL for PENs) program?
Select all that apply. (Required.)

12. What motivated you to apply to the CHRL-PENs training program?
Select all that apply. (Required.)

13. How easy was it to apply to the program? (Required.)

14. What are you hoping to achieve from participating in the program?
Select all that apply. (Required.)

15. On a scale from 'strongly disagree' to 'strongly agree', how would you rate the following statements (Required.)