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. Author manuscript; available in PMC: 2015 Jun 8.
Published in final edited form as: Am J Audiol. 2010 Jul 1;19(2):109–125. doi: 10.1044/1059-0889(2010/09-0027)
As a result of these classes…

Become
worse
Stayed
the same
Become a
little better
Become a
lot better

1. My ability to lipread has 1 2 3 4

2. My ability to understand speech in quiet has 1 2 3 4

3. My ability to understand speech in noise has 1 2 3 4

4. My ability to communicate with others has 1 2 3 4

5. If you would have had to pay for these classes, think about how much money you believe these 5 classes were worth
 in relation to other services that you pay for:
  1. $0 per class

  2. $5 per class ($25 for the 5-week course)

  3. $10 per class ($50 for the 5-week course)

  4. $15 per class ($75 for the 5-week course)

  5. $20 per class ($100 for the 5-week course)

  6. More than $20 per class

6. If you had the opportunity to continue taking these classes, how much would you be willing to pay?
  1. $0 per class

  2. $5 per class ($25 for the 5-week course)

  3. $10 per class ($50 for the 5-week course)

  4. $15 per class ($75 for the 5-week course)

  5. $20 per class ($100 for the 5-week course)

  6. More than $20 per class

  7. None of the above. I would not be interested in taking more classes.

7. Which statement best describes your feelings about this course?
  1. I did not enjoy the course, and I did not learn much.

  2. I did not enjoy the course, but I did learn some new skills.

  3. I enjoyed the course, but I did not learn much.

  4. I enjoyed the course, and I did learn some new skills.

Please rate how important each aspect of the course was to you:

Did
not occur
Not
important
A little
important
Somewhat
important
Very
important

8. Being with other people who have similar
 hearing problems as me
1 2 3 4 5

9. Learning how others with hearing loss cope 1 2 3 4 5

10. Understanding the feelings that others have
 about their hearing loss
1 2 3 4 5