allies against asthmaasthma.umich.edu/media/eval_autogen/eval_instruments.pdfq3. if you represent an...

Allies Against Asthma is a national project supported by the Robert Wood Johnson Foundation. Direction and technical assistance is provided by the National Program Office at the University of Michigan Center for Managing Chronic Disease.

ALLIES AGAINST ASTHMA EVALUATION INSTRUMENTS

Introduction

The enclosed instruments and tools were developed or adapted by Allies Against Asthma (Allies) for the cross-site evaluation. A cover page describes each instrument and provides further information to assist in the use or adaptation of these instruments by others. Appendix A describes how Allies used these instruments in its cross-site evaluation. The Allies Against Asthma program, funded by the Robert Wood Johnson Foundation, supports seven coalitions which aim to develop and sustain community-wide pediatric asthma control systems. Direction and technical assistance for Allies is provided by the National Program Office at the University of Michigan. Allies’ evaluation approach was designed collaboratively by leaders from all seven community coalitions, the program’s National Advisory Committee members and the Allies National Program Office staff. Additional information about the program can be found at www.AlliesAgainstAsthma.net.

Contents

Context Survey (English; 4 pages) Purpose: to collect quantitative and qualitative information from coalition leaders about coalition structure and functioning; the focus of coalition efforts; and the social, cultural and political environment of the community in which the coalition operates

Coalition Self-Assessment Survey (CSAS) (English and Spanish; 21 pages each)

Purpose: to capture quantitative information from coalition members on coalition structure and processes including coalition functioning, leadership, and effectiveness of effort

Key Informant Interview Guides (5 guides; English; total of 17 pages) Purpose: to collect information on the activities of a coalition from its leaders and staff, coalition members, and other community leaders who are not part of the coalition

Program Reach Forms (English; 9 pages)

Purpose: to document data on the extent of coalition activities

Core Caregiver Survey (English and Spanish; 10 pages each) Purpose: to measure individual health outcomes of an intervention group and a control/comparison group between baseline and follow-up periods

Appendix A: How Allies Used the Cross-site Evaluation Instruments (English; 3 pages)

Purpose: to explain how the instruments included in this toolkit were used in the Allies cross-site evaluation


ALLIES AGAINST ASTHMA CONTEXT SURVEY

Description The Context Survey can be used to conduct a semi-structured interview to collect both quantitative and qualitative information about coalition structure and functioning and the focus of coalition efforts. It also gathers information about the social, cultural and political environment of the community in which the coalition operates. The survey can be administered to coalition members and staff as a telephone or face-to-face interview.

Development and Conditions of Use Developed by Allies Against Asthma, 2003. For use and/or adaptations of this document, please credit Allies Against Asthma.

Contact Information

Allies Against Asthma National Program Office Center for Managing Chronic Disease University of Michigan 109 South Observatory Street Ann Arbor, MI 48109-2029 Phone: 734-615-3312 Fax: 734-763-7379 E-mail: [email protected] www.AlliesAgainstAsthma.net

________________________________________________________________________________________________________________ Allies Against Asthma Context Survey 2 of 5

COALITION SELF-ASSESSMENT SURVEY (CSAS) CONTEXT SURVEY Today’s date: Coalition: Names of interviewees: Interviewer read: The purpose of this survey is to characterize the current environment, context, and structure of your coalition

1. On what date did the 2nd follow-up administration of CSAS begin? 2. On what date did the follow-up period end? 3. How many members qualified for the first follow-up administration (attended two or more meetings in the 12 months prior)? 4. Describe the non-responders. 5. What was the total number of respondents for the 2nd follow-up administration?

6. Briefly describe the major focus of coalition efforts: Probe: Stage of development 7. How are decisions made within the coalition? Probes: Brought to a general meeting? Made within committees, etc? 8. Please describe any changes to the structure of the coalition (e.g. organization of committees) at the time of the second follow-up administration of CSAS.

Probe: Approximate number of individuals who serve on each of the committees.

9. During previous context interviews, we asked about a set of items1 related to specific characteristics of coalition structure. We are interested if there have been any changes related to these characteristics at the


present time. For each item, please indicate whether or not the characteristic was in place (yes), in process, or not in place (no). COALITION STRUCTURE

No

1

In Process

2

Yes

3 a. Bylaws/rules of operation b. Mission statement in writing c. Goals and objectives in writing d. Regularly scheduled meetings (with agendas) Probe: who sets the agenda?

e. Effective communication mechanisms (e.g. newsletters, minutes)

f. Organizational chart g. Written job descriptions h. Core planning group (e.g. steering or executive committee)

i. Subcommittees 1. Butterfoss, F. D., Coalition Effectiveness Inventory (CEI) Self-Assessment Tool . Center for Pediatric Research; Center for Health Promotion, South Carolina DHEC, 1994. Revised 1998. 10. Since the 2nd follow-up administration of CSAS, please describe any changes to the coalition’s leadership: Probes: How many are in leadership positions? How are leaders chosen? (e.g. rotating schedule) Are there opportunities for training new leaders? Are incentives provided for those who take on leadership roles? 11. We would like to get a sense of the people with decision-making power within their organization that are involved in or have influence on the coalition. They may or may not be “members” of the coalition or go to meetings.


Probes: If they do not come to coalition meetings, how do you get access to them? Through another member, or through some other relationship?

“Some come to meeting and have direct decision making power on behalf of their organization --Would people who are sitting at coalition meetings have access to their organization’s resources so that they could come back to the coalition and commit resources on behalf of their organization?”

Does the coalition have relationships outside of the coalition members that they go to, or do most of the resources that come through the coalition come through the membership?

12. Please describe any changes over the past year to your coalition’s staffing:

Probes: How many? Background, skills? How do staff view their role in the coalition? (e.g. sit on committees or staff committees)

13. Were there any changes to the role of the administrative agency in relationship to the coalition at the time of the second follow-up administration of CSAS? Probes: -Does the administrative agency manage the finances on behalf of the coalition? -Are they members of the coalition? -Do they serve as facilitators or conveners of the coalition? -Both? Probes: Do staff identify as: -Staff of the coalition? -Staff of the administrative agency? -Both? 14. Were there any events in the previous that may have had a major impact on coalition dynamics?

Interviewer: Keep focused on big events and only on the year prior to CSAS first follow-up administration. Probe: Any disappointing events?


15. Do you have any comments about the social, cultural, political, and/or economic environment

embedded in the community the coalition operates from around the time of the second follow-up administration of CSAS?

16. Describe your stage of coalition readiness at this time. (Readiness defined as having existing interoganizational networks, sense of trust, ability to come together and make decisions, history of collaboration) Probes: How much of the work did the coalition have to do to try to create some of these relationships? What changes occurred because of the coalition? If the coalition went away, what would be the readiness in the community of some of these organizations to work together based on the work that the coalition has done?

17. How do you think the work of the coalition for childhood asthma is different from stand- alone programs?

18. Describe any lessons learned in terms of the coalition and its work. 19. Do you have any other comments that might help us understand the environment, structure or context of your coalition at the time of the second follow-up administration of CSAS?


ALLIES AGAINST ASTHMA COALITION SELF-ASSESSMENT SURVEY

Description

The Coalition Self-Assessment Survey (CSAS) can be used to capture quantitative information from coalition members on coalition structure and processes including coalition functioning, leadership, and effectiveness of effort. This document contains the English version and a Spanish translation.

Development and Conditions of Use Developed by Erin Kenney, Ph.D. and Shoshanna Sofaer, Dr.PH. School of Public Affairs, Baruch College, City University of New York, 2000. Adapted by Allies Against Asthma, 2002. For use and/or adaptations of this document, please credit Erin Kenney, Ph.D. and Shoshanna Sofaer, Dr.PH., School of Public Affairs, Baruch College, City University of New York, 2000.

Contact Information

Allies Against Asthma National Program Office Center for Managing Chronic Disease University of Michigan 109 South Observatory Street Ann Arbor, MI 48109-2029 Phone: 734-615-3312 Fax: 734-763-7379 E-mail: [email protected] www.AlliesAgainstAsthma.net

Allies Against Asthma Coalition Self-Assessment Survey (CSAS) 2 of 45 English version

COALITION SELF-ASSESSMENT SURVEY

ALLIES AGAINST ASTHMA

Second Follow-up

(Coalition Name)

For office use only Site ID# _______ Administration Method: (check one) ____ on-site during meeting ____ return by mail ____ visit to member ____ interviewer administered Language: (check one) ____ English ____ Spanish


INSTRUCTIONS FOR RESPONDENTS

Please answer questions as they pertain to the past year of your involvement or the time period since joining the coalition within the past year. Sample Question S1. Please circle a number for each answer as in the sample answer: 1. no

2. yes

ROLE IN COALITION Q1. What is your role in the coalition? Circle more than one response, if appropriate.

a. Member of the steering or executive committee b. Coalition chair or officer c. Chair/co-chair of a coalition committee or task force d. Committee member e. Member (no other responsibility) f. Staff g. Other________________________

Q2. Are you part of the coalition as an individual member or as a representative of an

organization? Please circle either 1 or 2, or both, if appropriate.

1. Individual Member, not representing an organization 2. Representative of an organization 3. Both

Q2a. If you are an individual member not representing an organization, please specify your role

(for example, “parent”)

_______________________ Q2b. If an individual member not representing an organization, how long have you been an

individual member of the coalition?

_____ YEARS _____MONTHS _____DON’T KNOW _____NOT APPLICABLE


Q3. If you represent an organization, please indicate the one that best describes the organization you represent in this coalition. Please circle only one.

1. Community Health Center/Community clinic 2. Community/neighborhood group 3. Ethnic and minority group organization 4. Youth organization 5. Parent organization 6. Women’s organization 7. Religious/Faith-based organization 8. Housing organization 9. Environmental advocacy group 10. Environmental agency 11. Voluntary agency that has asthma control as a key part of their mission 12. Other voluntary agency 13. Other community-based organization 14. Other coalition 15. After school program/Parks and recreation 16. Day care/Preschool/Head Start center 17. School (any grades K-12) 18. Academic institution (college/university) 19. HMO and other managed care organization 20. Medicaid and other insurers 21. Pharmaceutical company 22. Hospital 23. Health care provider organization (non-hospital) 24. Physician practice 25. Local health department 26. State health department 27. Business 28. Media 29. Legislative office 30. Other (please specify)__________________________________ 31. None of the above

Q4. If a representative of an organization, how long has your organization been represented in

the coalition? _____ YEARS _____MONTHS _____DON’T KNOW _____NOT APPLICABLE


Q5. Please circle the role that fits you best. Circle only one.

1. Physician, please specify______________________________ 2. Physician assistant 3. Nurse/nurse practitioner 4. Respiratory therapist 5. Social worker/case worker 6. Case manager 7. Community health worker 8. Outreach worker 9. Health educator 10. Other health professional, please specify__________________________ 11. Day care/Head Start provider 12. After school/parks and recreation provider 13. Government official/staff 14. Parent/caregiver 15. Staff from non-profit 16. Administrator 17. Researcher/evaluator 18. Other, please specify_____________________________________

INCLUSION, RECRUITMENT, MEMBERSHIP Q6. In your opinion, does your coalition have sufficient representation from groups,

organizations, and/or schools in your community to accomplish the objectives of the coalition?

1. No 2. Yes

3. Don’t Know


Q6a. If you answered “no” above, in your opinion, which type of the following groups, organizations and/or schools listed are NOT well represented on the coalition? Circle all that apply.

1. Community Health Center/Community clinic 2. Community/neighborhood council or advisory group 3. Ethnic and minority group organization 4. Youth organization 5. Parent organization 6. Women’s organization 7. Religious/Faith-based organization 8. Housing organization 9. Environmental advocacy group 10. Environmental agency 11. Voluntary agency that has asthma control as a key part of their mission 12. Other voluntary agency 13. Other community-based organization 14. Other coalition 15. After school program/Parks and recreation 16. Day care/Preschool/Head Start center 17. School K-12 18. Academic institution (college/university) 19. HMO and other managed care organization 20. Medicaid and other insurers 21. Pharmaceutical company 22. Hospital 23. Health care provider organization (non-hospital) 24. Physician practice 25. Local health department 26. State health department 27. Business 28. Media 29. Legislative office 30. Individuals with asthma 31. Parents/caregivers of children with asthma 32. Other (please specify)__________________________________ 33. None of the above

Q6b. If you have circled one or more groups above as being not well represented, please select

the SINGLE group you think is most important to add to the coalition at this time. Write the number of the group in this box:


Q6c. Why do you think the group identified as most important to add to the coalition is not well represented at this time? (CIRCLE ALL THAT APPLY): 1. The coalition never tried to involve them 2. The coalition invited them but they chose not to participate 3. They used to participate but dropped out 4. The coalition cannot get access to representatives of this group 5. The coalition as a whole is not sure that this group should be asked to join 6. Resources are lacking to recruit new members 7. Some coalition members do not want to share power with this group 8. Don’t know Q7. Is your coalition actively recruiting new members?

1. No 2. Yes 3. Don’t know Q8. In your opinion, do new members receive adequate orientation to be effective members of

the coalition? 1. No 2. Yes 3. Don’t know Q9. Of those that represent organizations, please circle the number which best represents your

opinion about the number of members who participate in your coalition who have enough authority to make commitments of resources or other support for the coalition.

1. Less than one-quarter of the members 2. Less than half of the members 3. More than half of the members 4. Nearly all of the members 5. Doesn’t apply/Don’t know


DECISION-MAKING, CONFLICT RESOLUTION Q10. Please circle the number below that shows how much influence you think the person or

group has in deciding on the actions and policies for your coalition.

No Influence

Some Influence

A Lot of Influence

Not Applicable

a) Coalition Chair

1

2

3

4

b) Coalition Officers or Committee Chairs

1

2

3

4

c) Lead Staff

1

2

3

4

d) Coalition Members

1

2

3

4

Q11. Please circle a number to show how much influence you personally have in making coalition decisions.

No Influence Some Influence A Lot of Influence

1

2

3

Q12. How are decisions usually made regarding coalition priorities, policies and actions?

Circle the number of the main way(s) you think decisions are usually made. (CIRCLE NO MORE THAN TWO): 1. Coalition members vote, with majority rule 2. Coalition members discuss the issue and come to consensus 3. The coalition chair makes final decisions 4. The coalition executive or steering committee makes final decisions 5. The lead agency for the project makes the decisions

6. Don’t know Q13. Please circle a number to show how comfortable you are overall with the coalition

decision-making process.

Not at All Comfortable

Somewhat Comfortable

Very Comfortable

1

2

3


Q14. Please circle a number to show how much you agree or disagree with the following statements.

Strongly

Disagree Disagree Agree Strongly

Agree Don’t Know

a) The coalition has clear and explicit procedures for

making important decisions

1

2

3

4

5

b) The coalition follows standard procedures for

making decisions

1

2

3

4

5

c) The decision-making process used by the coalition is

fair

1

2

3

4

5

d) The decision-making process used by the coalition is

timely

1

2

3

4

5

e) The coalition makes good decisions

1

2

3

4

5

Q14a. Circle the number that represents the amount of conflict in your coalition. 1. More conflict than I expected 2. Less conflict than I expected 3. About as much conflict as I expected


Q14b. Circle the number that best represents your opinion of how much conflict within the coalition was caused by each of the following factors:

None

Some A Lot Don’t

Know

a) Differences in opinion about coalition mission and goals 1 2 3 4

b) Differences in opinion about specific objectives 1 2 3 4

c) Differences in opinion about the best strategies to achieve coalition goals and objectives

1 2 3 4

d) Personality clashes 1 2 3 4

e) Fighting for power, prestige and/or influence 1 2 3 4

f) Fighting for resources 1 2 3 4

g) Differences in opinion about who gets public exposure and recognition

1 2 3 4

h) Procedures used for completing the work 1 2 3 4

i) People aren’t sufficiently included in coalition processes/decision-making

1 2 3 4

j) Member(s) who dominate the coalition meetings and impede proper collaboration

1 2 3 4

Q15. Please circle the main strategy your coalition has used to address conflicts that occur.

(CIRLCE NO MORE THAN TWO): 1. Open debate about opposing viewpoints 2. Postponing or avoiding discussions of controversial issues 3. Having a third party mediate between those with opposing viewpoints 4. Having the opposing parties negotiate directly with each other 5. One party to the conflict gives in

6. Don’t know


LEADERSHIP, STAFFING, RELATIONSHIPS Q16. Who do you think is most significant in providing leadership for your coalition?

(CIRCLE ONLY ONE NUMBER): 1. Coalition Chair

2. Coalition Officers or Committee Chairs 3. Lead Staff 4. Coalition Members 5. Other 6. Don’t Know


Q17. With respect to the leadership you just identified, please circle a number to show how much you agree or disagree with the following statements. The leadership of our coalition:

Strongly Disagree

Disagree Agree Strongly Agree

Don’t Know

a) Has a clear vision for the coalition 1 2 3 4 5

b) Is respected in the community 1 2 3 4 5

c) Gets things done 1 2 3 4 5

d) Is respected in the coalition 1 2 3 4 5

e) Controls decisions 1 2 3 4 5

f) Intentionally seeks other’s views 1 2 3 4 5

g) Utilizes the skills and talents of many, not just a few

1 2 3 4 5

h) Creates an appropriate balance of responsibility between leaders, staff and embers

1 2 3 4 5

i) Advocates strongly for its own opinions and agendas

1 2 3 4 5

j) Builds consensus on key decisions 1 2 3 4 5

k) Works collaboratively with coalition members

1 2 3 4 5

l) Controls discussions 1 2 3 4 5

m) Keeps the coalition focused on tasks and objectives

1 2 3 4 5

n) Is skillful in resolving conflict 1 2 3 4 5

o) Is ethical 1 2 3 4 5


Q18. Who actually sets the agenda for meetings of the coalition and its committee/task forces? (PLEASE CIRCLE ALL THAT APPLY):

1. Coalition Chair 2. Coalition Officers or Committee Chairs 3. Lead Staff

4. Coalition Members 5. Don’t know

Q19. Please circle a number to show how much you agree or disagree with each statement.

Strongly Disagree


Don’t Know

a) The coalition is well managed

1

2

3

4

5

b) The work of the paid staff supports

the work of the coalition

1

2

3

4

5

c) People know the roles of staff as

compared to coalition members

1

2

3

4

5

d) Coalition members take responsibility

for getting the work done

1

2

3

4

5


Q20. Please circle a number to show whether the following functions are major, minor, not a function, or you don’t know.

The functions of our coalition are to: Not a

Function A Minor Function

A Major Function

Don’t Know

a) Network with other professionals

1

2

3

4

b) Network with concerned citizens

1

2

3

4

c) Conduct strategic planning

1

2

3

4

d) Make decisions about priority needs and problems

1

2

3

4

e) Recommend or make decisions to allocate resources

1

2

3

4

f) Operate particular programs or activities

1

2

3

4

g) Advocate for local public policy objectives

1

2

3

4

h) Advocate for state public policy objectives

1

2

3

4

i) Provide funding for current programs

1

2

3

4

j) Raise funds to sustain long-term coalition activities

1

2

3

4


TRUST1 Q21. Please circle a number to show how much you agree or disagree with the following

statements. Strongly


Agree Don’t Know

a) Relationships among coalition members go beyond individuals at the table, to include member organizations

1 2 3 4 5

b) I am comfortable requesting assistance from the other coalition members when I feel their input could be of value

1 2 3 4 5

c) I can talk openly and honestly at the coalition meetings

1 2 3 4 5

d) I am comfortable expressing my point of view even if they might disagree

1 2 3 4 5

e) I am comfortable bringing up new ideas at coalition meetings

1 2 3 4 5

f) Coalition members respect each others’ points of view even if they might disagree

1 2 3 4 5

g) My opinion is listened to and considered by other members

1 2 3 4 5

1. References: Israel B.A., Schurman S.J., House J.S. Action research on occupational stress: involving workers as researchers. International Journal of Health Services 19(1): 135-155, 1989. Israel B.A., Lantz P.M., McGranaghan, R.J., Kerr, D.L., Guzman, J.R. Documentation and evaluation of CBPR partnerships: In-depth interviews and closed-ended questionnaires. In Methods in Community-Based Participatory Research for Health Israel, B.A., Eng E., Schulz, A.J., Parker, E.A., eds. John Wiley & Sons, San Francisco, CA, 225-283, 2005. Israel B.A., Lantz P.M., McGranaghan, R.J., Kerr, D.L., Guzman, J.R. Detroit Community-Academic Urban Research Center. Closed-ended survey questionnaire for board evaluation, 1997-2002. In Methods in Community-Based Participatory Research for Health Israel, B.A., Eng E., Schulz, A.J., Parker, E.A., eds. John Wiley & Sons, San Francisco, CA, 430-433, 2005.


MISSION STRATEGIES AND ACTION PLANS Q22. Please circle a number to show how much you agree or disagree with the following statements. Strongly


Agree Don’t Know

a) Our coalition has a clear and shared understanding of the problems we are trying to address

1 2 3 4 5

b) There is a general agreement with respect to the mission of the coalition

1 2 3 4 5

c) There is general agreement with respect to the priorities of the coalition

1 2 3 4 5

d) Members agree on the strategies the coalition should use in pursuing its priorities

1 2 3 4 5

e) Our action plan defines well the roles, responsibilities and timelines for conducting the activities that work towards achieving the stated mission of the coalition

1 2 3 4 5

Q23. Please circle a number to show how much you agree or disagree with the following statements. Strongly


Agree Don’t Know

a) Notification of meetings is timely 1 2 3 4 5

b) Background materials needed for meetings are prepared & distributed in advance of meetings (agendas, minutes, study documents)

1 2 3 4 5

c) Informative committee and/or task force reports are routinely made to the entire coalition

1 2 3 4 5


PARTICIPATION Q24. Over the past year, how involved have you been in coalition activities? 1. Not at all involved 2. A little involved 3. Fairly involved 4. Very involved Q25. Please circle a number to show how many times over the last year you personally have

done the following for the coalition:

Never Rarely (1-2 times)

Sometimes (3-4 times)

Often (5+ times)

Not Applicable

a) Recruited new members 1 2 3 4 5

b) Served as a spokesperson 1 2 3 4 5

c) Attempted to get outside support for coalition positions on key issues

1 2 3 4 5

d) Worked on implementing activities or events sponsored by the coalition (other than coalition meetings)

1 2 3 4 5

e) Acquired funding or other resources for the coalition

1 2 3 4 5

Q26. Please circle a number to show how much you agree or disagree with the following statements:

Strongly Disagree


Don’t Know

a) I feel that I have a voice in what the coalition

decides

1

2

3

4

5

b) I go to coalition meetings only because it is

part of my job

1

2

3

4

5

c) I am satisfied with how the coalition operates

1

2

3

4

5

d) I feel a strong sense of “loyalty” to the

coalition

1

2

3

4

5


Q27. Please circle a number to show how much you agree or disagree with the following statements. If you consider yourself an individual member (and circled #1 in Q2), please do not answer this question and go to question Q28.

Strongly


Agree Don’t Know

a) Staff from my organization contribute time to the

coalition

1

2

3

4

5

b) Volunteers from my organization contribute time

to the coalition

1

2

3

4

5

c) My organization supports the positions of the

coalition publicly

1

2

3

4

5

d) Overall, my organization is committed to the work

of the coalition

1

2

3

4

5

e) My organization contributes funds to support the

coalition

1

2

3

4

5

Q28. Please circle a number to show to what extent each of the following has been a benefit to your participation or your organization’s participation on the coalition.

No Benefit A Little Benefit

Some Benefit

Great Benefit

Not Applicable

a) Developing collaborative relationships with other agencies

1 2 3 4 5

b) Helping my organization move toward our goals

1 2 3 4 5

c) Getting access to target populations with whom we have previously had little contact

1 2 3 4 5

d) Getting funding for my organization 1 2 3 4 5

e) Getting services for our clients 1 2 3 4 5

f) Getting client referrals from others 1 2 3 4 5

g) Increasing my professional skills and knowledge

1 2 3 4 5

h) Staying well informed in a rapidly changing environment

1 2 3 4 5

i) Getting access to key policy makers 1 2 3 4 5

j) Increasing my sense that others share my goals and concerns

1 2 3 4 5

k) Getting support for policy issues our organization feels strongly about

1 2 3 4 5


Q29. Please circle a number to show to what extent each of the following have been problems for your participation or your organization’s participation in the coalition.

No Problem

Minor Problem

A Major Problem

Not Applicable

a) Coalition activities do not reach my primary

constituency

1

2

3

4

b) My organization doesn’t get enough public

recognition for our work on the coalition

1

2

3

4

c) Being involved in policy advocacy is a problem

1

2

3

4

d) My skills and time are not well-used

1

2

3

4

e) My (or my organization’s) opinion is not valued

1

2

3

4

f) The coalition is not taking any meaningful action

1

2

3

4

g) I am often the only voice representing my

viewpoint

1

2

3

4

h) The financial burden of traveling to coalition meetings is too high

1

2

3

4

i) The financial burden of participating in coalition activities (barring travel) is too high

1

2

3

4

j) The coalition is competing with my organization

1

2

3

4

Q30. From your organization’s perspective (if applicable), do the benefits of participation in

the coalition appear to outweigh the costs at this point? 1. No 2. Yes 3. I do not represent an organization on the coalition Q31. From your own professional and/or personal perspective, do the benefits of participation in

the coalition appear to outweigh the costs at this point? 1. No 2. Yes 3. Don’t know


COMMUNICATION Q32. Please circle a number to show how much you agree or disagree with the following statements. Strongly


Agree Don’t Know

a) The current method for communication between coalition staff/leadership and its members is effective

1 2 3 4 5

b) Members can communicate between themselves as necessary or desired

1 2 3 4 5

c) The coalition staff facilitates communication between coalition members

1 2 3 4 5

d) The coalition staff effectively and efficiently notifies me of meetings, agenda items, etc.

1 2 3 4 5

ASTHMA KNOWLEDGE Q33. Do you feel you have adequate knowledge about childhood asthma to function effectively

in the coalition?

1. No 2. Yes

Q34. Has the coalition helped you learn more about childhood asthma?

1. No 2. Yes

COALITION MATURITY, READINESS, SUSTAINABILITY Q35. Has your coalition been responsible for activities or programs that otherwise would not have occurred? 1. No 2. Yes 3. Don’t know


Q36. Has your coalition brought benefit to your community? 1. No 2. Yes

3. Don’t know

Q37. Please circle a number to show how much you agree or disagree with the following statements.

Strongly


Agree Don’t Know

a) The coalition is making progress in implementing the activities that have potential to improve childhood asthma.

1 2 3 4 5

b) The coalition is improving health outcomes for children with asthma.

1 2 3 4 5

Q38. Please circle a number to show how much you agree or disagree with the following

statements. Strongly


Agree Don’t Know

a) The coalition is making plans to continue operating after current funding is terminated

1 2 3 4 5

b) The coalition has begun to find resources to continue operating after current funding is terminated

1 2 3 4 5

c) Resources are being identified to support the systemic, programmatic changes implemented through the work of the coalition

1 2 3 4 5

d) The coalition will continue to exist beyond the Robert Wood Johnson Foundation grant period

1 2 3 4 5


Q39. Please circle a number to show how much you agree or disagree with the following statements. Strongly


Agree Don’t Know

a) The coalition is essential to the improvement of pediatric asthma

1 2 3 4 5

b) One or a small number of people or agencies could make significant progress in pediatric asthma without the coalition

1 2 3 4 5

c) In general I am satisfied with the coalition 1 2 3 4 5

Q40. What issues should the coalition leadership and staff be paying more attention to? Q41. Are there any critical events over the past year that have had an impact on the coalition? Please describe.


Standard Section on Demographics of Respondents

D1. Your gender: 1. Female 2. Male

D2. Your Race or Ethnicity:

1. African American/Black 2. White 3. Asian American 4. Native Hawaiian or other Pacific Islander 5. Native American 6. Latino or Hispanic

If Latino or Hispanic, do you consider yourself: 6.1. Puerto Rican/ “Newyorrican” 6.2. Mexican/Mexican American/Chicano 6.3. Cuban/Cuban American 6.4. Dominican 6.5. Other Spanish-Caribbean 6.6. Central American 6.7. South American 6.8. Other Latino/Hispanic (please specify): _____________

7. Other Race or Ethnicity (please specify): _____________ D3. Your age at last birthday:

_____ YEARS

D4. Your education: 1. Grade 6 or less 2. Grade 7 or 8 3. Some high school 4. Graduated from high school 5. Graduated from technical or vocational school 6. Some college 7. Graduated from college 8. Some graduate school 9. Completed graduate school

D5. Did you complete this survey when it was administered a year ago?

1. No 2. Yes 3. Don’t Know

Allies Against Asthma Coalition Self-Assessment Survey (CSAS) 24 of 45 Spanish version

ENCUESTA DE AUTO-EVALUACION DE

LA COALICIÓN

Segunda Encuesta de Auto-evaluacion de la coalición

Para uso de la oficina solamente Número de Identificación del Lugar/”Site” _____________ Método de Administración: (marque uno) _____ En una reunión local _____ Devuelto por correo _____ Visita a miembro _____ Administrado por encuestador/a Idioma (marque uno) _____ Inglés _____ Español Fecha Entregado _____________________ Fecha Completado ____________________


INSTRUCCIONES PARA LOS/AS ENCUESTADOS/AS

Por favor conteste las preguntas que corresponden al último año de su participación, o al período dentro de ese año que Ud. se hizo miembro de la coalición. Ejemplo de preguntas S1. Por favor circule el número para cada respuesta basándose en este ejemplo: 1. No 2. Sí ROL EN LA COALICION Q1. ¿Cuál es su rol en la coalición? Circule más de una respuesta si aplica.

a. Miembro de la junta/mesa directiva o comité ejecutivo b. Presidente u oficial de la coalición

c. Presidente/co-presidente o Director/co-director de un comité de la coalición o “task force” d. Miembro de algún comité

e. Miembro (no tiene otra responsabilidad) f. Personal/Empleado/a g. Otro Q2. ¿Es Ud. parte de la coalición como miembro individual o como representante de una

organización? Por favor circule el 1, el 2 ó ambos, si aplica.

1. Miembro individual, no representa una organización 2. Representante de una organización.

3. Ambos Q2a. Si es usted miembro individual, que no representa una organización, por favor especifique

su rol. (por ejemplo, padre/madre/encargado) __________________________________

Q2b. Si es un miembro individual, que no representa una organización, ¿hace cuánto tiempo ha sido miembro individual de la coalición? _____ AÑOS _____ MESES _____ NO SE/NO SABE _____ NO APLICA


Q3. Si representa una organización, por favor indique la que mejor describe la organización que usted representa en la coalición. Por favor circule solo una alternativa.

32. Centro de Salud de la Comunidad/Clínica de la Comunidad 33. Consejo Vecinal/Comunitario o Grupo de Asesores 34. Organización de Grupos Étnicos y Minoritarios 35. Organización de Jóvenes 36. Organización de Padres 37. Organización de Mujeres 38. Organización Religiosa/ o de Fé 39. Organización de Vivienda 40. Group Defensor del Ambiente 41. Agencia Ambiental 42. Agencia de Voluntarios que tenga el control del asma como una parte clave de su misión 43. Otra Agencia de Voluntarios 44. Otra Organización de Base Comunitaria 45. Otra Coalición 46. Programa de Horario Extendido en la escuela o de Parques y Recreación 47. Cuidado Diurno de Niños/Centros Head Start/Pre-escolar 48. Escuelas de Kinder a Duodécimo Grado (12) 49. Institución Académica (colegio/universidad) 50. HMO y otras Organizaciones de Cuidado Dirigido o Coordinado 51. Medicaid y otras aseguradoras 52. Compañía Farmacéutica 53. Hospital 54. Organización que provee Cuidado de Salud (no hospitalaria) 55. Práctica médica 56. Departamento de Salud Local 57. Departamento de Salud Estatal 58. Negocio 59. Medios de Comunicación 60. Oficina Legislativa 61. Otro (por favor especifique)____________________________ 62. Ninguna de las anteriores

Q4. Si Ud. representa una organización, ¿hace cuánto tiempo que su organización está

representada en la coalición? _____ AÑOS _____MESES _____ NO SABE/NO SÉ _____NO APLICA


Q5. Por favor, circule el rol que mejor le describe. Circule solo una alternativa, por favor. a. Médico, por favor especifique ____________________________ b. Asistente médico c. Enfermera/ “Nurse practitioner” d. Terapista respiratorio e. Trabajador social/Trabajador de casos f. Manejador de casos g. Trabajador de salud comunitario/“Community Health Worker” h. Trabajador de alcance comunitario/“Outreach worker” i. Educador en Salud j. Otro profesional de la salud, por favor especifique ___________________ k. Cuidado Diurno de Niños/Proveedor de Head Start l. Proveedor de Horario Extendido en la escuela o de Parques y Recreación m. Oficial/Personal gubernamental n. Padre/Madre/Encargado o. Personal de Organización sin fines de lucro p. Administrador/a q. Investigador(a)/Evaluador(a) r. Otro, por favor especifique ________________________________

INCLUSIÓN, RECLUTAMIENTO, MEMBRESÍA Q6. En su opinión, ¿tiene su coalición suficiente representación de grupos, organizaciones, y/o

escuelas de la comunidad para lograr los objetivos de la coalición? 1. No 2. Sí

3. No sabe/No sé Q6a. Si contesto no en la pregunta anterior en su opinión, ¿cuáles de los siguientes grupos,

organizaciones y/o escuelas listados NO están bien representados en la coalición? (Circule todas las que apliquen)

1. Centro de Salud de la Comunidad/Clínica de la Comunidad 2. Consejo Vecinal/Comunitario o Grupo de Asesores 3. Organización de Grupos Étnicos y Minoritarios 4. Organización de Jóvenes 5. Organización de Padres 6. Organización de Mújeres 7. Organización Religiosa/ o de Fé 8. Organización de vivienda 9. Group Defensor del Ambiente


10. Agencia Ambiental 11. Agencia de Voluntarios que tenga el control del asma como una parte clave de su misión 12. Otra Agencia de Voluntarios 13. Otra Organización de base comunitaria 14. Otra Coalición 15. Programa de Horario Extendido en la escuela o de Parques y Recreación 16. Cuidado Diurno de Niños/Centros Head Start/Pre-escolar 17. Escuela de Kinder a Duodécimo Grado (12) 18. Institución Académica (Colegio/Universidad) 19. HMO y otras Organizaciones de Cuidado Dirigido o Coordinado 20. Medicaid y otras aseguradoras 21. Compañía Farmaceútica 22. Hospital 23. Organización que provee Cuidado de Salud (no hospitalaria) 24. Práctica médica 25. Departamento de Salud Local 26. Departamento de Salud Estatal 27. Negocio 28. Medios de Comunicación 29. Oficina Legislativa 30. Persona con asma 31. Padre/Madre/Encargado de niños/as con asma 32. Otro (Por favor especifique)_____________________________________________ 33. Ninguna de los anteriores

Q6b. Si Ud. ha circulado uno o más de los grupos mencionados arriba como uno que no

está bien representado, por favor seleccione SOLO UN grupo que usted piensa sea el más importante para ser incluido en la coalición en este momento. Escriba el número del grupo en este encasillado:

Q6c. ¿Por qué piensa Ud. que el grupo identificado como el más importante para incluir

en la coalición no está bien representado en este momento? (Circule todos los que apliquen):

1. La coalición nunca trató de involucrarlos 2. La coalición los invitó pero ellos decidieron no participar 3. Participaban pero dejaron de hacerlo 4. La coalición no puede obtener acceso a los representantes de este grupo 5. La coalición en pleno no está segura de pedirle a este grupo que participe 6. Faltan recursos para reclutar nuevos miembros 7. Algunos miembros de la coalición no desean compartir poder con este grupo

8. No sabe/No sé


Q7. ¿Está su coalición reclutando activamente miembros nuevos? 1. No 2. Sí 3. No sabe/No sé Q8. En su opinión, ¿reciben los miembros nuevos una orientación adecuada para ser miembros

efectivos de la coalición? 1. No 2. Sí 3. No sabe/No sé Q9. De aquellos que representan organizaciones, por favor circule el número que representa

mejor su opinión acerca del número de miembros que participan en su coalición y que tienen suficiente autoridad para comprometer recursos u otro apoyo para la coalición:

1. Menos de una cuarta parte de los miembros 2. Menos de la mitad de los miembros 3. Más de la mitad de los miembros 4. Casi todos los miembros 5. No aplica/No sabe/No sé

TOMA DE DECISIONES, RESOLUCIÓN DE CONFLICTOS Q10. Por favor circule abajo el número que indique cuánta influencia usted cree tiene la

persona o grupo en tomar decisiones sobre acciones y políticas para su coalición.

Ninguna

Influencia Alguna

Influencia Mucha

Influencia No Aplica

a) Presidente/Director de la coalición

1

2

3

4

b) Oficiales de la coalición o

presidentes/directores de los comités

1

2

3

4

c) Personal directivo

1

2

3

4

d) Miembros de la coalición

1

2

3

4

Q11. Por favor circule el número que indique cuanta influencia Ud. tiene personalmente en la

toma de decisiones de la coalición: Ninguna Influencia Alguna Influencia Mucha Influencia

1

2

3


Q12. Por lo general, ¿cómo se toman las decisiones relacionadas a las prioridades, políticas y acciones de la coalición? Circule el número que corresponda a la/s manera/s principal/es

en las que Ud. piensa se toman por lo general estas decisiones: (NO CIRCULE MAS DE DOS): 1. Los miembros de la coalición votan con regla de mayoría 2. Los miembros de la coalición discuten el asunto y llegan a un consenso 3. El presidente/director de la coalición toma las decisiones finales

4. La junta directiva o el comité ejecutivo de la coalición toma la decisiones finales 5. La agencia líder del proyecto toma las decisiones 6. No sabe/No sé

Q13. Por favor circule el número que indique cuan cómodo Ud. está generalmente con el proceso de toma de decisiones de la coalición:

Nada cómodo Algo cómodo Muy cómodo

1

2

3 Q14. Por favor circule el número que indique cuanto Ud. está de acuerdo o en desacuerdo con

lo siguiente:

Firmemente en

desacuerdo

En desacuerdo

De acuerdo

Firme-mente de acuerdo

No sabe/ No sé

b) La coalición tiene procedimientos claros y

explícitos para tomar decisiones importantes

1

2 3

4 5

b) La coalición sigue procedimientos estandarizados

para tomar decisiones

1

2

3

4 5

c) El proceso de toma de decisiones utilizado por la

coalición es justo

1

2

3

4 5

d) El proceso de toma de decisiones utilizado por la

coalición se lleva a cabo a tiempo

1

2

3

4 5

e) La coalición toma buenas decisiones

1

2

3

4 5


Q14a. Por favor circule el número que represente la cantidad de conflicto en su coalición: 1. Más conflicto del que esperaba 2. Menos conflicto del que esperaba 3. Más o menos la cantidad de conflicto que esperaba Q14b. Por favor circule el número que mejor represente su opinión de cuanto conflicto dentro

de la coalición fue causado por cada uno de estos factores:

Ninguno Alguno Mucho No sabe/ No sé

j) Diferencias de opinión acerca de la misión y metas de la

coalición

1

2

3

4

k) Diferencias de opinión con relación a objetivos específicos

1

2

3

4

l) Diferencias de opinión sobre las mejores estrategias para

alcanzar las metas y los objetivos de la coalición

1

2

3

4

m) Choque de personalidades

1

2

3

4

n) Enfrentamientos de poder, prestigio y/o influencia

1

2

3

4

o) Enfrentamientos por recursos

1

2

3

4

p) Diferencias de opinión acerca de quién obtiene exposición

pública y reconocimiento

1

2

3

4

q) Procedimientos utilizados para completar el trabajo

1

2

3

4

r) Las personas no están suficientemente incluidas en los

procesos/toma de decisiones de la coalición

1

2

3

4

j) Miembro(s) que dominan las reuniones de la coalición e impiden colaboración propia

1

2

3

4

Q15. Por favor circule la estrategia principal que su coalición ha utilizado para manejar

conflictos que suceden. (NO CIRCULE MÁS DE DOS):

1. Debate abierto sobre puntos de vista opuestos 2. Posponiendo o evitando discusiones sobre asuntos controversiales

3. Teniendo una tercera persona para actuar como mediador entre aquellos con puntos de vista opuestos

4. Haciendo que las partes en conflicto lleguen a negociar directamente una con la otra 5. Una de las partes en conflicto cede 6. No sabe/No sé


LIDERATO, PERSONAL, RELACIONES Q16. ¿Quién cree Ud. es la persona más significativa en ejercer liderato para su coalición?

(CIRCULE SOLO UN NÚMERO):

1. Presidente/Director de la coalición 2. Oficiales de la coalición o los presidentes/directores de los comités 3. Personal directivo 4. Miembros de la coalición 5. Otro(s) 6. No sabe/No sé


Q17. En relación al liderato que Ud. acaba de identificar, por favor circule el número que indique cuanto está de acuerdo o en desacuerdo con lo siguiente:

El liderato de nuestra coalición:

Firmemente en

Desacuerdo

En desacuerdo

De acuerdo Firmemente de acuerdo

No sabe/ No sé

p) Tiene una visión clara para la coalición

1

2

3 4

5

q) Es respetado/a dentro de la comunidad

1

2 3 4 5

r) Logra que se hagan las cosas

1

2 3 4 5

s) Es respetado/a en la coalición

1

2 3 4 5

t) Controla las decisiones

1

2 3 4 5

u) Busca la opinión de otros intencionalmente

1

2 3 4 5

v) Utiliza las habilidades y talentos de muchos, no solo de algunos

1

2 3 4 5

w) Crea un balance apropiado de responsabilidades entre los líderes, el personal y los miembros

1

2 3 4 5

x) Aboga fuertemente por sus propias opiniones y agendas

1

2 3 4 5

y) Crea consenso sobre decisiones claves

1

2 3 4 5

z) Trabaja en colaboración con los miembros de la coalición

1

2 3 4 5

aa) Controla las discusiones

1

2 3 4 5

bb) Mantiene la coalición enfocada en las tareas y objetivos

1

2 3 4 5

cc) Es hábil en resolver conflictos

1

2 3 4 5

dd) Es ético/a

1

2 3 4 5


Q18. ¿Quién realmente determina la agenda para las reuniones de la coalición y de sus comités/ “task forces”? (FAVOR CIRCULE TODOS LOS QUE APLIQUEN):

1. Presidente/Director de la coalición 2. Oficiales de la coalición o los presidentes/directores de los comités 3. Personal directivo

4. Miembros de la coalición 5. No sabe/No sé

Q19. Por favor circule el número que indique cuanto está de acuerdo o en desacuerdo con lo

siguiente:

Firmemente en

desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

e) La coalición está bien administrada

1

2

3

4

5

f) El trabajo del personal asalariado

apoya el trabajo de la coalición

1

2

3

4

5

g) Las personas conocen el rol del

personal en comparación con los miembros de la coalición

1

2

3

4

5

h) Los miembros de la coalición asumen

la responsabilidad de cumplir con el trabajo

1

2

3

4

5


Q20. Por favor circule el número que indique si las siguientes funciones son de mayor o menor

importancia, si no son una función o si no sabe:

Las funciones de nuestra coalición son: No es una

función Menor impor-tancia

Mayor impor-tancia

No sabe/ No sé

a) Intercambio con otros profesionales

1 2 3 4

b) Intercambio con ciudadanos interesados

1 2 3 4

c) Dirigir la planificación estratégica

1 2 3 4

d) Tomar decisiones acerca de las necesidades y los problemas que tienen prioridad

1 2 3 4

e) Recomendar o tomar decisiones sobre la distribución de recursos

1 2 3 4

f) Operar/dirigir programas o actividades específicas 1 2 3 4

g) Abogar por objetivos de política pública local 1 2 3 4

h) Abogar por objetivos de política pública del estado 1 2 3

4

i) Proveer fondos para mantener programas vigentes 1 2 3 4

j) Recaudar fondos para mantener las actividades de la coalición a largo plazo

1 2 3 4


CONFIANZA1 Q21. Por favor circule el número que indique cuanto Ud está de acuerdo o en desacuerdo con lo siguiente: Firmemente

en desacuerdo En

desacuerdo De

acuerdo Firmemente de acuerdo

No sabe/ No sé

a) Las relaciones entre miembros de la coalición van más allá de los individuos en la mesa de negociaciones para incluir a organizaciones miembros

1 2 3 4

5

b) Me siento cómodo/a pidiendo ayuda a otros miembros de la coalición cuando pienso que su insumo puede ser valioso

1 2 3 4

5

c) Puedo hablar abierta y honestamente en las reuniones de la coalición 1 2 3 4

5 d) Me siento cómodo/a cuando expreso mi

punto de vista aún cuando otros no estén de acuerdo

1 2 3 4

5

e) Me siento cómodo/a planteando nuevas ideas en las reuniones de la coalición 1 2 3 4

5 f) Los miembros de la coalición respetan los

puntos de vista de otros aún cuando no estén de acuerdo

1 2 3 4

5

g) Los otros miembros escuchan mi opinión y la consideran 1 2 3 4

5

1. References: Israel B.A., Schurman S.J., House J.S. Action research on occupational stress: involving workers as researchers. International Journal of Health Services 19(1): 135-155, 1989. Israel B.A., Lantz P.M., McGranaghan, R.J., Kerr, D.L., Guzman, J.R. Documentation and evaluation of CBPR partnerships: In-depth interviews and closed-ended questionnaires. In Methods in Community-Based Participatory Research for Health Israel, B.A., Eng E., Schulz, A.J., Parker, E.A., eds. John Wiley & Sons, San Francisco, CA, 225-283, 2005. Israel B.A., Lantz P.M., McGranaghan, R.J., Kerr, D.L., Guzman, J.R. Detroit Community-Academic Urban Research Center. Closed-ended survey questionnaire for board evaluation, 1997-2002. In Methods in Community-Based Participatory Research for Health Israel, B.A., Eng E., Schulz, A.J., Parker, E.A., eds. John Wiley & Sons, San Francisco, CA, 430-433, 2005.


ESTRATEGIAS RELACIONADAS A LA MISIÓN Y PLANES DE ACCIÓN Q22. Por favor circule el número que indique cuanto está de acuerdo o en desacuerdo con lo siguiente:

Firmemente en

desacuerdo

En desacuerdo

De acuerdo

Firmemente de acuerdo

No sabe/ No sé

e) Nuestra coalición comprende y comparte

claramente los problemas que estamos tratando de trabajar

1

2

3

4

5

f) Existe un acuerdo general con relación a

la misión de la coalición

1

2

3

4

5

g) Existe un acuerdo general con relación a

las prioridades de la coalición

1

2

3

4

5

h) Los miembros de la coalición están de

acuerdo con las estrategias a utilizarse para alcanzar sus prioridades

1

2

3

4

5

e) Nuestro plan de acción define bien los roles, las responsabilidades y el calendario de trabajo para llevar a cabo las actividades dirigidas a alcanzar la misión establecida por la coalición

1 2 3 4 5

Q23. Por favor circule el número que indique cuanto está de acuerdo o en desacuerdo con lo

siguiente: Firmemente

en desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

d) Las reuniones se notifican a tiempo

1

2

3

4

5

e) El material para las reuniones se prepara y

distribuye a tiempo y con anticipación (agendas, minutas, documentos de estudio)

1

2

3

4

5

f) Los informes que los comités y/o los “task

forces” preparan se distribuyen regularmente a toda la coalición

1

2

3

4

5


PARTICIPACIÓN Q24. Durante el último año, ¿cuán involucrado ha estado Ud. en las actividades de la coalición? 1. Para nada estuve involucrado 2. Un poco involucrado 3. Bastante involucrado 4. Muy involucrado Q25. Por favor circule el número que indique cuantas veces durante el último año Ud. ha hecho

personalmente una de las siguientes para la coalición:

Nunca Raramente (1-2 veces)

Algunas veces

(3-4 veces )

Frecuentemente (más de 5 veces)

No Aplica

f) Reclutar nuevos miembros

1

2

3

4

5

g) Servir como portavoz

1

2

3

4

5

h) Tratar de conseguir apoyo externo para

posiciones de la coalición sobre asuntos claves

1

2

3

4

5

i) Trabajar en la implementación de actividades

o eventos patrocinados por la coalición (fuera de reuniones de la coalición)

1

2

3

4

5

j) Adquirir fondos u otros recursos para la

coalición

1

2

3

4

5

Q26. Por favor circule el número que indique cuanto Ud está de acuerdo o en desacuerdo con lo siguiente:

Firmemente

en desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

e) Siento que tengo voz en lo que la coalición

decide

1

2

3

4

5

f) Participo en las reuniones de la coalición solo

porque es parte de mi trabajo

1

2

3

4

5

g) Estoy satisfecho/a de cómo funciona la

coalición

1

2

3

4

5

h) Tengo un gran sentido de “lealtad” hacia la

coalición

1

2

3

4

5


Q27. Por favor circule el número que indique cuanto Ud está de acuerdo o en desacuerdo con lo siguiente. Si Ud. se considera un miembro individual (si circuló el #1 en la Q2), por favor no conteste esta pregunta y pase a la pregunta Q28.

Firmemente en

desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

f) El personal de mi organización contribuye con

su tiempo a la coalición

1

2

3

4

5

g) Voluntarios de mi organización contribuyen con

su tiempo a la coalición

1

2

3

4

5

h) Mi organización apoya las posiciones de la

coalición públicamente

1

2

3

4

5

i) En general mi organización está comprometida

con la labor de la coalición

1

2

3

4

5

j) Mi organización contribuye con fondos para

apoyar la coalición

1

2

3

4

5


Q28. Por favor circule el número que indique hasta que punto cada uno de los siguientes ha sido

un beneficio por su participación o la de su organización en la coalición:

Ningún Beneficio

De Poco Beneficio

Algún Beneficio

De gran Beneficio

No Aplica

l) Desarrollando relaciones colaborativas con otras

agencias

1

2

3

4

5

m) Ayudando a mi organización a acercarse a sus

metas

1

2

3

4

5

n) Consiguiendo acceso a poblaciones seleccionadas

con las que antes teníamos poco contacto

1

2

3

4

5

o) Consiguiendo fondos para mi organización

1

2

3

4

5

p) Consiguiendo servicios para nuestros clientes

1

2

3

4

5

q) Consiguiendo referidos para nuestra clientela a

través de otras fuentes

1

2

3

4

5

r) Aumentando mis habilidades profesionales y

conocimiento

1

2

3

4

5

s) Manteniéndome bien informado en un ambiente de

cambios constantes

1

2

3

4

5

t) Consiguiendo acceso a personas que toman

decisiones políticas claves

1

2

3

4

5

u) Aumentando el sentido de que otros comparten mis

metas y preocupaciones

1

2

3

4

5

v) Consiguiendo apoyo para asuntos sobre las políticas que nuestra organización apoya firmemente

1

2

3

4

5


Q29. Por favor circule el número que indique hasta que punto cada uno de los siguientes han

sido problema en su participación o en la participación de su organización en la coalición.

No es un problema

Un problema

menor

Un problema

mayor

No Aplica

k) Las actividades de la coalición no alcanzan los grupos que

constituyen nuestro público primario

1

2

3

4

l) El trabajo de mi organización no obtiene suficiente

reconocimiento público en la coalición

1

2

3

4

m) Estar involucrado en abogar por políticas de apoyo es

problemático

1

2

3

4

n) Mis habilidades y tiempo no son bien utilizados

1

2

3

4

o) Mi opinión (o la de mi organización) no es valorada

1

2

3

4

p) La coalición no está tomando ninguna acción significativa

1

2

3

4

q) Con frecuencia soy la única voz que representa mi punto de vista

1

2

3

4

r) La carga financiera de viajar a las reuniones de la coalición es muy alta

1

2

3

4

s) La carga financiera de participar en actividades de la coalición (excepto gastos de viaje) es muy alta

1

2

3

4

t) La coalición compite con mi organización

1

2

3

4

Q30. Desde el punto de vista de su organización (si aplica), ¿los beneficios de participar en la

coalición en este momento sobrepasan los costos (por ejemplo, esfuerzo y tiempo invertido)?

1. No 2. Sí

3. No represento ninguna organización en la coalición

Q31. Desde el punto de vista personal y/o profesional, ¿los beneficios de participar en la coalición en este momento sobrepasan los costos (por ejemplo, esfuerzo y tiempo invertido)?

1. No 2. Sí 3. No sabe/No sé


COMUNICACIÓN Q32. Por favor circule el número que indique cuanto Ud. está de acuerdo o en desacuerdo con lo siguiente. Firmemente en

desacuerdo En

desacuerdo De

acuerdo

Firme- mente de acuerdo

No sabe/ No sé

a) El método actual de comunicación entre los miembros y líderes/personal de la coalición es efectivo

1 ó 3 4 5

b) Los miembros de la coalición pueden comunicarse entre ellos/as cuando lo necesiten o deseen

1 2 3 4 5

c) El personal de la coalición facilita la comunicación entre los miembros de la coalición

1 2 3 4 5

d) El personal de la coalición me notifica efectiva y eficientemente sobre reuniones, asuntos, agendas, etc.

1 2 3 4 5

CONOCIMIENTO SOBRE EL ASMA Q33. ¿Cree Ud. que tiene un conocimiento adecuado sobre el asma pediátrica para funcionar

efectivamente en la coalición?

1. No 2. Sí

Q34. ¿Le ha ayudado la coalición a aprender más sobre el asma pediátrica?

1. No 2. Sí

MADUREZ DE LA COALICIÓN, PREPARACIÓN, SOSTENIMIENTO Q35. ¿Ha sido su coalición responsable de actividades o programas que de otra forma no

hubieran ocurrido? 1. No 2. Sí 3. No sabe/No sé


Q36. ¿Ha traído su coalición beneficio a su comunidad? 1. No 2. Sí 3. No sabe/No sé Q37. Por favor circule el número que indique cuanto Ud. está de acuerdo o en desacuerdo con

lo siguiente:

Firmemente en

desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

c) La coalición está progresando en la

implementación de actividades que tienen el potencial de mejorar el asma pediátrica

1

2

3

4

5

d) La coalición está mejorando el estado de salud

de los niños/as con asma

1

2

3

4

5

Q38. Por favor circule el número que indique cuanto Ud. está de acuerdo o en desacuerdo con

lo siguiente:

Firmemente en

desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

a) La coalición está haciendo planes para continuar operando, aún después que sus fondos actuales se hayan terminado

1

2

3

4

5

b) La coalición empezó a conseguir fondos para continuar operando después que los fondos actuales se agoten

1

2

3

4

5

c) Se están identificando los recursos para apoyar los cambios programáticos y de sistema implementados durante el curso de trabajo de la coalición

1

2

3

4

5

d) La coalición continuará existiendo aún cuando los fondos de donación de la Fundación Robert Wood Johnson se terminen

1

2

3

4

5


Q39. Por favor circule el número que indique cuanto Ud. está de acuerdo o en desacuerdo con lo siguiente:

Firmemente

en desacuerdo

En desacuerdo

De acuerdo


No sabe/ No sé

a) La coalición es esencial para la mejoría del

asma pediátrica

1

2

3

4

5

b) Un individuo o un grupo pequeño de

individuos o agencias podrían hacer progreso significativo en la lucha contra el asma pediátrica sin la coalición

1

2

3

4

5

c) En general estoy satisfecho con la coalición 1 2 3 4 5

Q40. ¿A qué asuntos le deberían prestar mayor atención los directores/líderes de la coalición y

su personal? Q41. ¿Ha habido algún evento crítico en el año pasado que haya tenido algún impacto en la coalición? Por favor descríbalo.


Sección de Datos Demográficos de los Encuestados/as

D1. Sexo:

1. Mujer 2. Hombre

D2. Su etnicidad o raza (Circule todos los que apliquen):

1. Africano Americano/Negro 2. Blanco 3. Asiático Americano 4. Nativo de Hawaii u otras Islas del Pacífico 5. Indio Americano 6. Latino o Hispano

Si su respuesta es Latino o Hispano, usted se considera: 6a. Puertorriqueño/“Newyorrican” 6b. Mejicano/Mejicanoamericano/Chicano/a 6c. Cubano/Cubanoamericano/a 6d. Dominicano/a 6e. Otro/a caribeño/a hispano/a 6f. Sur americano/a 6g. Otro latino/Hispano/a

7. Otra raza o etnicidad (por favor especifique):_______________________ D3. Edad en su último cumpleaños: ______ Años D4. Su educación:

1. 6to grado o menos 2. 7mo u 8vo grado 3. Algo de escuela superior/“high school” 4. Graduado/a de escuela superior 5. Graduado/a de escuela técnica o vocacional 6. Algo de universidad 7. Graduado/a de universidad 8. Algo de escuela graduada 9. Completó escuela graduada

D5. ¿Completó usted este cuestionario cuando fue administrado el año pasado? 1. No 2. Sí 3. No sabe

This is a product of Allies Against Asthma, a national project supported by The Robert Wood Johnson Foundation. Direction and technical assistance is provided by the National Program Office at the University of Michigan Center for Managing Chronic Disease.

ALLIES AGAINST ASTHMA KEY INFORMANT INTERVIEW GUIDES

Description

The Key Informant Interview Guides can be used to collect a broad range of perspectives on the activities of a coalition. The semi-structured interviews were designed to collect information from the point of view of participants in their own words about the coalition planning process, level of their involvement in the coalition, goals and interventions, and perceptions of coalition impact. The follow-up interviews also address change in coalition structure and membership, implementation of interventions, and progress toward goals, including the individual’s satisfaction with the interventions implemented and perceptions of collaborations and linkages among community-based organizations. Both the baseline and follow-up interviews address participants’ expectations about future outcomes and their perspectives on the value of the coalition. Five Interview Guides are included in this document:

1. Baseline for coalition leaders or staff pgs. 2-5

2. Baseline for coalition members pgs. 6-9

3. Baseline for other community leaders pgs. 10-11

4. Follow-up for coalition leaders, staff or members pgs. 12-15

5. Follow-up for other community leaders pgs. 16-17

Development and Conditions of Use Developed by Allies Against Asthma and the Battelle Centers for Public Health Research and Evaluation, 2003.

For use and/or adaptations of this document, please credit Allies Against Asthma and the Battelle Centers for Public Health Research and Evaluation.

Contact Information Allies Against Asthma National Program Office Center for Managing Chronic Disease University of Michigan 109 South Observatory Street Ann Arbor, MI 48109-2029

Phone: 734-615-3312 Fax: 734-763-7379 E-mail: [email protected] www.AlliesAgainstAsthma.net

Allies Against Asthma Key Informant Interview Guides Baseline for Coalition Leaders or Staff 2 of 17

Allies Against Asthma Key Informant Interview Guide Baseline for Coalition Leaders or Staff

A. BACKGROUND First I’d like to learn about your role in local AAA name and how you became involved. 1. When did you first get involved with local AAA name? ________ mo/yr How did you find out about the coalition? (probe for past involvement with asthma issues) 2. How would you describe your involvement in the coalition? Probe for specific

committees and intervention activities.

Probes: Why did you choose to get involved with the coalition? How has your role changed over the life of the coalition? What changes do you anticipate in the future? What motivates you personally to participate?

If person is a coalition staff member, What was your previous job? If person represents an organization, What is your position? How did the

organization become involved? What was the organization’s involvement in asthma prior to joining the coalition?

3. What previous activities in this community, if any, did local AAA name build on?

(probe for earlier coalitions and activities either directly or indirectly related to asthma)

B. PLANNING PROCESS Next, I’d like to discuss the process that local AAA name used to develop its goals and interventions. 1. What strategies did the coalition use to bring relevant players to the table?

Probes: Has this changed over time? Are all important sectors represented? If no, What barriers exist to participation by those sectors? If yes, What factors facilitate their participation? Are there specific groups or organizations that are participating in the

coalition that were not part of previous asthma control efforts in this community?

If yes, What do you think has facilitated their involvement? What impact has their participation had on the decisions the coalition

has made? On the activities of your subcommittee?


2. How responsive do you feel that the coalition has been to your needs? To the needs of the other participants?

3. What have been the major challenges faced by the coalition so far? How did you

overcome them? 4. What have been the major strengths of the coalition to date? How does the coalition

build on these?

C. GOALS AND INTERVENTIONS Now I’d like to talk about the goals that local AAA name set through the planning process and the interventions that you are beginning to implement. 1. How realistic do you think the goals are? Are they attainable? Are they ambitious enough? 2. How satisfied are you overall with the interventions the coalition has planned? Do they target what is important? Do they reflect the needs of the community?

(probe for creativity and out-of-the-box thinking) 3. Thinking about the specific interventions, which ones could have been conceived

and implemented by one of the member organizations acting alone?

Probes: Which interventions could only have been generated through collective thinking and action? (ask for specific examples using matrix if needed)

To what extent do they require multiple organizations and/or groups to work together to be successful?

Did these groups work together before this coalition was formed? In what ways has the coalition supported and encouraged these partners to

work together? (probe for issues of trust, conflict, leadership) D. IMPACTS Next, I’d like to talk about what impacts the coalition is having on you personally, the organizations you are associated with, and the community at large. 1. How has being involved with this coalition been of benefit to you? Has

participation changed the way you personally think about or approach asthma? Have these changes in your thinking translated into specific actions already? (If yes, probe for examples). How might they in the future?


2. (Note: ask only if individual is a representative of an organization) How has being involved with this coalition been of benefit to your organization? Has participation changed the way your organization approaches asthma?

Probes: Has the presence of the coalition in the community had any effect on a) the level of exchange of resources and information among

organizations? (probe for formal agreements/structures) b) the ability of member organizations to secure additional resources

for asthma control? (probe for new funding, in-kind services) c) the ability of member organizations to pursue related goals, such as

other pediatric health issues, or asthma control among other populations? (probe for examples of applying new knowledge, skills, connections)

3. To what degree does the coalition collaborate with other organizations or

individuals outside the coalition that are involved in asthma control? How, or why not? (probe for new organizations and new sectors being involved) 4. How visible is the coalition in this community? (probe for media coverage,

visibility within top levels of key organizations, public awareness) 5. Has the coalition had an effect on support for pediatric asthma prevention and

control programs in this community? (probe for legislative/governmental involvement, increase in community involvement, nonmembers expressing interest in the coalition activities/results, dissemination of results within community, new policies, changes in clinical care systems, new systems introduced into the community)

6. Are there any other benefits or impacts of the coalition that you have observed at this

point in time? (probe for application of knowledge/skills beyond those directly funded)

7. Thinking about all of the impacts we just discussed, which of these do you think

might have happened even without the coalition?


E. FUTURE IMPACTS Next, I’d like to talk a little bit about what lies ahead for the coalition. 1. What are the main interventions that will be going on in the next two years?

Probes: What organizations are involved? What will your role be? What results do you expect from those interventions?

2. What, if any, major challenges do you anticipate in the future as the coalition

implements this plan? 3. What would you like to see occur for you to feel that local AAA name has been a

success? F. NPO Last, I’d like to ask you a couple of questions about the National Program Office of Allies Against Asthma. 1. Are you familiar with the NPO? (If not, explain that the Univ. of Michigan

serves as a coordinating center for the 7 community coalitions funded under AAA) If yes, What interaction have you had with the NPO? How do you view the role and function of the NPO?

Allies Against Asthma Key Informant Interview Guides Baseline for Coalition Members 6 of 17

Allies Against Asthma Key Informant Interview Guide Baseline for Coalition Members

A. BACKGROUND First I’d like to learn about your role in local AAA name and how you became involved. 1. When did you first get involved with local AAA name? ________ mo/yr How did you find out about the coalition? (probe for past involvement with asthma issues) 2. How would you describe your involvement in the coalition?

(probe for specific committees and intervention activities)

Probe: Why did you choose to get involved with the coalition? How has your role changed over the life of the coalition? What changes do you anticipate in the future? What motivates you personally to participate?

If person represents an organization, What is your position? How did the organization become involved? What was the organization’s involvement in asthma prior to joining the coalition?

3. What previous activities in this community, if any, did local AAA name build on?

(probe for earlier coalitions and activities either directly or indirectly related to asthma)

B. PLANNING PROCESS Next, I’d like to discuss the process that local AAA name used to develop its goals and interventions. 1. What strategies did the coalition use to bring relevant players to the table?

Probes: Has this changed over time? Are all important sectors represented? If no, What barriers exist to participation by those sectors? If yes, What factors facilitate their participation? Are there specific groups or organizations that are participating in the

coalition that were not part of previous asthma control efforts in this community?

If yes, What do you think has facilitated their involvement? What impact has their participation had on the decisions the coalition

has made?

2. During the planning phase, how responsive do you feel that the coalition has been to your needs? To the needs of the other participants?


3. What have been the major challenges faced by the coalition so far? How did the

coalition overcome them? 4. What have been the major strengths of the coalition to date? How does the coalition

build on these? C. GOALS AND INTERVENTIONS Now I’d like to talk about the goals that local AAA name set through the planning process and the interventions that you are beginning to implement. 1. How realistic do you think the goals are? Are they attainable? Are they ambitious enough? 2. How satisfied are you overall with the interventions the coalition has planned? Do they target what is important? Do they reflect the needs of the community?

(probe for creativity and out-of-the-box thinking) 3. Thinking about the specific interventions, which ones could have been conceived

and implemented by one of the member organizations acting alone?

Probes: Which could only have been generated through collective thinking and action? (ask for specific examples using matrix if needed)

To what extent do they require multiple organizations and/or groups to work together to be successful?

Did these groups work together before this coalition was formed? In what ways has the coalition supported and encouraged these partners to

work together? (probe for issues of trust, conflict, leadership) D. IMPACTS Next, I’d like to talk about what impacts the coalition is having on you personally, the organizations you are associated with, and the community at large. 1. How has being involved with this coalition been of benefit to you? Has

participation changed the way you personally think about or approach asthma? Have these changes in your thinking translated into specific actions already? (If yes, probe for examples). How might they in the future?


2. (Note: ask only if individual is a representative of an organization) How has being involved with this coalition been of benefit to your organization? Has participation changed the way your organization approaches asthma?



for asthma control? (probe for new funding, lobbying, in-kind services) c) the ability of member organizations to pursue related goals, such as



individuals outside the coalition that are involved in asthma control? How, or why not? (probe for new organizations and new sectors being involved) 4. How visible is the coalition in this community? (probe for media coverage,

visibility within top levels of key organizations, public awareness) 5. Has the coalition had an effect on support for pediatric asthma prevention and

control programs in this community? (probe for legislative/governmental involvement, increase in community involvement, nonmembers expressing interest in the coalition activities/results, dissemination of results within community, new policies, changes in clinical care systems, new systems introduced into the community)




might have happened even without the coalition?


E. FUTURE IMPACTS Next, I’d like to talk a little bit about what lies ahead for the coalition. 1. What are the main interventions that will be going on in the next two years?

Probes: What organizations are involved? What will your role be? What results do you expect from those interventions?

2. What, if any, major challenges do you anticipate in the future as the coalition

implements this plan? 3. What would you like to see occur for you to feel that local AAA name has been a

success? F. NPO Last, I’d like to ask you a couple of questions about the National Program Office of Allies Against Asthma. 1. Are you familiar with the NPO? (If not, explain that the Univ. of Michigan

serves as a coordinating center for the 7 community coalitions funded under AAA) If yes, What interaction have you had with the NPO? How do you view the role and function of the NPO?

Allies Against Asthma Key Informant Interview Guides Baseline for Other Community Leaders 10 of 17

Allies Against Asthma Key Informant Interview Guide Baseline for Other Community Leaders

(For people who are in leadership positions in the community in organizations whose mission overlaps with that of the coalition, and that may send representatives to the coalition but are not themselves involved in any intimate fashion) A. BACKGROUND I’d like to begin by having you tell me a little bit about yourself and what you do that brings you in contact with asthma control issues in your community. 1. What are your major job-related activities and responsibilities? (probe for how

these relate to asthma control issues) 2. How did you first learn about local AAA name? When was this? 3. What specific activities, if any, bring you in contact with local AAA name?

4. Do you or your organization currently provide any support to the coalition? Why or

why not? C. GOALS AND INTERVENTIONS I’d like to hear your perspective on local AAA name. 1. How do you see the role of local AAA name in the community? 2. Do you think local AAA name meets an important need? Please explain (probe

for their perspective on what the needs are and which of these the coalition could or could not appropriately address)

D. IMPACTS Next, I’d like to talk about what impacts the coalition is having on you personally, the organizations you are associated with, and the community at large. 1. What benefits, if any, have you or your organization experienced from the presence

of local AAA name in the community? 2. How visible is local AAA name in this community? (probe for media coverage,

visibility within top levels of key organizations, public awareness)

Allies Against Asthma Key Informant Interview Guides Baseline for Other Community Leaders 11 of 17

3. How, if at all, has local AAA name affected support for pediatric asthma

prevention and control programs in this community? 4. What, if any, other benefits or impacts of local AAA name have you observed at this

point in time? E. FUTURE IMPACTS Last, I’d like to talk a little bit about what lies ahead. 1. What interaction do you or your organization expect to have with local AAA

name over the next two years? (probe for support they might provide) 2. What would you like to see occur for you to feel that local AAA name has been a

success in this community?

Allies Against Asthma Key Informant Interview Guides Follow-up for Coalition Leaders, Staff or Members 12 of 17

Allies Against Asthma Key Informant Interview Guide Follow-up for Coalition Leaders, Staff or Members

A. BACKGROUND First I’d like to learn about how your role in local AAA name may have changed since we last spoke. 1. What have been your primary responsibilities or activities in the past year? How

does this differ from your earlier role? B. STRUCTURE AND MEMBERSHIP Next, I’d like to discuss how the membership of local AAA name may have changed in the past year and any significant changes you perceive in how the coalition operates. 1. How, if at all, has the membership in the coalition changed in the past year?

Probes: Who (sectors) is active that wasn’t before? Are they new to asthma control?

Have any members dropped out? Why do you think they have left? Are all important sectors currently represented?

2. What changes have there been in work group structure, decision-making procedures,

meeting schedules, or other operations of the coalition?

Probes: Why have these changes occurred? What effect do you think these changes have had on the activities or effectiveness of the coalition?

[If staff or PI, probe for changes in staffing or lead agency] 3. What have been the major challenges faced by the coalition in the past year? How

does the coalition overcome them? 4. What have been the major strengths of the coalition in the past year? How does the

coalition build on these?


C. GOALS AND INTERVENTIONS Before we move on to talking about the impacts of the coalition, I’d like to ask about the status of goals or interventions that you had established when we last spoke over a year ago. 1. Which interventions are currently active? How are they organized? Who (ie, which workgroup/committee/organization(s))

is active in implementing each one? What results have you seen so far? 2. Are there any interventions that have become inactive in the past year? Please

describe them and explain what motivated these developments. 3. Has the coalition established any new goals or developed new interventions in the

past year? Please describe them and explain what you think motivated these developments. What funding/resources/infrastructure do you have to begin and maintain these interventions?

4. At this point in time, how satisfied are you overall with the interventions the

coalition is implementing? Do they target what is important? Do they reflect the needs of the community? (probe for creativity and out-of-the-box thinking)

D. IMPACTS Next, I’d like to talk about what impacts the coalition is having on you personally, the organizations you are associated with, and the community at large. We asked you about impacts last time we spoke. This time, I would like you to focus your answers on what has occurred since we last spoke. 1. Since we last spoke, have you experienced any additional personal benefits of

participation in the coalition? How has being involved with this coalition been of benefit to you? Has participation changed the way you personally think about or approach asthma or your work in general? Have these changes in your thinking translated into specific actions already? (If yes, probe for examples). How might they in the future?

2. (Note: ask only if individual is a representative of an organization. How has

being involved with this coalition been of benefit to your organization? Since we last spoke, have you seen changes in the way your organization approaches asthma that may be due to being involved in the coalition?

2a. How has this coalition changed the activities and/or approaches of other

organizations or the way they interact with each other?




for asthma control? (probe for new funding, in-kind services) c) the ability of the coalition to secure additional resources? d) the ability of member organizations to pursue related goals, such as



individuals outside the coalition that are involved in asthma control? How, or why not? (probe for new organizations and new sectors being involved, increase in

community involvement, nonmembers expressing interest) 4. How visible is the coalition in this community currently? (probe for media

coverage, visibility within top levels of key organizations, public awareness, dissemination of results)

8. Has the coalition had an effect on pediatric asthma prevention and control in this

community? We define community broadly to include homes, clinics, schools, public policies, and interactions among these and other sectors (probe for environmental changes in homes, changes in community settings that improve patient self-management and family capacity building, provider training, changes in supportive policies, legislative/governmental involvement, changes in clinical care systems, new systems introduced into the community)




might have happened even without the coalition? E. FUTURE IMPACTS Last, I’d like to talk a little bit about what lies ahead for the coalition. 1. What do you hope to achieve during this remaining period of Allies funding? 2. Do you feel that local AAA name has been a success? In what way?


3. Has local AAA name fallen short of your expectations in any way? How? 4. After RWJF funding ends, what does the future look like for the coalition itself?

For the primary interventions? Will they continue and if so, how? (probe for institutionalization through the coalition, member organization, or individual member involvement) Why were these choices made?

5. Are there any additional comments you would like to share about being part of

this coalition?

Allies Against Asthma Key Informant Interview Guides Follow-up for Other Community Leaders 16 of 17

Allies Against Asthma Key Informant Interview Guide Follow-up for Other Community Leaders

(For people who are in leadership positions in the community in organizations whose mission overlaps with that of the coalition, and that may send representatives to the coalition but are not themselves involved in any intimate fashion) A. BACKGROUND I’d like to begin by learning how your role in asthma control issues in your community may have changed since we last spoke. 1. What are your current activities and responsibilities as they relate to asthma control? 2. What contact, if any, have you had with local AAA name since we last spoke? Do

you provide any support to the coalition? C. GOALS AND INTERVENTIONS I’d like to hear your current perspective on local AAA name. 1. How do you see the role of local AAA name in the community? 2. Do you think local AAA name meets an important need? Please explain (probe

for their perspective on what the needs are and which of these the coalition could or could not appropriately address)

D. IMPACTS Next, I’d like to talk about what impacts the coalition is having on you personally, the organizations you are associated with, and the community at large. 1. What benefits, if any, have you or your organization experienced from the presence

of local AAA name in the community? 2. How visible is local AAA name in this community? (probe for media coverage,

visibility within top levels of key organizations, public awareness) 3. How, if at all, has local AAA name affected support for pediatric asthma

prevention and control programs in this community?

Allies Against Asthma Key Informant Interview Guides Follow-up for Other Community Leaders 17 of 17

4. What, if any, other benefits or impacts of local AAA name have you observed at this point in time?

E. FUTURE IMPACTS Last, I’d like to talk a little bit about what lies ahead. 1. What interaction do you or your organization expect to have with local AAA

name in the next year or beyond? (probe for support they might provide during current funding period and beyond)

2. What would you like to see occur for you to feel that local AAA name has been a

success in this community? Have you witnessed any progress towards this definition of success since we last spoke?


ALLIES AGAINST ASTHMA PROGRAM REACH FORMS

Description Included in this document is a selection of forms that can be used to track coalition activities. The forms were developed by Allies Against Asthma for Program Reach, a web-based database used to capture data on the extent of coalition activities. Program Reach is a password-protected, site-specific tracking system used by coalition staff to enter data that describes the coalition activities conducted including the number and type of program participants, topics addressed and settings in which activities were conducted.

Development and Conditions of Use

Developed by Allies Against Asthma, 2003. The concept for Program Reach was based upon the Central California Asthma Project (CCAP) Activities Database. CCAP is a project of the San Joaquin Valley Health Consortium and the American Lung Association of Central California, Fresno, CA, and CCAP-affiliated community asthma coalitions. The Activities Database was developed for CCAP by the Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA, with support from the National Heart, Lung, and Blood Institute of National Institutes of Health.

For use and/or adaptations of this document, please credit Allies Against Asthma and the Department of Health Services Research, Palo Alto Medical Foundation Research Institute.

Contact Information

Allies Against Asthma National Program Office Center for Managing Chronic Disease University of Michigan 109 South Observatory Street Ann Arbor, MI 48109-2029

Phone: 734-615-3312 Fax: 734-763-7379 E-mail: [email protected] www.AlliesAgainstAsthma.net

_____________________________________________________________________________________________________________________ Allies Against Asthma Program Reach Forms 2 of 8

I. Training Individuals who Work with Children with Asthma

Curriculum/Description: (specify) Participants:(enter number of participants) Medical Providers

Physicians Nurses Other Allied Health

Professionals Medical Office Staff Other (specify):

School-Based/Day Care/HeadStart Personnel

Administrators Engineers/Custodians Physical Education

Staff/Coaches School Nurses Teachers Day Care/HeadStart Workers Other (specify):

Others Who Work with Children with Asthma

Community Health Workers Health Educators Social Workers Community Agency Staff Community Volunteer WIC Staff After-School/Parks and

Recreation Staff Other (specify):

Number of training sessions: Number of total educational hours:

Setting where Participants Work: (check all that apply)

Clinic Head Start Emergency Department Elementary School Hospital (Non-Emergency Department) Middle/Junior High Private Medical Practice High School Day Care After-School/Parks & Rec. Preschool Health Education Center Community Based Organization Other (specify):

Topics Addressed: (check all that apply)

Asthma Basics Recognition of Asthma Emergency Case Finding Self Management Skills Medical Therapies Communication Skills Improving Environmental Conditions Tobacco Cessation Policies and Procedures Interviewing Skills

Other (specify): Curriculum/Program Period Term of Activity (check one)

° Time Limited Activity � On-Going Activity Reporting Period/Date of Activity Start Date (mm/dd/yyyy): ______________ End Date (mm/dd/yyyy): ______________ Comments:


II. Care Coordination

Coordination Provided By: (Check all that apply) � Community Health Worker/Outreach Worker � Nurse/Public Health Nurse � Social Worker � Health Educator � Other (specify):

Coordination Provided Type: (Check all that apply) � Clinical Care � Asthma-related Educational Programs � Home-based Support � School-based Support � Social Services � Tobacco Cessation Education/Support � Advocacy � Assistance Obtaining Medications/Equipment � Assistance Enrolling / Maintaining Insurance �Other (specify):

Number of Children: Number of Children Served ______ Number of Total Contacts ______ Number of First Contacts ______ Reporting Period: Start Date (mm/dd/yyyy) _______ End Date (mm/dd/yyyy) _______ Comments:


III. Home Visiting

Visits Conducted By: (Check all that apply) � Community Health Worker/Outreach Worker � Nurse Public Health Nurse � Social Worker � Health Educator � Other (specify): Program Focus: (Check all that apply) � Education For Example: Asthma Basics Self-management Skills Environmental Triggers Advocacy Skills � Environmental Action For Example: Environmental Assessment Smoking Cessation Distribution of Trigger Reduction Materials � Case Management For Example: Referrals Other Social Issues � Other (specify):

Age of Target Population: (Check all that apply)

0 - 5 year olds Elementary School Middle/Junior High High School Above High School

Visits Conducted: Number of Homes Visited _______ Number of Children Visited _______ Number of Total Visits _______ Number of First Visits _______ Zip Codes of Homes Visited: Reporting Period: Start Date (mm/dd/yyyy) End Date (mm/dd/yyyy) Comments:


IV. Educating Children with Asthma and/or Their Parents/Caregivers Outside of Their Home

Curriculum: Title or Description: (specify) Topics Addressed: (Check all that apply) � Asthma Basics � Self Management Skills � Medications and Equipment � Environmental Triggers � Advocacy Skills � Peer Support � Other (specify): Setting: (check all that apply) � Day Care � Pre School � Head Start/Early Head Start � Elementary School � Middle/Junior High � High School � After-school/Parks and Recreation � Clinic � Emergency Department � Hospital (Non-ED) � Asthma Camp � Community � Other (specify): Educators: (Check all that apply) � Community Health Worker � Health Educator � Health Care Provider (Ex: Nurse) � Social Worker � Teacher �Community Volunteer �Other (specify):

Participants: Group or Individual:

° Group °Individual Number of Sessions Children with Asthma Number of Children ________ Number of New Children ________ Number of Total Educational Hours_______ Parents/Caregivers Number of Parents/Caregivers ________ Number of New Parents/Caregivers _______ Number of Total Educational Hours_______ Period and Location of Activity: Term of Activity: (check one)

° Time Limited Activity °On-Going Activity Reporting Period: Start Date (mm/dd/yyyy) __________ End Date (mm/dd/yyyy) __________ Zip Codes: Comments:


V. Actions to Improve Physical Environmental Conditions within Institutions

Setting: (choose one)

° Day Care

° Preschool (Non-Head Start)

° Head Start/Early Head Start

° Elementary School

° Middle/Junior High

° High School

° After-School/Parks and Recreation

° Housing

° Community

° Other (specify): Topics: (check all that apply) � Environmental Assessment � Mold/Spore Reduction � Pest Management � Dust/Air Allergen Reduction � Other (specify):

Date and Location of Activity: Reporting Period: Start Date (mm/dd/yyyy) ________ End Date (mm/dd/yyyy) ________ Zip Codes: Comments:


VI. Quality Improvement

Systems Involved (provide numbers) ____ In-Patient Hospital ____ Emergency Department ____ Primary Care Physicians ____ Specialists ____ Clinic ____ MCO/Insurer ____ School ____ Daycare/Preschool/Headstart ____ Home Visiting Program ____ Community Based Organization ____ After-school/Parks and Recreation ____ Other (specify):

Target Population/Participants: (provide numbers for all that apply) ____ Physicians ____ Nurses ____ Educators ____ Clerks/Administrative Personnel ____ Other (specify):

Breadth of Activity (optional) ____ Number of Charts Audited/Abstracted ____ Number of Incentives Provided ____ Number of Participants Provided Feedback on Performance ____ Other (specify): Reporting Period Start Date (mm/dd/yyyy) _______ End Date (mm/dd/yyyy) _______ Describe/Comments:


VII. General Community Awareness Activities

Activities: (complete all that apply) Community Events (enter number of activities) _____ Health Fairs _____ Community Forum _____ Fundraisers _____ Approximate Total Number of Participants Presentations (enter number of activities) _____ General Asthma Presentations _____ Presentations about the Coalition _____ Approximate Total Number of Participants Media Campaigns (enter number of activities) _____ Number of Newspaper/Magazine Stories _____ Number of TV/Radio Stories _____ Number of Billboard, Bus or Posters Mounted Other Community Events (enter number of activities) _____ Theater Production _____ Other (specify): Environmental Actions (Describe:)

Reporting Period: Start Date (mm/dd/yyyy): _________ End Date (mm/dd/yyyy): _________ Comments:


ALLIES AGAINST ASTHMA ASTHMA CORE CAREGIVER SURVEY

Instrument Description The Asthma Core Caregiver Survey can be used to assess individual-level asthma-related outcomes. This instrument is a compilation of previously existing surveys designed to collect self-report data about asthma management, exposures to community events and programs, and outcomes. It was designed to measure individual outcomes between baseline and follow-up periods within an intervention and control/comparison group. It measures the following: • Quality of Life: The Paediatric Asthma Quality of Life Questionnaire was used to

measure quality of life. (To obtain this questionnaire and additional information about its use, please go to http://www.qoltech.co.uk/PaedAsthma.htm )

• Asthma Symptoms • Exposure to Asthma-Related Community Events and Programs • Parent Asthma Management Strategies • Hospitalizations and Emergency Department visits (self-report) The English version and a Spanish translation are included in this document.

Development and Conditions of Use Adapted by Allies Against Asthma, 2003. For use and/or adaptations of this document, please credit Allies Against Asthma and the applicable references below. REFERENCES Quality of Life Juniper, E. F., Guyatt, G. H., Feeny, D. H., Ferrie, P. J., Griffith, L. E., & Townsend, M. (1996). Measuring quality of life in the parents of children with asthma. Quality of Life Research, 5, 27-34. Asthma Symptoms Evans, R. 3rd., Gergen, P.J., Mitchell, H., Kattan, M., Kercsmar, C., Crain, E., Anderson, J., Eggleston, P., Malveaux, F.J., Wedner H.J., (1999). A randomized


clinical trial to reduce asthma morbidity among inner-city children: Results of the National Cooperative Inner-City Asthma Study. Journal of Pediatrics, 135(3):332-8 Exposure to Community Events and Programs Fisher, E. B., Strunk, R. C., Sussman, L. K., Sykes, R. K., & Walker, M. S., (2004). Community organization to reduce the need for acute care for asthma among African American children in low-income neighborhoods: The Neighborhood Asthma Coalition. Pediatrics, 114, 116-123.

Fisher, E. B., Sussman, L. K., Arfken, C., Harrison, D., Munro, J., Sykes, R. K., Sylvia, S. & Strunk, R. C., (1994). Targeting high risk groups: Neighborhood organization for pediatric asthma management in the Neighborhood Asthma Coalition. Chest, 106, 248S-259S.

Fisher, E. B., Strunk, R. C., Sussman, L. K., Arfken, C., Sykes, R. K., Munro, J. F., Haywood, S., Harrison, D., & Bascom, S., (1996). Acceptability and feasibility of a community approach to asthma management: The Neighborhood Asthma Coalition (NAC). Journal of Asthma, 33, 367-383.

Parent Asthma Management Strategies Clark, N. M., Feldman, C. H., Evans, D., Duzey, O., Levison, M. J., Wasilewski, Y., Kaplan, D., Rips, J., Mellins, R.B., (1986). Managing better: children, parents, and asthma. Patient Education and Counseling, 8, 27-38.

Contact Information Allies Against Asthma National Program Office Center for Managing Chronic Disease University of Michigan 109 South Observatory Street Ann Arbor, MI 48109-2029 Phone: 734-615-3312 Fax: 734-763-7379 E-mail: [email protected] www.AlliesAgainstAsthma.net

___________________________________________________________________________________Allies Against Asthma Asthma Core Caregiver Survey 3 of 22 English version

ALLIES AGAINST ASTHMA ASTHMA CORE CAREGIVER SURVEY

Date of administration: _____/______/_______ Site ID# _______ Respondent ID# ________ Administration Method: (check one) ____ Self-administered ____ Interviewer-administered If interviewer-administered: Interviewer ID: _______ How interviewed? _____phone ______face-to-face Language: ____ English ____ Spanish ____ Other _____________________


Paediatric Asthma Caregiver’s Quality of Life Questionnaire

This section, two pages long, is not included in this document due to copyright restrictions; to obtain this questionnaire and additional information about its use, please go to http://www.qoltech.co.uk/PaedAsthma.htm


Asthma Symptoms

These next four questions ask about how asthma affects you and [CHILD] each day. The questions ask about asthma symptoms during two different time periods: in the last 14 days, and over the last 12 months. S1. During the daytime in the last 14 days, how many days did [CHILD] have asthma symptoms such as wheezing, shortness of breath, tightness in the chest, or cough? ____Days S1.1 How about in the last 12 months? ____Days

Begin with a PAUSE, if no answer restate the question. Avoid ranges: if given a range, i.e. 2 to 5 days a month, ask, “would that be closer to 2 or closer to 5? Is that every month? If respondent says it varies during the year ask “at the worst time how many days a month? For how many months? And the rest of the year, how many days a month?

If respondent says most of the time, or all of the time etc. restate the response “do you mean a few days a week? How many?” “Do you mean every day of the year?” INTERVIEWER: Calculate and enter responses adjusted for 12 months.

S2. During the nighttime in the last 14 nights, how many nights did [CHILD] wake up because of asthma symptoms such as wheezing, shortness of breath, tightness in the chest, or cough? ____Nights S2.1 How about in the last 12 months? ____Nights Use same probes as above replacing term “days” with “nights.”

These next two questions ask about hospitalizations and emergency visits over the past 12 months. S3. During the past 12 months (that is since _______), did [child] have to stay overnight in the hospital because of asthma? S4. Not counting hospitalizations, during the past 12 months, (that is, since _______), did [child] go to an emergency room because of asthma?


Items on Exposure to Community Events and Programs Related to Asthma

Next are some questions about your community. E1. Have you heard of (insert coalition name, program or other organization as appropriate)?

YES NO DON’T KNOW If NO or DON’T KNOW: Go to #3 If YES, ask: E2. How many times have you participated in activities or received help from (insert coalition

name, program or other organization as appropriate)? **Probe if per week, month, year**

1 - /week 2 - /month 3 - /year NEVER DON’T KNOW E3. How often do you hear someone in your neighborhood talking about asthma? VERY OFTEN SOMETIMES

SELDOM NEVER DON'T KNOW E4. Have you or your child talked with a doctor or nurse about your child’s asthma in the

last 6 months? YES

NO DON’T KNOW E5. Has anyone visited your home to talk with you about your child’s asthma in the last

6 months? YES

NO DON’T KNOW E6. Has anyone called you on the phone to talk with you about your child’s asthma in the

last 6 months? YES

NO DON’T KNOW


E7. Have you or your child attended a class on asthma in your child's school in the last 6 months?

YES NO DON'T KNOW E8. Have you or your child attended a class on asthma at any other place,

like a health clinic, neighborhood center, or church in the last 6 months? YES NO DON'T KNOW E9. Have you or your child participated in some other activity for people with

asthma such as a health fair, asthma camp, or neighborhood event in the last 6 months?

YES NO DON'T KNOW E10. Have you heard a presentation on asthma in a church or some other community

organization in the last 6 months? YES NO DON'T KNOW E11. Have you received hand-outs or fliers or manuals on asthma in the last 6 months? YES NO DON'T KNOW E12. Have you noticed posters or billboards or other announcements in your neighborhood

about asthma in the last 6 months? YES NO DON'T KNOW E13. (Optional) Have you been to an asthma support group in the last 6 months? YES NO DON’T KNOW


Parent Asthma Management Strategies (long version)

Now I am going to ask some questions about things YOU may have done to manage [child’s] asthma at home during the past 12 months. Some parents find some of these things helpful and others feel that they are not helpful. For the past 12 months, please tell me whether you did these things to manage [child’s] asthma All the time, Fairly often, Not too often or Never...... During the past 12 months....

All the time

Fairl

y often

Not too

often

Never

a. Did you give [child] asthma prescription medicine when s/he was having symptoms

[4] [3] [2] [1]

b. Did you find ways to keep yourself and [child] calm

[4] [3] [2] [1]

c. Did you have [child] rest or play quietly

[4] [3] [2] [1]

d. Did you take [child] away from what caused symptoms when possible

[4] [3] [2] [1]

e. Did you observe [child] to see if symptoms got better or worse

[4] [3] [2] [1]

f. Did you ask someone for advice or help

[4] [3] [2] [1]

g. Did you use a peak flow meter to try to predict [child’s] asthma attacks

[4] [3] [2] [1]

h. Did you watch [child] closely when symptoms began, in order to determine how serious they were

[4] [3] [2] [1]

i. Did you watch closely after giving [child] medicine to see if it was working to reduce or stop symptoms

[4] [3] [2] [1]

j. Did you try to identify things that might be triggering [child’s] symptoms

[4] [3] [2] [1]

k. Did you look for early warning signs of an asthma attack

[4] [3] [2] [1]

l. Did you decide on your own whether or not the medicine was working or needed to be changed

[4] [3] [2] [1]


m. Did you use some system or method for deciding when to change the type or dose of medicine according to the changes in [child’s] asthma symptoms

[4] [3] [2] [1]

n. Did you determine if the changes you made in [child’s] environment, for example, bedroom furnishings, household pets, or air quality had any effect on [child’s] symptoms

[4] [3] [2] [1]

o. Did you give [child] asthma medicines before s/he came in contact with something that might cause asthma symptoms to begin

[4] [3] [2] [1]

Parent Asthma Management Strategies (short version)

I’d like to ask you about things you may have done to manage (child’s name) at home during the past 12 months. Some parents find these things helpful, others find they are not helpful.

For each item, please tell me how often you did these things: all the time, fairly often, not too often, never.

How often did you:

All the

time

Fairly Often

Not too

often

Never

1. Give (child’s name) asthma prescription medicine when he/she was having symptoms.

4

3

2

1

2. Find ways to keep yourself and (child’s name) calm when he/she was having symptoms.

4

3

2

1

3. Have (child’s name) rest or play quietly when he/she was having symptoms.

4

3

2

1

4. Take (child’s name) away from what caused the symptoms.

4

3

2

1

5. Ask someone for help or advice about managing (child’s name)’s asthma.

4

3

2

1


6. Give (child’s name) asthma medicines before he/she had contact with something that might cause wheezing or coughing, for example, before entering a smoky restaurant or before he/she played sports.

4

3

2

1

* Clark, N.M., Gong, M, Kaciroti, N. A model of self-regulation for control of chronic disease. Health Education & Behavior 28(6):769-782, 2000.


Demographics

Child D1. What is your child’s sex? ___ Male ___ Female D2. What is your child’s age and date of birth? ___ Age (in years) Date of birth:

Month Day Year D3. Is your child Spanish/Hispanic/Latino? Mark (X) in the “NO” box if not Spanish/Hispanic/Latino. ___ No, not Spanish/Hispanic/Latino ___ Yes, Mexican, Mexican American, Chicano ___ Yes, Puerto Rican ___ Yes, Cuban ___ Yes, other Spanish, Hispanic, Latino (print group)______________________ D4. What is the child’s race? Mark (X) one or more races to indicate what race the caregiver considers him or her to be. ___ White ___ Black or African American ___ American Indian or Alaskan Native ___ Asian Indian ___ Chinese ___ Filipino ___ Japanese ___ Korean ___ Vietnamese ___ Other Asian (print race below) ___ Native Hawaiian ___ Guamanian or Chamorro ___ Samoan ___ Other Pacific Islander (print race below) ___ Other race (print race below) (print race) ___________________________ D5. Is your child currently covered by health insurance? ___ Yes ___ No

If yes, what insurance? _________________


Is that through Medicaid or CHIP (or whatever name appropriate for site)?_____

Primary Caregiver D6. What is your zip code of residence?____________________ D7. What is your sex? ___ Male ___ Female D8. What is your age and date of birth? ___ Age (in years) Date of birth:

Month Day Year D9. What is your relationship to [child]? ___ Mother ____Father ____ Grandmother ____Grandfather ____ Aunt ____Uncle ___Other: (specify)___________________ D10. Are you Spanish/Hispanic/Latino? Mark (X) in the “NO” box if not Spanish/Hispanic/Latino. ___ No, not Spanish/Hispanic/Latino ___ Yes, Mexican, Mexican American, Chicano ___ Yes, Puerto Rican ___ Yes, Cuban ___ Yes, other Spanish, Hispanic, Latino (print group)______________________ D11. What is your race? Mark (X) one or more races to indicate which race the caregiver consider herself or himself to be. ___ White ___ Black or African American ___ American Indian or Alaskan Native ___ Asian Indian ___ Chinese ___ Filipino ___ Japanese ___ Korean ___ Vietnamese ___ Other Asian (print race below) ___ Native Hawaiian


___ Guamanian or Chamorro ___ Samoan ___ Other Pacific Islander (print race below) ___ Other race (print race below) (print race) ___________________________ D12. What is the highest level of school you have COMPLETED? Mark (X) only ONCE. If currently enrolled, mark the previous grade or highest grade completed. Interviewer: Do not read responses. Check appropriate box and probe if necessary. ___ No schooling completed ___ Nursery school to 4th grade ___ 5th grade or 6th grade ___ 7th grade or 8th grade ___ 9th grade ___ 10th grade ___ 11th grade ___ 12th grade—NO DIPLOMA ___ HIGH SCHOOL GRADUATE—high school DIPLOMA or the equivalent (for example: GED) ___ Some technical/vocational school ___ Completed technical/vocational school ___ Some college credit, but less than 1 year ___ 1 or more years of college, no degree ___ Associate’s degree (for example: AA, AS) ___ Bachelor’s degree (for example: BA, AB, BS) ___ Master’s degree (for example: MA, MS, MEng, MEd, MSW, MBA) ___ Professional degree (for example: MD, DDS, DVM, LLB, JD) ___ Doctorate degree (for example: PhD, EdD) ___ Other (please describe, including country where education took place)______________________________________________________________


D13. What was your total family income before taxes last year? (Optional) ____________________ Or D14. Which category best describes your total family income before taxes last year? (For interviewer-administered: “Please stop me when I get to the category that best describes your total income.”) ___ Less than $5000 ___ $5001-$10,000 ___ $10,001-$15,000 ___ $15,001-$20,000 ___ $20,001-$30,000 ___ $30,001-$40,000 ___ $40,001-$50,000 ___ $50,001-$60,000 ___ $60,001-$70,000 ___ $70,001-$80,000 ___ $80,001 and above

_________________________________________________________________________________________Allies Against Asthma Asthma Core Caregiver Survey 15 of 22 Spanish version

ALIANZA CONTRA EL ASMA ENCUESTA PARA EL ENCARGADO O

GUARDIÁN PRINCIPAL DE ASMA

Fecha de administración: _____/______/______ ID. # del Sitio: _______ ID. # del entrevistado: ________ Método de administración: (marque uno) ____ Auto-administrado ____ Administrado por el entrevistador Si fue administrado por el entrevistador: ID. del entrevistador: _______ ¿Cómo entrevistó? _______ Teléfono ______Cara a cara Idioma: ____ Inglés ____ Español ____ Otro_____________________


Cuestionario de la Calidad de Vida de la Persona Encargada del Cuidado del Niño con Asma

This section, two pages long, is not included in this document due to copyright restrictions; to obtain this questionnaire and additional information about its use, please go to http://www.qoltech.co.uk/PaedAsthma.htm


Síntomas de asma

Las siguientes cuatro preguntas son acerca de cómo es que el asma los afecta a usted y a [nombre del niño/a] cada día. Las preguntas se refieren a los síntomas del asma durante dos períodos de tiempo distintos: durante los últimos 14 días y durante los últimos 12 meses. S1. Durante el día en los últimos 14 días, ¿cuántos días tuvo [nombre del niño/a] silbidos (pitos) al respirar, falta de aire, opresión en el pecho o tos? S1.1 ¿Y durante los últimos 12 meses? ____ Días

Empiece con una PAUSA, si no hay respuesta, repita la pregunta. Evite períodos de tiempo: por ejemplo si le contesta de 2 a 5 días al mes, pregunte “eso sería más cerca a 2 ó a 5? Y eso es ¿cada mes?

Si el entrevistado responde que varía durante el año pregunte, “durante la peor época ¿cuántos días al mes? ¿Cuántos meses? Y durante el resto del año ¿cuántos días al mes?”

Si el entrevistado responde la mayor parte del tiempo o todo el tiempo, etc. repita la respuesta diciendo “¿Usted quiere decir unos pocos días a la semana? ¿Cuántos días?” “¿Quiere decir todos los días del año?” ENTREVISTADOR: Calcule y escriba las respuestas ajustándolas a 12 meses.

S2. Durante la noche en las últimas 14 noches, ¿cuántas noches se despertó [nombre del niño/a] por el asma, con silbidos (pitos) al respirar, falta de aire, opresión en el pecho o tos? S2.1 ¿Y durante los últimos 12 meses? ____ Noches

Use las mismas preguntas que arriba, sustituyendo “días” con “noches.” Las próximas dos preguntas son acerca de hospitalizaciones y idas a la sala de emergencia durante los últimos 12 meses. S3. Durante los últimos 12 meses (eso es desde ________), ¿[nombre del niño/a] tuvo que pasar la noche en el hospital por el asma? Sin contar las hospitalizaciones durante los últimos 12 meses, (eso es desde ________), ¿[nombre del niño/a] ha tenido que ir a la sala de emergencia por el asma?


Preguntas sobre la exposición a eventos y programas de la comunidad relacionados con el asma

Ahora le haré algunas preguntas acerca de su comunidad. E1) ¿Ha oído acerca de (diga el nombre de la coalición, programa u otra organización que

corresponda)?

SÍ NO NO SABE

Si responde NO o NO SABE: Vaya al #3 Si responde SÍ, pregunte: E2) ¿Cuántas veces ha participado en las actividades o recibido ayuda de (diga el nombre de la

coalición, programa u otra organización que corresponda)? **Insista en aclarar si es a la semana, al mes, al año**

1 - ___ ___ / a la semana 2 - ___ ___ / al mes 3 - ___ ___ / al año NUNCA NO SABE

E3) ¿Con qué frecuencia escucha a alguien en su comunidad hablar acerca del asma?

MUY SEGUIDO/ FRECUENTEMENTE ALGUNAS VECES RARAS VECES NUNCA NO SABE

E4) Durante los últimos seis meses, ¿usted o su niño con asma han hablado con un doctor o una

enfermera acerca del asma de su niño? SÍ NO NO SABE

E5) Durante los últimos seis meses, ¿los ha visitado alguien en su casa para hablar acerca del

asma de su niño? SÍ NO NO SABE


E6) Durante los últimos seis meses, ¿los ha llamado alguien por teléfono para hablar acerca del asma de su niño?

SÍ NO NO SABE

E7) Durante los últimos seis meses, ¿usted o su hijo han asistido a una clase acerca del asma en la

escuela de su hijo? SÍ NO NO SABE

E8) Durante los últimos seis meses, ¿usted o su hijo han asistido a una clase acerca del asma en algún

otro lugar como una clínica, el centro de su comunidad o iglesia?

SÍ NO NO SABE

E9) Durante los últimos seis meses, ¿usted o su hijo han participado en alguna otra actividad para

personas con asma tal como una feria de salud, un campamento para niños con asma o un evento en su comunidad?

SÍ NO NO SABE

E10) Durante los últimos seis meses, ha asistido a una presentación acerca del asma en una iglesia u otra

organización en su comunidad? SÍ NO NO SABE

E11) Durante los últimos seis meses, ¿ha recibido impresos, folletos informativos o manuales acerca del

asma? SÍ NO NO SABE

E12) Durante los últimos seis meses, ¿ha visto carteles, letreros o anuncios acerca del asma en su

comunidad? SÍ NO NO SABE

E13) (Opcional) Durante los últimos seis meses, ¿ha asistido a un grupo de apoyo de asma?

SÍ NO NO SABE


Demografía Niño/a D1. ¿Cuál es el sexo de su niño/a? ___ Masculino ___ Femenino D2. ¿Cuál es la edad de su niño/a y su fecha de nacimiento? ___ Edad (en años) Fecha de Nacimiento:

Mes Día Año D3. ¿Qué es su niño/a, español/a, hispano/a, latino/a? Sí no es español/a, hispano/a o latino/a, ponga una “X” en la caja “NO”. ___ No, no es español/hispano/latino ___ Sí, mexicano, mexicano-americano, chicano ___ Sí, puertorriqueño ___ Sí, cubano ___ Sí, otro grupo español, hispano o latino Escriba el grupo en letra de molde______________________ D4. ¿Cuál es la raza del niño/a? Ponga una o más “X” para indicar la raza a la que pertenece el/la niño/a, según el/la encargado/a del cuidado del niño/a. ___ Blanca ___ Negra, africana americana ___ India americana o nativa de Alaska ___ India asiática ___ China ___ Filipina ___ Japonesa ___ Coreana ___ Vietnamita ___ Otra asiática (Escriba abajo la raza en letra de molde) ___ Hawaiano nativo ___ Guam o Chamorro ___ Samoano ___ Otra de las islas del Pacifico (Escriba abajo la raza en letra de molde) ___ Alguna otra raza (Escriba abajo la raza en letra de molde) ___________________________ D5. ¿Actualmente, tiene su niño/a seguro médico? ___ Sí ___ No

Si tiene, ¿qué seguro tiene? __________________________


¿El seguro es por medio de Medicaid o CHIP (o cualquier nombre apropiado al lugar)? __________________________

Persona encargada del cuidado del niño D6. ¿Cuál es el código postal del área donde vive? ____________________ D7. ¿Cuál es su sexo? ___ Masculino ___ Femenino D8. ¿Cuántos años tiene usted y cuál es su fecha de nacimiento? ___ Edad (en años) Fecha de Nacimiento:

Mes Día Año D9. ¿Cuál es su relación con [niño/a]? ___Madre ___Padre ___Abuela ___Abuelo ___ Tío/a ____Otro: (especifique) __________________ D10. ¿Es usted español/a, hispano/a, latino/a? Sí no es español/a, hispano/a o latino/a, ponga una “X” en la caja “NO”. ___ No, no es español/hispano/latino ___ Sí, mexicano, mexicano-americano, chicano ___ Sí, puertorriqueño ___ Sí, cubano ___ Sí, otro grupo español, hispano, latino Escriba el grupo en letra de molde______________________ D11. ¿Cuál es su raza?

Ponga una o más “X” para indicar la raza a la que él/ella considera que pertenece. ___ Blanca ___ Negra, africana americana ___ India americana o nativa de Alaska ___ India asiática ___ China ___ Filipina ___ Japonesa ___ Coreana ___ Vietnamita ___ Otra asiática (Escriba abajo la raza en letra de molde) ___ Hawaiano nativo ___ Guam o Chamorro ___ Samoano ___ Otra de las islas del Pacifico (Escriba abajo la raza en letra de molde) ___ Alguna otra raza (Escriba abajo la raza en letra de molde) _______________________


D12. ¿Cuál es el nivel más alto de educación que Ud. ha terminado? Ponga UNA SOLA “X”. Si Ud. está estudiando, por favor marque el nivel anterior al actual o el nivel más alto que haya completado.

Entrevistador: No lea las respuestas. Marque la caja apropiada y tantee si es necesario. ___ No ha completado ningún grado ___ Guardería infantil (nursery school) a 4o grado ___ 5 o ó 6 o grado ___ 7 o u 8 o grado ___ 9 o grado ___ 10 o grado ___ 11 o grado ___ 12 o grado—SIN DIPLOMA ___ GRADUADO/A DE ESCUELA SECUNDARIA— DIPLOMA de escuela secundaria o su equivalente (por ejemplo: GED) ___Alguna escuela técnica/vocacional ___Terminó escuela técnica/vocacional ___ Algunos créditos universitarios, pero menos de 1 año ___ 1 año o más de universidad, sin título ___ Título de asociado universitario (por ejemplo: AA, AS) ___ Título de bachiller universitario (por ejemplo: BA, AB, BS) ___ Título de maestría (por ejemplo: MA, MS, MEng, MEd, MSW, MBA) ___ Título profesional (por ejemplo: MD, DDS, DVM, LLB, JD) ___ Título de doctorado (por ejemplo: Ph.D, Ed.D) ___Otro (por favor describa; incluya el país donde estudió: _________________________ D13. Antes de pagar impuestos ¿cuál fue el ingreso de su familia el año pasado? (Opcional) _________________________ O D14. ¿Qué categoría describe mejor el ingreso total de su familia, el año pasado, antes de pagar impuestos? (Entrevistador: “Por favor párame cuando llegue a la categoría que describe mejor sus ingresos totales.”) ___ Menos de $5,000 ___ $5,001-$10,000 ___ $10,000-$15,000 ___ $15,001-$20,000 ___ $20,001-$30,000 ___ $30,001-$40,000 ___ $40,001-$50,000 ___ $50,001-$60,000 ___ $60,001-$70,000 ___ $70,001-$80,000 ____$80,000 o más

Appendix A: How Allies Used these Cross-site Evaluation Instruments 1 of 3

APPENDIX A: HOW ALLIES AGAINST ASTHMA USED

THESE CROSS-SITE EVALUATION INSTRUMENTS

Context Survey

The Context Survey provided both quantitative and qualitative information about coalition structure and functioning, the focus of coalition efforts and information about the social, cultural and political environment of the community in which the coalition operates. The survey is a semi-structured telephone interview that was conducted by the National Program Office staff with 1-3 coalition members and staff from each of the seven sites. Context surveys were conducted at baseline with a second administration two years later to coincide with the Coalition Self-Assessment Survey (CSAS) administration. Analyses include content analysis of coalition structure, community readiness, and lessons learned by the coalitions. Data from the context interviews will also be used to help interpret responses related to coalition processes from the CSAS.

Coalition Self-Assessment Survey (CSAS)

The Coalition Self-Assessment Survey (CSAS) was administered annually to the coalition membership to capture quantitative information on coalition structure and processes, including coalition functioning, leadership, and effectiveness of effort. The survey was administered by local staff at a general membership meeting or via U.S. mail to members attending at least two coalition meetings within the 12 months prior to the survey. CSAS responses from all sites were combined and analyzed descriptively, and bivariate relationships were explored, stratified by role in coalition, site, and other demographic variables. These results were reported to the Allies sites from the National Program Office annually as site-specific information along with ranges of responses from all sites combined. Reliability analysis of questions from CSAS using categories based on previous factor analyses by Kenney and Sofaer were used to formulate indices for further descriptive analysis, bivariate analysis, and regression model building.


Key informant interview guides

Key informant interviews were conducted by a neutral contractor at two points in time (baseline [2003] and follow-up [2005]) with a selected number of coalition staff and leaders, coalition members, and other community leaders. Key informants inside and outside of the coalition were selected based on their relationship to the coalition, history within the community, professional backgrounds, and personal connections to asthma. Interviews with 15-17 individuals from each site were intended to provide a broad range of perspectives on the activities of each coalition. Interview guides and key informant selection protocols were developed collaboratively with input from each coalition and the National Program Office staff. The semi-structured interviews were designed to collect information from the point of view of participants about the coalition planning process, level of their involvement in the coalition, goals and interventions, and perceptions of coalition impact. The follow-up interviews also address change in coalition structure and membership, implementation of interventions, and progress toward goals, including the individual’s satisfaction with the interventions currently being implemented and perceptions of collaborations and linkages among community-based organizations. Both the baseline and follow-up interviews address participants’ expectations about future outcomes and their perspectives on the value of the coalition. The electronic records of interview data were sorted by codes based on study questions and themes in order to analyze each specific topic qualitatively. Coded data for each site were analyzed independently. A summary report for each site was prepared by the contractor for both baseline and follow-up based on the interview data and any documents collected and reviewed. The site-specific reports were reviewed by each site prior to completion.

Program Reach

Program Reach, a password-protected, web-based, site-specific tracking system, captured data on the extent of coalition activities. Local coalition staff entered data to describe the activities conducted including the zip code area where the activity took place. The database includes information such as the number and type of program participants, topics addressed, settings in which activities were conducted, and system changes implemented.

Program Reach data for all sites were compiled by the National Program Office staff and will be examined to identify depth and breadth of program activities. Program


Reach data collection was ongoing throughout the implementation period; analyses will be conducted after the implementation period.

Core Caregiver Survey

The Core Caregiver Survey is a compilation of previously existing surveys used to measure individual health outcomes between baseline and one-year follow-up periods and was used by Allies to measure a cohort of individuals exposed to the coalition’s most intensive interventions and a control/comparison group. The National Program Office will conduct baseline to follow-up analyses for intervention and comparison groups collectively and for each coalition site. The analyses will pool data across the coalition sites, taking into account any differences between intervention and comparison groups at each site. Analyses of pooled data will include both stratification and control for coalition site. Bivariate relationships will be explored, and in particular, relationships between factors related to symptoms, health care utilization and quality of life outcomes will be investigated. Multi-level models will be constructed adjusting for site differences in treatments, individuals participating in the study and study site characteristics.

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