Form no number no number Example Web-Based Survey

Attachment 6

Example Web-Based Survey

Improving the Quality and Delivery of CDC’s Heart Disease and Stroke Prevention Programs

Improving the Quality and Delivery of

CDC’s Heart Disease and Stroke Prevention Programs

WEB-BASED SURVEY

First Page: Introduction and Participation Statement

Introduction

Thank you very much for agreeing to complete this web-based survey about the Evaluation Technical Assistance services you recently received from the Division for Heart Disease and Stroke Prevention (DHDSP) at the Centers for Disease Control and Prevention (CDC). Your ideas and opinions are very important to us.

Our goal today is to get your ideas and opinions about the Evaluation Technical Assistance that you received from the DHDSP this past six months. Information collected from this survey will be used by the DHDSP to help improve the Evaluation Technical Assistance that it delivers.

This survey should last about thirty minutes.

Participation Statement

Your participation today is purely voluntary. If you feel uncomfortable at any time you don’t have to answer a question or you can refuse to participate further. You will not be penalized in any way if you refuse to participate or skip any of the questions.

We will write a summary report of the findings from all the surveys we conduct. Your name won’t be used.

By clicking “Next” you give your consent to participate in this survey.

Second Page: Definition of “Technical Assistance”

Technical assistance is defined as “help and advice provided on a specialized subject matter”. For this survey, think about the one-on-one technical assistance you have received from individuals in the DHDSP on the subject of evaluation. During a one-on-one technical assistance session, guidance or resources may have been provided to you on a variety of evaluation topics, for example logic model development, evaluation plan development, or evaluation plan implementation. This technical assistance may have come from your project officer or your evaluation contact at the DHDSP. It may have been provided over the phone, via email, or in person, such as during a meeting or conference.

Third Page: Start of Survey

Technical Assistance Use

Thinking about the definition of evaluation technical assistance: one-on-one interaction over the phone, via email, or in person with your project officer or evaluation contact in which your received help or advice about evaluation…

1. How many times have you accessed evaluation technical assistance in the past six months? (Number) (If respondent has NOT accessed technical assistance in the past six months/responded “0” to question 1- continue to question 2; if respondent HAS accessed evaluation technical assistance in the past six months/responded at least “1” to question 1 – skip to question 9)

2. Why haven’t you access evaluation technical assistance? (Open ended)

3. If you or your organization have an evaluation need in the future, how likely are you to access evaluation technical assistance?

   1. Very likely (Skip to question 7)

   2. Somewhat likely (Skip to question 7)

   3. Not likely (Go to question 4)

4. Within the past six months, have you accessed evaluation technical assistance from another source other than DHDSP staff?

   1. Yes (Go to question 5)

   2. No (End survey)

   3. Not sure (End survey)

5. What makes you utilize this source for evaluation technical assistance? (open ended)

6. What would CDC need to do to make you inclined to ask CDC for evaluation technical assistance (open ended)? (End survey)

7. Though which mechanism are you most likely to access evaluation technical assistance?

   1. Email project officer

   2. Call project officer

   3. Email evaluation contact

   4. Call evaluation contact

   5. Speak with evaluation contact at a training session (i.e. Annual State Training)

   6. Speak with evaluation contact during a site visit

   7. Other (please specify: )

8. For which topics are you most likely to seek evaluation technical assistance?

   1. Evaluation plan development (i.e. selecting evaluation questions or data sources)

   2. Logic model development

   3. Evaluation plan implementation (i.e. analyzing data, reporting results)

   4. Other (please specify: ) (End survey)

9. How have you accessed evaluation technical assistance? (Check all that apply)

   1. Emailed project officer

   2. Called project officer

   3. Emailed evaluation contact

   4. Called evaluation contact

   5. Spoke with evaluation contact at a training session (i.e. Annual State Training)

   6. Spoke with evaluation contact during a site visit

   7. Other (please specify: )

10. How do you prefer to access evaluation technical assistance? (Check one)

    1. Email project officer

    2. Call project officer

    3. Email evaluation contact

    4. Call evaluation contact

    5. Speak with evaluation contact at a training session (i.e. Annual State Training)

    6. Speak with evaluation contact during a site visit

    7. Other (please specify: )

11. For which topics have you accessed evaluation technical assistance? (Check all that apply)

    1. Evaluation plan development (i.e. selecting evaluation questions or data sources)

    2. Logic model development

    3. Evaluation plan implementation (i.e. analyzing data, reporting results)

    4. Other (please specify: )

12. For which topic are you most likely to access evaluation technical assistance? (Check one)

    1. Evaluation plan development (i.e. selecting evaluation questions or data sources)

    2. Logic model development

    3. Evaluation plan implementation (i.e. analyzing data, reporting results)

    4. Other (please specify: )

Relevance

Thinking about the evaluation technical assistance you have received in the past six months, please rank the following statements on a scale of 1 (Strongly disagree) to 5 (Strongly agree).

13. It was easy to access the evaluation technical assistance.

14. The evaluation technical assistance I received was relevant to the heart disease and stroke prevention work that I do.

15. The evaluation technical assistance was appropriate for the skills I have.

Quality

Thinking about the evaluation technical assistance you have received in the past six months, please rank the following statements on a scale of 1 (Strongly disagree) to 5 (Strongly agree).

16. I understood the evaluation technical assistance I received.

17. The evaluation technical assistance I received came from a credible source.

18. The evaluation technical assistance I received was accurate.

19. I enjoyed speaking with the individual from whom I receive evaluation technical assistance

20. The individual from whom I received evaluation technical assistance treated me with respect.

21. Within the past six months, have you accessed evaluation technical assistance from another source other than DHDSP staff?

    1. Yes (Go to question 22)

    2. No (Skip to question 24)

    3. Not sure (Skip to question 24)

22. Compared to this evaluation technical assistance, would you say that DHDSP evaluation technical assistance is

    1. Much better

    2. Somewhat better

    3. The same

    4. Somewhat worse

    5. Much worse

23. Why do you say that? (open ended)

Thinking about the last time you accessed evaluation technical assistance.

24. Please describe the topic(s) that were discussed during this evaluation technical assistance session. (open ended)

25. Did the evaluation technical assistance meet your expectations?

1. Yes (Go to question 26)

2. No (Skip to question 27)

3. Not sure (Skip to question 27)

26. In what ways did the evaluation technical assistance meet your expectations? (open ended) (Skip to question 29)

27. In what ways did the evaluation technical assistance fail to meet your expectations? (open ended)

28. What could have been done differently in order for the evaluation technical assistance to more fully meet your expectations? (open ended)

Thinking about the overall technical assistance service.

29. In what ways can the evaluation technical assistance be improved? (open ended)

Impact

Thinking about the evaluation technical assistance you have received in the past six months, please rank the following statements on a scale of 1 (Strongly disagree) to 5 (Strongly agree).

30. The evaluation technical assistance I received increased my knowledge.

31. The evaluation technical assistance I received helped me address a specific problem, interest or need that I or my organization had.

32. The evaluation technical assistance I received helped to increase my organization’s capacity to prevent heart disease and stroke.

33. Describe some of the ways either your or your organization has used the evaluation technical assistance service you have received? (open ended)

34. If you or your organization have an evaluation need in the future, how likely are you to access evaluation technical assistance?

    1. Very likely

    2. Somewhat likely

    3. Not likely

35. What other comments do you have about the evaluation technical assistance provided by the CDC? (open ended)

36. What other guidance or resources do you need to enhance your organization’s heart disease and stroke prevention efforts? (open ended)