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pdfForm Approved OMB No. 0990-XXXX
Exp. Date XX/XX/XX11
Coalition Survey Posttest
This survey explores your understanding and views about bone health as well as your perceptions about
your team’s pilot project efforts over the past year. 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
improve future bone health program activities. We look forward to your feedback and suggestions. The
survey should take about 30 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/ethnicity? (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) Prior to working on this project, 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 did your team…
Coalition Pre Test Survey 01/29/2009
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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.
20) If the project were to continue, please check how
confident you would 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 provided to
teams. For each, please indicate if
you were aware of the service, if
your team used it during the past
year, and if so, how valuable the
service was to your team.
Column I
Were you
aware of
this
service? If
NO, skip
to next
service.
Column II
Column III
If YES, did your
team use this
service in the
past year?
If YES, how valuable was this
service to your team?
(Scale of 1-5)
Not at all
valuable
1
2
Extremely
Valuable
3
4
5
Yes
No
Yes
No
Don’t
Know
a. Understanding Bone Health:
Background Information
b. Action Planning Technical
Assistance: General
c. Evaluation Technical Assistance:
General
d. Marketing/Communication:
Planning
e. Marketing/Communication:
Implementation
f. Marketing/Communication:
Evaluation
g. Outreach: Planning
Don’t
Know
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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:
Body Works: Implementation
22) Below is a list of resources that
Hager Sharp provided to teams.
For each, please indicate if you
were aware of the resource, if you
used it during the past year, and, if
so, how valuable the resource was
to you.
Column I
Were you
aware of
this
resource?
If NO, skip
to next
resource.
Column II
Column III
If YES, did you
use this resource
in the past year?
If YES, how valuable was this
resource to you?
(Scale of 1-5)
Not at all
valuable
1
2
Extremely
Valuable
3
4
5
g. Pilot Site Web Site
h. Media kit
i.
Partner Toolkits (AFHK, NASN,
NOF)
j.
Other:
Yes
No
Yes
No
Don’t
Know
a. Funding Alerts/Opportunities
b. Listserv
c. Team E-Newsletter
d. Partnership/Coalition Building
Referrals
e. Best Bones Forever Identity
Materials (logo, letterhead)
f. Best Bones Forever Educational
Materials
Don’t
Know
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Please indicate the extent to which you agree or disagree with each statement. Be sure to answer
based on your own perspective and not what you think other team members would say.
23) When reflecting on the past year, I believe that
my team effectively….
Strongly
Disagree
Disagree
Agree
Strongly
Agree
Don’t
Know
a. Established realistic goals and objectives from
the outset.
b. Developed a feasible, thoughtful action plan to
implement communication/outreach activities.
c. Developed a feasible, thoughtful action plan to
implement Body Works.
d. Updated the action plan to keep team members
abreast of activities and on the same page.
e. Accomplished objectives stated in our action
plan.
f. Recruited the right team members to help
implement our action plan.
g. Worked well together.
h. Worked well with Hager Sharp.
i.
Maintained open and effective channels of
communication.
j.
Shared the work load between team members.
k. Developed high functioning sub-committees to
plan and implement elements of the program.
l. Integrated bone health messages and activities
into existing projects or partnerships.
m. Implemented communication & outreach
activities.
n. Evaluated communication & outreach activities.
o. Undertook planning & training efforts for Body
Works.
p. Undertook recruitment & retention of participants
for Body Works
q. Implemented Body Works
r.
Generated interest in bone health at the
community level.
s. Successfully integrated bone health into the
larger context of physical activity and nutrition.
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During the past year, in which of the following related activities did you participate? Please choose
one or more.
24) During the past year, did you…
Yes
No
a. Attend in-person meeting with Hager Sharp.
b. Participate in conference call(s) with Hager Sharp.
c. Help to mobilize others to join your team.
d. Use your organization’s communication vehicles to distribute
information related to the project.
e. Distribute Best Bones Forever Campaign materials
f.
g. Champion Bone Health initiatives with leaders outside your
organization.
h. Participate in one or more of your team’s subcommittees or projects.
i.
Author or co-author project related articles.
j.
Act as spokesperson for your team to the media.
k. Conduct media outreach
l.
m. Conduct community presentations
n. Other:
Champion Bone Health initiatives with leaders in your organization.
Conduct presentations about the project at professional meetings or
conferences.
25) As a team member, I participated in:
Too many activities this year, I felt overextended.
Just the right amount of activities, I would like to do the same next year.
Not enough activities, I was willing to do more this year.
No activities this past year.
26) What was your key contribution to your team?
27) Overall, how satisfied are you with Hager Sharp’s support of your team?
Not at all satisfied
Somewhat satisfied
Satisfied
Very satisfied
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Please indicate the extent to which you agree or disagree with each statement. Be sure to answer
based on your own perspective and not what you think other team members would say.
Strongly
Disagree
Disagree
Agree
Strongly
Agree
a. Provided effective leadership for teams.
b. Clearly articulated its goals and objectives for the
project to teams.
c. Was clear about the technical assistance it could
provide in support of my team's effort.
d. Was clear about the resources that it could
provide to support my team's effort.
e. Had the right partner organizations involved to
advance the goals of the project.
f. Fostered effective collaboration between the
partner organizations and teams.
g. Provided clear guidance with respect to Body
Works.
h. Provided needed support and resources with
respect to Body Works.
i. Provided clear guidance with respect to
community outreach.
j. Provided needed support and resources with
respect to community outreach.
28) Overall, I think that Hager Sharp…
29) What suggestions or comments do you have for Hager Sharp to improve its technical assistance and
support services?
30) What three aspects of the pilot program do you consider most crucial to its success? (Please select up
to three)
Funding
A Paid team Leader
Community Support
Technical Support: Outreach
Technical Support: Background Information
Technical Support: Action Planning
Technical Support: Marketing
Technical Support: Evaluation
Technical Assistance: BodyWorks
Resources Provided by Hager Sharp
Bone Health Materials
Other _______________________________
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31) What was your team’s greatest strength?
32) What was your team’s greatest success?
33) What was your team’s most significant challenge?
34) If your team had the opportunity to do this project all over again, do you think it should? Why or why
not?
35) What advice would you give to members of a new team just starting out?
36) Does your site intend to continue any of the following aspects of the program once the pilot intervention
has ended?
We plan to continue…
Coalition Activities
Outreach/Education Activities
BodyWorks Programs
Other:
Yes
No
Not Sure
Coalition Pre Test Survey 01/29/2009
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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 |