CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY SCORING KEY

Congregate Meal Site Satisfaction Survey KEY

The below questions are intended to help us assess your satisfaction with the congregate 

meal program and site. Your input will help us better serve you. 

1. How long have you been attending the meal program? (NO SCORE)

Months Years

2. On average, how many times a week do you attend the meal program? (NO SCORE)

 0 to 1 times

 2 to 3 times

 4 to 5 times

3. What is your primary purpose for coming to the meal site? (NO SCORE)

 Conversations with friends and lunch

 A nutritious meal

 Programs and activities

 Other

4. Think about the food you receive from the meal program. Please tell us, how often are you 

satisfied with the... 

Always

4

Usually

3

Sometimes

2

Rarely

1

Never

0

how well the menu options meet your 

dietary needs and preferences.

overall food quality.

overall menu choices.

temperature of the foods served.

variety of foods offered.

way the food is cooked.

way the food looks.

way the food smells.

way the food tastes.

Subtotal points 

Total Food Satisfaction Score (Max 36)

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD August 2023

Professor in Food Science & Human Nutrition, Iowa State University
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY SCORING KEY

5. Think about the dining experience at the meal program. Please tell us, how often are you satisfied

with the... 

Always

4

Usually

3

Sometimes

2

Rarely

1

Never

0

cleanliness of the facility.

friendliness of the staff.

helpfulness of the staff.

location of the facility.

overall ambience of the meal site.

overall meal site environment .

Subtotal points 

Total Dining Experience Score (Max 24)

6. Think about the programming offered through the meal program. Please tell us, how often are you 

satisfied with the...

Always

4 

Usually

3 

Sometimes

2 

Rarely

1 

Never

0 

Don’t 

Participate

0

Not 

available

0

Better ChoicesBetter Health

Chronic Disease 

Self-Management

Exercise programs

Foot care

Guest speakers (e.g., 

immunizations, 

diabetes, arthritis, 

etc.)

Health screenings: 

blood pressure, 

blood sugar

Matter of Balance

Nutrition Education

Stepping On

Tai Chi

Water Exercise 

program

Subtotal points 

Total Programming

Satisfaction Score 

(Max 44)

TOTAL SATISFACTION SCORE (add questions 4, 5 and 6 total scores; MAX 104) 

84-104 Very satisfied 63-83 More than satisfied 42-62 Satisfied

21-41 Partly satisfied < 20 Not at all satisfied

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD August 2023

Professor in Food Science & Human Nutrition, Iowa State University
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY SCORING KEY

7. Please rate your level of agreement with the following statements regarding how the meal 

program (including the meal and programming) has helped you... 

Strongly 

Agree

5

Agree

4 

Undecided

3 

Disagree

2 

Strongly 

Disagree

1

eat healthier foods.

gain nutrition and wellness 

knowledge

helped you remain in your home.

improve your health.

Subtotal points 

Total Perceived Health Impact Score 

(Max 20)

8. Do you have any recommendations to improve the meal program? (NO SCORE)

 No 

 Yes, please describe:

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD August 2023

Professor in Food Science & Human Nutrition, Iowa State University
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY SCORING KEY

The following questions help provide us with a general description of our meal program 

participants. (NO SCORES)

9. What year were you born? ______ 

10.Are you female or male?

 Female

 Male

 Transgender Female

 Transgender Male

 Non-binary

 Gender not listed above

 Prefer not to answer

11.Which one best describes your race? 

 American Indian or Alaska Native 

 Asian

 Black or African American

 Hispanic or Latino

 Native Hawaiian or other Pacific islander 

 White 

 Two or more races

 Prefer not to answer

 Other, please describe

12.Which one best describes your ethnicity?

 Hispanic, Latino, or Spanish Origin

 Not Hispanic, Latino, or Spanish Origin

 Prefer not to say

13.What is the highest degree of school you completed? 

 Less than High School

 High School/GED

 Some College

 Associates or Technical School

 Bachelor’s

 Graduate

14.Are you...? 

 Divorced

 Married

 Separated

 Single, never married

 Widowed

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD August 2023

Professor in Food Science & Human Nutrition, Iowa State University
CONGREGATE NUTRITION PROGRAM SATISFACTION SURVEY SCORING KEY

15.What best describes your living situation?

 Live alone in house, apartment or retirement community

 Live with a child (< 18 years of age) in a house, apartment, or retirement community

 Live with spouse, significant other or friend in house, apartment or retirement 

community

 Live with adult children in house, apartment or retirement community

16.Do you follow any special dietary practices?

 Dairy-free

 Diabetes diet

 Gluten-free

 Heart healthy diet (i.e., low fat, low cholesterol, low sodium)

 Restrict red meat or pork

 Vegetarian (includes: vegan, dairy/egg only, fish only) 

 None of the above

 Other

Survey developed by Dr. Sarah L. Francis, PhD, MHS, RD August 2023

Professor in Food Science & Human Nutrition, Iowa State University