0920-1154 ACOG Evaluation of Local Health Department Initiative

Form Approved

OMB No. 0920-1154

Exp. Date: 01/31/2020

ACOG Evaluation of Local Health Department Initiative

Demographic Questions

In what state or territory is your health department located?

▼ Alabama ... US Virgin Islands

What population size does your local health department serve? Please estimate to the nearest thousand. 

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How many months have you served in the health department as a CDC field assignee?

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How many months is your total field assignment at this health department?

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Local Health Department Initiative Call

How useful was the AAP/ACOG Zika Response Activities handout (in the form of a pdf) that your received before the call?

• Not at all useful

• Slightly useful

• Moderately useful

• Extremely useful

• I do not remember receiving a pdf of activities before the call

What additional information, if any, do you wish you had received before the call?

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To what extent do you agree or disagree that the call focused on topics relevant to your Zika response work?

• Strongly disagree

• Disagree

• Neutral

• Agree

• Strongly agree

How was the timing of the call with regards to your health department's response to Zika?

• Wish had been earlier in the period of Zika response

• Would not have changed timing

• Wish had been later in Zika response

How helpful was the information provided about each topic during the call?

	Not helpful	Somewhat helpful	Extremely helpful	Do not recall discussing
Suggestions for addressing challenges you have encountered in the community
AAP's national Zika activities (advocacy, survey, provider forum)
AAP's Zika resources (websites, courses, webinars, project ECHO, psychosocial support videos)
Identification of AAP's local chapter contacts
ACOG's national Zika activities (advocacy, survey, focus groups)
ACOG's Zika resources (website, Practice Advisory, toolkit, Zika Care Connect)
Identification of ACOG's local district and section contacts

How could this call have been improved? What other information provided was helpful? Is there anything that you wish had been discussed that wasn't?

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Call Follow-Up

Please note in the following questions that “local AAP/ACOG leaders or Zika experts” refers to AAP or ACOG members in your state or territory whose contact information was provided to you by national AAP or ACOG staff. “Local AAP/ACOG staff” refers to local staff whose contact information was provided to you by national AAP or ACOG staff. “Community pediatricians” and “community obstetrician-gynecologists” refer generally to those provider types in your area whose contact information was not provided to you by national AAP or ACOG staff.

How helpful was the follow-up information that your received from AAP and/or ACOG after the call?

	Not helpful	Somewhat helpful	Extremely helpful	Did not receive follow-up information on this topic
AAP's Zika resources (websites, courses, webinars, project ECHO, psychosocial support videos)
Contact information for local AAP staff and/or local AAP leaders or Zika experts
ACOG's Zika resources (website, Practice Advisory, toolkit, Zika Care Connect)
Contact information for local ACOG staff and/or local ACOG leaders or Zika experts
Other (please specify):

Have you contacted AAP/ACOG staff or local leaders or Zika experts as a result of this call?

	Yes	No, but plan to	No, do not plan to	Had contacted prior to call
National AAP staff
Local AAP staff
Local AAP leaders or Zika experts
National ACOG staff
Local ACOG staff
Local ACOG leaders or Zika experts

Display This Question:

If Have you contacted AAP/ACOG staff or local leaders or Zika experts as a result of this call? [ No, do not plan to] (Count) >= 1

Why have you decided not to contact AAP/ACOG staff or local leaders or Zika experts?

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Display This Question:

If Have you contacted AAP/ACOG staff or local leaders or Zika experts as a result of this call? [ No, do not plan to] (Count) < 6

What support have your requested or do you plan to request from AAP/ACOG staff or local AAP/ACOG leaders or Zika experts?

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How helpful have AAP/ACOG staff or local AAP/ACOG leaders or Zika experts been?

	Not helpful	Somewhat helpful	Extremely helpful	Have not been in contact
National AAP staff
Local AAP staff
Local AAP leaders or Zika experts
National ACOG staff
Local ACOG staff
Local ACOG leaders or Zika experts

Display This Question:

If Have you contacted AAP/ACOG staff or local leaders or Zika experts as a result of this call? [ Yes] (Count) >= 1

And Have you contacted AAP/ACOG staff or local leaders or Zika experts as a result of this call? [ Had contacted prior to call] (Count) >= 1

How could AAP/ACOG staff or local leaders or Zika experts have been more helpful?

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Thinking about the connections you've made with AAP/ACOG staff or local leaders or Zika experts since the call, do you believe that you will be less likely or more likely to contact them in the future when other relevant emerging healthcare issues arise?

	Less likely	No change	More likely	Have not been in contact
National AAP staff
Local AAP staff
Local AAP leaders or Zika experts
National ACOG staff
Local ACOG staff
Local ACOG leaders or Zika experts

How have the calls or call follow-up affected the likelihood that you will contact AAP/ACOG staff or local leaders or Zika experts in the future?

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How has your communication with providers in your community changed because of information you received from AAP or ACOG during or following the call?

	Communication is more difficult	No change	Communication is easier	Haven't tried to communicate with community providers since call
Community pediatricians
Community obstetrician-gynecologists

What could be done to further build connections between local health departments and local AAP chapters?

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What could be done to further build connections between local health departments and local ACOG districts/sections?

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How often did you access AAP/ACOG online resources before the call?

	At least once per week	Once per month	Once every other month	Less than once every other month
AAP online resources
ACOG online resources

How often do you access AAP/ACOG online resources now?

	At least once per week	Once per month	Once every other month	Less than once every other month
AAP online resources
ACOG online resources

What AAP/ACOG resources have you found useful?

	Useful	Not useful	Did not access
AAP Zika resource page
AAP educational courses: Challenging Cases: Dengue, Chikungunya, and Zika Virus Infections
AAP psychosocial support videos and/or handouts for providers
AAP psychosocial support videos and/or handouts for caregivers
AAP Project ECHO
AAP webinars on Zika virus
Healthychildren.org Zika web page for patients
Zika Care Connect
ACOG Zika resource page
ACOG Zika Practice Advisory of clinical guidance
ACOG patient education video on Zika and pregnancy
ACOG Zika infographic poster
Other (please specify):

Having received links to online resources from AAP and ACOG, are there any resources that AAP or ACOG do not have available but that you wish exited for patients or providers? Do you have other needs for support than have not been met?

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Do you have any other feedback?

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Public reporting burden of this collection of information is estimated to average 15 minutes, 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, Georgia 30333; ATTN:  PRA (0920-1154).