CCOE Community Partner Survey

DataCollection for the Identification ofComparisonGroups for the National Com. Ctrs of Excellencein Women's Health (CCOE) Program

Round II CCOE Participant Survey_20061004

CCOE Community Partner Survey

OMB: 0990-0271

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(For Office Use Only: CCOE location: ______)



NATIONAL COMMUNITY CENTERS OF EXCELLENCE

(CCOE) IN WOMEN’S HEALTH

NATIONAL EVALUATION: ROUND II


CCOE Client Survey

You were randomly selected to participate in Round II of the National Evaluation of the National Community Centers of Excellence (CCOE) in Women’s Health program. The CCOE program is sponsored by the Department of Health and Human Services (DHHS) Office on Women’s Health (OWH). The goal of the CCOE program is to help coordinate quality health care services and information for women. The survey includes questions about your experience with the <insert CCOE Name>. Please answer the questions to the best of your ability. Choose ‘Does Not Apply’ to a question if you have not received the service. (If you are not sure what the CCOE is or does, please ask someone for help.)



The information you provide will be anonymous. Your name will not be associated with this survey or your responses. If you have any questions or concerns about this survey or would like more information about this project please contact Fatima Riaz at (240) 314-5675 or at 1101 Wootton Parkway, Suite 9246, Rockville, MD 20852.



The survey will only take 10-15 minutes. Thank you for your participation!

______________________________________________________________


  1. How did you hear about the CCOE program?

  • Friends or family member

  • Newspaper/radio

  • Television

  • Church

  • Community Center

  • Other, please list: _________________________________


  1. Have you received services from this organization before today?

  • Yes (go to Question 3)

  • No (skip to Question 5)


  1. If yes, how long ago was your last visit?

  • 3 years ago

  • 2 years ago

  • 1 year ago

  • 6 months ago

  • 3 months ago

  • 1 month ago

  • 3 weeks ago

  • Less than 3 weeks ago


  1. How long have you been receiving health care from the CCOE?

  • Less than one year

  • 1-2 years

  • 3-5 years

  • More than 5 years


Please circle the choice that best reflects your opinion about the CCOE program.

Are you able to easily get to (i.e., access) the CCOE?

Yes

To Some Extent

No


Are you able to speak to someone in your native or primary language?

Yes

To Some Extent

No


Are you treated with respect?

Yes

To Some Extent

No


Is the CCOE staff courteous?

Yes

To Some Extent

No


Do you trust the health professionals at the CCOE?

Yes

To Some Extent

No


Do you usually go to the CCOE when you need health care or health care information?

Yes

To Some Extent

No


Do you have a regular provider (or health care professional) you see at the CCOE?

Yes

To Some Extent

No


Has the CCOE helped you learn how to manage your own health?

Yes

To Some Extent

No

Not Sure

Would you recommend the CCOE to your (female) friends and family?

Yes


No

Not Sure



The CCOE has many programs and services. Please select all of the services or help you received through the CCOE network in the last six months.

  • Health care services (includes primary and specialty care services)

  • Transportation assistance (i.e., help in getting to the CCOE)

  • Referral services (for health care)

  • Child care services

  • Counseling services (such as hormone replacement therapy, smoking, diet or weight management, domestic violence, mental health, etc.)

  • Classes (such as childbirth, exercise, parenting skills programs, or diet)

  • Printed health information (such as brochures, newsletter, etc.)

  • Health information hotline/telephone line

  • Access to the women’s health resource center

  • Participation in a research study

  • Clinical resource directory

  • Internet access

  • Support groups (such as for substance abuse, domestic violence, alcoholism, working mothers, etc.)

  • Leadership and skills training

  • Family Planning Services (such as contraception, safe sex, teen pregnancy, parenting education, or other services)

  • Mentoring programs

  • Services for the Elderly (for topics such as osteoporosis, menopause, estrogen replacement therapy, living wills, etc.)

  • Assistance with getting your medication (such as helping you enroll in Medicare Part D, medication therapy management, etc.)

  • Other (please list): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Section 1: Health Care Service(s)

SKIP to Section 2 if you have NOT received health care services from the CCOE.


What was the main reason for your health care visit to the CCOE?

  • Prenatal or postpartum

  • Contraception (including emergency contraception)

  • STD

  • Routine exam

  • New health problem

  • Follow-up care

  • Other, please specify: ______________________________

Does the CCOE provide you the chance to get both gynecological and general health care?

Yes

To Some Extent

No

Does Not Apply

Were you satisfied with the health professional who provided your care?

Yes

To Some Extent

No

Does Not Apply

Were you satisfied with the overall quality of care you received?

Yes

To Some Extent

No

Does Not Apply

Were you satisfied with the overall coordination of your care?

Yes

To Some Extent

No

Does Not Apply

Did you have to provide the same information (e.g., name, address, phone) more than once?

Yes

To Some Extent

No

Does Not Apply

Did you receive help with scheduling your next visit?

Yes

To Some Extent

No

Does Not Apply

Was it easy to get a referral for a health care service?

Yes

To Some Extent

No

Does Not Apply

If you received a referral, how many business days did it take to get the referral?

O 1 day O 2 days O 3 days O 4 days O 5 days O More than 5 days

Did you use the referral?

Yes

To Some Extent

No

Does Not Apply

If you did not use the referral, why not? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Section 2: Community Research

SKIP to Section 3 if you have NOT participated in a research study through the CCOE program.


Have you participated in a CCOE research study during the last 6 months?

Yes


No


Was the purpose of the research study explained to you?

Yes

To Some Extent

No

Does Not Apply

Were the procedures of the research study explained to you in an understandable manner?

Yes

To Some Extent

No

Does Not Apply

Was it convenient to participate in the research study?

Yes

To Some Extent

No

Does Not Apply



Section 3: Training

SKIP to Section 4 if you have NOT participated in leadership training or health care skills training sponsored by the CCOE.


Have you been involved in any leadership development and/or skills training (i.e., mentoring) within the last 6 months at the CCOE?

Yes


No


If you received training, list what type of training you took and what you learned.

________________________________________________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

Was it easy to sign up for the leadership and skills training?

Yes

To Some Extent

No

Does Not Apply

Did you get a job in health care after you finished the leadership development and/or skills training?

Yes

To Some Extent

No

Does Not Apply

Do you have a mentor who provides you with career advice?

Yes

To Some Extent

No

Does Not Apply

Are leadership opportunities available to you through the CCOE program?

Yes

To Some Extent

No

Does Not Apply

Were you satisfied with the leadership development and/or skills training you received?

Yes

To Some Extent

No

Does Not Apply


Section 4: Classes, Events, and Information

SKIP to the next page if you have NOT taken a class (e.g., breast feeding), attended a community event (e.g., health fair) , or received brochures or other information from the CCOE.


Have you participated in a CCOE sponsored event or class (i.e., health fair or parenting skills classes) during the last 6 months?

Yes


No


If you took a class or attended a health care event, describe the event or class and how you heard about it.





Were you asked for suggestions about topics for educational sessions or classes?

Yes

To Some Extent

No

Does Not Apply

Was the most recent event or class presented in your primary language?

Yes

To Some Extent

No

Does Not Apply

Was the most recent event or class presented in a manner that was respectful of different cultures?

Yes

To Some Extent

No

Does Not Apply

Did you learn new information during your most recent event or class?

Yes

To Some Extent

No

Does Not Apply

Did you change your habits or behavior (e.g., quit or reduce smoking) because of information you learned from an event, class, or information you received?

Yes

To Some Extent

No

Does Not Apply

Did you receive help with finding information resources in women’s health?

Yes

To Some Extent

No

Does Not Apply

Was the information you received helpful?

Yes

To Some Extent

No

Does Not Apply

Was the information you received easy to read?

Yes

To Some Extent

No

Does Not Apply

Was information about healthy living (such as diet and exercise) available to you?

Yes

To Some Extent

No

Does Not Apply


What types of events or classes would you like to see offered by the CCOE?







General Information

How many times did you go to the CCOE (or a CCOE partner) in the last year? ___

Overall, how would you rate your health today?

  • Excellent

  • Good

  • Poor

  • Very Poor

Do you prefer a male or female health professional to treat you?

  • Male

  • Female

  • Either Male or Female

What is your age? years

I am:

  • Hispanic or Latino

  • Not Hispanic or Latino

What is your race/national origin? (check all that apply)

  • American Indian or Alaska Native

  • Black or African American

  • White

  • Asian

  • Native Hawaiian or Other Pacific Islander

What kind of health care insurance do you currently have?

  • HMO

  • Medicare

  • Other

  • PPO

  • Medicaid

  • I do not have health care insurance

If you are insured by Medicaid, are you dual-eligible for the Medicare Part D Prescription Drug Benefit program?

  • Yes

  • No

If you are insured by Medicare or dual-eligible for both Medicaid and Medicare, please select all of the areas the CCOE helped you with from the list below? (check all that apply)

  • Part D Enrollment

  • Selecting a Plan

  • Understanding your benefits

  • Other

What is your highest level of education?

  • Less than High School

  • Some College

  • Some High School

  • College Graduate

  • High School Graduate

  • Graduate School

What is your household yearly income?

  • $20,000 or less

  • $20,001 to $50,000

  • $50,001 to $75,000

  • $75,001 and over



Share Your Thoughts


How could the CCOE improve the coordination of your health care? Please include any additional services you would like the CCOE and/or their partner organizations to offer.







Thank you for taking this survey.

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CCOE Client Survey

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