Senior Deputy Directors

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-xxxx . The time required to complete this information collection is estimated to average 18 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Attachment 1

Main Survey Instrument

Instrument 1. Main Survey Instrument

Use of Healthy People 2020

Healthy People is a national health promotion and disease prevention initiative. The current iteration, Healthy People 2020, has four overarching goals: to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; to achieve health equity, eliminate disparities, and improve the health of all groups; to create social and physical environments that promote good health for all; and to promote quality of life, healthy development, and healthy behaviors across all life stages. Healthy People 2020 consists of 42 topic areas and over 1200 objectives that monitor the health of the Nation over the course of the decade.

1. Prior to beginning this survey, were you aware of Healthy People 2020?

¹ Yes

² No (If no, thank you for completing the survey)

2. Does your organization/entity use Healthy People 2020?

¹ Yes

² No (If no, go to Non-users section)

³ Don’t know (If Don’t Know, go to Non-users section)

3. Has your organization/entity used any of the previous iterations of Healthy People (i.e. Healthy People 1990, Healthy People 2000, Healthy People 2010)?

¹ Yes

² No

³ Don’t know

4. How does your organization/entity use Healthy People 2020?

	Yes	No	Don’t know	Not Applicable
For research/assessment:
As a data source	1	2	3	4
To conduct community health assessments	1	2	3	4
To develop community health improvement plans	1	2	3	4
For meeting national public health accreditation standards	1	2	3	4
For comparison with organizational data (e.g. benchmarking)	1	2	3	4
To inform program planning to address health disparities	1	2	3	4
For collaboration/outreach or education:
As a resource for building community partnerships for promoting health	1	2	3	4
As a learning tool for staff or students	1	2	3	4
For setting internal priorities:
To guide priorities for the organization/entity	1	2	3	4
As a guide for allocating resources in the organization/entity	1	2	3	4
To support applications for grants or other funding	1	2	3	4
As a framework for planning, goal-setting or decision making	1	2	3	4
Other uses:
To support applications for grants or other funding
To create or inform quality improvement activities	1	2	3	4
To inform policy development	1	2	3	4
Other, please specify _______________________________	1	2	3	4

5. To what degree has Healthy People 2020 impacted the work of your organization/entity?

¹ 1 – No impact

² 2

³ 3

⁴ 4

⁵ 5 – Significant Impact

6. Which element of Healthy People 2020 is the most useful to your organization/entity?

¹ Overarching goals

² Topic areas

³ Specific health objectives

⁴ Leading Health Indicators

7. Has Healthy People 2020 influenced decision making regarding the development of new programs or the expansion of existing ones? (If you answer “Yes” to either item below, please describe in the space provided)

   	Yes	No	Don’t know
   For research/assessment:
   Developed new programs If yes, please specify ___________________________________	1	2	3
   Expanded existing programs If yes, please specify ___________________________________	1	2	3

8. Does your organization/entity measure progress toward Healthy People 2020 objectives and targets?

¹ Yes, once, mid-decade

² Yes, other frequency

Specify frequency: ­_______________

³ No (Skip to Question 10)

⁴ Don’t know (Skip to Question 10)

9. What data sources does your organization/entity use to assess progress toward the Healthy People 2020 objectives? (Check all that apply)

¹ DATA2020/National data sources

² State data sources

³ New data collection to obtain health outcome information

⁴ Other existing data, please specify ____________________

⁵ Don’t know

10. Do any of the following limit your organization/entity from using Healthy People 2020?

For each line	Yes	No	Don’t know
Issues related to Healthy People 2020:
Don’t agree with Healthy People 2020’s priorities	1	2	3
Lack of guidance on how to implement	1	2	3
No available data to track objectives	1	2	3
Too much material	1	2	3
Too little material	1	2	3
Issues related to your organization/entity:
Lack of buy-in from primary decision-makers	1	2	3
Insufficient resources available (e.g., staffing, financial)	1	2	3
Competing priorities	1	2	3

11. Please list any other issues that limit your organization/entity from using Healthy People 2020.

Leading Health Indicators

A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to address them.

12. Are you aware of the Leading Health Indicators?

¹ Yes

² No (Skip to Question 15)

13. Does your organization/entity use the Leading Health Indicators?

¹ Yes

² No

³ Don’t know

14. Indicate the extent to which you agree or disagree with the following statements.

	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
The Leading Health Indicators are a valuable element of Healthy People 2020.	1	2	3	4	5
The Leading Health Indicators make navigating the Healthy People 2020 content more manageable.	1	2	3	4	5
My organization/entity uses the Leading Health Indicators to guide program planning.	1	2	3	4	5

Tools and Activities

HHS has developed tools to assist with the implementation of Healthy People 2020. The following questions ask about your awareness and use of these implementation tools and activities.

15. Which of the following Healthy People 2020 tools and activities are you aware of? Which have you used?

Tool/Activity	I am aware of this tool/activity	I have used this tool/activity
Data (The DATA2020 tool, Objective blocksHealthy People 2020 objectives, topic area data)	 Yes  No	 Yes  No
Implementation stories from organizations like yours (e.g. Stories from the Field, Leading Health Indicator bulletins, Healthy People eLearning)	 Yes  No	 Yes  No
Tools for program planning (e.g. Evidence Based Resources, Federal prevention initiatives, MAP-IT)	 Yes  No	 Yes  No
Healthy People webinars (e.g. Leading Health Indicator webinars, Spotlight on Health webinars, Progress Review webinars)	 Yes  No	 Yes  No
Healthy People communication (e.g. the Healthy People listserv, Healthy People social media)	 Yes  No	 Yes  No

16. Are there additional tools and activities that would be useful for your organization/entity?
    (Check all that apply)

¹ Informational Toolkits

² Program planning Toolkits

³ More examples of how people are using Healthy People 2020

⁴ Examples of evaluation instruments or tools/templates from other organizations

⁴⁵ Additional data resources (more timely data, local data, or infographics)

⁵⁶ More outreach and engagement from HHS

⁶⁷ Additional partnership opportunities

⁷⁸ Other, please specify _________________________

Looking Forward to Healthy People 2030

Thank you for providing your feedback on Healthy People 2020. Please take a few minutes to complete the next set of questions, which will help in the development of Healthy People 2030.

17. Should the scope of issues covered in Healthy People 2030 topic areas and objectives be:

¹ Narrower than Healthy People 2020

² Broader than Healthy People 2020

³ Remain the same

⁴ Don’t know

18. Healthy People 2020’s more than 1200 objectives were organized around 42 topic areas; would a reorganization of health objectives be helpful for the next iteration of Healthy People?

¹ Yes

² No (Skip to Question 20)

³ Don’t know (Skip to Question 20)

⁴ No opinion (Skip to Question 20)

19. Which format for the global organization of Healthy People 2030 objectives would be most useful?

¹ Disease areas

² Risks/determinants

³ Life stages

⁴ Other, please specify ______________________

20. Are there topic areas you believe will be important to include in Healthy People 2030 that are not currently included in Healthy People 2020?

¹ Yes, please specify ___________________________

² No

21. Healthy People stakeholders will be invited to participate in the development of Healthy People 2030. Would you plan to participate in any of the following activities?

    For each line	Yes	No	Don’t know
    Issues related to Healthy People 2020:
    Submit written comments through Healthypeople.gov	1	2	3
    Submit written comments by mail	1	2	3
    Attend a regional meeting	1	2	3
    Present public comments at a regional meeting	1	2	3
    Provide comments via webinar	1	2	3
    Engage with Healthy People through social media platforms (e.g., Twitter, Facebook, LinkedIn)	1	2	3

22. Does your organization have any suggestions for ways HHS can improve the next iteration of Healthy People?

Demographics

23. What is the name of your organization/entity?

23a. [For consortium members only] Which of the following best describes your organization/entity?

¹ Federal Government Agency

² State Government Agency

³ Local Government Agency

⁴ Educational Institution

⁵ Hospital or Health Center

⁶ Nonprofit /Community-Based Organization

⁷ For Profit Organization

⁸ Faith Organization

⁹ Professional or Industry Association

¹⁰ Clearinghouse

¹¹ International Organization

¹² Research Organization

¹³ Tribal Entity

¹⁴ Public/Private Partnership

¹⁵ Other, please specify _______________________________

24. What is the size of your organization/entity’s staff?

____________ Number of full time equivalent (FTE) employees

25. What is the size of the population served by your organization/entity? (Numerical value)

Non-Users of Healthy People 2020

The next set of questions ask about potential barriers to the use of Healthy People 2020 and the development of Healthy People 2030.

3. Do any of the following prevent your organization/entity from using Healthy People 2020?

For each line	Yes	No	Don’t know
Issues related to Healthy People 2020:
Don’t agree with Healthy People 2020’s priorities	1	2	3
Lack of guidance on how to implement	1	2	3
No available data to track objectives	1	2	3
Too much material	1	2	3
Too little material	1	2	3
Issues related to your organization/entity:
Insufficient resources available (e.g. staffing, financial)	1	2	3
Lack of buy-in from primary decision-makers	1	2	3
Competing priorities	1	2	3

4. Of items a through h in Question 3, what factor most strongly prevents your organization/entity from using Healthy People 2020? (Drop down menu of all possibly options)

5. What framework does your organization/entity use to set health objectives?

6. Should the scope of issues covered in Healthy People 2030 topic areas and objectives be:

¹ Narrower than Healthy People 2020

² Broader than Healthy People 2020

³ Remain the same

⁴ Don’t know

7. Healthy People 2020’s more than 1200 objectives were organized around 42 topic areas; would a reorganization of health objectives be helpful for the next iteration of Healthy People?

¹ Yes

² No (Skip to Question 9)

³ Don’t know (Skip to Question 9)

⁴ No opinion (Skip to Question 9)

8. Which format for the global organization of Healthy People 2030 objectives would be most useful?

¹ Disease areas

² Risks/determinants

³ Life stages

⁴ Other, please specify _____________________

9. Use the space below to share with us any additional comments your organization has about Healthy People 2020.

10. Does your organization/entity anticipate using Healthy People in the future for the following activities?

For each line	Yes	No	Don’t know	Not Applicable
For research/assessment:
As a data source	1	2	3	4
To conduct community health assessments	1	2	3	4
To develop community health improvement plans	1	2	3	4
For meeting national public health accreditation standards	1	2	3	4
For comparison with organizational data (e.g. benchmarking)	1	2	3	4
To inform program planning to address health disparities	1	2	3	4
For collaboration/outreach or education:
As a resource for building community partnerships for promoting health	1	2	3	4
As a learning tool for staff or students	1	2	3	4
For setting internal priorities:
To guide priorities for the organization/entity	1	2	3	4
As a guide for allocating resources in the organization/entity	1	2	3	4
To support applications for grants or other funding	1	2	3	4
As a framework for planning, goal-setting or decision making	1	2	3	4
Other uses:
To support applications for grants or other funding
To create or inform quality improvement activities	1	2	3	4
To inform policy development	1	2	3	4
Other, please specify _______________________________	1	2	3	4

11. Does your organization have any suggestions for ways HHS can improve the next iteration of Healthy People?

Demographics

12. What is the name of your organization/entity?

12a. [for consortium members only] Which of the following best describes your organization/entity?

¹ Federal Government Agency

² State Government Agency

³ Local Government Agency

⁴ Educational Institution

⁵ Hospital or Health Center

⁶ Nonprofit /Community-Based Organization

⁷ For Profit Organization

⁸ Faith Organization

⁹ Professional or Industry Association

¹⁰ Clearinghouse

¹¹ International Organization

¹² Research Organization

¹³ Tribal Entity

¹⁴ Public/Private Partnership

¹⁵ Other, please specify _______________________________

13. What is the size of your organization/entity’s staff?

____________ Number of full time equivalent (FTE) employees

14. What is the size of the population served by your organization/entity? (Numerical value)

14