Form 1 PEPH Aware Act Use Survey Final

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

PEPH_Aware-Act-Use_Survey_Final_03-05-2018v2 (2)

Partnerships for Environmental Public Health (PEPH) Aware-Act-Use (State, Local, and Tribal)

OMB: 0925-0648

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OMB#: 0925-0648 Exp., date: 03/2018


Burden Statement

Public reporting burden for this collection of information is estimated to average 5 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 (0925-0648*). Do not return the completed form to this address.


PEPH Aware-Act-Use

Final Questionnaires



Awareness/Actions/Use of Newsletters:


  1. How did you find out about the PEPH newsletter?

    1. Email from PEPH

    2. Colleague forwarded it to me

    3. Visited PEPH website

    4. I don’t know, they just started showing up

    5. Other (please specify): [TEXT BOX]


  1. How long have you been receiving the PEPH newsletter?

    1. Less than one month

    2. One to six months

    3. Six months to a year

    4. One to two years

    5. More than two years


  1. How often do you normally read the PEPH newsletter?

    1. Monthly

    2. Every 2-3 months

    3. A few times per year

    4. Rarely

    5. Never


  1. How often do you generally click on at least 1 item in the newsletter?

    1. Monthly

    2. Every 2-3 months

    3. A few times per year

    4. Rarely

    5. Never


  1. How often do you share the newsletter or information from the newsletter with a colleague?

    1. Monthly

    2. Every 2-3 months

    3. A few times per year

    4. Rarely

    5. Never


  1. If you shared the newsletter, how much do you agree with this statement: My colleagues found the newsletter to be helpful.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know

    7. Not applicable (didn’t share)


  1. How much do you agree with this statement: The newsletter meet your needs

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please indicate the one way in which you find the newsletter MOST useful?

TEXT BOX (OPEN ENDED RESPONSE)


  1. How much do you agree with this statement: I have acted on information that I obtained in the PEPH newsletter in my professional activities.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please describe one way in which you have acted on information you obtained in a PEPH newsletter? If you have not, please describe why not.

TEXT BOX (OPEN ENDED RESPONSE)


  1. Are there additional things you would like to see included in the newsletter?

TEXT BOX (OPEN ENDED RESPONSE)


  1. If you are interested in participating in related future research, please provide your email address here." Then include a text box for them to enter it.


 Awareness/Actions/Use of PEPH webinars:


  1. How did you find out about today’s PEPH webinar?

    1. Email from PEPH

    2. A colleague told me about it

    3. Visited PEPH website

    4. Don’t know

    5. Other (please specify): [TEXT BOX]


  1. How often do you normally participate in the PEPH webinars?

    1. Every webinar

    2. Most webinars

    3. A few webinars per year

    4. Rarely

    5. Never


  1. What’s the most useful information you have gotten from this month’s PEPH webinar?

    1. TEXT BOX (OPEN ENDED RESPONSE)

    2. Not applicable/did not participate in this month’s Webinar


  1. What topics are of greatest interest to you?


  1. How much do you agree with this statement: I have gained useful information in the PEPH webinars.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please briefly explain how you have or have not gained useful information from the PEPH webinars.

    1. TEXT BOX (OPEN ENDED RESPONSE)


  1. How much do you agree with this statement: I have acted on information that I obtained in PEPH webinars in my professional activities.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please name and describe one way in which you have acted on information you obtained in a PEPH webinar? If you have not, please describe why not.

    1. TEXT BOX (OPEN ENDED RESPONSE)

  2. Are there any additional ways we can improve future webinars?

    1. TEXT BOX (OPEN ENDED RESPONSE)


  1. If you are interested in participating in related future research, please provide your email address here." Then include a text box for them to enter it.




Awareness/Actions/Use of Podcasts:


  1. How did you find out about the PEPH podcast series (Environmental Health Chat)?

    1. Email from PEPH

    2. A colleague told me about it

    3. Visited PEPH website

    4. From another website

    5. iTunes

    6. Don’t know

    7. Other (please specify): [TEXT BOX]


  1. How often do you normally listen to the PEPH podcasts?

    1. Every podcast

    2. Most podcasts

    3. A few podcasts per year

    4. Rarely

    5. Never


  1. What’s the most useful information you have gotten from a PEPH podcast?

    1. TEXT BOX (OPEN ENDED RESPONSE)

    2. Not applicable/have not listened to any podcasts


  1. What topics are of greatest interest to you?


  1. How much do you agree with this statement: I have gained useful information from listening to the PEPH podcasts.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please briefly explain how you have or have not gained useful information from listening to the PEPH podcasts.

    1. TEXT BOX (OPEN ENDED RESPONSE)


  1. How much do you agree with this statement: I have acted on information that I obtained from the PEPH podcasts in my professional activities.

    1. Strongly disagree

    2. Disagree

    3. Neither agree nor disagree

    4. Agree

    5. Strongly agree

    6. Don’t know


  1. Please name and describe one way in which you have acted on information you obtained from a PEPH podcast? If you have not, please describe why not.

    1. TEXT BOX (OPEN ENDED RESPONSE)


  1. Are there additional ways we can improve future podcasts?

    1. TEXT BOX (OPEN ENDED RESPONSE)


  1. If you are interested in participating in related future research, please provide your email address here." Then include a text box for them to enter it.




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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSatisfaction surveys
AuthorEvans, William Douglas
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