Introductory Session Landscape Assessment

OMB No. xxxx

Exp. Date xx/xx/xx

National Diabetes Prevention Program Lifestyle Change Program Introductory Session Landscape Assessment

Thank you for agreeing to participate in this survey about your National Diabetes Prevention Program (DPP) lifestyle change program and the strategies that you use to recruit participants. The purpose of this survey is to gain insight into how you use your recruitment strategies and introductory sessions (also known as session zeros) to recruit and enroll participants in your National DPP lifestyle change program. Findings from this survey will be used to further examine introductory sessions as an effective recruitment strategy to enroll participants in the National DPP lifestyle change program. Your organization was selected because you offer a Centers for Disease Control and Prevention (CDC) recognized lifestyle change program. Participation in this survey is completely voluntary and will not affect your CDC recognition status.

CDC estimates the average public reporting burden for this collection of information as 15 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-xxx). If you have any questions about this survey please contact       [insert contact name, organization affiliation, e-mail address, and telephone number].

The following questions ask about the characteristics of the community where your organization is located and, if applicable, of lifestyle change program participants at your location.

1. Which of the following best describes your organization? Please select only one.

• Business coalition on health

• Community Health Center or Federally Qualified Health Center

• Community-based organization

• Cooperative extension site

• Faith-based organization

• Health plan or insurer

• Hospital, healthcare system, medical group, or physician practice

• Indian health service, tribal, or urban Indian health system

• Pharmacy, drug store, or compounding pharmacy

• Senior, aging, or elder center

• State or local health department

• University or school

• Worksite or employee wellness program

• YMCA

• Other (please specify) [organization type]: _______________

2. In what county is your organization located?

County: _______________

The following questions ask about your organization, how many National DPP lifestyle change program classes that you offer, and how long they have been offered.

3. Does your organization currently offer National DPP lifestyle change program classes at this location (e.g., organization headquarters or main office?)

• Yes

• No, do not offer classes at this location (answer questions 4 and 5, then skip to question 16)

• We are an online program and only offer classes online (skip to question 6)

4. Not including the location of your organization’s headquarters or main office, at how many different locations do you offer lifestyle change program classes?

Number of locations:

• Do not offer classes at other locations  (if Question 3 is “yes,” skip to question 6; if Question 3 is “no,” skip to question 16)

5. Please list the name and contact information for the point of contact for each class location other than your organization’s main headquarters or main office related to the DPRP code assigned to your organization. If you need to list additional contact information, please complete the questionnaire and there will be space for you to list additional class locations on page 9.

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Please answer the following questions about the classes that take place at your location only.

6. For approximately how many months has your location offered National DPP lifestyle change program classes?

Number of months:

7. Which racial or ethnic groups are most participants who attend National DPP lifestyle change program classes at your location? Please select only one.

• White/Caucasian

• Black/African American

• Hispanic/Latino

• Asian

• American Indian or Alaskan Native

• Pacific Islander

• Other (please specify): ________________________

• Multiple racial or ethnic groups served primarily

8. Which gender are most participants who attend National DPP lifestyle change program classes at your class location? Please select only one.

• Male

• Female

• Usually an equal number of males and females

9. Which age range are most participants who attend National DPP lifestyle change program classes at your class location? Please select only one.

• 18–44 years

• 45–64 years

• 65 years and older

The following questions ask about how your lifestyle change program is delivered at your location only.

10. Which of the following best describes when you start a new National DPP lifestyle change program year-long class?

• Once we have a sufficient number of people enrolled

• On a pre-established date, regardless of the number of people enrolled

• On a pre-established date and based on a sufficient number enrolled

• Other (please specify): _______________

11. During the past 12 months, did your organization begin National DPP lifestyle change program class(es) based on the season of the year (for example, no classes in the summer, begin most classes after the New Year)?

• Yes

• No

• Don’t know

12. During the past 12 months, did the session times of the National DPP lifestyle change program vary throughout the course of a year-long class?

• No, each session was held at the same time of day

• Yes, the session time varied

13. During the past 12 months, how many National DPP lifestyle change program year-long classes did your organization deliver?

Number of classes:

14. During the past 12 months, what was the average number of participants enrolled (i.e., attended at least one session) in a National DPP lifestyle change program year-long class?

Average number of participants:

15. During the past 12 months, approximately how many staff, in terms of full-time equivalents (FTEs), were dedicated to conducting a National DPP lifestyle change program year-long class (i.e., including recruiting, registering, and delivering the lifestyle change program to participants)? An FTE is the hours worked by one employee on a full-time basis.

Number of FTE: .

The following questions ask about how you recruit participants to enroll in your lifestyle change program at your organization.

16. Does your organization implement any recruitment strategies to promote enrollment into your National DPP lifestyle change program?

• Yes

• No  (skip to Question 18)

• Don’t know  (skip to Question 18)

17. Select the recruitment strategies that you use to promote enrollment into your National DPP lifestyle change program. Please select all strategies that apply.

• Flyers, brochures, and/or fact sheets

• One-on-one conversations with interested individuals

• Newspaper or billboard advertisements

• Marketing campaigns

• Social media

• Health fairs

• Referrals from health care providers

• Word-of-mouth referrals from current lifestyle change program participants

• Other (please specify): _______________

18. Does your organization offer program support tools (for example, gym memberships, digital fitness trackers, cookbooks, digital weight scales) to encourage participant enrollment?

• Yes

• No

• Don’t know

19. Some programs assess the readiness of potential participants by looking at factors like previous chronic disease prevention program participation, motivation to change, time to participate (lifestyle) and general attitude. Do you assess the readiness of potential participants before they enroll in a National DPP lifestyle change program?

• Yes

• No  (skip to Question 21)

• Don’t know  (skip to Question 21)

20. What do you assess? Please select all that apply.

• Stage of change (based on Stages of Change theory)

• Diagnosis / severity of pre-diabetes (e.g., A1C test)/ gestational diabetes

• Previous experience (success or challenges) with lifestyle change, exercise or physical activity programs

• Motivation to change

• Time to participate

• Financial resources to participate

• General attitude

• Other (please specify): _______________

21. What do you do to support an individual’s readiness to enroll in a National DPP lifestyle change program? Please select all that apply.

• Do not conduct or offer specific activities or resources to support an individual’s readiness to change

• Provide introductory sessions (also known as “session zeros”)

• Recommend participants consult with other health care professionals (e.g., dieticians)

• Share testimonials from previous participants

• Provide printed resources and related materials

• Offer trial period or brief intervention

• Provide access to a gym or other resources to encourage physical activity, healthy eating or stress reduction

• Conduct motivational interviewing/brief counseling

• Offer childcare, transportation or other supports to increase access

• Other (please specify): _______________

22. In what ways do your National DPP lifestyle change program coaches engage participants before the program begins? Please select all that apply.

• Coaches do not engage participants before the program begins

• Lead introductory sessions (also known as “session zeros”)

• Attend/participate in introductory sessions

• Have individual meetings or phone calls with participants

• Assess participant readiness or learning needs

• Other (please specify): _______________

The following questions ask about your introductory session (also known as “session zero”).

23. Do you offer an introductory session (also known as “session zero”) to potential participants?

• Yes, we have only this one class location, and we offer an introductory session for potential participants

• Yes, we have multiple class locations, and we offer introductory sessions for potential participants for all of our affiliated class locations (including this location, if applicable)

• Yes, we have multiple class locations, but offer introductory sessions for potential participants for this location only

• Yes, we are an online program and offer introductory sessions for potential participants online

• No  (skip to Question 36)

• Don’t know  (skip to Question 36)

24. Which of the following best describes why you offer an introductory session? Please select all items that apply.

• As a recruitment strategy to inform potential participants about your lifestyle change program

• As a recruitment strategy to encourage enrollment into your program

• As an orientation session to help people who already enrolled in your National DPP lifestyle change program (for example, to help participants fill out paperwork before the first session)

• Other (please specify): _______________

25. Which of the following elements are included in your program’s introductory session? Please select all items that apply.

• Information about Type 2 diabetes, Type 2 diabetes prevention, and pre-diabetes

• Overview of your National DPP lifestyle change program (for example, what to expect, time commitment, cost of the program, date, time, and location of classes)

• Opportunity for introductory session participants to take a risk test to determine their eligibility for the program if they haven’t already done so

• Opportunity during the introductory session to assess a potential participant’s readiness to take part in a lifestyle change program

• Opportunity for National DPP lifestyle change program staff and introductory session participants to introduce each other, mingle, and get to know one another

• Opportunity for potential participants to meet the lifestyle change coach who will be teaching their class

• Testimonial from successful past or current participants in the National DPP lifestyle change program

• Light refreshments, such as water and healthy snacks

• Opportunity for introductory session participants to enroll in the National DPP lifestyle change program if interested

• Resources for introductory session participants who are not eligible for the National DPP lifestyle change program

• Assessment of how soon a participant plans to enroll in a National DPP lifestyle change program

• Activities that help introductory session participants feel confident that they can be successful in the program

26. Does your location adhere to a consistent agenda or format for all introductory sessions offered?

• Yes

• No

27. During the past 12 months, how many individuals, on average, attended each introductory session?

Number of individuals:

28. During the past 12 months, approximately how long, on average, was your introductory session?

• 30 minutes or less

• 31–44 minutes

• 45–59 minutes

• 60 minutes or more

• Duration varies

29. Do you offer an introductory session before each upcoming year-long class?

• Yes, we offer one introductory session for each upcoming year-long class

• Yes, we offer more than one introductory session for each upcoming year-long class

• No, we offer introductory sessions that are not timed to occur at the same time as the beginning of a year-long class

• Don’t know

30. During the past 12 months, approximately how many introductory sessions did you offer?

Number of introductory sessions:

31. During the past 12 months, approximately how many staff, in terms of full-time equivalents (FTEs,) were dedicated to organizing and delivering an introductory session (i.e., including recruiting and delivering the introductory session to participants and registering participants for the National DPP lifestyle change program)? An FTE is the hours worked by one employee on a full-time basis.

Number of FTE: .

32. On average, how many people deliver the introductory session each time to potential lifestyle change program participants?

Number of people:

33. Who usually delivers the introductory session to potential National DPP lifestyle change program participants? Please select all that apply.

• Lifestyle coach

• Program coordinator

• Past participants

• Other staff (please specify): _______________

34. Does the location where your introductory sessions are offered vary?

• No, each introductory session is provided at the same location

• Yes, the locations for the introductory sessions vary

35. Does the meeting day and/or time of your introductory session(s) vary?

• No, the introductory sessions are offered on the same day of the week and at the same time of day

• Yes, the introductory sessions are offered on different days of the week and/or at different times of day to accommodate various schedules

The final two questions ask about your organization’s interest in participating in future CDC activities to identify successful strategies to increase enrollment in the National DPP lifestyle change program.

36. Would you be interested in collaborating on future projects that the CDC’s Division of Diabetes Translation is working on to increase enrollment in the National DPP lifestyle change program?

• Yes

• No

• Don’t know

37. Can RTI International, on behalf of CDC’s Division of Diabetes Translation, contact you with more information about an upcoming CDC project? The purpose is to assess an intervention to increase enrollment in the National DPP lifestyle change program.

• Yes

• No

Question 3, continued: Please list the name and contact information for the point of contact for each class location other than your organization’s main headquarters or main office related to the DPRP code assigned to your organization.

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Name: ______________________________________

Email Address: _______________________________

Mailing Address: ______________________________

Thank you for completing this survey!

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