Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit

Attachment 2 of Supporting Statement

Data Collection Instrument: Web-Based Survey

for

Evaluation of the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit

(0920-07AL)

CDC Task Order Officer (TOO): Dyann Matson Koffman

National Center for Chronic Disease Control and Health Promotion

TOO Contact Information: 770-488-8002 (phone), 770-488-8151(fax)

Form Approved

OMB No.: 0920-07AL

Exp. Date: xx/xx/20xx

State Survey on the CDC’s Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit

Public Reporting Burden

Public reporting burden of this collection of information is an estimated average of 30 minutes per response. This estimate includes the time for reviewing instructions, searching existing data sources, and completing and reviewing the survey. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number, which is displayed on the first page of the survey instructions. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: PRA(0920-07AL)

Use of the Survey Information

Completion of this survey is voluntary. The information you report here will be used by independent researchers at the American Institutes for Research (AIR), who are working under contract with the CDC to evaluate the CDC’s Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit. They will treat this data in a confidential manner, unless otherwise compelled by law. All data will be reported to the CDC and to you in the aggregate, without identifying individual States or respondents. You may choose to answer this survey or not. If you choose not to do so, this will not affect your program’s funding.

The first 25 states to complete the survey

will receive an additional copy of the Toolkit!

OMB No. 0920-07AL

Purpose of the Survey

This survey is being used to collect information on your experiences with the CDC Toolkit on Successful Business Strategies to Prevent Heart Disease and Stroke and working with employer groups. It also asks for your feedback on the trainings and consultations provided during 2006 and 2007 to facilitate your use of the Toolkit. The results for this survey will be used to make revisions to the Toolkit and to evaluate its dissemination and use. As part of the evaluation, they will be compared to responses to the survey conducted at the beginning of the evaluation. With your input, we will be able to develop an improved version of the Toolkit that can better serve you in your work with employers and health plans to prevent heart disease and stroke.

Before You Begin…

Instructions

This survey is a Web-based survey, so it can be completed at your convenience between the dates of XXX and XXX. Please have only one representative from your State complete the survey and summarize the experience of your State as a whole.

1. For questions with a set of answer choices, click with your mouse on the box corresponding to your choice and an “x” will appear. To change your answer, click again and the “x” will disappear. You can repeat the process to select a different answer.

2. For questions that have blank lines to write in your answer, click with your mouse right above the blank line in the grayed out space and start typing your answer. Please note that even though the space may look small, it will extend as you type.

2. When you are finished, click on the button on the final page. This will indicate that you have completed the survey and your responses will be submitted electronically to AIR researchers.

Questionnaire

I. General Aspects

1. What state (or jurisdiction) do you represent? ____________________________

2. How many staff and consultants are currently employed in your State HDSP Program? To answer this question, calculate the number of full-time equivalent (FTE) staff. For example, three people working full time is 3.0 FTE, two people working half time is 1.0 FTE, for a total of 4.0 FTE.

____________ FTEs

3. How many State HDSP Program staff and consultants are dedicated to working on employer-based initiatives? To answer this question, calculate the number of full-time equivalent (FTE) staff. For example, 2 people working quarter time on employer-based initiatives is 0.5 FTE.

__________ staff and consultants

4. What percentage of your State HDSP Program budget is dedicated to employer-based initiatives?

<10%

10-20%

21-30%

31-40%

41-50%

>50%

5. a) During the last 12 months, how often has your State Heart Disease and Stroke Prevention (HDSP) Program collaborated with other programs in the State Health Department (for example, those addressing obesity, physical activity, tobacco control or nutrition) to promote worksite interventions on heart disease and stroke prevention as part of broader chronic disease prevention efforts?

Never Sometimes Usually Always

b) If you collaborated with these types of programs in your State Health Department, briefly describe your experience and note successes and challenges faced.

____________________________________________________________________

____________________________________________________________________

6. During the last 12 months, has your State HDSP Program worked directly with employers, employer groups, or those who can help reach employers, to establish and improve worksite health promotion interventions and negotiate employee preventive health benefits for HDSP?

   1. Yes

   2. No  If “NO”, go to Question 14

II. Macro-Marketing Activities

7. During the last 12 months, which of the following HDSP macro-marketing activities has your State HDSP Program engaged in with employers and employer groups?

(Macro-marketing is an approach for reaching and selling to organizations in a market on a large scale and involves providing information to multiple organizations at one time.)

ACTIVITY

No, not at all

Yes, somewhat

(1 to 7 times)

Yes, extensively

(8 times or more)

Promoting the importance of comprehensive HDSP programs at the state and regional levels

Providing technical assistance in program design and evaluation to businesses

Disseminating best or promising practices that demonstrate successful worksite policy and system changes leading to cost savings

Establishing partnerships or task groups with organizations that encourage employers to implement HDSP policies and system changes in worksite settings

Establishing partnerships or task groups with employers and organizations that influence policy and system changes to improve employee access to quality care services for HDSP

Participating in a series of seminars or presentations for employers on HDSP and business

Conducting local and/or statewide media campaigns to educate employers, employees, or the general population about HDSP at the worksite

Writing monthly or quarterly business column about HDSP for print media

Writing occasional business columns or articles on HDSP for any type of mass media

Providing business leaders resource materials or referrals for information pertaining to HDSP

III. Partnerships

8. During the last 12 months, which of the following activities did your State HDSP Program work on with each type of organization listed below? (Check all that apply). Please scroll to the right to see the complete table.

ACTIVITY

ORGANIZATION

Coverage HDSP clinical preventive services

Reduced employee cost-sharing for HDSP preventive services

Financial incentives for employees or members to participate in worksite health promotion programs

HDSP materials for health plans, insurers, or other vendors

Policy and system changes to improve employee access to quality care services for HDSP

Worksite policy changes

Worksite surveillance and assessments

Worksite health promotion & education

Worksite screening and risk factor counseling and follow-up

None

Health plans or insurance companies

Worksite health promotion vendors not affiliated with health plans or insurance companies

Disease management companies

Employer group or business coalition (e.g., National Business Group on Health, National Business Coalition on Health)

Employee group (e.g., employee task forces)

Government agencies

National not-for-profit organizations (e.g., American Red Cross, National Stroke Association, Society for Human Resources Management)

Community-based organizations (e.g., church group, community health clinic)

Unions

Pharmaceutical companies

9. Which skills, expertise and/or resources has your State HDSP Program obtained through each of the following partnerships? (Check all that apply)

PARTNERSHIP

Knowledge about worksite HDSP interventions

Access to HDSP expertise and resources

Access to networks with employer-based organizations

Access to key decision-makers, stakeholders, and employers

None

Health plans or insurance companies

Worksite health promotion vendors not affiliated with health plans or insurance companies

Disease management companies

Employer group or business coalition

Employee group

Government agencies

National not-for-profit organizations

Community-based organizations

Unions

Pharmaceutical companies

IV. Usefulness of the Toolkit

10. Has your State HDSP Program used the Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit?

Yes

No  If “NO”, go to Question 14

11. How often have you used the Toolkit for the following purposes?

PURPOSE	Not at all	Yes, somewhat (1 to 7 times)	Yes, extensively (8 times or more)
As resource material to prepare a presentation or workshop
As a resource to develop locally produced materials for employers or related groups
To provide employers with the Health Plan Checklist
To provide employers with the Six-Step Guide
To provide technical assistance to partners
To orient new partners or staff implementing the HDSP program

12. How useful has the Toolkit been for planning and implementing activities with employers, unions, and others engaged in worksite interventions as well as those engaged in discussing or negotiating employee preventive health benefits for HDSP?

TOOLKIT COMPONENT	Not at all Useful	Not Very Useful	Somewhat Useful	Very Useful	Extremely Useful	Did Not Use
Overall Toolkit
Toolkit Components
Toolkit Guide
Six-Step Guide
Health Plan Checklist
Promising Practices
PowerPoint Presentation
CVH & Business Glossary
Additional Resources
Articles

13. Thinking of the Toolkit as a whole, please indicate the extent to which you agree or disagree with the following statements.

STATEMENT	Strongly Disagree	Disagree	Agree	Strongly Agree
Overall, the Toolkit provides credible information to our audience(s)
Overall, the Toolkit helped us plan activities with employers, unions, and others engaged in worksite interventions
Overall, the Toolkit helped us advise employers, unions, and others in purchasing and providing employee health benefits
The information provided in the Toolkit was easily understood by our audience(s)
The information in the Toolkit is appropriate for all employers, regardless of size
The information in the Toolkit is useful for not-for-profit employers
The components of the Toolkit are clearly written
Some components of the Toolkit are irrelevant to our audience(s)

V. Knowledge and Skills

14. How confident are you that your State’s HDSP or CVH Program staff have the following knowledge and skills?

KNOWLEDGE/SKILL

Not at all confident

Not very confident

Moderately confident

Very confident

Extremely confident

Knowledge of effective worksite interventions for HDSP

Knowledge of businesses or companies with effective worksite programs (promising practices) for HDSP

Knowledge of effective clinical preventive benefits, services, and systems of care for HDSP

Knowledge of health plans with effective programs (promising practices) for HDSP

Knowledge of HDSP resources for employers

Knowledge of key employer groups, unions, and organizations with whom to work and partner

Knowledge of private sector business concerns/motivators for improving employee health

Skills in conducting macro-marketing activities with employers and stakeholders

Skills in persuading and making the business case to decision-makers about the importance of worksite interventions and clinical preventive services for HDSP

Skills in developing and maintaining partnerships and networks with employer-based organizations

Skills in providing training and technical assistance to employers and other partners on HDSP policy and system changes

Skills in translating science into documents for employer audiences

VI. Trainings, Consultations and Other Resources

15. Which of the following trainings on the Toolkit did you or any of your staff have the opportunity to attend (Check all that apply) ?

Overview of the Toolkit (March 30, 2006)

Macro-Marketing Activities (May 22, 2006)

Health Plan Checklist I (June 22, 2006 at CDC conference)

Health Plan Checklist II (August 28, 2006)

Promising Practices I: Health Plans (September 26, 2006)

Promising Practices II: Employers (October 30, 2006)

None of the above

16. Which of the following consultation calls did you or any staff in the HDSP Program have the opportunity to attend?

Consultation Call 1 (November 13, 2006)

Consultation Call 2 (January 29, 2007)

Consultation Call 3 (April 23, 2007)

None of the above

17. Thinking of the Toolkit trainings and consultations, please indicate the extent to which you agree or disagree with the following statements.

STATEMENT	Strongly Disagree	Disagree	Agree	Strongly Agree	Did Not Attend
The trainings/Webinars offered by the CDC helped us use the Toolkit more effectively
The trainings/Webinars offered by the CDC helped us improve our HDSP program
The consultations offered by the CDC helped us use the Toolkit more effectively
The consultations offered by the CDC helped us improve our HDSP program

18. Please describe your overall experience implementing the Toolkit and related activities including successes, challenges and lessons learned.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

19. Please provide any additional comments below regarding your experience using the Toolkit and other resources to promote HDSP with employers, employer groups, unions and others engaged in worksite interventions and in purchasing and providing employee preventive health benefits.

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

20. Name of the person who completed this survey:

________________________________