Fast-track template NMOI pilot study 04 17 12

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0925-0648)

TITLE OF INFORMATION COLLECTION: The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Multicultural Outreach Initiative (NMOI) Pilot Study

PURPOSE: The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) National Multicultural Outreach Initiative (NMOI) aims to raise awareness in multicultural communities about the availability of NIAMS and NIH resources to help people with conditions of the bones, joints, muscles and skin. To meet this aim, the NIAMS has created a culturally relevant health planner with research-based tips about self-care, prevention, and disease management, and recommended NIH health information resources. One set of health planners is designed for Hispanics/Latinos and another for American Indians, Alaska Natives, and Native Hawaiians.

Prior to launching a national distribution of the health planners, the NIAMS is conducting a pilot study in four community sites – two targeting the Hispanic/Latino population and two targeting the American Indian population – to test the effectiveness of both the health planners and the community distribution methods. At each site, an effort will be led by a selected community-based health outreach organization to distribute a limited number of health planners through its regular material distribution channels, using direct and indirect methods.

The purpose of the customer satisfaction survey is to obtain respondents’ feedback on the format and content of the health planners, their attitudes about receiving and using the planners, their awareness of the need for such information, and how the NIAMS and NIH has or can provide them with relevant health information. The survey will not include any demographic information (age, gender, health or education status).

To facilitate the conduct of a customer satisfaction survey, each organization will be asked to insert a survey package into every planner. The package will include 1) a survey with basic instructions on how to complete and return it, and 2) a pre-addressed stamped envelope. When the planners that include the survey packages are given directly to people, outreach workers will tell them about the importance of the survey and ask if they are interested in participating. The survey will also be available online, and people will be directed to a link for a Survey Monkey version in the survey instructions, for those who choose to complete the survey electronically.

The results will be used to determine the level of satisfaction that users have with the health planner, and whether the distribution of the planner meets the general goals of the NIAMS (to increase awareness of specific health issues and of the NIAMS/NIH role in disseminating information to multicultural populations). These results will help inform the development of future planners and a national distribution method.

DESCRIPTION OF RESPONDENTS: Respondents will include Hispanic/Latino or American Indian adults living within the catchment area of the study site organizations. The health planner and the feedback survey for the Hispanic/Latino audience will be bilingual, thus allowing the collection of data to include those who speak English and/or Spanish.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:_____Mimi Lising___________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [] Yes [X ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X ] No

BURDEN HOURS

Category of Respondent	No. Respondents	Participation Time	Burden
Individuals	200	20 minutes	67 hours
Totals	200	20 minutes	67 hours

FEDERAL COST: The estimated annual cost to the Federal government is $3500 and includes 1) costs for envelopes and stamps, and 2) printing copies of the surveys.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [ X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Each of the four study sites will receive a predetermined number of planners for distribution in April, May and June. Each study site will distribute health planners through direct and indirect methods. Direct methods (when outreach workers are in contact with the users) include during home visits, office visits, at community events, at in-service presentations, and other educational/outreach opportunities. Indirect methods (when outreach workers are not in contact with the users) include mailings or placement of brochures in public areas for people to pick up on their own. When the survey packages arrive at each site, outreach workers will be asked to place a survey package into every planner. For planners distributed directly, outreach workers will actively recruit people receiving the survey package to participate in the survey.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ x ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ x ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

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