Form 16ADY B. Health Director Referral Instrument_CHSI

Attachment B—Health Director Referral Instrument

Form Approved OMB No. 0920-0879 Expiration Date 03/31/2018

Attachment B: Health Director Referral Instrument

Dear [Health Director],

NACCHO is currently working with the CDC to obtain local health department (LHD) feedback about the Community Health Status Indicators (CHSI) 2015 website. CHSI 2015 is an interactive web application that produces health profiles for all 3,143 counties in the United States. Each profile includes indicators which describe the population health status of a county including health outcomes, health care access, health behaviors, and factors in the social and physical environments.

The purpose of the requested feedback is to generate information on awareness, use, and benefits of CHSI 2015 for local health departments. Based on responses to a pilot field test of the 2016 NACCHO Profile Survey, your health department has been identified as one that has used CHSI 2015. In order to get comprehensive feedback about CHSI, we are interested in speaking with staff from your health department who are direct users of CHSI or have significant familiarity with the tool and who may be interested in participating in a focus group.

We have attached a preliminary assessment tool for the purpose of assessing individuals’ level of familiarity with CHSI and other community assessment tools and gauge their interest in participating in a 90-minute focus group to provide feedback about the utility and benefits of CHSI for their work. We are particularly interested in attracting individuals such as data analysts and other staff who are engaged in community health assessment (CHA) and community health improvement planning (CHIP) activities at your health department and who may be active users of CHSI.

Please forward the attached recruitment assessment to at least 2 individuals in your health department who may be good candidates to provide feedback about CHSI. Also, please provide the names and contact information for the staff that you suggest and return this information by replying to this email to [email protected] so that I can look out for their recruitment assessment and follow-up with them if necessary. Your completion of this information is entirely voluntary and takes approximately 20 minutes. There are no known risks or direct benefits to you from participating or not participating, but your responses will help NACCHO identify individuals who can provide more feedback. Your privacy will be protected, and no unique identifying information about you will be published in any form or shared beyond the NACCHO staff collecting this feedback.

Name	Email	Phone

Thank you for providing us with the contacts of up to 2 targeted staff from your health department who can provide feedback about CHSI and for forwarding the attached recruitment instrument to these staff. If you have any questions, please contact me at [email protected] or 202-507-4206.

Sincerely,

Pooja Verma, MPH

Senior Analyst, Performance Improvement

National Association of County and City Health Officials

CDC estimates the average public reporting burden for this collection of information as 20 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 burden to CDC/ATSDR Information Collection Review Office; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0879).