AgDARE - Agricultural Disability Awareness and Risk Education

Farmer's Lung - Narrative Simulation

Answer Sheet

As you read the problem booklet, circle your answer to each question on this answer sheet. Please don't write in the problem booklet. That way the problem booklets can be reused.

Circle a T or F in front of each answer number that appears in the problem booklet.

Question A	Question B	Question C	Question D	Question E
T   F   1.	T   F   9.	T   F   15.	T   F   22.	T   F   26.
T   F   2.	T   F   10.	T   F   16.	T   F   23.	T   F   27.
T   F   3.	T   F   11.	T   F   17.	T   F   24.	T   F   28.
T   F   4.	T   F   12.	T   F   18.	T   F   25.	T   F   29.
T   F   5.	T   F   13.	T   F   19.		T   F   30.
T   F   6.	T   F   14.	T   F   20.		T   F   31.
T   F   7.		T   F   21.
T   F   8.

Questionnaire

1) Name of exercise: Ben Can't Breathe

2) Your age? ______

3) Your sex? ____ M ____ F

4) Do you work around farm jobs where there is a lot of dust in the air? ____ Yes ____ No

5) If "Yes" to item 4, about how many days a month do you work around jobs that make a lot of dust in the air that you breathe? _______ days a month

6) a. Do you work on a farm? ____ Yes ____ No

b. Size of farm (acres) ______

7) Please rate how well you can breathe after working around dusty jobs. (check only one item)

____ Have a lot of trouble breathing ___ Have a little trouble breathing

___ Cough a little ___ Can breathe well with no problems

8) After working around dusty jobs do you ever wheeze and feel short of breath? ____ Yes ____ No

9) Have you ever been so ill after working around dust that you had to see a doctor?
____ Yes ____ No

10) Do you ever wear a dust mask or respirator when you work around dusty jobs?
____ Yes ___ No

11) If "Yes" to item 10, what type of respirator do you wear? ___ paper mask ___ respirator with cartridges

12) Out of every 10 times you work around dusty jobs, how many times do you wear a paper dust mask or a respirator? (circle one number )
Never   0   1   2   3   4   5   6   7   8   9   10   Always

Now think about the story you just finished. Circle the number that tells how much you agree or disagree with the following statements.

Statement

Strongly Disagree

Strongly Agree

1)	This story is realistic.	1	2	3	4	5
2)	I enjoyed working through the story.	1	2	3	4	5
3)	The written directions were easy to follow.	1	2	3	4	5
4)	The story was easy to read.	1	2	3	4	5
5)	The story took too long to complete.	1	2	3	4	5
6)	The story taught me new information about the relationship between disability and farm finances.	1	2	3	4	5
7)	Prior to working through this story, I had thought about the consequences of doing dusty farm work without using a respirator.	1	2	3	4	5
8)	Working through the story will help me think about using a respirator when working on dusty jobs.	1	2	3	4	5
9)	Working through the story has helped me to know how to prevent breathing organic particles.	1	2	3	4	5
10)	Until I read this story I only thought about dying from a disease, not having a life long illness.	1	2	3	4	5
11)	Working through the story will help me plan to have respirators available and to use them when I am doing dusty work.	1	2	3	4	5
12)	What I learned in the story will help me to prevent lung disease caused from breathing organic particles.	1	2	3	4	5
13)	The questions and answers were easy to understand.	1	2	3	4	5
14)	Working through the story helps me to understand the impact a disability may have on my life.	1	2	3	4	5
15)	Working through this story helps me to understand how an illness may become a disability I have to live with the rest of my life.	1	2	3	4	5
16)	The pictures were easy to understand.	1	2	3	4	5

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