NPRC Outcomes Evaluation

Peer End-User Survey1

Section 1. Introduction

The Administration for Community Living (ACL) is conducting an evaluation of the National Paralysis Resource 

Center (NPRC), which is implemented by the Reeve Foundation. The purpose of this evaluation is to learn more 

about the Reeve Foundation’s programs and what lessons can be learned to inform other ACL programs.

As part of this evaluation, ACL needs your help. You have been specially selected because you participated in the 

Reeve Foundation’s peer mentoring program. Your participation in this survey will ensure that the evaluation 

captures the full range of participants’ experiences with the Reeve Foundation programs and services.

Section 2. Program experience

(Required) Q1. In the past 12 months, have you received mentorship from one or more mentors requested 

through the Reeve Foundation?

a. Yes

b. No [GO TO END1]

Q2. How long ago was your first meeting with a peer mentor?

a. 6 months or less

b. More than 6 months ago but less than 1 year ago

c. 1-2 years ago

d. More than 2 years ago

(Required) Q3. Which of the following choices best described you when you requested a peer mentor? 

a. Someone living with paralysis

b. Caregiver to someone living with paralysis

Section 3. Peer mentoring outcomes

Q4. When you started participating in peer mentoring, what did you hope to achieve from participating in the Peer 

Mentor program? Choose up to three of the following answers.

[PROGRAMMER: USE HIDE OPTION LOGIC FOR FILL INS. UPON SELECTION, SHOW FILL INS FOR Q5 TO Q7.2] 

a. Better physical health [FILL IN TEXT: your physical health]

b. Better mental health [FILL IN TEXT: your mental health]

c. Learn about services for those living with paralysis [FILL IN TEXT: your knowledge about services for those 

living with paralysis]

d. Access services that could be helpful to me [FILL IN TEXT: your access to services that would be helpful for 

you]

e. Gain practical advice about living with paralysis (for example, about equipment or a medical condition) 

[FILL IN TEXT: your knowledge about practical tips for those living with paralysis]

f. Increase sense of control over decisions (empowerment) [FILL IN TEXT: your sense of control]

g. Feel more confident to take action to achieve life goals [FILL IN TEXT: your sense of confidence]

h. Greater independence [FILL IN TEXT: your independence]

i. Strengthen my support network [FILL IN TEXT: your support network]

j. Participate more in community life [FILL IN TEXT: your ability to participate in community life]

k. Other (Specify) [FILL IN TEXT: write in reason]

1 Unless flagged, questions are not required and will only get a soft prompt encouraging them to answer to the 

best of their ability.
The following questions will ask about the types of things you hoped to achieve from mentorship from the Peer 

Mentor program. We will also ask how you felt about these aspects of your life before and after being matched 

with a peer mentor.

Q5. [IF Q3=a, then FILL2=”your paralysis”; ELSE IF Q3=b, then FILL2=”paralysis in someone you care for”]

Thinking about your situation before being matched with a peer mentor, to what extent did [FILL2] affect

[PROGRAMMER: INSERT WITH FILL IN OF FIRST ORDERED SELECTION IN Q4].

1

Not at all

2 3 4

Somewhat

5 6 7

To a great extent

Q6. On a scale from 1 to 7, how was [PROGRAMMER: INSERT FILL IN TEXT OF FIRST ORDERED SELECTION IN Q4]

just before being matched with a peer mentor? 

1

Poor

2 3 4

Neutral

5 6 7

Excellent

Q7. On a scale from 1 to 7, how is [PROGRAMMER: INSERT FILL IN TEXT OF FIRST ORDERED SELECTION IN Q4] after

being matched with a peer mentor? 

1

Poor

2 3 4

Neutral

5 6 7

Excellent

Q5.1 [IF Q3=a, then FILL2=”your paralysis”; ELSE IF Q3=b, then FILL2=”paralysis in someone you care for”]

Thinking about your situation before being matched with a peer mentor, to what extent did [FILL2] affect

[PROGRAMMER: INSERT WITH FILL IN OF SECOND ORDERED SELECTION IN Q4]

1

Not at all

2 3 4

Somewhat

5 6 7

To a great extent

Q6.1 On a scale from 1 to 7, how was [PROGRAMMER: INSERT FILL IN TEXT OF SECOND ORDERED SELECTION IN 

Q4] just before being matched with a peer mentor? 

1

Poor

2 3 4

Neutral

5 6 7

Excellent

Q7.1 On a scale from 1 to 7, how is [PROGRAMMER: INSERT FILL IN TEXT OF SECOND ORDERED SELECTION IN Q4] 

after being matched with a peer mentor? 

1

Poor

2 3 4

Neutral

5 6 7

Excellent

Q5.2 [IF Q3=a, then FILL2=”your paralysis”; ELSE IF Q3=b, then FILL2=”paralysis in someone you care for”]

Thinking about your situation before being matched with a peer mentor, to what extent did [FILL2] affect

[PROGRAMMER: INSERT WITH FILL IN OF THIRD ORDERED SELECTION IN Q4]

1

Not at all

2 3 4

Somewhat

5 6 7

To a great extent

Q6.2 On a scale from 1 to 7, how was [PROGRAMMER: INSERT FILL IN TEXT OF THIRD ORDERED SELECTION IN Q4] 

just before being matched with a peer mentor? 

1

Poor

2 3 4

Neutral

5 6 7

Excellent

Q7.2 On a scale from 1 to 7, how is [PROGRAMMER: INSERT FILL IN TEXT OF THIRD ORDERED SELECTION IN Q4] 

after being matched with a peer mentor? 
1

Poor

2 3 4

Neutral

5 6 7

Excellent

Section 4. Background information

Q8. How old are you?

a. 18 to 24

b. 25 to 34

c. 35 to 44

d. 45 to 54

e. 55 to 64

f. 65 or over

Q9. Which of the following describes you? Select all that apply. 

a. American Indian/Alaska Native

b. Black/African American

c. Native Hawaiian/Pacific Islander

d. Asian

e. White/Caucasian

f. Some other race

99. Prefer not to answer

Q10. Are you of Hispanic, Latino, or Spanish origin or descent?

a. Yes

b. No

98. Don ́t know

99. Prefer not to answer

Q11. What is the highest level of school you have completed?

a. Less than high school

b. High school or equivalent

c. Some college/university, no degree

d. College or university degree

e. Postgraduate degree

Q12. What sex were you assigned at birth, on your original birth certificate?

a. Female

b. Male

98. Don’t know

99. Prefer not to answer

Q13. What is your current gender? 

a. Female

b. Male

c. Transgender

d. [If Q9=a] Two-Spirit

e. I use a different term. (OPEN ENDED)

98. Don’t know

99. Prefer not to answer

Q14. Which of the following best represents how you think of yourself? 

a. Lesbian or gay

b. Straight, that is, not gay or lesbian

c. Bisexual
d. [If Q9=a] Two-Spirit

e. I use a different term (Specify)

98. Don’t know

 99. Prefer not to answer

Q15. [IF Q3=a, then question=“Please provide the approximate date of the onset of paralysis.”;

ELSE IF Q3=b, then question=“Please provide the approximate date of your caregiving role.”]

[PROGRAMMER: CALENDAR QUESTION FORMAT MONTH/YEAR]

98. Don ́t know

Q16. [If Q3=a, then question=“What caused your paralysis? Select all that apply.”

Else if Q3=b, then question=“What caused the paralysis of the person you are providing care for? Select all that 

apply.]

a. Spinal cord injury

b. Brain injury

c. Disease or syndrome

d. Result of surgical or medical procedure

e. Stroke

f. Other (Specify)

98. Don’t know

Q17. [If Q3=a, then question=“What type of paralysis do you have? Choose one of the following answers.”

Else if Q3=b, then question= “What type of paralysis do you provide care for? Choose one of the following 

answers.]

a. Paraplegia (T1 and below) 

b. Hemiplegia

c. Quadriplegia (C8 and above)

d. Other (Specify)

98. Don’t know

[GO TO END2]

Section 5. End

END1. Thank you for your willingness to participate; however, you are ineligible at this time.

END2. We thank you for your time and cooperation in this study. Your anonymous responses are very important 

and will help the Administration for Community Living improve its support to resource centers nationwide.

Public Burden Statement: 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless 

such collection displays a valid OMB control number (OMB 0985-New). Public reporting burden for this collection of 

information is estimated to average .17 hours per response, including time for gathering and maintaining the data needed and 

completing and reviewing the collection of information. The obligation to respond to this collection is voluntary.