Attachment C—Focus Group Participant Recruitment Instrument |
Form Approved OMB No. 0920-0879 Expiration Date 03/31/2018 |
Focus Group Recruitment Instrument
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. In order to get comprehensive feedback, we are targeting those who are direct users or have significant familiarity with CHSI. Your response to the following questions will help us to assess your level of familiarity with CHSI and other community assessment tools and gauge your interest in participating in a 90-minute focus group. Your completion of this information is entirely voluntary and takes approximately 5 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. NACCHO will use your contact information only for the purpose of coordinating a focus group.
This form was forwarded to you by the health director of your local health department on behalf of NAACHO. Please complete and return this form directly to Pooja Verma at NACCHO by email: [email protected] or by Fax: 202-783-1583. For questions, contact Pooja Verma, Senior Analyst at NACCHO, Phone 202-507-4241.
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Please Complete the Following Questions
What is the local health department that you work for? Click here to enter text.
What is your job title or function? Click here to enter text.
Which of the following best describes your level of familiarity with Community Health Status Indicators (CHSI)? (Select one)
☐ I have never heard of CHSI
☐ I have heard of CHSI but have never visited the website
☐ I have visited the CHSI website but have never or rarely used it
☐ I have actively used CHSI in my work
Which of the following best describes your level of familiarity with County Health Rankings & Roadmaps? (Select one)
☐ I have never heard of CHR&R
☐ I have heard of CHR&R but have never visited the website
☐ I have visited the CHR&R site but have never or rarely used it
☐ I have actively used CHR&R in my work
Which of the following best describes your level of familiarity with Community Commons? (Select one)
☐ I have never heard of Community Commons
☐ I have heard of Community Commons but have never visited the website
☐ I have visited the Community Commons site but have never or rarely used it
☐ I have actively used Community Commons in my work
Are you interested in participating in a 90 minute focus group by telephone to provide feedback on CHSI? ☐ Yes ☐ No
If Yes, please provide your name, email, and phone number
Are there other staff in your health department who may be able to contribute feedback on CHSI during a focus group? Please specify, so that we may contact those individuals.
Thank you for completing this information.
We may be contacting interested persons to arrange for their participation in a focus group.
CDC estimates the average public reporting burden for this collection of information as 5 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).
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | 558022 |
| File Modified | 0000-00-00 |
| File Created | 2021-01-26 |