PRC Changes

Page 22 of 22

Deletions from the PRC Information System (PRC IS)

1. (p. 2) Community Description

Enter a description of your partnering community in the text box below.

2. (p. 21) Select one of the options below that describes how the center and partner would characterize their relationship?

Select ONE option listed below:

____ Networking

____ Cooperating

____ Partnering

____ Merging

____ Unifying

3. (p. 23-24) What is one of the health priorities identified by the center?

How did the idea for this health priority originate?

(maximum text length is 100 characters, about 20 words)

Data Sources and Documents Use the lists provided below to indicate which data sources and documents were used to support the prioritization of this health priority. Select at least one option from either column below, and select all that apply:
National Data Sources and Documents	State, County or Local Data Sources and Documents
___Behavioral Risk Factor Survey Surveillance (BRFSS) ___Centers for Medicare and Medicaid Services (CMS) ___Guide to Clinical Preventive Services Recommendations ___Guide to Community Preventive Services Recommendations ___Health Plan Employer Data and ___Information Sets (HEDIS) ___Healthy People 2010 ___National Ambulatory Medical Care Survey ___National Health and Nutrition Examination Survey (NHANES) ___National Health Interview Survey (NHIS) ___National Hospital Discharge Survey (NHDS) ___Peer Review Organization/Quality Improvement Organization ___Pregnancy Risk Assessment Monitoring System (PRAMS) ___Technical report national agency ___U.S. Bureau of Census Data ___Vital Statistics ___Youth Risk Behavior Surveillance system (YRBSS) ___Other published report or review document, please specify below: ___Other data source or document, please specify below	___Behavioral Risk Factor Survey Surveillance (BRFSS) ___Community needs or assets assessment conducted by PRC ___Report or data provided by the partnering community ___Youth Risk Behavior Surveillance System (YRBSS) ___Other state report, please specify below: ___Other local report, please specify below: ___Other, please specify below:

4. (p. 25) Briefly describe the center’s overall research agenda (maximum characters is 1400 characters, about 280 words):

In which research agenda activities were the partners involved?

Select all that apply:

___ Assessing the needs or assets of the partnering community

___ Communicating the research agenda to the community or

partners

___ Identifying or selecting research topics

___ Planning the research agenda

___ Other, please specify below:

Where can evidence be found of partner input into the activities listed above?

Select all that apply:

___ Letters of support

___ Meeting minutes

___ Memorandum of understanding

___ Retreat summary

___ Other, please specify below:

5. (p. 26) In which Center Evaluation Plan activities was the Community Committee involved?

Select all that apply:

___Collecting data for the evaluation.

___Communicating results to the community partners.

___Communicating results in publications or presentations.

___Developing or refining the PRC logic model.

___Developing the evaluation plan.

___Recruiting or engaging other partners in implementing the evaluation.

___Recruiting or engaging other partners in planning the evaluation.

___Other, please specify below:

Where can evidence be found of community committee input into the activities listed above?

Select all that apply:

___Letters of support

___Meeting minutes

___Memorandum of understanding

___Retreat summary

___Other, please specify:

6. (p. 34) Which data sources were used to support the development of the project?

Select all that apply:

____ Guide to Clinical Preventive Services

____ Guide to Community Preventive Services

____ Healthy People 2010

____ Other national data source, please specify below:

____ Other state data source, please specify below:

____ Other local data source, please specify below:

7. (p. 41) How would the center and partner characterize their relationship?

Select ONE option:

___ Networking

___ Cooperating

___ Partnering

___ Merging

___ Unifying

8. (p. 43-44) Expected Outcomes

What are the expected outcomes in Community, Practice, Policy, and Health for the project? (maximum text length is about 700 characters, about 140 words.)

Actual Outcomes

What are the actual outcomes in Community, Practice, Policy, and Health that resulted from the project? (The PRC Program Office understands that these outcomes may not be realized until after the project is completed. Thus, you may check the item below “Not applicable at this time” and this item does not need to be explained in the “Actual Outcome Description.”)

Select all that apply:

___Change in health status or behavior

___Change in physical environment

___Change in clinical practice

___Change in public health practice

___Change in sociocultural environment

___Enhanced community capacity

___Policy change

___Uptake of intervention

___Not applicable at this time

___Other, please specify below:

Actual Outcome Description

(required if any items above except “Not applicable at this time” are selected)

Briefly describe each outcome selected above. Include, as applicable, the specific community or communities affected, the numbers reached or served, and the time frame of outcome. For each description, first state the outcome as shown above, then the describe the outcome. Examples: Change in health status or behavior: description. Policy change: description. (Maximum text length is about 700 characters, about 140 words.)

Methodological and Theoretical Advances

The project furthered the field of prevention research by developing, testing, or disseminating which of the following? (The PRCO understands that these advances may not be realized until after the project is completed. Thus, you may check the item below “Not applicable at this time” and this item does not need to be explained in the “Actual Outcome Description.”)

Select all that apply

___Guidelines

___Methods

___Measures

___Models

___Procedures

___Theories

___Not applicable at this time

___Other, please specify:

Methodological and Theoretical Advances Description

(required if any items above except “Not applicable at this time,” are selected)

Briefly describe each of the methodological and theoretical advances selected above. For each description, first state the Advance as shown above, then the describe it. For example: Guidelines: description. Models: description. (Maximum text length is about 140 words/700 characters.)

9. (p. 47) Status

___ In progress (the product is being developed)

___ In press (the product has been accepted by the publisher or producer, but it is not

yet published or available for use – Show only for publications.)

___ Complete (the product has been published, produced, or otherwise made available

for use.)

If completed, what is the date the product was completed (month/year)? _______

10. (p. 47) Provide a brief description of the product. Include the product’s purpose and content, and any other relevant information. For audiovisual products, indicate the length of time, if known (maximum text length is 500 characters, about 75 words).

11. (p. 49) Does the content of the product focus on any particular groups (e.g., adolescents, American Indians, older adults, etc.)?

____ Yes ____ No

If yes, please describe the group in the space below (maximum text length is 400 characters, about 75 words.)

Modification to the PRC Information System (PRC IS)

12. (p. 36) Age Group

Select all that apply

___Infant (1 to 23 months)

___Child (2 to 12 years )

___Adolescent (3 to 17 years)

___Adult (18 to 64 years)

___Older adult (65 years and older)

___ 0- 11 months

___ 12 – 23 months

___ 2-3 years

___ 4-11 years

___ 12-13 years

___ 14-18 years

___ 19 years

___ 20 – 22 years

___ 23 – 49 years

___ 50 – 64 years

___ 65 years and older

___Unknown at this time

___No specific focus on age group

___Other, please specify:

Additions to the PRC Information System (PRC IS)

13. (p. 3) Enter the number of students trained or mentored by the PRC during this fiscal year (do not include those who were only trained during a formal training session

a. Number of high school students: ____

b. Number of Undergraduate students that are:

____ Research assistant

____ Independent study, practicum, or internship

____ Other (specify below)

c. Number of masters-level students that are:

____ Research assistant

____ Independent study, practicum, or internship

____ Thesis

____ Other (specify below)

d. Number of doctoral students that are:

____ Research assistant

____ Independent study, practicum, or internship

____ Dissertation

____ Other (specify below)

e. Number of post-doctoral fellows _____

14. (p. 3) Does the PRC have designated physical space in which to operate on or in close proximity to the university or school campus?

___ Yes

___ No

Does the PRC have designated physical space in which to operate in or in close proximity to the partnering community?

___ Yes

___ No

Does the PRC’s academic institution provide financial support for any PRC faculty or staff?

___ Yes

___ No

If yes, how many faculty or staff are supported in some way? (enter number)

15. (p. 28) Enter the name of the grant or contract facilitated by the center and awarded to center partners or communities.

What partner was awarded a grant or contract? Select from drop down list of partners. (Or add name of awardee)

What was the purpose of the grant or contract?

Select all that apply

__ Service-oriented grant

__ Training grant

__ Research grant

__ Infrastructure grant

__ Other (specify below)

__ Plus additional text box options after PRC feedback

How was the center involved?

Select all that apply

___ Assisted with writing application

___ Developed or wrote the evaluation component

___ Wrote application

___ Involved in developing concept

___ Provided grant writing training

___ Advised about application

___ Reviewed and edited application

___ Provided data

___ Provided letters of support, MOAs, or MOUs

___ Other (specify below)

___ Plus additional text box options after PRC feedback

Enter the dollar amount of the grant or contract, or enter ‘Unknown.’

$ ________________ dollar amount

16. (p. 28) What is the name of the recognition award?

What is the name of the awarding organization? Select from drop down list of funding organizations [or enter name]

To whom was the recognition award given?

___ PRC overall

___ Community or partner organization

___ Individual faculty or staff person

___ Individual community member

___ Other

To what project was the recognition award related? Select from drop down list of projects to include “Not related to a project”

What is the purpose of the recognition award?

Select all that apply

___ Recognition in science or research

___ Recognition in community involvement

___ Recognition within the PRC’s university

___ Recognition of training

___ Other (specify below)

___ Plus additional text box options

For each media report, answer the following questions.(Enter a report with multiple citations only once.)

Title of media highlight:

What was the overall subject of the media highlight?

Select all that apply

___ Overall PRC

___ Core research project

___ SIP or other project

___ Community event

___ Community involvement in training

___ Training

___ Faculty or staff member

___ Policy change

___ Community member or partner

___ New facility

___ Community service

___ Other (specify below)

What is the distribution of the media?

Select all that apply

___ Local

___ State

___ National

___ Other (specify below)

What media venue highlighted the PRC?

Select all that apply

___ Internet

___ Journal

___ Newsletter

___ Newspaper

___ Magazine

___ Radio

___ Television

___ Video

___ Other (specify below)

To what project was the media report related? (Select from drop-down list to include “Not related to a project.”)

Enter the media citations.

(Limit to 3 citations for this report).

17. (p. 29) What other research topic is a focus of the project?

Select all that apply

___ Community-based participatory research

___ Evaluation research

___ Formative Research

___ Epidemiological research

___ Guidelines or procedures

___ Methods development

___ Models or theories

___ Psychometrics (Measures, scales, or instruments)

___ Not focused on other research topic

___Other, (specify below)

If this is a dissemination or intervention project, answer the 2 questions

below.

For the intervention that is part of this project, is it

Select all that apply

___ Being developed as part of the project

___ Being tested as part of the project

___ Being disseminated as part of the project

Was any part of the intervention developed or tested outside of the PRC core funds?

___ Yes ___ No

What is the main research design?

Select all that apply.

A. Observational designs

___ Cohort

___ Case control

___ Cross-sectional

___ Case studies or case series

___ Surveillance-based secondary studies

___ Other (specify below)

B. Experimental designs

___ Quasi-experimental with control or comparison

___ Quasi-experimental without control or comparison

___ Randomized trial

___ Group randomized trial

___ Other (specify below)

C. Qualitative method

___ Focus group

___ Ethnographic

___ Key informant interviews

___ Content analysis

___ Participant observation

___ Cognitive interview

___ Other (specify below)

18. (p. 35) Which public health topic is a focus of the project?

Select all that apply

___ Advocacy

___ Behavioral change

___ Communication skills or strategies

___ Community-based programs

___ Community or coalition capacity building

___ Community partnerships and collaborations

___ Cultural competence

___ Environmental factors or changes

___ Evidence-based decision making

___ Family participation or involvement

___ Health care delivery

___ Health communication

___ Health disparities

___ Health education and promotion

___ Intervention planning

___ Leadership or management skills

___ Life skills

___ Needs assessment or assets mapping

___ Organizational development

___ Policy

___ Professional development

___ Program evaluation

___ Public health infrastructure

___ Public health preparedness (including bioterrorism)

___ Risk assessment

___ Social marketing

___ Surveillance

___ Training

___ Not focused on a specific public health topic

___ Other (specify below)

19. (p. 41) Does a written agreement exist between this partner and the PRC (e.g., memorandum of agreement, contract)?

___ Yes

___ No

If yes, is the agreement: (Select all that apply)

___ funded (e.g. subcontract)

___ in-kind

If funded, which institution/organization is funding the other? (select all that apply. ___ Partner is funding the PRC

___ PRC is funding the partner

20. (p. 46) For the intervention that is part of this project, what is the level of effectiveness of the intervention?

___ Demonstrated to be promising

___ Demonstrated to be effective

___ Demonstrated to be not effective or insufficient evidence

___ Demonstrated to be adoptable

___ Findings not available at this time

___ None of the above

Has this intervention (the intervention(s) in the project) been recommended for use by a national agency or organization?

___ Yes ___ No

If yes, what is the name of the agency or organization? (drop down list of agencies)

Provide the publication or Web site that recommends the intervention.

21. (p. 46) Has the PRC made this intervention available for dissemination?

___ Yes ___ No

Is there a system in place to track dissemination of this intervention?

___ Yes ____ No

If yes, during this fiscal year, to how many organizations was the intervention disseminated?

If yes, to what kinds of organizations was the intervention disseminated?

Select all that apply

___Academia

___Advocate of health issue

___Business sector

___Community coalition

___Community health center or clinic

___Community resident

___Community-based organization

___County or local government agency

___County or local health department

___Cultural organization

___Environmental agency

___Faith-based organization

___Federal government agency

___Foundation

___Healthcare or medical professional organization

___Health care provider

___Hospital

___Indian Health Service (IHS)

___Labor union

___Managed care

___Media

___National nonprofit organization

___Public health practitioner

___Research center

___School or school-based organization

___State government agency

___State health department

___State, county or local nonprofit organization

___Training center

___Tribal government agency

___Tribal health department

___Youth agency

___ No specific organization types

___ Information not available

___ Other, (specify below)

What methods were used to disseminate the intervention?

Select all that apply

___ Web site (free access)

___ Web site (fee)

___ Partner organization

___ Distributed through external company

___ Other (specify below)

Has the intervention been adopted by any organizations, agencies or communities?

___ Yes ___ No

If yes, during this fiscal year, by how many organizations, agencies, or communities was the intervention adopted?

Within this group, what are the types of organizations, agencies, or communities that adopted the intervention?

Select all that apply

___Academia

___Advocate of health issue

___Business sector

___Community coalition

___Community health center or clinic

___Community resident

___Community-based organization

___County or local government agency

___County or local health department

___Cultural organization

___Environmental agency

___Faith-based organization

___Federal government agency

___Foundation

___Healthcare or medical professional organization

___Health care provider

___Hospital

___Indian Health Service (IHS)

___Labor union

___Managed care

___Media

___National nonprofit organization

___Public health practitioner

___Research center

___School or school-based organization

___State government agency

___State health department

___State, county or local nonprofit organization

___Training center

___Tribal government agency

___Tribal health department

___Youth agency

___ No specific organization types

___ Information not available

___ Other, (specify below)

Have any environmental changes been made, or policies made or changed, as a result of the PRC research project?

___ Yes ___ No

If yes, what was the type of policy or environmental change?

Select all that apply

___ Health care access

___ Physical activity requirement

___ Vending machine restrictions

___ Walking or bicycling trails built

___ Nutrition or food service

___ Pedestrian/bicycle safety

___ Access to new or recreational areas or facilities

___ Health care recommendations or guidelines

___Tobacco or smoking policies

___ School health policies

___ Other (specify below)

If yes, what was the level of the policy or environmental change?

Select all that apply

___ Agency or organization

___ Multiple agencies

___ City/town

___ County

___ National

___ School (individual)

___ School district

___ State

___ Health care provider or system

___ Worksite or business

___ Other (specify below)

If yes, how was PRC involved in the policy or environmental change?

Select all that apply

___ Educated policy- or decision-makers

___ Provided data to policy- or decision-makers

___ PRC research findings or intervention used to create policy

___ Facilitated discussion or meetings around the policy issue

___ Other (specify below)

22. (p. 49) Which health or behavioral topic is a focus of the product?

Select all that apply

___ Access to health care

___ Aging health

___ Adolescent health

___ Arthritis, osteoporosis, and chronic back conditions

___ Birth defects and disabilities

___ Cancer

___ Chronic kidney disease

___ Complementary and alternative medicine

___ Diabetes

___Disability and secondary conditions

___Environmental health

___Family planning

___Food safety

___Global Health

___Heart disease and stroke

___Human Immunodeficiency Virus

(HIV) and AIDS

___Immunization and infectious diseases

___Injury and violence prevention

___Maternal, infant and child health

___Medical product safety

___Mental health and mental illness

___Nutrition

___Obesity and overweight

___Occupational safety and health

___Oral Health

___Physical fitness and activity

___Respiratory diseases

___ School health

___Sexually transmitted diseases

___Social determinants

___Substance abuse prevention and control

___Tobacco use prevention and control

___Vision and hearing

___ Not focused on a specific health topic

___Other (specify below)

Which research topic is a focus of the product?

Select all that apply

___ Determinant research

___ Intervention research

___ Dissemination research

___ Discussion of research

___ Evaluation research

___ Formative Research

___ Epidemiological research

___ Guidelines or procedures

___ Community-based participatory research

___ IRB issues

___ Methods

___ Psychometrics (Measures, scales, or instruments)

___ Models or theories

___ Review of literature

___ Not focused on a specific research topic

___ Other (specify below)

Which public health topic is a focus of the product?

Select all that apply

___ Advocacy

___ Behavioral change

___ Communication skills or strategies

___ Community-based programs

___ Community or coalition capacity building

___ Community partnerships and collaborations

___ Cultural competence

___ Environmental factors or changes

___ Family participation or involvement

___ Evidence-based decision making

___ Health care delivery

___ Health communication

___ Health disparities

___ Health education and promotion

___ Intervention planning

___ Leadership or management skills

___ Life skills

___ Needs assessment or assets mapping

___ Organizational development

___ Policy

___ Professional development

___ Program evaluation

___ Public health infrastructure

___ Public health preparedness (including bioterrorism)

___ Risk assessment

___ Social marketing

___ Surveillance

___ Training

___ Not focused on a specific public health topic

___ Other (specify below)

On which demographic characteristics does the product focus?

Ethnicity

Select all that apply

___Hispanic or Latino

___Non Hispanic or Latino

___Unknown at this time

___No specific focus on ethnicity

Race

Select all that apply

___American Indian or Alaska Native

___Asian

___Black or African American

___Native Hawaiian or Other Pacific Islander

___White

___Unknown at this time

___No specific focus on race

Sex

Select all that apply

___Men or boys

___Women or girls

___Unknown at this time

___No specific focus on gender

___Other, please specify:

Age Group

Select all that apply

___ 0- 11 months

___ 12 – 23 months

___ 2-3 years

___ 4-11 years

___ 12-13 years

___ 14-18 years

___ 19 years

___ 20-22 years

___ 23 – 49 years

___ 50 – 64 years

___ 65 years and older

___Unknown at this time

___No specific focus on age group

___Other, please specify:

Setting or Site

Select all that apply

___City

___County or parish

___Homes

___Medical or clinical site

___Neighborhood

___Rural Area

___Schools or school districts

___Tribal nation

___Urban area

___Work site

___Unknown at this time

___No specific focus on setting or site

___Other, please specify below:

23. (p. 55) How does the PRC or another organization track distribution of the product?

Select all that apply

___ Web site hits

___ Numbers distributed or sold

___ The distribution of this product is not being tracked

___ Other (specify below)

If PRC is tracking distribution, what is the number of Web site hits to the product in the last fiscal year?

If PRC is tracking distribution, what is the number distributed during this fiscal year?

24. (p. 56) Name of the training

To what project does the training relate?

To what product does the training relate?

What mode of delivery is used for the training?

Select all that apply

___ Classroom

___ Web-based

___ Video-based

___ CD ROM

___ Self-learning materials

___ On the job training

___ Consulting or advising

___ Other (specify below)

For what audience is the training intended?

Select all that apply

___ Academic faculty and other researchers
___ Community advisory committee members

___ Community members, general
___ Community agencies and other non-governmental organizations
___ Government officials and staff
___ Health care practitioners
___ Post doctoral fellows

___ Project staff or facilitators

___ State, county, local or tribal public health employees

___ Students, high school
___ Students, undergraduate

___ Students, master’s level
___ Students, doctoral

___ Students, medical, nursing or other health care

___ Other (specify below)

Does the training have a Web site?

___ Yes ___ no

If yes, enter the link (URL) to the Web site.

25. (p. 56) Enter the name of the contact person

Select from drop-down list of center staff or enter new name below

First name

Middle name

Last name

Degrees

Affiliation

Telephone

E-mail address

26. (p. 56) Which health or behavioral topic is a focus of the training?

Select all that apply

___Access to health care

___Aging health

___Adolescent health

___Arthritis, osteoporosis, and chronic back conditions

___ Birth defects and disabilities

___Cancer

___Chronic kidney disease

___ Complementary and alternative medicine

___Diabetes

___Disability and secondary conditions

___Environmental health

___Family planning

___Food safety

___Global health

___Heart disease and stroke

___Human Immunodeficiency Virus (HIV) and AIDS

___Immunization and infectious diseases

___Injury and violence prevention

___Maternal, infant and child health

___Medical product safety

___Mental health and mental illness

___Nutrition

___ Obesity and overweight

___Occupational safety and health

___Oral Health

___Physical fitness and activity

___Respiratory diseases

___School health

___Sexually transmitted diseases

___Social determinants

___Substance abuse prevention, and control

___Tobacco use prevention, and control

___Vision and hearing

___Not focused on a specific health topic

___ Other focus area (specify below)

Which research topic is a focus of the training?

Select all that apply

___ Determinant research

___ Intervention research

___ Dissemination research

___ Discussion of research

___ Evaluation research

___ Formative research

___ Epidemiological research

___ Guidelines or procedures

___ Community-based participatory research

___ IRB issues

___ Methods

___ Psychometrics (Measures, scales, or instruments)

___ Models or theories

___ Review of literature

___ Not focused on a specific research topic

___ Other (specify below)

Which public health topic is a focus of the training?

Select all that apply

___ Advocacy

___ Behavioral change

___ Communication skills or strategies

___ Community-based programs

___ Community or coalition capacity building

___ Community partnerships and collaborations

___ Cultural competence

___ Environmental factors or changes

___ Evidence-based decision making

___ Family participation or involvement

___ Health care delivery

___ Health communication

___ Health disparities

___ Health education and promotion

___ Intervention planning

___ Leadership or management skills

___ Life skills

___ Needs assessment or assets mapping

___ Organizational development

___ Policy

___ Professional development

___ Program evaluation

___ Public health infrastructure

___ Public health preparedness (including bioterrorism)

___ Risk assessment

___ Rural programs

___ Social marketing

___ Surveillance

___ Urban programs (34)

___ Worksite (37)

___ Not focused on a specific public health topic

___ Other (specify below)

27. (p. 56) How many times was the training implemented during this fiscal year?

Select from drop down list of numbers or select ‘Not implemented this year’

What is the total number of hours the training was implemented during this fiscal year? (Includes all times the training was implemented.)

___ Enter number of hours

___ Not implemented this year

___ Not applicable to training format.

Enter the number of people for each category shown below that attended the training program(s) during this fiscal year. (If a person fits in more than one category, select the category that best describes him or her. Do not count them twice.)

___ Academic faculty and other researchers

___ Community members

___ Community agencies and other non-governmental organizations
___ Government officials and staff
___ Health care practitioners

___ Project staff or facilitators
___ State, county, local or tribal public health employees

___ Students, high school

___ Students, undergraduate

___ Students, master’s, doctoral, or postdoctoral

___ Students, medical, nursing or other health care

___ Other (specify category and number below)

PRC Information System Change (83-C) - 0920-0650 August 17, 2006