Pre- and Post-Intervention Survey Template

This pre- and post-intervention survey records participants’ self-reported understanding and confidence before and after a learning program. Use matched questions to examine reported change without claiming the program caused it.

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Pre- and Post-Intervention Survey: first question and response field, desktop preview — Pre- and Post-Intervention Survey Preview

Pre- and Post-Intervention Survey: first question and response field, tablet preview — Pre- and Post-Intervention Survey Preview

A before-and-after comparison needs the same subject, wording, and response options at both points. This version is designed for a nonclinical learning program with one named skill. It collects perceptions, not an objective skill test or proof of effectiveness.

When to use this pre- and post-intervention survey

Academic and program-evaluation teams can use this starting questionnaire for a nonclinical learning intervention. Any research use still needs the study’s own consent, data handling, and review arrangements.

If you only need feedback on the completed session, use our workshop feedback template.

7 questions for your pre- and post-intervention survey

Use these 7 questions as a starting point. All fields are optional; choose one answer where choices are listed. Leave an irrelevant open field blank.

Respondent introduction:
Refer to the named skill and task in the program context. Answer about how you feel now. If the study team has provided a participant code, you may enter it; do not enter your name.

How to customize your pre- and post-intervention survey

Define one skill and one application task in a context card shown at both time points. Keep the core wording identical. If you need paired analysis, arrange an appropriate participant-code process without using names here. Review the instrument against your study question before collection; it is not validated. Before sharing widely, try the questions with a few people from the intended audience and clarify anything they interpret differently.

Printable pre- and post-intervention survey template

Use this printable pre- and post-intervention survey template at the beginning and end of a learning program. It includes the same questions and space to write, giving people who prefer paper or are less comfortable online another way to take part. SurveyLegend helps you offer both formats. Tell respondents where to return the completed form and who will review it. Paper answers need a separate review or manual entry process; they are not automatically added to online responses.

AI prompt for a pre- and post-intervention survey

Use these questions to collect consistent self-reports at two points in a learning program.

The full prompt below specifies your pre- and post-intervention survey, including all 7 questions and response settings. Copy it, register for a free SurveyLegend account, and paste it into SurveyLegend’s AI survey creation tool. Review the result and add your organization’s details before sharing.

Create a pre- and post-intervention survey in SurveyLegend using the exact questionnaire below.

Purpose: Use these questions to collect consistent self-reports at two points in a learning program.

Creator setup before sharing:
Nonclinical learning only. Supply program, one skill, one application task, collection times, and study-specific consent/review process. Optional study code must be issued or agreed through an appropriate process; no names. Not a validated instrument.

Requirements:
- Include exactly 7 fields in the order shown. Preserve wording, field types, choice order, and optional settings verbatim.
- Show every field. Single choice means one selection. Preserve instructions for irrelevant fields; do not invent branching.
- Do not add questions, answers, scores, outcome predictions, certifications, or promises of anonymity.
- Do not invent organization details, dates, offer prices, a concept card, a job criterion, or other required context. Ask the creator for missing setup information before the survey is shared.
- This prompt creates a draft questionnaire. It does not process transactions, change accounts, issue tickets, publish testimonials, or make employment decisions.
- If an exact field or setting is unavailable, explain the limitation separately rather than silently changing it.

Respondent introduction:
Refer to the named skill and task in the program context. Answer about how you feel now. If the study team has provided a participant code, you may enter it; do not enter your name.

Exact questionnaire:

1. Which collection point is this?
Field type: Single choice
Answer choices, in order:
- Before the program
- After the program
Required: No
Display rule: Always

2. What participant code has the study team provided, if any?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No
Display rule: Always

3. How well do you currently understand the named skill?
Field type: Single choice
Answer choices, in order:
- Not at all well
- Slightly well
- Moderately well
- Very well
- Extremely well
- Not sure
Required: No
Display rule: Always

4. How confident are you that you could carry out the named task?
Field type: Single choice
Answer choices, in order:
- Not at all confident
- Slightly confident
- Moderately confident
- Very confident
- Extremely confident
- Not sure
Required: No
Display rule: Always

5. How clear are the steps you would take to carry out that task?
Field type: Single choice
Answer choices, in order:
- Very unclear
- Somewhat unclear
- Neither clear nor unclear
- Somewhat clear
- Very clear
- Not sure
Required: No
Display rule: Always

6. What would you currently find most difficult about the task?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No
Display rule: Always

7. What support would help you carry out the task?
Field type: Long text
Answer choices: none; respondent enters their own text.
Required: No
Display rule: Always

Compare every field with this specification before finishing. Report differences separately. Ask the creator to review the draft and required context before sharing. Do not publish automatically.

Use prompt directly in SurveyLegend

Create a free account, then paste the copied prompt into SurveyLegend.

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How to use the answers

Keep before and after records separate until time-point labels and optional study codes are checked. Compare the same items, and report how many participants supplied both responses. Changes in confidence are not objective learning gains, and a simple before-and-after design does not establish causation. Do not interpret unmatched respondents as individual change.

Does this prove an intervention worked?

No. It records self-reported change. Causal conclusions need an appropriate research design and analysis beyond this template.

Must participants use a code?

Only if your study requires matching and has an appropriate process. Without matching, compare groups rather than claiming individual change.

Is this a validated assessment?

No. It is an original starting questionnaire for nonclinical learning. Review its suitability and research requirements before use.

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Pre- and Post-Intervention Survey Template

When to use this pre- and post-intervention survey

7 questions for your pre- and post-intervention survey

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