0920-24AA Program Director Survey

Program Director Survey
Form Approve
OMB No: xxxx-xxxx
Exp. Date: xx-xx-xxxx
The public reporting burden of this information collection is estimated at 30 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; a person is only required to respond to a collection of
information if 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 NW, MS D-74, Atlanta, GA 30333; Attn: PRA (xxxx-xxxx).

Recipient organization name:
Contact Person:

SECTION 1. STRATEGIC PLANNING AND PRIORITIZATION
1. What factors have impacted the development and/or enhancement of your State/Tribal Action
Plan? (300 words)
2. How does your organization work in collaboration with partners and subrecipients to plan
primary prevention activities in your state/territory/tribe? (750 characters)
3. What factors have facilitated effective collaboration with partners and subrecipients for
program planning?
4. What barriers have you encountered with respect to collaborating with partners and
subrecipients for program planning? How are you addressing those barriers?
SECTION 2. PARTNERSHIPS AND MEANINGFUL INVOLVEMENT
5. To what extent has your program made progress in participating in meaningful involvement with
SA coalitions, Tribal SA coalitions, representatives from underserved communities of the State or
Territory and other collaborators working to prevent SV?
❍ Substantial progress
❍ Moderate progress
❍ Very little progress

❍ No progress
❍ Not yet measured
6. Which partners have you identified as missing from your work to advance health equity? How
will you communicate your shared goals and engage with these partners?
7. In what ways has your program collaborated with RPE-funded SA coalitions in your
state/territory?
8. How, if at all, have you increased knowledge about SV prevention among your partners and
subrecipients?
9. What lessons have you learned about collaboration and choosing partners and subrecipients
strategically?
10. How do you share information and lessons learned on community and societal level prevention
efforts with partners and subrecipients?
SECTION 3. CAPACITY BUILDING
11. In what ways has your organization been able to assess your capacity to enhance and expand
primary prevention and health equity work?
12. To what extent has your organization’s capacity to facilitate, monitor, implement, and evaluate
community and societal level SV prevention strategies and promote health equity increased
since the start of the NOFO?
❍ To a large extent
❍ To a moderate extent
❍ To a small extent
❍ Not at all
13. How has your organization been able to leverage findings from your primary prevention
capacity assessment to enhance and expand primary prevention work?
14. How, if at all, have you increased capacity within your organization to facilitate, monitor,
implement, and evaluate community and societal level SV prevention strategies and promote
health equity?
15. How, if at all, have you increased capacity among partners and subrecipients to facilitate,
monitor, implement, and evaluate community and societal level SV prevention strategies and
promote health equity?

16. What facilitators has your organization experienced with respect to increasing capacity for
community and societal level SV prevention and promoting health equity?
17. What barriers is your program still experiencing with respect to increasing capacity for
community and societal level SV prevention and promoting health equity? How are you
addressing those challenges?

SECTION 4. IMPLEMENTATION
18. What factors have facilitated implementation of your SV prevention efforts since the start of
the NOFO?
19. What legislative/political barriers, if any, have you encountered during the implementation of
SV prevention efforts? What are you doing to address those barriers?
20. What additional barriers have you encountered during the implementation of SV prevention
efforts? How are you addressing those barriers?
21. Can you describe any adaptations you made or are planning to make in order to make your
programs accessible and available to participants regardless of age, race/ethnicity, sexual
orientation, gender identity, sex, ability, or socioeconomic status?
22. What have been effective ways to engage partners and subrecipients to implement prevention
strategies?
23. What have been barriers to engaging partners and subrecipients to implement prevention
strategies? How are you addressing those barriers?
24. What changes, if any, have you observed in partners’ and subrecipients’ knowledge and
attitudes toward community and societal level SV prevention and health equity promotion?
25. Regarding the observed changes, how do these align with your goals for community and
societal level SV prevention and health equity?
SECTION 5. PROGRESS TOWARD GOALS

26. Think about the progress your program has made toward intended program outcomes for SV
prevention and health equity promotion. Can you share any success stories that reflect the
efforts you have made toward achieving program outcomes? (3,000 characters)
SECTION 6. REACH

27. To date, what progress have you made reaching your priority population(s) with SV prevention
efforts?
❍ Substantial progress
❍ Moderate progress
❍ Very little progress
❍ No progress
❍ Not yet measured
28. What methods are you using to engage your priority population(s) as you implement and
monitor progress on your SV prevention efforts?
29. Please describe what factors have impacted the current progress you have made to reach your
priority population(s).
30. Are you currently reaching or planning to reach other populations? If so, which populations and
how do you intend to reach those additional populations?
SECTION 7. SUSTAINABILITY
31. How are you working to ensure the sustainability of your activities and partnerships?
SECTION 8. HEALTH EQUITY
32. How is your program implementing SV prevention strategies to increase health equity?
33. What challenges have you faced with incorporating health equity into SV prevention efforts?
34. How have you, or how do you plan to, overcome these challenges?
35. How, if at all, could CDC support you in overcoming these challenges?
36. How have you, or how do you plan to, involve and incorporate community feedback in refining
and adapting your SV prevention strategies to better align with health equity goals?
37. What lessons learned about addressing health inequities would you share with other
programs?
SECTION 9. DATA TO ACTION

38. To what extent do you feel your organization has adequate access to data needed for planning,
monitoring, and evaluation of community and societal level SV prevention activities?
❍ To a very large extent
❍ To a large extent

❍ To some extent
❍ To little extent
❍ To no extent
39. To what extent does your organization use data (e.g., surveys, interviews, reports, focus
groups) for planning, monitoring, and evaluation of community and societal level SV prevention
activities?
❍ To a very large extent
❍ To a large extent
❍ To some extent
❍ To little extent
❍ To no extent
40. How are state and local data being used to inform program strategies and activities?
41. How is your organization increasing data access and sharing among partners and subrecipients?
42. What factors have facilitated enhancing data sharing and use among partners and
subrecipients?
43. What barriers have been encountered with enhancing data sharing and use among partners
and subrecipients? How are you addressing those barriers?
SECTION 10. TECHNICAL ASSISTANCE

44. What types of technical assistance and support from CDC and its technical assistance partners
have been most useful to your organization?
45. How could technical assistance and support CDC and its technical assistance partners provide
be improved?
SECTION 11. CONCLUSION

46. Thank you for taking the time to complete this survey! We value your time and really
appreciate your input. If you have any additional comments about your program’s
implementation, please provide them here.