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pdfForm Approved OMB No. 0990-XXXX
Exp. Date XX/XX/XX11
Coalition Survey Pretest
This survey explores your understanding and views about bone health as well as your perceptions about
the needs of your team in the coming year. You will note that we use the term “team” to address your site’s
coalition throughout the survey. Please read each question carefully and provide your honest feedback. The
survey results will be used by the Office on Women’s Health and Hager Sharp to tailor technical and training
services to the needs of you and your team through the duration of the pilot project. We look forward to
your feedback and suggestions. The survey should take between 15-20 minutes to complete. Thank you in
advance for your time.
The first set of items asks about your team and your role on your team.
1) Last 4 digits of your HOME phone number: ___ ___ ___ ___
2) What is your gender?
Male
Female
3) How old are you?
18-24 years
25-29 years
30-39 years
40-49 years
50-59 years
60+ years
4) Are you Hispanic or Latino?
No
Yes
5) What is your race? (Choose one or more.)
Black/African American
White
American Indian or Alaska Native
Asian
Native Hawaiian or Pacific Islander
6) What team do you represent?
City 1
City 2
City 3
7) What is your role on your team? (Choose one or more)
Site Coordinator
Team Leader
Team Member
Body Works Trainer
Other: _________________________
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990- . The time required to
complete this information collection is estimated to average ( hours)(minutes) per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you
have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.
Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201,
Attention: PRA Reports Clearance Officer
8) What stakeholder group do you primarily represent? (Choose one.)
Community Organization
Health Professional
Nutrition Professional
Physical Education Professional
School Administrator
Teacher
Business/Industry
Student
Parent
Other:______________________________
9) Prior to working on this project, in which of the following areas did you have experience working on
projects or with partnerships? (Choose one or more.)
Childhood obesity prevention
Nutrition
Physical activity
Bone health
None of the above
10) Have members of your team worked together on previous projects or partnerships?
No, not at all
Yes, some have worked together before
Yes, most have worked together before
Yes, all have worked together before
Not sure
Weekly
Biweekly
Monthly
Quarterly
Never
Not
Sure
a. Meet in person?
b. Conduct conference calls?
c. Conduct web meetings?
11) How often will your team…
Coalition Pre Test Survey Draft 1/14/09
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This set of questions assesses what you currently know about bone health.
12) By age ___, females have built most of their bone mass (how solid and strong bones are from the
inside) for the rest of their lives.
5 yrs
13 yrs
18 yrs
30 yrs
55 yrs
13) How many minutes of DAILY physical activity are recommended for pre-teen and adolescent girls to
stay healthy?
20 minutes 30 minutes 45 minutes 60 minutes 90 minutes
14) How many days per week of bone-strengthening activity are recommended for pre-teen and adolescent
girls to build strong bones?
1 Day
2 Days
3 Days
4 Days
5 Days
15) How many minutes of DAILY physical activity are recommended for adults to be active and stay
healthy?
20 minutes 30 minutes 45 minutes 60 minutes 90 minutes
16) How many milligrams (mg) of calcium are recommended DAILY for pre-teen and adolescent girls to
build strong bones and stay healthy?
200 mg
500 mg
750 mg
900 mg
1300 mg
17) How many international units (IU) of vitamin D are recommended DAILY for pre-teen and adolescent
girls to build strong bones and stay healthy?
100 IU
200 IU
300 IU
400 IU
500 IU
The next set of items examines your views about bone health and your capacity to help your team in
current or future efforts to plan, implement and evaluate a variety of project activities.
18) Please check how important you think it is to help girls
and their parents to:
d. Better understand how to build strong bones to
prevent osteoporosis
e. Identify foods and drinks that are high in calcium and
Vitamin D
f. Better understand the role of physical activity in
building strong, healthy bones
g. Choose foods and drinks that are high in calcium and
Vitamin D
h. Get the recommended amount of physical activity
everyday
Not At All
Important
A Little
Important
Quite
Important
Very
Important
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19) Please check how confident you feel helping girls
and their parents to:
a. Better understand how to build strong bones to
prevent osteoporosis
b. Identify foods and drinks that are high in calcium and
Vitamin D
c. Better understand the role of physical activity in
building strong, healthy bones
d. Choose foods and drinks that are high in calcium and
Vitamin D
e. Get the recommended amount of physical activity
everyday
Not At All
Confident
A Little
Confident
Quite
Confident
Very
Confident
Not At All
Confident
Not Very
Confident
Quite
Confident
Very
Confident
b. Communication and Outreach implementation efforts
c. Communication and Outreach evaluation efforts
d. Body Works planning efforts
e. Body Works implementation efforts
f.
Not at All
Valuable
Extremely
Valuable
Extremely
Valuable
Don’t
Know
b. Action Planning Technical Assistance: General
c. Evaluation Technical Assistance: General
d. Marketing/Communication: Planning
e. Marketing/Communication: Implementation
f.
g. Outreach: Planning
h. Outreach: Implementation
i.
Outreach: Evaluation
j.
Body Works: Planning & Training
k. Body Works: Recruitment & Retention of Participants
l.
m. Body Works: Evaluation
n. Other:
20) Please check how confident you feel helping your
team with….
a. Communication and Outreach planning efforts
Body Works evaluation efforts
21) Below is a list of technical assistance and training
services that Hager Sharp could provide to teams. For
each, please indicate how valuable that service would
be to your team.
a. Understanding Bone Health: Background Information
Marketing/Communication: Evaluation
Body Works: Implementation
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22) Below is a list of resources that Hager Sharp could
provide to teams. For each, please indicate how
valuable that resource would be to your team.
a. Funding Alerts/Opportunities
Not at All
Valuable
Extremely
Valuable
Extremely
Valuable
Don’t
Know
b. Listserv
c. Team E-Newsletter
d. Partnership/Coalition Building Referrals
e. Best Bones Forever Identity Materials (logo, letterhead)
f.
g. Pilot Site Web Site
h. Media kit
i.
Partner Toolkits (AFHK, NASN, NOF)
j.
Other:
Best Bones Forever Educational Materials
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| File Type | application/pdf |
| File Title | Hager Sharp – Capacity Building |
| Author | Teresa Shattuck |
| File Modified | 2009-01-29 |
| File Created | 2009-01-29 |