Web Survey Instrument

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Survey Instrument – Program Directors

Web Survey Component

Introduction [1^st Web screen]

This online questionnaire is the first part of a two-part survey of comprehensive cancer control programs funded by the National Comprehensive Cancer Control Program at the U.S. Centers for Disease Control and Prevention (CDC). Part two of the survey will consist of a brief telephone interview that will occur during your appointment scheduled with the survey staff.

You have been asked to participate in this survey because of your involvement with the comprehensive cancer control program in your state, tribe, or U.S. Associated Pacific Island Jurisdiction/territory. Please answer the following questions based on your personal knowledge and experience with the program. (Please note: because some survey questions may be skipped based on your responses, the numbering of the questions may not always be consecutive.) The results of this survey will help CDC better understand the issues regarding the use of evidence-based cancer control practices by the funded programs.

Your answers will be maintained in a secure manner and your responses will not be linked to you personally. You may choose not to participate in this survey, or terminate your involvement at any time, without any penalty to you or your program.

Important Terms and Definitions [2^nd Web screen]

For the purposes of this survey, we have provided the following terms and definitions:

• Public health practices: Actions encompassing all aspects of public health including interventions, programs, strategies, policies, procedures, processes, and/or activities, that are intended to affect a change, including improvements in outcomes such as morbidity, mortality, disability, quality of life, or other aspects of the ten essential services of public health (http://www.cdc.gov/nphpsp/essentialServices.html).

• Evidence-based practices (EBPs): Evidence-based practices (EBPs) are public health practices that have been tested or evaluated and shown to be effective. The evidence for a public health practice may be based on the results of a single study or on the systematic review of the accumulated results over multiple studies.

• NCCCP: The National Comprehensive Cancer Control Program in the Division of Cancer Prevention and Control at the U.S. Centers for Disease Control and Prevention (CDC).

• Comprehensive cancer control (CCC) program: a public health program focused on supporting comprehensive cancer control processes and activities in a particular state, tribe, or U.S.-affiliated territory through coalitions, collaborations, and partnerships with organizations and communities. CDC-funded CCC programs receive support from the NCCCP through financial and technical assistance. CCC programs are typically housed in health departments or similar government agencies, but also universities and non-governmental organizations.

• Jurisdiction: The area that a particular NCCCP-funded program covers, such as a state, tribe/tribal organization, or U.S. Associated Pacific Island Jurisdiction/territory.

A. Use of Evidence-based Practices (EBPs) and EBP Resources.

1. In general, to what extent does your comprehensive cancer control (CCC) program currently use evidence-based practices (EBPs) to address the objectives of its action plan (also known as the “work plan”)? (Please check only one)

[ ] To a great extent

[ ] To a moderate extent

[ ] To a small extent

[ ] Not at all

[ ] Don't know/not sure

2. In general, to what extent are EBPs used to address the goals and objectives of the comprehensive cancer control plan for your jurisdiction (for example, state, tribe, or Pacific Island Jurisdiction/territory)? (Please check only one)

[ ] To a great extent

[ ] To a moderate extent

[ ] To a small extent

[ ] Not at all

[ ] Don't know/not sure

The next several questions ask about your use of various resources for finding evidence-based practices to address cancer control objectives in your jurisdiction.

3. Have you ever heard of the Guide to Community Preventive Services (The Community Guide)?

[ ] Yes Go to Question 4

[ ] No Skip to Question 9

4. Have you ever used The Community Guide to find EBPs for your jurisdiction?

[ ] Yes Go to Question 5

[ ] No Skip to Question 9

5. Approximately how many times in the last 12 months have you visited The Community Guide website to find EBPs for use in your jurisdiction? (Please choose ONE of the responses below for your best estimate)

[ ] 0 (zero)

[ ] 1-5

[ ] 6-10

[ ] 11-15

[ ] 16 or more

[ ] Don't know/not sure

6. What do you usually look for when visiting The Community Guide website? (Check all that apply)

[ ] Effective intervention strategies or approaches for cancer control

[ ] Specific evidence-based programs and products

[ ] Links to other resources

[ ] Information on areas where more evidence is needed

[ ] Logic models or analytic frameworks listing strategies for cancer control 

[ ] More information about The Community Guide

[ ] Nothing in particular

[ ] Other – Please describe: ________________________________________________

7. How useful is The Community Guide for finding EBPs for your jurisdiction? (Please check only one)

[ ] Not at all useful

[ ] Somewhat useful

[ ] Moderately useful

[ ] Very useful

[ ] Don’t know/not sure

8. If you selected “not at all useful” for Question 7 please briefly tell us why: __________________________________________

9. Have you ever heard of the Cancer Control P.L.A.N.E.T. website?

[ ] Yes Go to Question 10

[ ] No Skip to Question 15

10. Have you ever used the Cancer Control P.L.A.N.E.T. website to find EBPs for your jurisdiction?

[ ] Yes Go to Question 11

[ ] No Skip to Question 15

11. Approximately how many times in the last 12 months have you visited the Cancer Control P.L.A.N.E.T. website to find EBPs for use in your jurisdiction? (Please choose ONE of the responses below for your best estimate)

[ ] 0 (zero)

[ ] 1-5

[ ] 6-10

[ ] 11-15

[ ] 16 or more

[ ] Don't know/not sure

12. What do you usually look for when visiting the Cancer Control P.L.A.N.E.T. website? (Check all that apply)

[ ] Data on the cancer and/or risk factor burden within my state

[ ] Potential program/community partners

[ ] Potential research partners

[ ] Evidence-based practices for cancer control

[ ] Guidance for planning or evaluating your CCC program

[ ] Information about specific cancer control topics (e.g., breast cancer, diet/nutrition, survivorship)

[ ] Opportunities for training or continuing education

[ ] Other – Please describe: ________________________________________________

[ ] Don’t know/not sure

13. How useful is the Cancer Control P.L.A.N.E.T. website for finding EBPs for your jurisdiction? (Please check only one)

[ ] Not at all useful

[ ] Somewhat useful

[ ] Moderately useful

[ ] Very useful

[ ] Don’t know/not sure

14. If you selected “not at all useful” for Question 13 please briefly tell us why: ___________________________________________

15. Have you ever heard of the Research-Tested Interventions & Programs (RTIPs) website?

[ ] Yes Go to Question 16

[ ] No Skip to Question 21

16. Have you ever used the RTIPs website to find EBPs for your jurisdiction?

[ ] Yes Go to Question 17

[ ] No Skip to Question 21

17. Approximately how many times in the last 12 months have you visited the RTIPs website to find EBPs for use in your jurisdiction? (Please choose ONE of the responses below for your best estimate)

[ ] 0 (zero)

[ ] 1-5

[ ] 6-10

[ ] 11-15

[ ] 16 or more

[ ] Don't know/not sure

18. What do you usually look for when visiting the RTIPs website? (Check all that apply)

[ ] EBPs that would be appropriate for our use with no modifications

[ ] EBPs that have aspects that could be used for existing cancer control activities

[ ] EBPs that have aspects that could be used for newly-developed cancer control activities

[ ] Guidance on adapting EBPs for populations in your jurisdiction

[ ] Program/community partners

[ ] Research partners/technical support

[ ] Other – Please describe: ________________________________________________

[ ] Don't know/not sure

19. How useful is the RTIPs website for finding EBPs for your jurisdiction? (Please check only one)

[ ] Not at all useful

[ ] Somewhat useful

[ ] Moderately useful

[ ] Very useful

[ ] Don’t know/not sure

20. If you selected “not at all useful” for Question 19 please briefly tell us why:

___________________________________________

21. Have you ever utilized any of the additional resources listed below to find EBPs to address your CCC program’s objectives? For each one that you have used, please indicate how useful it is for finding EBPs for your jurisdiction.

Resources for Finding Evidence-Based Practice (EBPs)s	Check here if you have ever used the resource to find EBPs	If you have used a resource, please indicate how useful you think it is for finding EBPs.
		Not at all useful	Somewhat useful	Moderately useful	Very useful
Conferences	[ ]	[ ]	[ ]	[ ]	[ ]
Colleagues/co-workers	[ ]	[ ]	[ ]	[ ]	[ ]
Community members	[ ]	[ ]	[ ]	[ ]	[ ]
Newsletters/list serves	[ ]	[ ]	[ ]	[ ]	[ ]
CDC/NCCCP program staff	[ ]	[ ]	[ ]	[ ]	[ ]
Professional organizations	[ ]	[ ]	[ ]	[ ]	[ ]
Journal articles/scientific literature	[ ]	[ ]	[ ]	[ ]	[ ]
U.S. Preventive Services Task Force	[ ]	[ ]	[ ]	[ ]	[ ]
Cochrane Reviews	[ ]	[ ]	[ ]	[ ]	[ ]
The Internet-websites showcasing EBPs	[ ]	[ ]	[ ]	[ ]	[ ]
Other:_________________________	[ ]	[ ]	[ ]	[ ]	[ ]
Other:_________________________	[ ]	[ ]	[ ]	[ ]	[ ]

B. Knowledge and Attitudes about Evidence-based Practices

22. In general, how important are each of the following factors to your CCC program when choosing an EBP?

    	Not at all important	Somewhat important	Moderately important	Very important	Don't know/not sure
    Easy to implement	[ ]	[ ]	[ ]	[ ]	[ ]
    Available for free, or low cost	[ ]	[ ]	[ ]	[ ]	[ ]
    Other organizations like ours are using it	[ ]	[ ]	[ ]	[ ]	[ ]
    Easy to evaluate	[ ]	[ ]	[ ]	[ ]	[ ]
    Cost effective	[ ]	[ ]	[ ]	[ ]	[ ]
    Consistent with our organization's mission	[ ]	[ ]	[ ]	[ ]	[ ]
    Technical assistance is available	[ ]	[ ]	[ ]	[ ]	[ ]
    Innovative	[ ]	[ ]	[ ]	[ ]	[ ]
    We had used it before	[ ]	[ ]	[ ]	[ ]	[ ]
    People in our community requested it	[ ]	[ ]	[ ]	[ ]	[ ]
    Encouraged by our funders	[ ]	[ ]	[ ]	[ ]	[ ]
    Easily adaptable	[ ]	[ ]	[ ]	[ ]	[ ]
    Scientific evidence saying the EBP works	[ ]	[ ]	[ ]	[ ]	[ ]
    Lack of alternatives	[ ]	[ ]	[ ]	[ ]	[ ]

23. Please list up to three of the most important factors in choosing an EBP from among those listed in Question 22

(1) _______________________ (2) ____________________ (3) _______________________

24. In your opinion, to what extent does each of the following contribute to establishing a public health practice as being evidence-based?

    	Not at all	A little	Moderately	A lot
    It was funded by a peer-reviewed grant (A panel of experts had to approve the intervention and evaluation study design)	[ ]	[ ]	[ ]	[ ]
    The findings have been published in at least one peer-reviewed journal	[ ]	[ ]	[ ]	[ ]
    It has been evaluated by a systematic review process (other researchers have tested similar practices)	[ ]	[ ]	[ ]	[ ]
    It uses strategies listed in the Guide to Community Preventive Services	[ ]	[ ]	[ ]	[ ]
    It uses strategies listed by other systematic reviews (such as Cochrane) but it is not recommended by the Community Guide	[ ]	[ ]	[ ]	[ ]
    It has findings published in a peer-reviewed journal but is not funded by a peer-reviewed grant	[ ]	[ ]	[ ]	[ ]
    It has been tested or evaluated and proven to be effective in a single study	[ ]	[ ]	[ ]	[ ]
    It has been reviewed and approved by members of the target audience or community	[ ]	[ ]	[ ]	[ ]
    It was used previously by your (or another) CCC program but has not been evaluated	[ ]	[ ]	[ ]	[ ]

25. When adapting an EBP for local use, to what extent would each of the following changes potentially reduce the effectiveness of the EBP?

Adaptations to an evidence-based practice	Not at all	A little	Moderately	A lot
Changing names of health care centers or systems	[ ]	[ ]	[ ]	[ ]
Changing pictures of people and places in materials	[ ]	[ ]	[ ]	[ ]
Changing hard-to-read words in materials that affect reading level	[ ]	[ ]	[ ]	[ ]
Reaching your target audience in ways other than those discussed in the EBP	[ ]	[ ]	[ ]	[ ]
Changing the incentives for participation	[ ]	[ ]	[ ]	[ ]
Altering time-lines	[ ]	[ ]	[ ]	[ ]
Changing culturally-tailored components or materials in order to fit a new population	[ ]	[ ]	[ ]	[ ]
Changing the health topic	[ ]	[ ]	[ ]	[ ]
Removing existing strategies or components	[ ]	[ ]	[ ]	[ ]
Adding more strategies or components	[ ]	[ ]	[ ]	[ ]
Changing the underlying communication theory or conceptual model	[ ]	[ ]	[ ]	[ ]
Changing quotes and personal testimonials	[ ]	[ ]	[ ]	[ ]

26. Have you ever used the resource manual “Using What Works: Adapting Evidence-Based Programs to Fit Your Needs” produced by the National Cancer Institute as a guide for adapting EBPs for implementation in your jurisdiction?

[ ] Yes Go to Question 26a

[ ] No Skip to Question 27

26a. How useful is the Using What Works resource manual for adapting EBPs for implementation in your jurisdiction? (Please check only one)

[ ] Not at all useful

[ ] Somewhat useful

[ ] Moderately useful

[ ] Very useful

[ ] Don’t know/not sure

27. The following statements represent different opinions about EBPs for cancer control, in general. Please indicate your level of agreement for each statement.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Don’t know/not sure
EBPs may lack “real world”/practical evidence	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
EBPs don't come with much information about how to implement them	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
People in our jurisdiction do not respond well to public health practices developed somewhere else	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
EBPs are too costly	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
EBPs require more resources than other practices	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
Using an existing EBP keeps our organization from getting credit for developing our own	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
Scientists don't agree about what is evidence-based	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
EBPs lack technical assistance or support	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
EBPs are difficult to adapt to local conditions or our unique population	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
It is difficult to find EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
Adopting a new EBP is more difficult than continuing to use our existing practices	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]

C. Organizational Characteristics

28. Given the resources currently available (financial, staffing, organizational), how confident are you in your CCC program’s ability to do the following regarding EBPs for cancer control?

    	Not at all confident	Not very confident	Somewhat confident	Totally confident	Don’t know/not sure
    Find potential EBPs that could be used by your CCC program	[ ]	[ ]	[ ]	[ ]	[ ]
    Assess whether EBPs are appropriate for your jurisdiction	[ ]	[ ]	[ ]	[ ]	[ ]
    Adapt EBPs for specific populations or settings in your jurisdiction	[ ]	[ ]	[ ]	[ ]	[ ]
    Implement EBPs with fidelity (i.e., as intended by the developers)	[ ]	[ ]	[ ]	[ ]	[ ]
    Evaluate the implementation and effectiveness of EBPs	[ ]	[ ]	[ ]	[ ]	[ ]

29. How confident are you in your ability to do the following regarding EBPs for cancer control?

	Not at all confident	Not very confident	Somewhat confident	Totally confident	Don’t know/not sure
Find potential EBPs that could be used by your CCC program	[ ]	[ ]	[ ]	[ ]	[ ]
Assess whether EBPs are appropriate for your jurisdiction	[ ]	[ ]	[ ]	[ ]	[ ]
Adapt EBPs for specific populations or settings in your jurisdiction	[ ]	[ ]	[ ]	[ ]	[ ]
Implement EBPs with fidelity (i.e., as intended by the developers)	[ ]	[ ]	[ ]	[ ]	[ ]
Evaluate the implementation and effectiveness of EBPs	[ ]	[ ]	[ ]	[ ]	[ ]

30. Please indicate your level of agreement with the following:

    	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree	Don’t know/not sure
    My CCC program has sufficient staff in place to develop new EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has sufficient staff in place to implement EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has sufficient financial resources to develop new EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has sufficient financial resources to implement EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has adequate access to cancer registry data	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has sufficient data support to inform our cancer control planning (e.g., data analysis support, access to other data sources)	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has sufficient access to epidemiological expertise	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has community members who can advise us on EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program has a champion who supports the use of EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    My CCC program understands the importance of using EBPs	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]
    Using EBPs is part of the norm in my CCC program	[ ]	[ ]	[ ]	[ ]	[ ]	[ ]

31. Which of the following processes or outcomes does your CCC program use to evaluate the cancer control EBPs or strategies listed in the action plan? (Check all that apply)

[ ] Implementation fidelity – whether it is implemented as planned

[ ] Number of participants enrolled or reached

[ ] Participant satisfaction

[ ] Media coverage

[ ] Knowledge and attitudes

[ ] Behavior change

[ ] Morbidity

[ ] Mortality

[ ] Other – Please describe: ________________________________________________

[ ] None of the above

32. Which of the following activities does your CCC program engage in to help build capacity among program staff and/or partners to support the use of EBPs? (Check all that apply)

[ ] Organizes internal trainings and workshops

[ ] Supports staff to attend external trainings and workshops

[ ] Subscribe to professional journals

[ ] Other – Please describe: ________________________________________________

[ ] None of the above

D. Technical Assistance and Capacity-Building

33. Which types of training would help your CCC program to identify, adapt, and implement EBPs? (Check all that apply)

[ ] How to involve other stakeholders/partners

[ ] How to assess and utilize current available resources

[ ] How to find and secure additional resources (e.g. funding, technical assistance)

[ ] How to obtain EBP materials (e.g. educational/promotional materials)

[ ] How to adapt an EBP and its materials for cultural appropriateness

[ ] How to identify what aspects should and should not be changed in an EBP

[ ] How to pilot test an EBP with the intended audience

[ ] How to develop an implementation and evaluation plan

[ ] How to recruit participants for interventions

[ ] How to implement and evaluate an EBP

[ ] Other – Please describe: ________________________________________________

[ ] No training or technical assistance is needed

[ ] Don't know/not sure

34. Please list up to three of the most important types of trainings that you identified in Question 33.

(1) _______________________ (2) ____________________ (3) _______________________

E. Respondent Characteristics

35. What is your position or title in your CCC program?

______________________________________________

36. What is the highest level of education you have completed?

[ ] Some high school or less

[ ] High school graduate/GED

[ ] Technical or vocational school

[ ] Some college

[ ] College graduate

[ ] Graduate or Professional degree

37. If you have a graduate or professional degree, is that degree in a public health or medical field?

[ ] Yes, please specify:_______________________

[ ] No

[ ] Not applicable - I do not have a graduate or professional degree

38. Please indicate the length of time you have been working with the Comprehensive Cancer Control program in your jurisdiction.

[ ] Less than 1 year

[ ] 1-3 years

[ ] 4-5 years

[ ] More than 5 years

39. Is there anything else that you would like to tell us?

________________________________________________

Thank you for taking this survey. Your responses are very important to this study.

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx).