Form 1 Comprehensive Survey

OMB Number: 0906-0084

Expiration Date: 02/28/2027

Public Burden Statement: The purpose of this collection is to assess the usability, relevance, and effectiveness of a technical assistance (TA) resource developed to expand health center awareness of sexual assault-related health care needs among users including health care providers, community advocates, and health care administrators. This evaluation will also assess the utilization, reach, and engagement of dissemination materials and the impact of public and on-demand TA activities. 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. The OMB control number for this information collection is 0906-0084 and it is valid until 2/28/2027. This information collection is voluntary. Data will be private to the extent permitted by the law. Public reporting burden for this collection of information is estimated to average 11 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14NWH04, Rockville, Maryland, 20857 or [email protected].  Please see https://www.hrsa.gov/about/508-resources for the HRSA digital accessibility statement. 

Comprehensive Survey

Introduction

ICF, under contract with the Health Resources and Services Administration (HRSA), manages and evaluates the Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs project. This project aims to collaboratively facilitate the development of a technical assistance (TA) resource that will help health centers identify and meet the needs of individuals impacted by sexual assault. This has included developing the TA Resource, implementing strategic efforts to disseminate the TA Resource, and conducting TA activities to support the use of the TA Resource. We are asking people who have participated in TA and used the TA resource to talk with us a bit about how you learned of TA resource, how effective the TA activities were, and how useful the TA resource has been for you. The survey is designed to take about 15 minutes to complete.

Informed Consent

Your participation in this survey is completely voluntary and will not result in any direct benefits to you. However, your input is valuable and will inform the refinement and future use of the TA Resource. We do not anticipate any risks to you related to participating in this survey.

We will not associate your name with the information that you provide. We will not share any identifying information in any reports or presentations that include findings from this survey. Only members of the research team will have access to study information.

If you have questions about this initiative, please contact the Project Manager at ICF, Jessie Rouder, at [email protected]. If you have any questions about your rights as a research participant, you can contact the ICF Institutional Review at [email protected]

* Please choose one of the options below and click “next” to confirm:

I have read the above information and I AGREE to participate in this survey.

I have read the above and I DO NOT wish to participate in this survey.

Draft Comprehensive Survey

Section 1. Demographics

[ASK ALL]

Q1. What state do you currently work in?

1. [DROPDOWN OF STATES AND TERRITORIES (https://www.astho.org/topic/territories-freely-associated-states/)]

[ASK ALL]

Q2. In which setting is most (i.e., more than half) of the population you serve located?

2. Urban

3. Suburban

4. Rural

5. Frontier

6. An equal mix of the above

7. Other (please specify): __________________

[ASK ALL, Required]

Q3. Which of the following best describes your current role(s) at the HRSA-funded health center (select all that apply):

1. Clinical staff (i.e., front desk, medical assistant, etc.)

2. Clinical provider (i.e., physician, nurse practitioner, SAFE examiner, etc.)

3. Health center administration (i.e., Medical Director, Director of Patient Services)

4. Patient navigator

5. Community health worker

6. Other (please specify): __________________

[ASK ALL]

Q4. How long have you provided health care at an HRSA-funded health center?

1. [OPEN TEXT]

Section 2. Dissemination activities

This section will ask you questions about the different ways in which the TA offerings were promoted for use among health care professionals working in HRSA-funded health centers. Please read each question carefully and select the answer that best applies.

[ASK ALL]

Q5. There were several different ways that HRSA promoted the TA offerings (i.e., webinars, trainings, TA Resource website, etc.). How did you hear about them? Select all that apply.

1. Social media (LinkedIn, Instagram, X, etc.)

2. Colleagues at my organization

3. Colleagues from another organization

4. HRSA Newsletter

5. Conference

6. I did not hear about the TA offerings.

7. Other: [OPEN TEXT]

[IF Q5. = 6, SKIP TO TA ACTIVTIES SECTION]

[ASK IF Q5 = 1-5 or 7]

Q6. HRSA did a good job using various platforms (i.e., social media, newsletter, conferences) to promote and share information about the TA Resource.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q5 = 1-5 or 7]

Q7. Did you see any of the messages or images that were used to promote these TA offerings? For example, the messages (i.e., the text or language) and/or the images (i.e., the pictures or graphics) used on social media, in the newsletter, or on any printed materials.

1. Yes

2. No

3. I don’t know

[ASK IF Q5 = 1-5 or 7]

Q8. The images or pictures that were used to promote the TA offerings were relevant to me and the work that I do.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q5 = 1-5 or 7]

Q9. The images or pictures that were used to promote the TA offerings did a good job of showing a diverse group of people (i.e., age, race, gender, body type, etc.).

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q5 = 1-5 or 7]

Q10. The messaging or text that was used to promote the TA offerings resonated with me.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q5 = 1-5 or 7]

Q11. The messaging and materials (i.e., the images/pictures and text) that were used to promote the TA offerings prompted me to engage with TA (i.e., register for a TA activity or visit the TA Resource website).

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

Section 3. TA Activities

This section will ask you questions about the different TA activities that were offered as a part of the HRSA SA TA project. Please read each question carefully and select the answer that best applies.

[ASK ALL]

Q12. Which TA activity/activities did you attend (select all that apply)?

1. [Name of TA offering]

2. [Name of TA offering]

3. [Name of TA offering]

4. Individual consultation/on-demand TA

5. I don’t know

6. I did not participate in any of the TA activities

7. Other: ____________

[IF Q12 = 6, SKIP TO TA RESOURCE SECTION]

[ASK IF Q12= 1-5 or 7]

Q14. Which type(s) of TA activity did you attend (select all that apply)?

1. Public (not specifically requested by you/your organization; open to everyone)

2. On-demand (specifically requested by you/your organization; not open to everyone)

3. I don’t know.

[ASK IF Q12= 1-5 or 7]

Q. The topics of the TA offered were relevant to providing health care to survivors of sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q12= 1-5 or 7]

Q16. The TA activities (i.e., webinars, in-person support, trainings, etc.) were useful and increased my knowledge and skills in providing care to people who have experienced sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q12= 1-5 or 7]

Q17. The knowledge and skills I gained from the public TA activities (i.e., will list names of public TA activities here) prompted me to visit the TA Resource website.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q.=1 and/or Q. =2]

Q18. The knowledge and skills I gained from the on-demand TA activities (i.e., in-person site visits, etc.) prompted me to visit the TA Resource website.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

Section 4. TA Resource

The next group of questions are about the TA Resource website [will link to it]. Please read each question carefully and select the answer that best applies.

[ASK ALL]

Q19. Did you use the TA Resource?

1. Yes

2. No

3. I don’t know

[IF Q. = 3, SKIP TO CONCLUSION SECTION]

[ASK IF Q19 = 1]

Q21. It was easy to find the information I needed in the TA resource.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q19 = 1]

Q22. The TA resource increased my comfort and confidence in providing care to people who have experienced sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q19 = 1]

Q23. The TA resource increased my skills in providing health care to people who have experienced sexual assault.

7. Strongly agree

8. Agree

9. Neither agree nor disagree (neutral)

10. Disagree

11. Strongly disagree

12. I don’t know

[ASK IF Q19 = 1]

Q24. The TA resource increased my knowledge about the different health care needs of someone who has experienced sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q19 = 1]

Q25. The TA resource increased my use of patient-centered practices in providing health care to people who experienced sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q19 = 1]

Q26. The TA resource increased the number of referrals to supportive services that I provided to people who experienced sexual assault.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. Not applicable

[ASK IF Q19 = 1]

Q27. Please select the degree to which you agree with the statements below about the TA Resource.

After using the TA resource, I better understood:

	Strongly agree	Agree	Neither agree, nor disagree (neutral)	Disagree	Strongly Disagree	I don’t know
Why universal screening and education is important for all patients
How to check if a patient might be at risk for sexual assault.
Why it is important to use trauma-informed practices when responding to patients who disclose sexual assault.
How to use trauma-informed practices when responding to patients who disclose sexual assault
Why it is important to refer patients who disclosed sexual assault for additional care.
How to refer patients who disclosed sexual assault for additional care.

[ASK IF Q19 = 1]

Q28. The health center where I work created new policies, procedures, and/or protocols based on information gained from the TA resource.

1. Strongly agree

2. Agree

3. Neither agree nor disagree (neutral)

4. Disagree

5. Strongly disagree

6. I don’t know

[ASK IF Q19 = 1]

Q. Do you intend to share the TA resource with any of your colleagues?

1. Yes

2. No

3. I already did

4. I don’t know

Section 5. Follow-up interview

Q29. Would you like to participate in a follow-up conversation (approx. 1 hour) about your experience with the TA resource and TA activities? Those who are selected to participate will receive a gift-card incentive in the amount of $125.

1. Yes

2. No

[IF Q29 = 1]

Q30. Please provide your name.

Q31. Please provide the email address where we may contact you with further information about participating in the qualitative interviews.

[IF Q29 = 2, SKIP TO CONCLUSION]

Section 6. Conclusion

Thank you for your time completing this survey! Your responses will help ensure the TA Resource is effective and useful.