Form 1 CBOs: Qualtrics survey

AHA NHCI Quarterly Evaluation Survey – Community Based Organizations

AHA NHCI Quarterly Evaluation Survey Instrument – Community Based Organizations

Purpose: The Data Reporting, Evaluation, and Monitoring (DREaM) Dashboard is a metrics reporting tool. The purpose of the tool is to track efforts across the NHCI initiative regarding efforts to raise public awareness, strengthen health center care, and build health center-community linkages to improve blood pressure control. Community-based Organizations (CBOs) participating in the American Heart Association’s National Hypertension Control Initiative (NHCI) will provide qualitative and aggregated quantitative data to the DREaM on a quarterly basis throughout the duration of the grant. Access to the DREaM will be offered electronically and the AHA and its contracted evaluator (Summit) will provide technical assistance to all participating CBOs on how to navigate and respond to the data requested in the DREaM.

Key Definitions: In this questionnaire, the term “health center” refers to your HRSA-funded health center organization, which may be composed of multiple locations within a geographic area. The terms “health center sites” or “sites” refers to the individual locations of your health center.

Hypertension refers to a blood pressure reading of greater than 140/90. Controlled hypertension refers to a blood pressure reading of less than 140/90, consistent with UDS Measure of SMS165 V10.

Time Commitment of Key Personnel: This questionnaire will take approximately 10 minutes to complete. Please answer all questions as clearly and accurately as possible. Please have the same person at your CBO respond to the survey each quarter. You may need to consult with multiple people at your CBO, including people who can access population-level visit and demographic data (such as Information Technology (IT) or Quality Improvement (QI) team members), and people familiar with blood pressure devices, staff training, and referrals to community health centers within your CBO (such as a clinical leader or QI team member). Actual data is highly preferred over estimated data if you have the reporting capability.

Once you have completed all questions, please press ‘Submit’ to save and submit your responses. All responses will be sent to AHA for the purposes of evaluating the National Hypertension Control Initiative (NHCI) and helping you reach your target audiences with blood pressure information and support. Aggregated responses from all health centers will be shared to inform quality improvement activities. Individual health center responses will not be shared publicly and will be reviewed confidentially by AHA’s team to inform individualized health center support.

The same person at your health center should answer this survey each quarter.

1. Are you a:

   1. Community Health Center

   2. Community-Based Organization

[If Q1 = a, respondent will be directed to the Community Health Center Questionnaire; if Q1 = b, respondent will be directed to the Community-Based Organization Questionnaire]

AHA NHCI Quarterly Evaluation Survey Instrument – Community Based Organizations

1. Background Questions – Community Based Organization

1. What is the name of your community-based organization (CBO)? [insert free text]

2. Does your CBO include affiliate membership?

   1. Yes

   2. No

3. [If yes to Q2] How many affiliate members does your CBO include?

4. Thinking about the geographic reach of your CBO, how would you describe the type of this CBO:

   1. National CBO

   2. Regional CBO

   3. Other

5. What populations does your CBO typically serve? (Select all that apply.)

1. Low-income / low socioeconomic status populations

2. Hispanic, Latino, or Spanish-speaking populations

3. Black / African American populations

4. American Indian / Alaska Native populations

5. Native Hawaiian or Other Pacific Islander populations

6. Asian populations

7. White

8. Unreported or Unknown

9. None of these

6. Thinking about the location of your CBO (include affiliate members if your CBO has affiliate membership), where are the majority (more than half) of locations?

1. In urban areas

2. In suburban areas

3. In rural areas

7. How many full-time employees does your CBO have? [input value]

1. Section 1 - CBO Community Outreach and Integration

8. How does your organization track and document recommendations (“referrals”) of community members to community health centers for blood pressure-related care? (Select All That Apply.)

1. Aunt Bertha / findhelp.org (learn more)

2. UniteUS (learn more)

3. Other online or digital platform

4. Manually

5. Don’t know

9. [IF YES TO FIND HELP OR UNITE US] Is your organization currently sharing information collected using Find Help or Unite Us with the American Heart Association?

   1. Yes (Skip out this section)

   2. No (Complete this section)

   3. I don’t know (Complete this section)

10. Thinking about how your organization determines the type of services needed by community members (that is, your intake process), does your organization assess the following social determinants of health? [Check all that apply]

    1. Participant’s housing situation

    2. Whether participants are facing challenges meeting household utility bills

    3. Participant’s refugee status

    4. Whether lack of transportation kept a participant from medical appointments, meetings, work, or from getting things needed for daily living

    5. Whether a participant was experiencing symptoms of depression or other mental health issues

    6. Whether a participant is facing challenges with access to food to every day

    7. Whether a participant is facing challenges obtaining healthy/nutritious foods such as fruits and vegetables

    8. Other social determinants of health

11. Including community health centers, what types of partners does your organization have related to monitoring or managing blood pressure? (Select all that apply.)

1. State/local Health Department

2. Non-profit organizations

3. Private companies

4. Local healthcare organizations

5. State/local government agencies (e.g., social services, transportation)

6. Academic institutions

7. Other community-based partners (e.g., charities, faith-based organizations, community center, senior center)

8. I don’t know

12. Between January and March 2022, how many people has your CBO recommended (“referred”) to receive blood pressure-related care at a community health center?

1. None

2. 1-25

3. 26-50

4. 51-75

5. 75-100

6. More than 100

7. I don’t know

13. Do you conduct follow-up checks with individuals that you recommended (“referred”) to a community health center for blood pressure-related care?

1. Yes

2. No

3. Don’t know

3. Strategy 2 – CBO Engagement with EmpOwered to Serve

[Header instructions] The American Heart Association (AHA) will be partnering with community-based organizations (CBOs) to disseminate the Empowered to Serve curriculum to participants. Participants will be asked to complete four training modules:

1. Control your Blood Pressure

2. Get Active

3. Know Diabetes by Heart

4. Salt and Cardiovascular Risk

1. Is your CBO currently providing any of the Empowered to Serve Curriculum modules to participants?

   1. Yes [Skip to 15]

   2. No [Skip to 16 – non ETS section]

15. [Yes to ETS modules] Is your CBO currently reporting the data collected using the ETS platform to the American Heart Association using another platform other than this survey?

    1. Yes [Skip out of this section]

    2. No [Complete this DREaM ETS reporting section]

ETS Reporting questions for ETS providers not reporting directly to AHA

16. Between January and March 2022, how many participants completed the following Empowered to Serve Lessons?

    1. Control your Blood Pressure [Enter #]

    2. Get Active [Enter #]

    3. Know Diabetes by Heart [Enter #]

    4. Salt and Cardiovascular Risk [Enter #]

17. Between January and March 2022, what percentage of participants completed health lesson quizzes for the following Empowered to Serve Lessons?

    1. Control your Blood Pressure [Enter percent]

    2. Get Active [Enter percent]

    3. Know Diabetes by Heart [Enter percent]

    4. Salt and Cardiovascular Risk [Enter percent]

18. Between January and March 2022, what percentage of participants that completed the Empowered to Serve Lessons did your CBO recommend or refer to a community health center?

    1. Control your Blood Pressure [Enter #]

    2. Get Active [Enter #]

    3. Know Diabetes by Heart [Enter #]

    4. Salt and Cardiovascular Risk [Enter #]

DREaM questions for non-ETS providing CBOs

19. Is your organization providing materials related to managing blood pressure and/ or self-monitoring blood pressure to participants? Please check all the materials you are providing.

    1. Conducting blood pressure screenings

    2. Educating participants about self-monitoring blood pressure

    3. Providing participants with resources and tools for self-monitoring blood pressure

    4. Educating participants on making lifestyle changes to help manage blood pressure

    5. Educating participants on the potential consequences of high blood pressure

    6. Educating participants on healthy sodium intake for adults

    7. Educating participants on how to read nutrition labels

    8. Educating participants on alternatives to salt like spices or herbs

    9. Educating participants on the role of physical activity and managing blood pressure

    10. Education participants about diabetes

    11. Education patients about the link between diabetes and heart disease and stroke.

    12. Other

    13. None

20. Between January and March 2022, how have you shared those materials with community members?

1. We give them to every community member

2. We give them to most community members

3. We directly provide them for some community members

4. They are available but we do not directly hand them to community members

5. We do not provide them to community members

6. I don’t know

21. Between January and March 2022, what populations have you been able to reach to disseminate materials on the importance of BP screenings, self-monitoring and management? (Select all that apply.)

    1. Low-income / low socioeconomic status populations

    2. Hispanic, Latino, or Spanish-speaking populations

    3. Black / African American populations

    4. American Indian / Alaska Native populations

    5. Native Hawaiian or Other Pacific Islander populations

    6. Asian populations

    7. White

    8. Unreported or Unknown

    9. None of these

22. Does your organization provide population-specific materials (such as materials in Spanish to Spanish speakers) on the importance of BP screenings, self-monitoring and management?

1. Yes

2. No

3. I don’t know

23. How many NHCI webinars, workshops, or one-on-one Technical Assistance opportunities hosted by AHA did you or someone from your organization attend between January and March 2022?

    1. None

    2. 1-5

    3. 6-10

    4. 11-15

    5. 16 or more

    6. I don’t know

24. Between January and March 2022, how many e-learning training courses or literature related to BP monitoring did your organization use within the last three months?

1. None

2. 1-5

3. 6-10

4. 11-15

5. 16 or more

6. I don’t know

25. Between January and March 2022, how many virtual or in-person workshop trainings related to blood pressure treatment and management did you or another person from your organization attend within the last quarter? These can include virtual, or in-person trainings meant to increase awareness, prioritization, or skill-based training on BP measurement, treatment, and control.

1. None

2. 1-3

3. 4-6

4. 7-10

5. 11 or more

4. Closing

1. How many people did you consult in order to complete the questions in this survey? (insert #)

Thank you for participating in this survey.

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