Pre-Questionnaire

Pre-Questionnaire

Step 1 of 5

Dear ECHO Community Partner,

We are asking you to complete this questionnaire because you are participating in ECHO Pain Canada [insert hub site name ex.McGill University]. This Pre-ECHO questionnaire is 4 sections long and takes on average 20 min or less to complete. It will cover the following:

1. Self-efficacy
2. Attitudes and behaviours about chronic pain
3. Knowledge test
4. Adherence to guidelines (to be completed only by physicians, nurse practitioners, physician assistants, dentists, residents, fellows)


We ask you to complete all sections before you begin attending weekly ECHO sessions. By completing this questionnaire, you are consenting to participate in this program evaluation study. If you have any question regarding your rights as a program evaluation participant, please contact our Study Manager, Yalnee Shantharam at yalnee.shantharam@uhn.ca or the Quality Improvement Review Committee (QIRC) at QI@uhn.ca.

The aggregate data collected here will be used as part of an evaluation of this project funded by Health Canada. There is no industry or commercial involvement with any research conducted by ECHO Pain Canada.

Completion of this survey is voluntary and your participation, or choice not to participate, will not affect your current or future affiliation with ECHO Pain Canada. ECHO Pain Canada will not share your data with any external institution. Your responses are confidential.

Thank you for your time and support,
ECHO Pain Canada

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