Introduction
|
The
Centers
for Disease Control Diabetes Prevention Program and Deloitte
Consulting would
like to invite you to participate in a survey to learn more about
the implementation of 1815 Diabetes Self-Management Education
(DSMES) strategies at the site level and how the state health
department is supporting your efforts through 1815-funds.
Your
participation in this survey is voluntary,
and you may opt out of any question in the survey. Your answers
will be kept strictly confidential and will never be associated
with your name.
The
survey should take no more than 30 minutes to complete,
and you have until {survey
close date} to
submit your response.
Click
NEXT
to begin the survey.
If
you have any questions about the survey or experience technical
issues accessing or submitting the survey, please email
Nicolle Dally, [email protected].
We
really appreciate your
time and
contribution to this effort.
Thank
you,
1815
National Evaluation Team
Deloitte
Consulting, LLP
Note:
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, Georgia 30333; ATTN: PRA
(0920-19BHC)
|
Background
|
Please
select the option that best reflects your position within the
[insert
program name].
Program
Coordinator/Quality Coordinator
Nutritionist
Nurse
Pharmacist
Community
Health Worker
Peer
Educator
Medical
Assistant
Pharmacy
Technician
Other,
please specify _____________________
|
Are
you actively credentialed in the following areas (select
all that apply)?
Registered
Nurse
Registered
Dietitian/Nutritionist
Certified
Diabetes Educator
Certified
Health Educator
Community
Health Worker Certification
I
am not actively credentialed in the listed areas
|
Are
you actively credentialed in any other areas? [Open
ended]
|
How
long have you been in your current role with this program?
Less
than a year
1-2
years
2-3
years
3-4
years
5
or more years
|
In
total, how long have you worked with this DSMES program?
Less
than a year
1-2
years
2-3
years
3-4
years
5
or more years
|
DSMES
Program Overview:
|
Please
select the setting or type of organization in which the [insert
program name]
operates
Health
care organization (e.g. FQHC, Rural Health Center, Pharmacy)
Pharmacy
Community-based
organization (e.g. community center, place of worship, etc)
YMCA
Program
is independently operated
Other
setting, please specify ________________________
|
Please
provide a brief description of your program (i.e. curriculum
used, how many sessions, how long each session is, etc.).
|
Does
the [insert
program name]
have a strategic focus on reaching and serving specific
population groups?
Yes
No
[Skip to Q9]
I
don’t know/ I’m not sure [Skip to Q9]
|
Please
indicate the population groups the program focuses on (select
all that apply)
Race/Ethnicity
White
Black
or African-American
American
Indian/Alaska Native
Asian
Native
Hawaiian or Other Pacific Islander
Latino/Hispanic
Other,
please specify___________
Gender
Identity
Male
Female
Other,
please specify___________
Age
Group
18-24
years
25
to 44 years
45
to 64 years
65
years and over
Geographic
focus:
Urbanized
Areas (population greater than 50,000)
Urbanized
Clusters (population more than 2,500 but less than 50,000)
Rural
Areas (population less than 2,500)
American
Indian/Alaskan Native community
Other,
please specify: __________________________
Please
specify any other populations of focus in the field below (e.g.
low socioeconomic status, people with disabilities) (open-ended)
|
Marketing/Promotions
|
What
are the most common methods your program uses to market/promote
DSMES services? (select
all that apply)
Our
program does not directly market/promote DSMES services [Skip to
Q14]
Health
fairs
Printed
informational materials for people with diabetes
Printed
informational materials for health care providers
Mass
media campaigns
Presentations
to community groups
Presentations
to health care providers/professionals
Swag
items (bags, totes, mugs, kitchen utensils)
Other,
please specify ___________________
I
don’t know/ I’m not sure (Skip to Q14)
|
In
your opinion, which strategies have been most successful in
increasing awareness and interest in your program?
Health
fairs
Printed
informational materials for people with diabetes
Printed
informational materials for health care providers
Mass
media campaigns
Presentations
to community groups
Presentations
to health care providers/professionals
Swag
items (bags, totes, mugs, kitchen utensils)
Other,
please specify: ___________________
I
don’t know/ I’m not sure
|
To
what extent are these marketing/promotion efforts tailored to
meet the language or cultural needs of different target
populations?
1=Not
at all
2=Very
few materials/strategies are tailored
3=Some
materials/strategies are tailored
4=Most
materials/strategies are tailored
5=All
materials/strategies are tailored
99=I
don’t know
|
How
do you rate the state health department’s assistance with
expanding your program’s overall marketing/promotion
efforts?
0
= The SHD provided no assistance
1
= Not at all useful
2
= Slightly useful
3
= Moderately useful
4
= Very useful
5
= Extremely useful
99
= I don’t know
|
How
do you rate the state health department’s assistance with
expanding your program’s marketing/promotion efforts to new
population groups or geographic areas?
0
= The SHD provided no assistance
1
= Not at all useful
2
= Slightly useful
3
= Moderately useful
4
= Very useful
5
= Extremely useful
99
= I don’t know
|
How
do you rate the influence of health care organizations in
referring people with diabetes to your program?
1
= Not at all influential
2
= Slightly influential
3
= Moderately influential
4
= Very influential
5
= Extremely influential
99
= I don’t know
|
How
do you rate local health care providers’ support of DSMES
services for the management of diabetes?
1
= Not at all supportive
2
= Slightly supportive
3
= Moderately supportive
4
= Very supportive
5
= Extremely supportive
99
= I don’t know
|
To
what extent has the COVID-19 pandemic affected the marketing
and/or promotion these efforts? [open ended]
|
Enrollment
and Retention
|
What
are the most common methods your program uses to encourage
enrollment and retention in the program?
(select all that apply)
Our
program does not have any special efforts to encourage
enrollment and retention [Skip to Q18]
Transportation
vouchers
Child
care assistance
Meal
prep assistance
Gym
memberships
Digital
physical activity trackers
Other,
please specify __________________________
I
don’t know/ I’m not sure
|
In
your opinion, which strategies have been most successful in
increasing enrollment and retention in the program? (select
all that apply)
Our
program does not have any special efforts to encourage
enrollment and retention
Transportation
vouchers
Child
care assistance
Meal
prep assistance
Gym
memberships
Digital
physical activity trackers
Other,
please specify __________________________
I
don’t know/ I’m not sure
|
How
would you rate the state health department’s assistance
with supporting your program’s enrollment and retention
efforts?
0
= The SHD provided no assistance
1
= Not at all useful
2
= Slightly useful
3
= Moderately useful
4
= Very useful
5
= Extremely useful
99=
I don’t know
|
What
would you say are the top 3 major challenges in enrolling
people with diabetes? [Rank
your challenges on a scale of 1-3, with 1 being the most
challenging factor and 3 the least challenging]
|
What
would you say are the top 3 major challenges in getting
people with diabetes to return for follow-up sessions?
[Rank
your challenges on a scale of 1-3, with 1 being the most
challenging factor and 3 the least challenging]
|
What
additional support do you need to assist with expanding your
program’s enrollment and retention efforts?
|
To
what extent has the COVID-19 pandemic affected the enrollment
and/or retention efforts? [open ended]
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Training
|
Have
you completed any trainings on how to deliver DSMES services?
Yes
No
[Skip to Q22]
I
don’t know/ I don’t recall [Skip to 22]
|
When
was the last time you completed follow-up training?
Less
than a year ago
1-2
years ago
3-4
years ago
5
or more years
I
have not had any follow-up training
|
Does
your organization provide opportunities to attend ADA/ADCES
sponsored workforce training webinars?
Yes
No
I
don’t know
|
How
confident do you feel in your ability to deliver DSMES services?
0
= I do not deliver DSMES services
1
= Not confident at all
2
= Slightly confident
3
= Somewhat confident
4
= Fairly confident
5
= Completely confident
|
Are
you aware of the Diabetes Self-Management Education and Support
(DSMES) Toolkit provided by the CDC?
Yes
No
[Skip
Q28]
|
If
yes, please indicate in what ways you have used the Diabetes
Self-Management Education and Support (DSMES) Toolkit by
selecting all that apply from the following list of items:
Disseminated
the toolkit to partners or other team members
Presented
the toolkit at partner or team meetings
Referred
to the toolkit for guidance on how to start (ADA-recognized or
ADCES-accredited) DSMES services
Used
the toolkit with partners to address barriers to DSMES
Engaged
health care providers in discussion on making referrals to DSMES
by using resources in the toolkit
Referenced
the toolkit to gain insight on reimbursement and coverage for
DSMES
Other,
please describe ______________________________________
|
Have
you seen an example where using the Diabetes
Self-Management Education and Support (DSMES) toolkit has
helped a DSMES service or other DSMES stakeholder make progress
or achieve an outcome?
Yes
No
If
yes, please describe: ___________________
|
To
what extent has the COVID-19 pandemic affected training efforts?
[open ended]
|
Program
Effectiveness
|
In
your opinion, what is the biggest benefit program participants
gain from DSMES services? [open
ended]
|
How
successful do you think [insert program name] is in helping
people manage their diabetes?
[Open
ended]
1=Not
at all successful
2=Slightly
successful
3=Moderately
successful
4=Very
successful
5=Extremely
Successful
99=I
don’t know/ I’m not sure
|
To
what extent has the COVID-19 pandemic impacted program
effectiveness? [open ended]
|
Please
share any other thoughts you may have about the [insert
program name].
[open
ended]
|