USE OF EVIDENCE-BASED PRACTICES FOR
COMPREHENSIVE CANCER CONTROL
New
Supporting Statement – Part B
October 24, 2011
(Revised January 18, 2012)
Primary Contact:
C. Brooke Steele
Technical Monitor
National Center on Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention (CDC)
4770 Buford Highway NE, MS K-57
Atlanta, GA 30341-3724
Telephone: (770) 488-4261
Fax: (770) 488-4335
Email: [email protected]
Table of Contents
B. Collections of Information Employing Statistical Methods 1
B.1. Respondent Universe and Sampling Methods 1
B.2. Procedures for the Collection of Information 2
B.3. Methods to Maximize Response Rates and Deal with Nonresponse 3
Attachment A: Authorizing Legislation
Attachment B.1: Federal Register Notice
Attachment B.2: Summary of Public Comments and CDC Response
Attachment C.1: Program Director Web Survey Questionnaire
Attachment C.2: Program Director Telephone Interview Script
Attachment C.3: Program Director Advance Letter
Attachment C.4: Program Director Survey Scheduling Script
Attachment C.5: Program Director Follow-up E-mail Messages
Attachment D.1: Program Partner Web Survey Questionnaire
Attachment D.2: Program Partner Invitation E-mail Message
Attachment D.3: Program Partner Follow-up E-mail Messages
Attachment D.4: Program Partner Follow-up Postcard Messages
Attachment D.5: Program Partner Thank You E-mail Message
Attachment E: Battelle IRB Notice of Exemption
B. Collections of Information Employing Statistical Methods
B.1. Respondent Universe and Sampling Methods
In order to understand how the NCCCP-funded programs are using evidence-based practices for cancer prevention and control in their respective jurisdictions (states, tribal areas, and Pacific Island Jurisdictions/territories), it is necessary to collect data on this topic from the key stakeholders with the most involvement in selecting and implementing those practices. Therefore, this study will involve surveys conducted among two related populations:
Program Directors. Directors of the NCCCP-funded programs (or their designees); and
Program Partners. Program partners/collaborators identified by the program directors as instrumental to the selection and implementation of cancer control EBPs.
Program Directors. The goal is to survey the directors (or their designees) of programs supported by the NCCCP. CDC currently supports 65 comprehensive cancer control (CCC) programs, including in all 50 states, the District of Columbia, 7 tribes/tribal organizations, and 7 Pacific Island Jurisdictions/territories. One of the Pacific Island Jurisdiction grantees is the national CCC program in the Federated States of Micronesia (FSM). The national program supports CCC programs in four FSM states, each of which submits a cancer plan to CDC. Therefore, CDC receives cancer plans from 69 programs. Because directors of 3 of the 69 programs have participated in the survey instrument pilot testing, the survey will focus on the remaining 66 program directors. The program directors are in the best position to directly shape how their programs utilize EBPs, and will often be the most knowledgeable about the current use of EBPs to address cancer control objectives specified in their action plans. However, it is possible that some directors will not be the most knowledgeable person regarding the use of EBPs. In these cases, as part of the study recruitment process, we will ask the directors to specify the staff person with the most knowledge about and direct involvement with the use of EBPs for their programs.
Program Partners. The second survey will be conducted among key partners for the NCCCP-funded programs. Program partners are key collaborators to the CCC programs and members of the cancer control coalitions in their respective jurisdictions. Program partners will be identified by the program directors participating in the first survey – as the directors are called to set up a time for the telephone survey, they will be asked to provide names and contact information for 3-4 partners who play a substantial role in helping their programs utilize (identifying, adapting, implementing, and evaluating) evidence-based cancer control practices. Thus, we expect a 50% response rate among partners for a final sample of 132.
Recruitment of survey participants from the two study populations will be conducted by the contractor (Battelle). Recruitment begins with the program directors, but because we rely on them to provide referrals to key partners we can only begin partner recruitment once the director survey is underway.
Program Directors. The directors of 66 CCC programs will be invited to participate in the survey. The survey recruitment process will involve three main steps:
Advance Letters to Program Directors. Battelle will send an advance letter to all program directors describing the purpose and importance of the study, inviting them to participate, and describing what they can expect if they choose to participate (see Attachment C.3). The advance letters will be printed on CDC letterhead and signed by the appropriate CDC staff person.
Scheduling Calls. Within approximately one week of the advance letters being mailed, Battelle will contact all program directors by telephone, inviting them to participate in the survey and to schedule a one-hour appointment during which they can complete the survey (see Attachment C.4 for copy of the scheduling script), which will include text and instructions for describing the purpose and procedures of the survey, and for confirming their willingness to participate. The schedulers will perform the informed consent procedures during the call. If a director (or the designee) consents to participate, then she/he will be asked to provide names and contact information for 3–4 key partners/collaborators who play a substantial role in helping the programs utilize EBPs. Obtaining the partner referrals during the scheduling calls will allow Battelle to initiate recruitment for the partner survey as soon as possible. However, if a director is not able to provide the partner referrals at the time of the scheduling call, they will be asked to e-mail the list to the scheduler following the call, or provide the partner information during the telephone interview component of the scheduled survey appointment.
Confirmation E-mails. For the program directors (or their designees) choosing to participate, Battelle will send a confirmation e-mail message that contains the date and time for the scheduled survey appointment and instructions for completing the survey when the appointment occurs (see Attachment C.5).
Program Partners. Recruitment for the program partner survey will commence as soon as the program directors (or their designees) begin providing the names and contact information for their recommended partners. Once the partner recommendations are obtained, the names and contact information will be entered into the survey tracking system, which will be linked to the web survey software and will facilitate the distribution of recruitment and reminder/follow-up e-mail messages to the potential partner participants.
Invitation E-mail. Within one day of the partner information being entered, the tracking system will generate e-mail messages to each partner, inviting them to participate in the survey. The e-mail message will contain a description of the study, an explanation of how their responses will be maintained in a secure manner, and instructions for how to participate in the survey including an embedded hyperlink “button” that if clicked will direct the partner to the web-based survey (see Attachment D.2 for invitation e-mail message template).
Follow-up E-mails and Postcards. One week after the invitation e-mail has been sent, the tracking system will generate and send to non-respondents the first of two follow-up e-mail messages containing similar content as the initial message. Two weeks after the invitation e-mail has been sent, the tracking system will generate and send to non-respondents a second and final follow-up e-mail message similar to the first, but with the acknowledgement that the survey will be closing soon and that those who wish to complete the survey must do so within a given deadline (see Attachment D.3 for follow-up e-mail message templates). We expect that most if not all of the partners identified by the program directors will have an active e-mail address that they use regularly and they will have regular access to the Internet, so e-mail correspondence should work well in reaching the partners. Nevertheless, Battelle will also send postcard reminders to the program partners for whom they obtain mailing addresses in case the e-mail messages are not received (see Attachment D.4 for follow-up postcard templates).
B.2. Procedures for the Collection of Information
Though the modes of administration and populations are different, the two surveys are closely linked – both surveys share a related purpose and will have similar measures, and the sample for the partner survey will depend on who is recommended by the program directors. Given this linkage and the time frame for the surveys, we expect to conduct the two surveys concurrently, though with a brief lag in start-up time between them. The survey process will proceed through several main steps: (1) the Battelle team will initiate contact with the program directors to schedule their participation in the survey; (2) as the program director survey is scheduled and conducted, we solicit recommendations for partners, and their names and contact information will be entered into the survey database; (3) as partners are added to the database, we will generate e-mail invitations to those partners; and (4) respondent tracking will commence and reminder e-mails and postcards will be distributed for both surveys.
Program directors. The program director survey consists of two distinct components: (1) an on-line self-administered web survey; and (2) a telephone interview conducted by a Battelle team member (see Figure 1). Both components of the survey will be completed during the one-hour appointment scheduled with each director (see Recruitment Procedures above): One day prior to their scheduled appointments, directors will receive a reminder e-mail message with a link to the web survey and instructions on how to participate in the survey (see Attachment C.5). At the start of the scheduled appointments, Battelle interviewers will call the directors to confirm that they received the reminder e-mail and assist with getting started if necessary. Once the directors have completed the web survey, the Battelle interviewers will contact them by telephone again for a brief interview with a small set of additional questions. If they have not done so already, at the end of the telephone interviews the directors will be asked to provide the names and contact information for 3-4 partners who are instrumental in helping their programs use evidence-based practices for cancer control. These partners will be asked to participate in the second survey. After the survey has been completed, directors will receive a final e-mail message thanking them for their participation in the study and letting them know when they can expect to receive the study executive summary as an incentive (pending CDC approval). If a program director requests a paper version of the questionnaire to complete instead of using the web-based instrument, then a hardcopy will be sent by express mail to her/him along with a postage-paid envelope (express mail). After the completed questionnaire is returned and received by Battelle, an interviewer will call the director to conduct the telephone interview or schedule the interview at a later time.
Program partners. The program partner instrument is designed to be a web-based self-administered questionnaire. A hyperlink to the web survey will be included in all of the e-mail correspondence (including initial invitation and follow-up messages). The follow-up postcards will include an URL and survey code. Once an invited partner has arrived at the survey website, they will be able to follow the instructions for completing the survey. The survey software will allow the survey coordinator to coordinate the invitations and reminders, track responses, and communicate with respondents to answer questions and help resolve technical issues. After respondents have completed their surveys, the tracking system will generate e-mail messages to thank them for their participation. If a program director requests a paper version of the questionnaire to complete instead of using the web-based instrument, then a hardcopy will be sent by express mail to her/him along with a postage-paid envelope (express mail).
B.3. Methods to Maximize Response Rates and Deal with Nonresponse
The contractor (Battelle) will use the following methods to maximize response rates and deal with nonresponse for the two study populations.
Program directors. Because the program directors oversee CDC-funded programs, we expect a high degree of cooperation for this CDC-sponsored survey. However, Battelle will employ several methods to facilitate high response rates:
Both components of the survey will be completed during the one-hour appointment scheduled with each director at a time and date determined by the director.
After the scheduling call, a follow-up e-mail will confirm the date/time of the scheduled survey appointment (Attachment C.5).
One day prior to their scheduled appointments, directors will receive reminder e-mail messages with a link to the web survey and instructions on how to participate in the survey (see Attachment C.5).
At the start of the scheduled appointments, Battelle interviewers will call the directors to confirm that they received the reminder e-mail and assist with getting started if necessary. Interviewers will be able to reschedule the survey appointments, if necessary.
Once the directors have completed the web survey, the Battelle interviewers will contact them by telephone again for a brief interview with a small set of additional questions. Interviewers will be able to reschedule the interview component of the survey, if necessary.
Program partners. We expect a high degree of cooperation by program partners for this survey due to the high degree of commitment to comprehensive cancer control among these stakeholders. However, Battelle will employ several methods to facilitate high response rates:
Program directors will be asked to provide up to 4 recommended partners as a way to oversample with the goal of achieving 1-2 partners per director.
Program partners will receive multiple reminders to participate in both e-mail and postcard formats.
A hyperlink to the web survey will be included in all of the e-mail correspondence (including initial invitation and follow-up messages). The follow-up postcards will include an URL and survey code.
The survey software will allow the survey coordinator to coordinate the invitations and reminders, to track responses, and to communicate with respondents to answer questions and help resolve technical issues.
B.4. Tests of Procedures or Methods to be Undertaken
Prior to submission of the OMB clearance package, the contractor (Battelle) conducted pilot tests of the two survey instruments with nine respondents. The purposes of the pilot test were to obtain an estimate of respondent burden; seek feedback on the format, appropriateness and relevance of survey questions; and test participant contact and recruitment methods. Battelle conducted the pilot testing with 3 Program Directors along with 2 partners recommended by each of the selected Program Directors. This yielded a total of 9 participants and mimicked the process for the full survey. These pilot test participants will be excluded from the full survey.
The goal was to recruit program directors each representing a different type of jurisdiction in which funded programs reside (states, tribes/tribal organizations, Pacific Island Jurisdictions/territories). We randomly selected three funded programs for each type of jurisdiction, and then proceeded with recruiting them one-by-one for the pilot testing until the first one agreed to participate.
Battelle staff made telephone screening calls to selected Program Directors to confirm interest in the pilot test, to schedule the telephone interview component of the survey, and to obtain names and contact information for partners. Battelle sent a copy of the web survey component questionnaire to complete and return via Federal Express (envelope provided). The directors were asked to record the time required to complete the survey, as well as to mark spots where they had any problems interpreting the instructions, specific questions, or response categories. During the telephone interview component, Battelle staff kept track of time needed to conduct the interviews. Immediately following the completion of the telephone interview, Battelle staff conducted a debriefing with each director to ask about areas for clarification or any difficulties in responding to the questions for both survey components.
We also contacted the directors’ partners to assess their interest in completing the survey. For partners we sent a copy of the web survey questionnaire to complete and return via Federal Express (envelope provided). Partner respondents were asked to record the time required to complete the survey. They were also asked to make notes on the survey if they had any problems interpreting the instructions, specific questions, or response categories. Once completed surveys were received, Battelle survey staff called partner respondents to discuss their experience in completing the survey.
In consultation with the CDC Technical Monitor, the Battelle Team revised the survey instrument based on the results of the pilot test. The final surveys, reflecting changes made following the pilot test, were submitted to OMB for review. The revised surveys will also be submitted to the various IRBs before they are used in the study.
B. 5. Individuals Consulted on Statistical Aspects and Individuals Collecting and/or Analyzing Data
Battelle Centers for Public Health Research and Evaluation (CPHRE) staff worked with staff from CDC to design the study protocol and data collection instruments. John Rose, Ph.D. (919-544-3717) led the Battelle effort to design the protocol and data collection instruments. Gary Chovnick, MPH (206-528-3013) and Alessandra Favoretto (404-460-1462) assisted in the Battelle effort to design and test survey instruments.
Battelle will collect and analyze the data for CDC. The overall data collection, analysis, and reporting effort will be directed by Dr. Rose.
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