Form 4 Leadership Forum 12 Month Post Interview

12-Month Post-Forum Call Introduction Script and Questions

OMB No.: 0925-XXXX

Expiration Date: xx/xx/20xx

Collection of this information is authorized by The Public Health Service Act, Section 411 (42 USC 285a). Rights of study participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties for not participating or withdrawing from the study at any time. Refusal to participate will not affect your benefits in any way. The information collected in this study will be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the study. Information provided will be combined for all study participants and reported as summaries. You are being contacted by telephone to complete this instrument so that we can improve future workshops.

Public reporting burden for this collection of information is estimated to average 60 minutes per response, 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, and a person is not required to respond to, a collection of information unless 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-XXXX). Do not return the completed form to this address.

The primary purpose of this phone call is to provide continuing technical support on cancer control planning and implementation within the NCI Cancer Control Leadership Forum Program at the 12-month time point after your attendance at the Leadership Forum. In addition, your candid responses to questions will allow the U.S. National Cancer Institute to assess whether the program’s objectives are being met, and provide insight into how we can improve future program efforts. This information is being collected by NCI.

All information obtained will be kept secure, to the extent provided by law. NCI has obtained Office of Management and Budget clearance to collect this information under OMB number TBD, expiration date TBD. Public reporting burden for this collection of information is estimated to average 60 minutes per telephone interview including the time for reviewing instructions, searching existing data sources, gathering and maintaining the information needed, and responding to questions

1. What are the action items that the team agreed to complete within 12 months of the Forum?

2. To what extent have each of the action items identified during the Forum been implemented by the country team?

3. What challenges has the country team encountered in implementing the Forum action plan? How has the team addressed these challenges? In what ways could the team address the remaining challenges?

4. Have adjustments/additions been made to the action plan? If so, what has been changed or added? What prompted the changes?

5. What successes did the country team have related to implementing their action plans?

6. What types of resources/support has the country team used to implement the action plan?

7. Has your country team been successful in finding new resources/support including funding?

8. Are there resources you were referred to at the Forum or in subsequent communications with NCI that you have found useful? If so, describe:

9. Have new partners joined the cancer planning and implementation efforts? If so, who? What will be their contribution?

10. With regard to the cancer planning and implementation team, have there been any challenges in areas such as communication, roles/responsibilities, leadership, etc.? If so, describe:

11. Has your country team developed any written materials as a group (e.g. publications, reports, white papers) or presentations (seminars, webinars, etc.)? If so, describe:

12. Has your country team developed any tools related to cancer control planning and implementation? If so, describe:

13. Is the country team communicating regularly with government leaders on their work and progress? If so, who and how often?

14. Has the country team been involved in building new cancer control planning and implementation partnerships or strengthening existing ones? If so, describe challenges and successes (e.g. in the areas of new partner recruitment, partnership accomplishments, national visibility):

15. Has the country team been involved in using data and information to guide cancer control efforts and policymaking? If so, describe challenges and successes (e.g. improving data reporting from registries, improving data quality, using data to guide policy):

16. Has the country team been involved in strengthening implementation of the cancer control plan? If so, describe challenges and successes (e.g. identification of priorities, securing funding, mobilizing support, tracking progress):

17. Has the country team been involved in enhancing evaluation of the cancer control plan? If so, describe challenges and successes (e.g. formulating measurable objectives, consulting evaluation experts, developing strategies):

18. Has the work you are doing with international or regional partners on cancer control planning and implementation changed? If so, describe:

19. What action items will the group undertake in the coming year?

20. What suggestions do you have for improving NCI follow-up support in future Forums?

21. Were there any events in the country that have bolstered cancer control planning and implementation efforts or impeded progress?

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