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Ukraine MENTORS enrolment form

Welcome to Training in Assistive Products (TAP). Please read the information below and complete part A and part B of this form before you begin the training.

Participant information sheet

 Welcome to Training in Assistive Products (TAP). This training is the first step of the project,

‘Enabling rapid access to essential assistive technology (AT10) for internally displaced people in Ukraine’, led by the Ministry of Health of Ukraine and the World Health Organization. This project is intended to facilitate rapid access to essential assistive technology (AT) for Ukrainians with mobility and self-care needs who have been displaced by the war.

Please read the information below and complete parts A (agreement) and part B (enrolment survey) before you begin the training

 Information about TAP: TAP is an online learning programme for personnel who are, or will be:

  • Identifying people who need assistive products and/or
  • Providing simple assistive products.

TAP can be accessed using a computer, tablet or smart-phone. TAP learners will also have face to face support from mentors. You will be taking TAP modules in order to prepare for your role as a mentor.

If you have a question now, or at any time when you are going through this training, you can:

  • Discuss with the project supervisor
  • Bring your questions to the mentor briefing

 Your feedback is important: At the end of the training, you may be asked to provide feedback through an interview (of up to 30 minutes). Your participation in feedback activities is voluntary, and it will be carried out during working hours, at a convenient time for yourself and your service manager.

 TAP data collection: TAP collects information about TAP learners and mentors (including you) through the enrolment survey (up to 20 minutes) and feedback survey (learners only). Quiz scores are also collected, and information such as how many and which modules learners and mentors complete. When learners or mentors participate in discussion groups or interviews to give feedback, an audio recording of the discussions may be made and then used to create a written record. The audio record will then be deleted.

 Before this information is used it will be de-identified. This means that the names, and personal details are removed. This way, no-one looking at the information will know whose information it is. The de-identified information is then used to help prepare reports about this TAP training and for research to help understand:

  • How well TAP is working for learners and mentors and how it can be improved
  • The thoughts of learners and mentors about the provision of assistive products
  • What other actions could be taken to improve access to assistive technology.

The de-identified information is held securely by the World Health Organization. It may be combined with data from other TAP projects, and it may be shared with project partners, donors, and researchers.

Fields marked with an * are required

PART A: Agreement for the use of information

 Please let us know if you give consent for information collected during this training to be used as described above. Check yes or no to each question below. If you select no, you are still very welcome to continue your participation in the TAP project as a mentor. 
1. I have read the information above and I have had the opportunity to ask questions about the training and TAP information collection. *
2. I understand that de-identified information collected during this training (including this enrolment survey, quiz results and feedback) will be used in reports and research to help improve TAP and improve access to assistive technology and I give my consent. *

PART B: Enrolment
1. Name of service/organization *
2. Date *
5. Your age *
6. Do you use any assistive products? *
7. What is your role or job title? *
8. How many years of experience do you have in your profession? *
9. What is your highest level of formal education? *
10. Do you use and have daily access to a smart phone? *
11. Do you use and have access to a tablet at least 2-3 times per week? *
12. Do you use and have access to a computer at least 2-3 times per week? *
13. Do you have daily (funded and reliable) access to the internet? *
14. Have you taken any online courses before? *
15. Have you taken any training about assistive products or assistive technology services before? *
16. Do you directly provide assistive products? *
If yes, which product types:
17. Do you currently have a training or supervisory role? *
If yes, does this include training or supervising others in relation to assistive products?
18. For this TAP training, which module stream/s are you mentoring? *
19. How prepared do you feel to mentor the learners on this TAP training? *
20. Do you think that your health facility should play a role in assistive technology now? *
21. If yes, what role should your health facility play? (You can select more than one.)
22. Do you think that your health facility should continue to play a role in assistive technology when the current crisis ends? *
23. If yes, what role should your health facility play? (You can select more than one.)

24. If yes, for your health facility and personnel to fulfil a role in assistive technology, how important are each of the following:
Awareness: People in need and others are aware that the service provides assistive products *
Policy and financing: Policy in place supporting primary health services playing a role in assistive technology *
Policy and financing: Finance system and funding in place for primary health services to play a role in assistive technology *
Products and other resources: The service has assistive products at the service to provide at an affordable cost *
Products and other resources: The service has the tools, equipment and space to provide assistive products *
Provision systems: Referral pathways are in place and understood by everyone *
Provision systems: Service systems in place (such as assessment forms, procurement) *
Provision systems: Managers appoint personnel to carry out this role and support them to do it. *
Personnel: Personnel are provided with mentoring / supervision *
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