CDC’s WISEWOMAN Program
Year 3 Evaluation Survey: Part II
Introduction
We would like to thank you for agreeing to complete this survey about the WISEWOMAN program. In concert with our continued assessment of the quality and impact of programs, this survey will focus on participant enrollment, consideration of program requirements for direct service providers, quality of care, participant outcomes, and other program activities.
Responses provided to this survey are considered those of individual WISEWOMAN programs—not those of individuals—and all responses provided will be maintained securely by ICF Macro staff.
You will receive Part III of the survey in approximately 1 month. We anticipate sharing preliminary findings during the 2011 Annual WISEWOMAN Meeting in Atlanta, and we will share an executive summary and facilitate a Webinar after all data analysis has been completed before the end of this year.
We would like to thank you for agreeing to complete this survey, and ask that you respond to the questions that follow.
Informed Consent Statement
ICF Macro is conducting this survey as part of the evaluation of the CDC’s WISEWOMAN program. The purpose of this survey is to better understand WISEWOMAN program implementation in your State/Tribe, including:
how programs maximize reach to priority populations
specific training and technical assistance needs
how programs develop and use quality assurance protocols
programs’ use of non-WISEWOMAN resources to provide services
program sustainability
data use
supplemental program activities
Participation in the survey is voluntary; you may choose to end the survey at any time for any reason with no penalty and may choose not to answer any questions at any time for any reason. Your participation in the survey poses few, if any risks to you and you may choose not to participate in the survey for any reason.
ICF Macro evaluation staff will know which program has provided responses. This will allow us to follow up with programs should any responses require clarification. In addition, ICF Macro staff will track responses from each of the 3 surveys to link a given program’s responses across the 3 data collection points. All responses provided to CDC will be in aggregate—across all programs—and without linking specific responses to the programs that provide them.
Your answers will help CDC assess how well WISEWOMAN is able to meet its objectives, and your responses will help CDC work with program staff to improve the program in the most sustainable manner moving forward.
If you have any questions about this survey, or evaluation, please contact Mr. Lawrence Scholl, ICF Macro Senior Project Manager, at Phone: (404) 433-0735, E-mail: [email protected].
unless otherwise indicated, these questions relate to your current program activities. Please answer all questions about your current activities, performed DURING THE PERIOD of the current Funding opportunity announcement (DP08-804, june 30, 2008-PRESENT).
Section A: Participant Enrollment
The WISEWOMAN Program is interested in learning about efforts to maximize the enrollment of participants into the program. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
If applicable, please describe your program’s procedures to ensure that WISEWOMAN-eligible participants enroll in WISEWOMAN. [Open entry]
Do you have plans to develop new procedures to ensure that eligible women are enrolled in WISEWOMAN?
Yes
No (Skip to Question #4)
Do not know (Skip to Question #4)
Please describe your reasons for developing new procedures to ensure that eligible women are enrolled in WISEWOMAN? [Open entry]
If applicable, please describe your program’s policies to ensure that WISEWOMAN-eligible participants enroll in WISEWOMAN. [Open entry]
Do you have plans to develop new policies to ensure that eligible women are enrolled in WISEWOMAN?
Yes
No (Skip to Question #7)
Do not know (Skip to Question #7)
Please describe your reasons for developing new policies to ensure that eligible women are enrolled in WISEWOMAN? [Open entry]
How often does your program review the process to ensure that WISEWOMAN-eligible participants are enrolled in WISEWOMAN? Select all that apply.
Monthly
Quarterly
Annual reporting
Other (please specify) _____
Do not know
SECTION B: PROGRAM REQUIREMENTS FOR DIRECT SERVICE PROVIDERS
The WISEWOMAN Program is interested in learning about efforts to maximize the adherence by direct service providers to program requirements. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
Which type(s) of procedures do you have in place to ensure that direct service providers provide WISEWOMAN services in accordance with Program requirements? Select all that apply.
Site visits
Participant record review
Audits
Other protocols, practices, or procedures (Please specify) _____
None – we do not have any protocols, practices or procedures to ensure implementation of services per the program requirements
Do not know
What are barriers to developing procedures to ensure that direct service providers implement services according to WISEWOMAN Program requirements? Select all that apply.
Not enough time to develop procedures
Not enough funding to develop procedures
Not enough staff expertise to develop procedures
Lack of involvement of partner organizations
Lack of involvement by direct service providers
Other barriers (please specify) ______
None – we have not faced any barriers with developing procedures
Do not know
What are barriers to implementing procedures to ensure that direct service providers implement services according to WISEWOMAN Program requirements? Select all that apply.
Not enough time to implement procedures
Not enough funding to implement procedures
Not enough staff expertise to implement procedures
Lack of involvement of partner organizations
Lack of involvement by direct service providers
Other barriers (please specify) ______
None – we have not faced any barriers with implementing procedures
Do not know
How can CDC help you develop procedures to ensure that WISEWOMAN direct service providers implement program direct services based on program requirements?
Formal training (e.g., Webinar)
Technical assistance (TA) (e.g., individual consultation, assistance with developing tools)
Guidance (e.g., emails, documents, and tools to provide suggestions or advice based on policies or evidence)
Other assistance (please specify) _____
None – we do not need assistance from CDC to develop protocols (Skip to Question #13)
Do not know (Skip to Question #13)
Please describe the training, TA, and guidance (e.g., emails, documents, tools) that would be helpful to assist you with developing procedures to ensure direct service providers adhere to program requirements. [Open entry]
SECTION C: QUALITY OF CARE and access to care
The WISEWOMAN Program is interested in learning about efforts to maximize access to and receipt of care. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
What strategies do you use to ensure participants have access to quality care? Select all that apply.
Provider contracts
Focus on rural providers
Focus on underserved geographic areas
Expanded office hours
Transportation incentives
Childcare/eldercare
Other strategies (please specify) _____
None – we do not use specific resources to ensure participants’ access to quality of care (Skip to Question #15)
Do not know (Skip to Question #15)
Please further describe the above strategies and how they increase access to quality care. [Open entry]
What strategies do you use to ensure participants receive quality care? Select all that apply.
Written policies
Written procedures
Provider contracts
National guidelines
Electronic medical records
Other strategies (please specify) _____
None – we do not use specific resources to ensure participants receive quality of care (Skip to Question #17)
Do not know (Skip to Question #17)
Please describe the strategies you use to ensure participants receive quality care. [Open entry]
section D: participant outcomes
The WISEWOMAN Program is interested in learning about any participant health behavior data collected. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
Does your program collect data on LSI participant health behaviors (e.g., physical activity behavior)?
Yes
No (Skip to Question #19)
Do not know
Which of the following types of data does your program collect to assess lifestyle intervention (LSI) participant health behaviors? Select all that apply.
Physical activity behavior
Healthy eating behavior
Smoking behavior
Other participant health behaviors (please specify) _______________
None – we do not collect data to assess LSI participant health behaviors
Do not know
Does your program collect biometric data from LSI participants prior to re-screen?
Yes
No (Skip to Question #21)
Do not know
Which of the following types of biometric data does your program collect from LSI participants prior to re-screen?
Blood pressure
Body mass index (BMI)
Blood glucose or H1Ac levels
Blood cholesterol
Other biometric data (please specify) _______________
None – we do not collect biometric
Do not know
For which of the following variables does your program collect information to help explain LSI participant outcomes for engaging in physical activity? Select all that apply.
Physical activity knowledge
Physical activity motivation (e.g., readiness to change)
Physical activity behavioral intention
Physical activity beliefs
Physical activity attitudes
Physical activity self-efficacy
Physical activity perceived barriers
Other variables to explain changes in physical activity behaviors (please specify) _____________
None – we do not collect data to help explain LSI participant outcomes for physical activity
Do not know
For which of the following variables does your program collect information to help explain LSI participant outcomes for engaging in healthy eating? Select all that apply.
Healthy eating knowledge
Healthy eating motivation (e.g., readiness to change)
Healthy eating behavioral intention
Healthy eating beliefs
Health eating attitudes
Healthy eating self-efficacy
Healthy eating perceived barriers
Other variables to explain changes in healthy eating behaviors (please specify) _____________
None – we do not collect data to help explain LSI participant outcomes for healthy eating
Do not know
What barriers, if any, does your program face in collecting information to assess LSI participant outcomes?
Not enough time to identify existing data collection instruments
No existing data collection instruments available
Not enough time to develop data collection instruments
Not enough time to collect data
Not enough funding to develop data collection instruments
Not enough funding to collect data
Not enough staff expertise to develop data collection instruments
Not enough staff expertise to collect data
Not enough knowledge about what data to collect
Lack of interest among the LSI participants
Lack of involvement of partner organizations
Lack of involvement by direct service providers
CDC has not required collecting data to assess LSI participant outcomes
Other barriers (please specify) _____
None – we have not faced any barriers
Do not know
Section E: Other Heart Disease and Stroke Prevention-Related Activities
The WISEWOMAN Program is interested in learning about any activities and data collected about heart disease and stroke prevention. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
Does your program collect information about participant sodium reduction?
Yes
No (Skip to Question #27)
Do not know (Skip to Question #27)
Please describe the types of information that your program collects about participant sodium reduction. [Open entry]
How does your program collect information about participant sodium reduction?
Using participant intake form
During risk reduction counseling
Using a lifestyle assessment survey
Other (please specify) _____
None – we do not collect information related participant sodium reduction
Do not know
Does your program collect information about participant use of aspirin or aspirin therapy?
Yes
No (Skip to Question #30)
Do not know (Skip to Question #30)
Please describe the types of information that your program collects about participant use of aspirin or aspirin therapy. [Open entry]
How does your program collect information from participants about their use of aspirin or aspirin therapy?
Using participant intake form
During risk reduction counseling
Using a lifestyle assessment survey
Other (please specify) _____
None – we do not collect information related participant sodium reduction
Do not know
Section F: work with community health workers
The WISEWOMAN Program is interested in learning about your program’s experiences working with community health workers. The WISEWOMAN Program acknowledges that your funded program may operate differently than others. Responses to these questions will not impact your funded program negatively, and programs will not be penalized in any way.
In what ways does your program work with community health workers (CHWs) to support the WISEWOMAN program? Select all that apply.
Recruit participants
Provide clinical services
Provide risk reduction counseling
Assess participant health behaviors
Assess participant readiness to change health behaviors
Deliver LSIs
Other ways (please specify) ______
None – our program does not work with community health workers (Skip to Closing)
Do not know (Skip to Closing)
Please rate the extent to which you agree with the following statements related to your program’s work with community health workers (CHWs).
Working with CHWs improves our program’s ability to reach potential WISEWOMAN participants.
Strongly disagree
Somewhat disagree
Neither disagree or agree
Somewhat agree
Strongly agree
Do not know
Working with CHWs improves our programs ability to provide clinical services.
Strongly disagree
Somewhat disagree
Neither disagree or agree
Somewhat agree
Strongly agree
Do not know
Working with CHWs aids our program’s ability to provide risk reduction counseling.
Strongly disagree
Somewhat disagree
Neither disagree or agree
Somewhat agree
Strongly agree
Do not know
CHWs have been instrumental in improving our program’s ability to assess participants health behaviors or readiness to change health behaviors.
Strongly disagree
Somewhat disagree
Neither disagree or agree
Somewhat agree
Strongly agree
Do not know
CHWs have improved our program’s ability to deliver lifestyle interventions.
Strongly disagree
Somewhat disagree
Neither disagree or agree
Somewhat agree
Strongly agree
Do not know
CLOSING
These are all of the questions that we have for now. Thank you for taking the time to complete this survey today. As previously mentioned, should you have any questions about this survey, or evaluation, please contact Mr. Lawrence Scholl, Senior Project Manager, at Phone: (404) 433-0735, E-mail: [email protected].
Information Collection #3
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| File Type | application/msword |
| Author | Thearis A. Osuji |
| Last Modified By | Scholl, Larry |
| File Modified | 2011-02-12 |
| File Created | 2011-02-12 |