Attachment B: Web-Based Survey
Form Approved OMB No. 0990-XXXX
Exp. Date XX/XX/XX11
Multidisciplinary Health Care Models for Women Sustainability Assessment Survey
Introduction: Welcome to the Multidisciplinary Health Models for Women (MHMW) Sustainability Survey being conducted by the Altarum Institute on behalf of the Office of Women’s Health’s (OWH) in the U.S. Department of Health and Human Services. This survey is designed to collect information on which aspects of the five-component core model of the MHMW Initiative have been implemented and sustained.
The survey will take approximately 35 minutes to complete and should be completed by respondents who are familiar with their organization’s MHMW program, women’s health services, and related issues since OWH funding has ended.
Your participation is voluntary. You can decline to participate. You can also stop your participation at any time by choosing not to submit your responses.
Your name and organization will not be attached to specific comments that you share today. Your responses may be included with those of other respondents in aggregate form in reports or journal articles.
Do you agree to voluntarily participate in this survey?
Yes [Go to Q1]
No [Display the following statement, “Thank for your time.”, and end the survey]
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-XXXX . The time required to complete this information collection is estimated to average 95 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer
Grantee/Contractor Characteristics
The first set of questions is designed to find out a little about your organization.
Please select the name of the organization for which you are completing the survey from the list below:
DROPDOWN LIST OF ALL THE MHMW SITES
Please list the title(s) of the individual(s) who completed this survey in the spaces below:
SPACE FOR TITLE 1
SPACE FOR TITLE 2
SPACE FOR TITLE 3
SPACE FOR TITLE 4
SPACE FOR TITLE 5
Thinking about the larger health care organization in which the MHMW program operated, approximately how many clients did that organization serve during the last year of OWH funding (to the extent available please include clinical encounters and education and outreach efforts)?
Number of Clients
IMPLEMENTATION OF Five CORE COMPONENTS
Clinical Care Component
The next set of questions asks you about your experience providing clinical care to girls and women during and after the period in which [NAME OF ORGANIZATION] received OWH funding for your MHMW program.
To what extent did you develop or enhance a comprehensive, coordinated system of clinical care for women during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 4 EQ 1-4] To what extent have you maintained or improved this system of care since OWH funding ending? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 5 EQ 1 OR 2] Why have you been able to maintain or improve this system of care? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 5 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this system of care? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you develop or improve a women’s health tracking and referral system during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 8 EQ 1-4] To what extent have you maintained or improved this health tracking and referral system since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 9 EQ 1 OR 2] Why have you been able to maintain or improve this health tracking and referral system? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 9 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this health tracking and referral system? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did the number of women’s health patients served increase during the period you received OWH funding? Select one.
1¨ Increased more than 30 percent
2¨ Increased 21–30 percent
3¨ Increased 11–20 percent
4¨ Increased 1–10 percent
5¨ Did not increase at all
Has the number of women’s health patients changed since OWH funding ended? Select one.
1¨ Number of patients has continued to increase
2¨ Number of patients has remained steady
3¨ Number of patients has decreased
[ASK IF 13 EQ 1] Why has the number of patients continued to increase? Select all that
apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 13 EQ 3] Why has the number of women’s health patients decreased since OWH funding ended? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did your site assist in improving access to women’s health services either within the organization or within partner organizations helping to deliver care during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 16 EQ 1-4] To what extent have you maintained or improved this level of access to care since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 17 EQ 1 OR 2] Why have you been able to maintain or improve this level of access to care? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 17 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this level of access to care? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you improve the level of coordination and integration of women’s health care with other types of services during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 20 EQ 1-4] To what extent have you maintained or improved this level of coordination and integration since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 21 EQ 1 OR 2] Why have you been able to maintain or improve this level of coordination and integration? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 21 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this level of coordination and integration? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
Research Component
The next set of questions asks about your experience implementing women’s health research during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
To what extent did you increase your organization’s involvement in women’s health research during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 24 EQ 1-4] To what extent have you maintained or improved this level of involvement since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 25 EQ 1 OR 2] Why have you been able to maintain or improve this level of involvement? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 25 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this level of involvement? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase the level of community participation in women’s health research during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 28 EQ 1-4] To what extent have you maintained or improved this level of community participation since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 29 EQ 1 OR 2] Why have you been able to maintain or improve this level of community participation? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 29 EQ 4 OR 5] Why have you had difficulty in maintaining or improving this level of community participation? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you develop or improve an interdisciplinary approach to conducting women’s health research (i.e. across academic departments or health care specialties) during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 32 EQ 1-4] To what extent have you maintained or improved an interdisciplinary approach since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 33 EQ 1 OR 2] Why have you been able to maintain or improve an interdisciplinary approach? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 33 EQ 4 OR 5] Why have you had difficulty in maintaining or improving an interdisciplinary approach? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you incorporate best practices identified through women’s health research into clinical practice during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 36 EQ 1-4] To what extent have you maintained or improved the incorporation of these best practices into clinical practice since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 37 EQ 1 OR 2] Why have you been able to maintain or improve the incorporation of these best practices into clinical practice? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 37 EQ 4 OR 5] Why have you had difficulty maintaining or improving the incorporation of these best practices into clinical practice? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase women’s health research conducted with diverse populations during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 40 EQ 1-4] To what extent have you maintained or improved this level of women’s health research conducted with diverse populations since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 41 EQ 1 OR 2] Why have you been able to maintain or improve this level of women’s health research conducted with diverse populations? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 41 EQ 4 OR 5] Why have you had difficulty maintaining or improving this level of women’s health research conducted with diverse populations? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
Public Education and Outreach Component
The next set of questions asks about your experience implementing public education and outreach to girls and women during and after the period in which [NAME OF ORGANIZATION] received OWH funding.
To what extent did you increase community education and outreach programs during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 44 EQ 1-4] To what extent have you maintained or improved this level of community education and outreach programs since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 45 EQ 1 OR 2] Why have you been able to maintain or improve this level of community education and outreach programs? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 45 EQ 4 OR 5] Why have you had difficulty maintaining or improving this level of community education and outreach programs? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you develop or improve education programs to help prevent/manage health conditions common among your female patients during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 48 EQ 1-4] To what extent have you maintained or improved these types of women’s education programs since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 49 EQ 1 OR 2] Why have you been able to maintain or improve this level of these types of education programs? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 49 EQ 4 OR 5] Why have you had difficulty maintaining or improving these types of education programs? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you identify and reach out to underserved populations during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 52 EQ 1-4] To what extent have you maintained or improved these outreach efforts since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 53 EQ 1 OR 2] Why have you been able to maintain or improve this these outreach efforts? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 53 EQ 4 OR 5] Why have you had difficulty maintaining and improving these outreach efforts? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you tailor education and outreach materials to ensure that they were appropriate to different target audiences (e.g., literacy level, age, cultural background) during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 56 EQ 1-4] To what extent did you maintain or improve these efforts since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 57 EQ 1 OR 2] Why have you been able to maintain or improve these efforts? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 57 EQ 4 OR 5] Why did you have difficulty maintaining or improving these efforts? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
Training Component
The next set of questions asks about your experience implementing women’s health training activities during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
To what extent did you increase training activities for professional health care providers serving women during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 60 EQ 1-4] To what have you maintained or improved these training activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 61 EQ 1 OR 2] Why have you been able to maintain or improve these training activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 61 EQ 4 OR 5] Why have you had difficulty maintaining or improving these training activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you develop or increase training activities for lay health care workers (i.e., health care workers lacking a professional degree) serving women? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 64 EQ 1-4] To what extent have you maintained or improved these training activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 65 EQ 1 OR 2] Why have you been able to maintain or improve these training activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 65 EQ 4 OR 5] Why have you had difficulty maintaining and improving these training activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you improve joint training activities with community partners during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 68 EQ 1-4] To what extent have you maintained or improved these training activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 69 EQ 1 OR 2] Why have you been able to maintain or improve these training activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 69 EQ 4 OR 5] Why have you had difficulty in maintaining or improving these training activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you initiate or improve strategies to recruit professional and lay health care workers from underrepresented groups for women’s health training activities during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 72 EQ 1-4] To what extent have you maintained or improved these recruitment strategies since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 73 EQ 1 OR 2] Why have you been able to maintain or improve these recruitment strategies? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 73 EQ 4 OR 5] Why have you had difficulty maintaining or improving these recruitment strategies? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase the availability of financial assistance or offer training free of charge to improve access to training activities during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 76 EQ 1-4] To what extent have you maintained or improved access to training activities? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 77 EQ 1 OR 2] Why have you been able to maintain or improve access to training activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 77 EQ 4 OR 5] Why have you had difficulty in maintaining and improving access to training activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
Leadership Development Component
The next set of questions asks about your experience implementing women’s leadership development activities during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
To what extent did you increase leadership development activities for female health care providers and community members during the period you received OWH funding?
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 80 EQ 1-4] To what extent have you maintained or improved these leadership development activities since OWH funding ended?
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 81 EQ 1 OR 2] Why have you been able to maintain or improve these leadership development activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 81 EQ 4 OR 5] Why have you had difficulty in maintaining or improving these leadership development activities?
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase leadership development activities targeting female allied health care professionals and community health workers during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 84 EQ 1-4] To what extent have you maintained or increased these leadership development activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 85 EQ 1 OR 2] Why have you been able to maintain or increase these leadership development activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 85 EQ 4 OR 5] Why have you had difficulty in maintaining or increasing these leadership development activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase the availability of leadership positions for female allied health care professionals and community health workers? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 88 EQ 1-4] To what extent have you maintained or increased the availability of these leadership positions since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 89 EQ 1 OR 2] Why have you been able to maintain or increase the availability of these leadership positions? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 89 EQ 4 OR 5] Why have you had difficulty in maintaining or increasing the availability of these leadership positions? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you initiate or increase activities to interest girls, young women, and career-changing women in the health professions during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 92 EQ 1-4] To what extent have you maintained or increased these activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 93 EQ 1 OR 2] Why have you been able to maintain or increase these activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 93 EQ 4 OR 5] Why have you had difficulty in maintaining or increasing these activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
To what extent did you increase activities that support the promotion and retention of female professional and lay health care workers during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 96 EQ 1-4] To what extent have you maintained or increased these activities since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 97 EQ 1 OR 2] Why have you been able to maintain or increase these activities? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 97 EQ 4 OR 5] Why have you had difficulty in maintaining or increasing these activities? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
IMPLEMENTATION OF OTHER COMPONENTS
The next set of questions asks about your experience implementing technical assistance and replication activities during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
Technical Assistance
To what extent did you provide technical assistance to help other organizations implement a comprehensive, coordinated system of women’s health care during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 100 EQ 1-4] To what extent have you maintained or increased this type of technical assistance since OWH funding ended? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 101 EQ 1 OR 2] Why have you been able to maintain or increase this type of technical assistance? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 101 EQ 4 OR 5] Why have you had difficulty in maintaining or increased this type of technical assistance? Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
REPLICATION
To what extent did you replicate a comprehensive, coordinated system of women’s health care at other organizations or health care facilities during the period you received OWH funding? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 104 EQ 1-4] To what extent have you continued efforts to replicate this system of care at other organizations since OWH funding ended?
Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 105 EQ 1 OR 2] Why have you been able replicate this system of care at other organizations? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong organizational support
5¨ Strong community support
6¨ Changes in local, State, or Federal policy
7¨ Other reason (please describe) _______________________________________
[ASK IF 105 EQ 4 OR 5] Why have you had difficulty in continuing to replicate this system of care at other organizations?
Select all that apply.
1¨ Insufficient funding
2¨ Insufficient staff capacity
3¨ Insufficient structural resources (e.g., facilities, supplies, data systems)
4¨ Insufficient organizational support
5¨ Insufficient community support
6¨ Other reason (please describe) _______________________________________
organizational support
The next set of questions asks about your experience garnering support from organizational leadership in implementing MHMW-related activities during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
While you were receiving OWH funding, to what extent did top-level leaders of your organization (e.g., university dean, hospital directors, clinic directors) support your MHMW program? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 108 EQ 1 OR 2] Why do you feel that top-level leaders were highly supportive of your MHMW program? Select all that apply.
1¨ Leaders viewed women’s health issues as a high priority
2¨ Leaders embraced or understood the proposed benefits of the MHMW program
3¨ Leaders felt there were sufficient resources to support the MHMW program
4¨ Leaders recognized the prestige of being recognized as a national center of excellence
5¨Other reason (please describe) _______________________________________
[ASK IF 108 EQ 3-5] Why do you feel that top-level leaders were less than highly supportive of your MHMW program? Select all that apply.
1¨ Leaders did not view women’s health issues as a high priority
2¨ Leaders did not embrace or understand the proposed benefits of the MHMW program
3¨ Leaders did not feel there were sufficient resources to support the MHMW program
4¨ Other reason (please describe) _______________________________________
Since OWH funding ended, to what extent do top-level leaders of your organization support your efforts to maintain and/or expand an integrated approach to improving women’s health? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 111 EQ 1 OR 2] Why do you feel that top-level leaders of your organization are highly supportive of current efforts to maintain and/or expand an integrated approach to improving women’s health? Select all that apply.
1¨ Received additional funding
2¨ Innovative use of staff
3¨ Innovative use of structural resources (e.g., facilities, supplies, data systems)
4¨ Strong community support
5¨ Changes in local, State, or Federal policy
6¨ Other reason (please describe) _______________________________________
[ASK IF 111 EQ 3-5] Why do you feel that top-level leaders of your organization are less than highly supportive of current efforts to maintain and/or expand an integrated approach to improving women’s health? Select all that apply.
1¨ Leaders do not view women’s health issues as a high priority
2¨ Leaders do not embrace or understand the benefits of this approach
3¨ Leaders do not feel there are sufficient resources to support this approach
4¨ Other reason (please describe) _______________________________________
Community Involvement
The next set of questions asks about your experience involving partner organizations and community members in implementing MHMW-related activities during and after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
While you received OWH funding, to what extent were community leaders and partners involved in your MHWM program? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 114 EQ 1-4] Since OWH funding ended, to what extent are community leaders and partners involved in the delivery of women’s health services? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 115 EQ 1 OR 2] Why have you been able to involve community leaders and partners in current efforts to deliver women’s health care? Select all that apply.
1¨ Existence of formal mechanisms for collaboration (e.g., Memoranda of Understanding, regular community group meetings)
2¨ Strong interest from the community
3¨ Strong support from leaders within our organization
4¨ Strong staff capacity to support partnership building
5¨ Other reason (please describe) _______________________________________
[ASK IF 115 EQ 4 OR 5] Why have you had difficulty in involving community leaders
and partners in current efforts to deliver women’s health care? Select all that apply.
1¨ Lack of formal mechanisms for collaboration (e.g., Memoranda of Understanding, regular community group meetings)
2¨ Lack of interest from the community
3¨ Lack of support from leaders within our organization
4¨ Lack of staff capacity to support partnership building
5¨ Other reason (please describe) _______________________________________
While your organization received OWH funding, to what extent did your MHMW
program use a community advisory group to inform the development of your MHMW
program? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
[ASK IF 118 EQ 1-4] Since OWH funding ended, to what extent have you changed the
amount you use your community advisory group to inform delivery of women’s
services? Select one.
1¨ Increased its use
2¨ Maintained its use at the same level
3¨ Decreased its use
Sustainability Planning
The next set of questions covers issues related to any sustainability planning you may have engaged in during or after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
While your organization received OWH funding, were you required by OWH to plan for the sustainability of your MHMW program (i.e., the continuation of all or some of its five core components) once OWH funding ended? Select one.
1¨ Required by OWH to conduct sustainability planning
2¨ Encouraged but not required by OWH to conduct sustainability planning
3¨ Neither required nor encouraged by OWH to conduct sustainability planning
While your organization received OWH funding, how did you plan for the sustainability of your MHMW program? Select one.
1¨ Developed a formal sustainability plan
2¨ Developed an informal sustainability plan
3¨ Did not develop any type of sustainability plan, but had discussions about sustainability
4¨ Did not develop any type of sustainability plan or have discussions about sustainability
[ASK IF 120 EQ 1-3] In what year did you begin discussing or planning for the sustainability of your MHMW program?
[Drop down box with years from 1996-2007 along with a “don’t know” response]
[ASK IF 121 EQ 1-3] In planning for sustainability, did you conduct a self-assessment to explore what needed to be done by your organization to sustain the MHMW components? Select one.
1¨ Yes
2¨ No
[ASK IF 121 EQ 1-3] Did you receive any guidance or resources to help plan for sustainability? Select all that apply.
1¨ Yes, from OWH
2¨ Yes, from another source (please describe) ______________________________
3¨ Yes, from another source (please describe) ______________________________
4¨ Yes, from another source (please describe) ______________________________
5¨ No
[ASK IF 124 EQ 1] What type of guidance or resources did you receive from OWH to help plan for sustainability? Select all that apply.
1¨ Sustainability planning publications
2¨ One-on-one technical assistance
3¨ Other type of assistance (please describe) ______________________________
4¨ Other type of assistance (please describe) ______________________________
[ASK IF 124 EQ 2–4] What type of guidance or resources did you receive from other sources to help plan for sustainability? Select all that apply.
1¨ Sustainability planning publications
2¨ One-on-one technical assistance
3¨ Other type of assistance (please describe) ______________________________
4¨ Other type of assistance (please describe) ______________________________
Since OWH funding ended, to what extent has your organization been able to sustain aspects of your MHMW program? Select one.
1¨ Great extent
2¨ Large extent
3¨ Moderate extent
4¨ Slight extent
5¨ Not at all
Since OWH funding ended, has your organization been able to secure other sources of funding to support all or some aspects of your MHMW program? Select one.
1¨ Yes, we have been able to secure a greater level of funding than we had previously
2¨ Yes, we have been able to secure the same level of funding as we had previously
3¨ Yes, we have been able to secure a lower level of funding than we had previously
4¨ No, we have not been able to secure any additional funding from other sources
EVALUATION
Finally, we have a couple of questions about any evaluations you may have conducted of your MHMW-related activities during or after the period in which [NAME OF ORGANIZATION] received OWH funding for its MHMW program.
Did you ever conduct an evaluation of activities related to your MHMW program before or after receiving funding from OWH? Select one.
1¨ Yes
2¨ No
[ASK IF 129 EQ 1] What type of information did your evaluation(s) collect? Select all that apply.
1¨ Number and type of program activities implemented
2¨ Number of individuals participating in MHMW program activities
3¨ Demographics of individuals participating in MWHW program activities
4¨ Data on patient satisfaction
5¨ Data on health outcomes
6¨ Other (Please describe) ______________________________________________
[ASK IF 129 EQ 1] Since OWH funding ended, have you actively used the results of your evaluation in seeking support to sustain the model? Select one.
1¨ Have made extensive use of evaluation results
2¨ Have made moderate use of evaluation results
3¨ Have made limited use of evaluation results
4¨ Have not actively used evaluation results at all
[ASK IF 129 EQ 1] Since OWH funding ended, have you actively used the results of your evaluation to improve the model? Select one.
1¨ Have made extensive use of evaluation results
2¨ Have made moderate use of evaluation results
3¨ Have made limited use of evaluation results
4¨ Have not actively used evaluation results at all
Please feel free to provide any comments or information that would help those who analyze the survey to understand your responses.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Appendix A: Web-Based Survey |
| Author | Amy Brown |
| File Modified | 0000-00-00 |
| File Created | 2021-02-03 |