Form 1 Cancer Control Leadership Forum Survey

Instructions: Please complete the following questionnaire designed to gather information on the pre-work, content
and delivery of the Cancer Control Leadership Forum. This information is being collected by the U.S. National
Cancer Institute. The information collected will be used to improve development, delivery, and follow-up of future
Forums. Please answer the following questions thoroughly and return your completed form to Forum organizers.
OMB NO: 0925-0642-38
EXPIRATION DATE: 09/30/2014
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including the time for reviewing instructions, searching existing data sources, gathering and maintaining the information
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comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN:
PRA (0925-0642). Do not return the completed form to this address.
Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of
study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for
not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any
way. The information collected in this study will be kept private under the Privacy Act. Names and other identifiers will
not appear in any report of the study. Information provided will be combined for all study participants and reported as
summaries.

1. Did the pre-work help prepare the country team for participation in the Forum?
Yes
No
Comments
2. Was the Forum delivered in a way that met your learning needs as a participant?
Strongly
Disagree
Forum in general
Module Presentations
Action planning sessions

Comments

Disagree

Neutral

Agree

Strongly
Agree

3. Please indicate the extent to which the content of the "Building Effective Partnerships"
module improved your understanding of the following:
Strongly Moderatel Slightly
Improved
y
Improved
Improved

Did Not
Improve

The need for and role of diverse partnerships
Identifying potential partnership gaps
Engaging and sustaining partner involvement

Comments
4. Please indicate the extent to which the content of the "Using Data and Information for
National Cancer Control Efforts" module improved your understanding of the following:
Strongly Moderatel Slightly
Improved
y
Improved
Improved
The use of data to guide national cancer
control efforts
The importance of different types of data and
information needed for plan development and
implementation
Assessing your country's data and information
needs

Comments

Did Not
Improve

5. Please indicate the extent to which you believe the content of the "Effective Cancer
Control Plan Implementation" module improved your understanding of the following:
Strongly Moderatel Slightly
Improved
y
Improved
Improved

Did Not
Improve

Identifying priorities for the cancer control plan
Securing funding for the cancer control
priorities
Mobilizing support for the cancer control plan
and its implementation
Evaluating progress in implementing the plan

Comments
6. How useful were the supplemental talks to you as a participant?
Very
Useful
CISNET
ASCO
Registries
Tobacco
Research Capacity
IAEA-PACT
UICC
Cervical Cancer
Implementation Science

Comments

Moderatel
y Useful

Slightly
Useful

Not
Useful

7. After participating in the Forum, what potential needs for technical assistance can you
identify?

8. Please provide any additional comments or recommendations for improving future
Forums: