Variable / Field Name,Form Name,Section Header,Field Type,Field Label,"Choices, Calculations, OR Slider Labels",Field Note,Text Validation Type OR Show Slider Number,Text Validation Min,Text Validation Max,Identifier?,Branching Logic (Show field only if...),Required Field?,Custom Alignment,Question Number (surveys only),Matrix Group Name,Matrix Ranking?,Field Annotation
record_id,community_based_research_request_for_consult,,text,Record ID,,,,,,,,,,,,,
first_name,community_based_research_request_for_consult,,text,First name,,,,,,y,,y,,,,,
last_name,community_based_research_request_for_consult,,text,Last Name,,,,,,y,,y,,,,,
phone_number,community_based_research_request_for_consult,,text,Phone number,,,phone,,,y,,y,,,,,
email_address,community_based_research_request_for_consult,,text,Email address,,,email,,,y,,y,,,,,
your_role,community_based_research_request_for_consult,,radio,Which selection best describes your role?,"7, Faculty Member | 8, Health Provider | 14, Research Study Coordinator/Manager | 9, Medical Resident/Fellow | 10, Student | 11, Community Organization | 12, Community Member | 13, Other",,,,,,,y,,,,,
affiliation,community_based_research_request_for_consult,,radio,Please check your primary affiliation:,"1, Cleveland Clinic (CCF) | 2, Cleveland State University (CSU) | 3, Case Western Reserve University (CWRU) | 4, MetroHealth Medical Center (MHMC) | 5, University Hospitals (UH) | 6, Louis Stokes Veterans Administration (VA) Medical Center | 7, Community organization | 8, Other",,,,,y,,y,,,,,
commun_organization,community_based_research_request_for_consult,,text,Please provide the name of your community organization.,,,,,,y,[affiliation] = '7',y,,,,,
other_organization,community_based_research_request_for_consult,,text,Please provide your other affiliation.,,,,,,y,[affiliation] = '8',y,,,,,
learn_about_us,community_based_research_request_for_consult,,checkbox,"How did you learn about our consult service?
(Check all that apply)","1, Institutional Review Board (IRB) application | 2, Center for Reducing Health Disparities (CRHD) website | 3, Clinical & Translational Science Collaborative (CTSC) website | 4, CTSC Concierge service | 5, Word-of-mouth | 6, Newsletter | 7, Presentation | 8, Other | 9, Contacted directly by the CRHD | 10, Partner or affiliated with CRHD | 11, Former client/Prior use of the CRHD",check all that apply,,,,,,y,,,,,
which_irb,community_based_research_request_for_consult,,radio,From which institutional IRB did you learn about us?,"1, MetroHealth Medical Center IRB | 2, University Hospitals IRB | 3, Cleveland Clinic IRB | 4, Case Western Reserve University IRB",,,,,,[learn_about_us(1)] = '1',y,,,,,
which_newsletter,community_based_research_request_for_consult,,text,In which newsletter did you learn about us?,,,,,,,[learn_about_us(6)] = '1',,,,,,
which_presentation,community_based_research_request_for_consult,,text,In which presentation did you learn about us?,,,,,,,[learn_about_us(7)] = '1',,,,,,
which_other_source,community_based_research_request_for_consult,,text,From which other source did you learn about us?,,,,,,,[learn_about_us(8)] = '1',,,,,,
research_question,community_based_research_request_for_consult,,notes,What is your research question/objective?,,,,,,,[affiliation] = '1' or [affiliation] = '2' or [affiliation] = '3' or [affiliation] = '4' or [affiliation] = '5' or [affiliation] = '6',y,,,,,
goal_objective,community_based_research_request_for_consult,,notes,Please provide a brief description of your goal or objective.,,,,,,,[affiliation] = '7' or [affiliation] = '8',y,,,,,
purpose_of_consult,community_based_research_request_for_consult,,checkbox,"The purpose of your consult is to gain assistance with:
(Please check all that apply)","1, Research Project Development or Design | 2, IRB Application Process: completing and submitting an Institutional Review Board (IRB) application. | 3, Grants Assistance and/or Funding: writing grant applications and locating grant funding sources. | 4, Survey Development and Refinement: developing/refining data collection tools. | 5, Needs Assessments: help with determining if your organization is meeting the needs of the population being served. | 6, Data Collection: collecting data, data input/analysis, report writing, database development. | 7, Program Evaluation: assessing the progression in achieving your program's established goals/objectives. | 8, Best Practices: helping your organization identify and adopt best practices. | 9, Dissemination of Findings: spreading research findings to the community. | 10, Spanish Translation: Spanish/English translation of study materials (i.e. study flyers, consent forms, questionnaires, etc.) | 12, Focus Groups | 13, Recruitment Strategies | 11, Other",check all that apply,,,,,,,LV,,,,
other_assistance,community_based_research_request_for_consult,,notes,Other assistance - please describe:,,,,,,,[purpose_of_consult(11)] = '1',y,,,,,
file_attach,community_based_research_request_for_consult,,radio,"In preparation for your consult meeting, please provide a brief description of your research project in narrative/text format.
How would you like to provide the description?
","1, Type it in a text box | 2, Attach a document",,,,,,,y,LV,,,,
brief_descrotion,community_based_research_request_for_consult,,notes,Please provide a brief description of your research project.,,,,,,,[file_attach] = '1',y,,,,,
attach_a_file,community_based_research_request_for_consult,,file,"Please attach a brief description of your research project by clicking on the ""Upload document"" button to the right.",,,,,,,[file_attach] = '2',y,,,,,
additional_information,community_based_research_request_for_consult,,notes,Is there any additional information that you would like to provide to help us assist you?,,,,,,,,,,,,,
date_contact,stages_of_engagement_data_entry_form,"STAGE 1: Initial Contact
Definition: Request for Consult Form is sent prior to the consult meeting.
",text,"Stage1: Date of initial contact with client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization]:",,,date_mdy,,,,,y,,,,,
crhd_contact,stages_of_engagement_data_entry_form,,text,Contact person at CRHD,,CRHD personnel,,,,,,y,,,,,
addit_interact_dates,stages_of_engagement_data_entry_form,,notes,"Additional interactions with client prior to consult meeting.
Format:
Date (M-D-Y), name of contact, notes.",,"Use format: Date (M-D-Y), name of contact, notes.",,,,,,,,,,,
addit_contacts_names,stages_of_engagement_data_entry_form,,notes,Additional client contact persons and contact information.,,,,,,,,,,,,,
date_consult_mtg,stages_of_engagement_data_entry_form,"STAGE 2: Consult Meeting
- Includes discussing project and specific needs of the individual or organization.
- Meeting summary and recommended next steps are provided.",text,"Stage 2: Date of consult meeting with client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization]:",,,date_mdy,,,,,y,,,,,
summary_sent,stages_of_engagement_data_entry_form,,text,Date that meeting summary was sent.,,,date_mdy,,,,,,,,,,
mtg_summary,stages_of_engagement_data_entry_form,,file,"Consult meeting summary.
(Upload document)",,,,,,,,,,,,,
follow_up_consult,stages_of_engagement_data_entry_form,,radio,Was there a follow-up consult meeting?,"1, Yes | 2, No",,,,,,,,,,,,
mtg_summary_2,stages_of_engagement_data_entry_form,,file,"Second consult meeting summary.
(Upload document)",,,,,,,[follow_up_consult] = '1',,,,,,
date_service_id,stages_of_engagement_data_entry_form,"STAGE 3: Follow Up
- Specific service need identified.
- Information provided to individual or organization (sample forms, articles, contact information, etc.).
",text,"Stage 3: Date that project was identified with client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization]:",,,date_mdy,,,,,y,,,,,
project_title,stages_of_engagement_data_entry_form,,text,Title of Project,,,,,,,,,,,,,
consult_services,stages_of_engagement_data_entry_form,,notes,"Consult service(s) to be provided:
(Copy & paste services below into text box - one per line)
(NOTE: this is for piping the services delivered to the Long Term Follow-Up Survey)
1, Research Project Development or Design
2, IRB Application Process: completing and submitting an Institutional Review Board (IRB) application.
3, Grants Assistance and/or Funding: writing grant applications and locating grant funding sources.
4, Survey Development and Refinement: developing/refining data collection tools.
5, Needs Assessments: help with determining if your organization is meeting the needs of the population being served.
6, Data Collection: collecting data, data input/analysis, report writing, database development.
7, Program Evaluation: assessing the progression in achieving your program's established goals/objectives.
8, Best Practices: helping your organization identify and adopt best practices.
9, Dissemination of Findings: spreading research findings to the community.
10, Spanish Translation: Spanish/English translation of study materials (i.e. study flyers, consent forms, questionnaires)
11, Focus Groups
12, Recruitment strategies
13, Other (please specify)
14, Letter of Support
15,Steering/Advisory Committee",,check all that apply,,,,,,,LV,,,,
consult_services_tally,stages_of_engagement_data_entry_form,,checkbox,"Which consult services were provided?
(NOTE: This is a repeat question that allows CRHD to gather data on the number of each type of service provided. Just click the choices that were entered in the text box above.)","1, Research Project Development/Design | 2, IRB Application Process | 3, Grants Assistance and/or Funding | 4, Survey Development and Refinement | 5, Needs Assessments | 6, Data Collection | 7, Program Evaluation | 8, Best Practices | 9, Dissemination of Findings | 10, Spanish Translation | 11, Focus groups | 12, Participant recruitment | 13, Other | 14, Letter of Support | 15, Steering/Advisory Committee",,,,,,,y,LV,,,,
consult_other,stages_of_engagement_data_entry_form,,notes,Other consult service (please specify).,,,,,,,,,,,,,
information_provided,stages_of_engagement_data_entry_form,,file,"Information provided to individual or organization (sample forms, articles, contact information, etc.).",,upload any info provided as one document,,,,,,,,,,,
network_referral,stages_of_engagement_data_entry_form,,radio,"Suggested Network Referrals
Was this client provided with referrals to contact additional persons or organizations?","1, Yes | 2, No",,,,,,,,,,,,
referrals,stages_of_engagement_data_entry_form,,notes,"Please enter each referral full name and their organization on a separate line.
*Mark confirmed network connections with an *.
Example:
Referral #1 First & Last Name, Organization
Referral #2 First & Last Name, Organization
Referral #3 First & Last Name, Organization
etc.",,"First & Last Name, Organization",,,,,[network_referral] = '1',,,,,,
date_plan,stages_of_engagement_data_entry_form,"STAGE 4: Planning
- Necessary courses of action to complete project tasks are identified.",text,"Stage 4: Date of project plan, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,,,,,,,
plan_description,stages_of_engagement_data_entry_form,,notes,Brief description of plan.,,,,,,,,,,,,,
plan_upload,stages_of_engagement_data_entry_form,,file,Plan for course of action:,,,,,,,,,,,,,
stg4_date_plan2,stages_of_engagement_data_entry_form,,text,"Date of project plan, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,"[date_plan] <> """"",,,,,,
stg4_plan_description2,stages_of_engagement_data_entry_form,,notes,Brief description of plan.,,,,,,,"[date_plan] <> """" and [plan_description] <> """"",,,,,,
stg4_plan_upload2,stages_of_engagement_data_entry_form,,file,Plan for course of action:,,,,,,,"[date_plan] <> """" and [plan_description] <> """" and [plan_upload] <> """"",,,,,,
date_implement,stages_of_engagement_data_entry_form,"STAGE 5: Implementation
-Implementation of project tasks.",text,"Stage 5a: Date of project implementation, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,,,,,,,
project_implement,stages_of_engagement_data_entry_form,,notes,Briefly describe the implementation of the project.,,,,,,,,,,,,,
upload_file_implement,stages_of_engagement_data_entry_form,,file,Upload a document containing details of the implementation process (optional).,,,,,,,,,,,,,
date_implement2,stages_of_engagement_data_entry_form,,text,"Stage 5b: Date of project implementation, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,"[date_implement] <> """"",,,,,,
project_implement2,stages_of_engagement_data_entry_form,,notes,Briefly describe the implementation of the project.,,,,,,,"[date_implement] <> """" and [project_implement] <> """"",,,,,,
upload_file_implement2,stages_of_engagement_data_entry_form,,file,Upload a document containing details of the implementation process (optional).,,,,,,,"[date_implement] <> """" and [project_implement] <> """"",,,,,,
date_implement3,stages_of_engagement_data_entry_form,,text,"Stage 5c: Date of project implementation, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,"[date_implement2] <> """" and [project_implement2] <> """"",,,,,,
project_implement3,stages_of_engagement_data_entry_form,,notes,Briefly describe the implementation of the project.,,,,,,,"[date_implement2] <> """" and [project_implement2] <> """"",,,,,,
upload_file_implement3,stages_of_engagement_data_entry_form,,file,Upload a document containing details of the implementation process (optional).,,,,,,,"[date_implement2] <> """" and [project_implement2] <> """"",,,,,,
date_completion,stages_of_engagement_data_entry_form,"STAGE 6: Completion & Outcomes
-Date of project completion
-Description of outcomes
-Outcome documents (if applicable)",text,"Stage 6: Date of project completion, for client, [first_name] [last_name], [affiliation], [commun_organization], [other_organization], [project_title]:",,,date_mdy,,,,,,,,,,
project_outcome,stages_of_engagement_data_entry_form,,notes,Briefly describe the outcome of the project.,,,,,,,,,,,,,
upload_file,stages_of_engagement_data_entry_form,,file,Upload a document containing details of the outcome (optional).,,,,,,,,,,,,,
project_terminate_yn,stages_of_engagement_data_entry_form,,yesno,"Did project terminate prematurely?
(i.e. project did not reach stage 6)",,,,,,,,,,,,,
last_completed_stage,stages_of_engagement_data_entry_form,,dropdown,After which [completed] stage did the project terminate?,"1, Stage 1 | 2, Stage 2 | 3, Stage 3 | 4, Stage 4 | 5, Stage 5",,,,,,[project_terminate_yn] = '1',y,,,,,
terminate_reasons,stages_of_engagement_data_entry_form,,checkbox,Reason for termination of project:,"1, Client lost to follow-up | 2, Lack of time | 3, Lack of resources (personnel, funding) | 4, Change of project direction | 5, Consult pre-dates Redcap tracking system | 6, Survey sent and not returned | 7, Other",,,,,,[project_terminate_yn] = '1',y,,,,,
terminate_reason_other,stages_of_engagement_data_entry_form,,notes,Other reason for termination of project:,,,,,,,[terminate_reasons(7)] = '1',y,,,,,
location_convenient,immediate_postconsult_meeting_satisfaction_survey,"Consultation Meeting Satisfaction
Please rate the quality of our meeting with the following variables:",radio,The meeting location was convenient.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
time_convenient,immediate_postconsult_meeting_satisfaction_survey,,radio,The meeting time was convenient.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
responsive_team,immediate_postconsult_meeting_satisfaction_survey,,radio,Consultation team addressed all questions and concerns.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
action_items_clear,immediate_postconsult_meeting_satisfaction_survey,,radio,Action items were clearly stated.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
courteous,immediate_postconsult_meeting_satisfaction_survey,,radio,The consultation team was courteous and professional.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
summary_timely,immediate_postconsult_meeting_satisfaction_survey,,radio,Meeting summary was sent in a timely manner.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,consult_meeting,,
goals_changed,immediate_postconsult_meeting_satisfaction_survey,,radio,Have your project goals changed following the consultation meeting?,"1, Yes | 2, No",,,,,,,y,,,,,
explain_goal_change,immediate_postconsult_meeting_satisfaction_survey,,notes,Please explain how your goals have changed:,,,,,,,[goals_changed] = '1',y,,,,,
summary_helpful,immediate_postconsult_meeting_satisfaction_survey,,radio,How helpful was the meeting summary?,"1, Not at all helpful (1) | 2, Somewhat helpful (2) | 3, Neutral (3) | 4, Helpful (4) | 5, Very Helpful (5)",,,,,,,y,,,helpfulness,,
overall_helpful,immediate_postconsult_meeting_satisfaction_survey,,radio,"Overall, how helpful was the consultation meeting to you?","1, Not at all helpful (1) | 2, Somewhat helpful (2) | 3, Neutral (3) | 4, Helpful (4) | 5, Very Helpful (5)",,,,,,,,,,helpfulness,,
likely_recommend,immediate_postconsult_meeting_satisfaction_survey,,radio,How likely are you to recommend this service to someone else?,"1, Extremely unlikely (1) | 2, Unlikely (2) | 3, Neutral (3) | 4, Likely (4) | 5, Extremely likely (5)",,,,,,,,,,recommend,,
comments,immediate_postconsult_meeting_satisfaction_survey,,notes,Please list any additional comments or suggestions you have regarding our consultation meeting.,,,,,,,,,,,,,
form_date,immediate_postconsult_meeting_satisfaction_survey,,text,Please enter the date you completed this form.,,,date_mdy,,,,,y,,,,,
which_consult_serv,longterm_follow_up_post_consultation,"The following questions refer to your project entitled:
""[project_title]""
The originally identified services to be provided were as follows:
[consult_services]
Your plans may have changed or you may have received different services, so please identify or confirm below the services that you actually received. ",checkbox,"Which consult service(s) did you receive?
(Please check all that apply)","1, Research Project Development or Design | 2, IRB Application Process: completing and submitting an Institutional Review Board (IRB) application. | 3, Grants Assistance and/or Funding: writing grant applications and locating grant funding sources. | 4, Survey Development and Refinement: developing/refining data collection tools. | 5, Needs Assessments: help with determining if your organization is meeting the needs of the population being served. | 6, Data Collection: collecting data, data input/analysis, report writing, database development. | 7, Program Evaluation: assessing the progression in achieving your program's established goals/objectives. | 8, Best Practices: helping your organization identify and adopt best practices. | 9, Dissemination of Findings: spreading research findings to the community. | 10, Spanish Translation: Spanish/English translation of study materials (i.e. study flyers, consent forms, questionnaires, etc.) | 11, Focus groups | 12, Participant recruitment | 13, Other | 14, Letter of Support | 15, Steering/Advisory Committee",check all that apply,,,,,,,LV,,,,
other_service,longterm_follow_up_post_consultation,,text,What other consult service did you receive?,,,,,,,[which_consult_serv(13)] = '1',y,,,,,
referral_benefit,longterm_follow_up_post_consultation,,notes,"Network Referrals:
The consult service provided names of people or organizations as potential referrals to help with your project. Were any of the following referrals successful?
Referrals:[referrals]
If yes, for each referral, please briefly describe how your project benefitted.
",,"If yes, please briefly describe how your project benefitted.",,,,,"[referrals] <> """"",,,,,,
other_outcomes,longterm_follow_up_post_consultation,,notes,What have been the overall outcomes of this service?,,,,,,,[which_consult_serv(13)] = '1',y,,,,,
helpful_how_other,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your objectives?",,,,,,,[which_consult_serv(13)] = '1',,,,,,
pd_move_forwrd,longterm_follow_up_post_consultation,"Research Project Development or Design
",yesno,"After your initial consult meeting, did your project move forward?",,,,,,,[which_consult_serv(1)] = '1',y,,,,,
pd_status,longterm_follow_up_post_consultation,,radio,What is the current status of your project?,"1, Project completed | 2, Currently in progress | 3, Currently not working on it | 4, Currently inactive or on hold | 5, Other",check all that apply,,,,,[which_consult_serv(1)] = '1',y,,,,,
pd_status_other_explain,longterm_follow_up_post_consultation,,notes,Other project status - Please explain:,,,,,,,[which_consult_serv(1)] = '1' and [pd_status] = '5',y,,,,,
pd_date_complete,longterm_follow_up_post_consultation,,text,"When was your project, [project_title], completed?",,Approximate completion date,date_mdy,,,,[which_consult_serv(1)] = '1' and [pd_status] = '1',,,,,,
reasons_not_forwrd,longterm_follow_up_post_consultation,,checkbox,"What are the reasons that your project did not move forward?
(Check all that apply)","1, Project no longer of interest | 2, Lack of funding | 10, Lack of time | 3, Lack of personnel | 4, Need additional assistance with design | 5, Need additional assistance with implementation | 6, IRB problems or delays | 7, Data collection problems | 8, Data analysis problems | 9, Other",check all that apply,,,,,[which_consult_serv(1)] = '1' and [pd_move_forwrd] = '0',y,,,,,
other_reason,longterm_follow_up_post_consultation,,notes,Other reason your study did not move forward - Please briefly explain:,,,,,,,[reasons_not_forwrd(9)] = '1' and [which_consult_serv(1)] = '1',y,,,,,
provide_what,longterm_follow_up_post_consultation,,notes,"Is there something that we could do/provide to help it move forward? (Briefly, please explain)",,,,,,,[pd_move_forwrd] = '0' and [which_consult_serv(1)] = '1',y,,,,,
helpful_how,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your research project development objectives?",,,,,,,[which_consult_serv(1)] = '1',,,,,,
irb_submitted,longterm_follow_up_post_consultation,"IRB Application Process
The following questions refer to your project entitled:
[project_title]",radio,Which institution did you submit your IRB application to?,"1, MetroHealth Medical Center | 2, University Hospitals | 3, Cleveland Clinic | 4, Case Western Reserve University | 5, Other",,,,,,[which_consult_serv(2)] = '1',y,,,,,
irb_submitted_other,longterm_follow_up_post_consultation,,text,Other IRB institution - please provide name of institution:,,,,,,,[irb_submitted] = '5' and [which_consult_serv(2)] = '1',y,,,,,
irb_approval,longterm_follow_up_post_consultation,,yesno,Did your application receive IRB approval?,,,,,,,[which_consult_serv(2)] = '1',y,,,,,
date_irb_approval,longterm_follow_up_post_consultation,,text,"What date did your project, [project_title], receive IRB approval?",,IRB approval date,date_mdy,,,,[which_consult_serv(2)] = '1' and [irb_approval] = '1',y,,,,,
irb_project_status,longterm_follow_up_post_consultation,,radio,What is the current status of your project?,"1, Project completed | 2, Currently in progress | 3, Currently not working on it | 4, Currently inactive or on hold | 5, Other",check all that apply,,,,,[which_consult_serv(2)] = '1',y,,,,,
irb_status_other,longterm_follow_up_post_consultation,,notes,Other project status - Please explain:,,,,,,,[which_consult_serv(2)] = '1' and [irb_project_status] = '5',y,,,,,
irb_no_reason,longterm_follow_up_post_consultation,,notes,Please let us know why your application was not approved.,,,,,,,[which_consult_serv(2)] = '1' and [irb_approval] = '0',,,,,,
helpful_how_irb,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your IRB application objectives?",,,,,,,[which_consult_serv(2)] = '1',,,,,,
grant_app_title_y_n,longterm_follow_up_post_consultation,"Grants Assistance and Funding
The following questions refer to your project titled:
[project_title].",yesno,Was the title of your grant application different than your project title?,,,,,,,[which_consult_serv(3)] = '1',y,,,,,
grant_applic_title,longterm_follow_up_post_consultation,,notes,Please provide your grant title:,,Grant title,,,,,[which_consult_serv(3)] = '1' and [grant_app_title_y_n] = '1',y,,,,,
funding_agency,longterm_follow_up_post_consultation,,checkbox,"Which grant funding agency did you apply to?
(Check all that apply)","1, NIH | 2, CTSC annual pilot funding | 3, CTSC core utilization pilot funding | 4, CTSC themed pilot grants | 5, Practice-Based Research Network (PBRN) micro pilot grant funding | 6, Other",Check all that apply,,,,,[which_consult_serv(3)] = '1',y,,,,,
other_grant,longterm_follow_up_post_consultation,,text,"Which other funding agency did you apply to?
",,,,,,,[funding_agency(6)] = '1',y,,,,,
grant_status,longterm_follow_up_post_consultation,,radio,What is the current status of your grant application?,"1, Funded | 2, In submission | 3, Not Submitted | 4, Other",,,,,,[which_consult_serv(3)] = '1',y,,,,,
grant_other_explain,longterm_follow_up_post_consultation,,notes,Other status of grant application - please explain:,,,,,,,[grant_status] = '4' and [which_consult_serv(3)] = '1',y,,,,,
grant_amount,longterm_follow_up_post_consultation,,text,What was the dollar amount of the funded grant?,,,number,,,,[grant_status] = '1' and [which_consult_serv(3)] = '1',y,,,,,
helpful_how_grants,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your grants assistance objectives?",,,,,,,[which_consult_serv(3)] = '1',,,,,,
survey_title_y_n,longterm_follow_up_post_consultation,"Survey Development and Refinement
The following questions refer to the project titled:
[project_title]",yesno,Was the name/title of your survey different than your project title?,,,,,,,[which_consult_serv(4)] = '1',y,,,,,
survey_name,longterm_follow_up_post_consultation,,notes,What was the name/title of the survey?,,,,,,,[which_consult_serv(4)] = '1' and [survey_title_y_n] = '1',y,,,,,
survey_target_pop,longterm_follow_up_post_consultation,,checkbox,"Who was the target population?
(Check all that apply)","1, General Public | 2, Specific Race/Ethnicity | 3, Specific Gender | 4, Specific Age | 5, Specific Sexual Orientation",Check all that apply,,,,,[which_consult_serv(4)] = '1',y,,,,,
survey_target_race_ethnic,longterm_follow_up_post_consultation,,checkbox,"Which race/ethnicity was the target population?
(Check all that apply)","1, American Indian or Alaskan Native | 2, Asian | 3, Black or African American | 4, Native Hawaiian or Other Pacific Islander | 5, White | 6, Hispanic or Latino | 7, Not Hispanic or Latino",Check all that apply,,,,,[survey_target_pop(2)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_target_gender,longterm_follow_up_post_consultation,,checkbox,"Which gender was the target population?
(Check all that apply)","8, Male | 9, Female | 10, Transgender",Check all that apply,,,,,[survey_target_pop(3)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_target_age,longterm_follow_up_post_consultation,,checkbox,"Which age group was the target population?
(Check all that apply)","11, Under 18 | 12, 19-29 | 13, 30-49 | 14, 50-64 | 15, 65 and older",Check all that apply,,,,,[survey_target_pop(4)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_specific_sex,longterm_follow_up_post_consultation,,checkbox,"Which specific sexual orientation?
(Check all that apply)","1, Lesbian | 2, Gay | 3, Bisexual",Check all that apply,,,,,[which_consult_serv(4)] = '1' and [survey_target_pop(5)] = '1',y,,,,,
survey_topic,longterm_follow_up_post_consultation,,checkbox,"What was your survey topic?
(Check all that apply) ","1, No specific health condition | 2, Health and wellness | 3, Heart conditions | 4, Diabetes | 5, Obesity | 6, Alzheimer/dementia | 7, Neurological conditions | 8, Cancer | 9, Mental health | 10, Asthma | 11, Nutrition/Physical activity | 12, Infectious Disease | 13, Alcohol or other drug use | 14, Physical or mental disability | 15, Gender identity or sexual orientation | 16, Environmental issues | 18, Child Health | 17, Other",Check all that apply,,,,,[which_consult_serv(4)] = '1',y,,,,,
survey_topic_other,longterm_follow_up_post_consultation,,text,Other survey topic - please provide:,,,,,,,[survey_topic(17)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_admin,longterm_follow_up_post_consultation,,yesno,Did you successfully administer the survey to the target population?,,,,,,,[which_consult_serv(4)] = '1',y,,,,,
survey_why_not,longterm_follow_up_post_consultation,,checkbox,"Why was the survey not administered?
(check all that apply)","1, Project no longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance with design | 6, Need additional assistance with implementation | 7, IRB problems or delays | 8, Other",Check all that apply,,,,,[which_consult_serv(4)] = '1' and [survey_admin] = '0',y,,,,,
survey_not_reason,longterm_follow_up_post_consultation,,notes,Other reason survey was not administered - please explain:,,,,,,,[survey_why_not(8)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_method,longterm_follow_up_post_consultation,,checkbox,"How was the survey administered?
(check all that apply)","1, Web-based | 2, Mail | 3, Telephone | 4, In person, completed by subject | 5, In person, completed by interviewer",Check all that apply,,,,,[survey_admin] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_numbers,longterm_follow_up_post_consultation,,radio,"Approximately, how many people completed the survey? ","1, 0-25 | 2, 26-50 | 8, 51-100 | 9, 101-500 | 10, 501-1000 | 11, over 1000",Range: approximate number of people,,,,,[survey_admin] = '1' and [which_consult_serv(4)] = '1',y,,,,,
project_outcomes,longterm_follow_up_post_consultation,,checkbox,"Did your survey project have any of the following outcomes?
(Check all that apply)","1, Developed a new project or program | 2, Developed a class/course | 3, Submitted a grant application | 4, Expanded an existing project or program | 5, Did a quality improvement (QI) project | 6, Other",,,,,,[survey_admin] = '1' and [which_consult_serv(4)] = '1',y,,,,,
program_developed,longterm_follow_up_post_consultation,,notes,What new program did you develop?,,,,,,,[project_outcomes(1)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
program_outlook,longterm_follow_up_post_consultation,,radio,What is the future outlook for the new program?,"1, Program is sustained long-term | 2, Program was one-time only | 3, Program is being expanded | 4, Program needs additional help/resources to become sustaining",,,,,,[project_outcomes(1)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
program_outlook_expand,longterm_follow_up_post_consultation,,radio,What is the future outlook for the expanded program?,"1, Program is sustained long-term | 2, Program was one-time only | 3, Program is being expanded even further | 4, Program needs additional help/resources to become sustaining",,,,,,[project_outcomes(4)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
program_who_benefit,longterm_follow_up_post_consultation,,notes,Please describe who will benefit from this program:,,,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(1)] = '1' and [program_outlook] = '1' or [program_outlook] = '2' or [program_outlook] = '3' or [program_outlook_expand] = '1' or [program_outlook_expand] = '2' or [program_outlook_expand] = '3',y,,,,,
help_addit_sustain,longterm_follow_up_post_consultation,,notes,What additional help/resources could we provide to help your program be sustaining?,,,,,,,[program_outlook] = '4' or [program_outlook_expand] = '4' and [which_consult_serv(4)] = '1',y,,,,,
course_developed,longterm_follow_up_post_consultation,,notes,What class/course did you develop?,,,,,,,[project_outcomes(2)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
qi_program,longterm_follow_up_post_consultation,,notes,What quality improvement (QI) project did you perform?,,,,,,,[project_outcomes(5)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
qi_completed,longterm_follow_up_post_consultation,,yesno,Was your quality improvement (QI) project completed?,,,,,,,[project_outcomes(5)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
qi_impact,longterm_follow_up_post_consultation,,yesno,Has your QI project had an impact on quality?,,,,,,,[qi_completed] = '1' and [which_consult_serv(4)] = '1',y,,,,,
qi_impact_yes,longterm_follow_up_post_consultation,,notes,"Briefly, please describe how your QI project had an impact on quality:",,,,,,,[qi_impact] = '1' and [which_consult_serv(4)] = '1',y,,,,,
qi_addit_help,longterm_follow_up_post_consultation,,notes,"What additional help could we provide to assist your QI project? (Briefly, please describe)",,,,,,,[qi_completed] = '0' or [qi_impact] = '0' and [which_consult_serv(4)] = '1',y,,,,,
survey_data_used_other,longterm_follow_up_post_consultation,,notes,Other outcome has resulted - Briefly explain how the survey data was used:,,,,,,,[project_outcomes(6)] = '1' and [which_consult_serv(4)] = '1',y,,,,,
survey_grant_app_title,longterm_follow_up_post_consultation,,yesno,Was the title of your grant application different than your survey title?,,,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1',y,,,,,
grant_applic_title2_248,longterm_follow_up_post_consultation,,notes,Please provide your grant title:,,Grant title,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1' and [survey_grant_app_title] = '1',y,,,,,
sur_funding_agency,longterm_follow_up_post_consultation,,checkbox,"Which grant funding agency did you apply to?
(Check all that apply)","1, NIH | 2, CTSC annual pilot funding | 3, CTSC core utilization pilot funding | 4, CTSC themed pilot grants | 5, Practice-Based Research Network (PBRN) micro pilot grant funding | 6, Other",Check all that apply,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1',y,,,,,
sur_other_grant,longterm_follow_up_post_consultation,,text,"Which other funding agency did you apply to?
",,,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1' and [sur_funding_agency] = '6',y,,,,,
sur_grant_status,longterm_follow_up_post_consultation,,radio,What is the current status of your grant application?,"1, Funded | 2, In submission | 3, Not Submitted | 4, Other",,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1',y,,,,,
grant_other_explain2_1bc,longterm_follow_up_post_consultation,,notes,Other status of grant application - please explain:,,,,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1' and [sur_grant_status] = '4',y,,,,,
grant_amount2_5dc,longterm_follow_up_post_consultation,,text,What was the dollar amount of the funded grant?,,,number,,,,[which_consult_serv(4)] = '1' and [project_outcomes(3)] = '1' and [sur_grant_status] = '1',y,,,,,
helpful_how_survey,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your survey development objectives?",,,,,,,[which_consult_serv(4)] = '1',,,,,,
na_purpose,longterm_follow_up_post_consultation,Needs Assessment,notes,What was the purpose of the needs assessment?,,,,,,,[which_consult_serv(5)] = '1',y,,,,,
na_topic,longterm_follow_up_post_consultation,,checkbox,"What was your needs assessment topic?
(Check all that apply) ","1, No specific health condition | 2, Health and wellness | 3, Heart conditions | 4, Diabetes | 5, Obesity | 6, Alzheimer/dementia | 7, Neurological conditions | 8, Cancer | 9, Mental health | 10, Asthma | 11, Nutrition/Physical activity | 12, Infectious Disease | 13, Alcohol or other drug use | 14, Physical or mental disability | 15, Gender identity or sexual orientation | 16, Environmental issues | 18, Child Health | 17, Other",Check all that apply,,,,,[which_consult_serv(5)] = '1',y,,,,,
na_topic_other,longterm_follow_up_post_consultation,,text,What was your other needs assessment topic?,,,,,,,[which_consult_serv(5)] = '1' and [na_topic(17)] = '1',y,,,,,
target_pop_na,longterm_follow_up_post_consultation,,checkbox,"Who was the target population?
(Check all that apply)","1, General Public | 2, Specific Race/Ethnicity | 3, Specific Gender | 4, Specific Age | 5, Specific Sexual Orientation",Check all that apply,,,,,[which_consult_serv(5)] = '1',y,,,,,
target_race_ethnic_na,longterm_follow_up_post_consultation,,checkbox,"Which race/ethnicity was the target population?
(Check all that apply)","1, American Indian or Alaskan Native | 2, Asian | 3, Black or African American | 4, Native Hawaiian or Other Pacific Islander | 5, White | 6, Hispanic or Latino | 7, Not Hispanic or Latino",Check all that apply,,,,,[target_pop_na(2)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
target_gender_na,longterm_follow_up_post_consultation,,checkbox,"Which gender was the target population?
(Check all that apply)","8, Male | 9, Female | 10, Transgender",Check all that apply,,,,,[target_pop_na(3)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
target_age_na,longterm_follow_up_post_consultation,,checkbox,"Which age group was the target population?
(Check all that apply)","11, Under 18 | 12, 19-29 | 13, 30-49 | 14, 50-64 | 15, 65 and older",Check all that apply,,,,,[target_pop_na(4)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
na_specific_sex,longterm_follow_up_post_consultation,,radio,"Which specific sexual orientation?
(Check all that apply)","1, Lesbian | 2, Gay | 3, Bisexual",check all that apply,,,,,[which_consult_serv(5)] = '1' and [target_pop_na(5)] = '1',y,,,,,
na_admin,longterm_follow_up_post_consultation,,yesno,Did you successfully administer the needs assessment?,,,,,,,[which_consult_serv(5)] = '1',y,,,,,
na_why_not,longterm_follow_up_post_consultation,,checkbox,"Why was the needs assessment not administered?
(check all that apply)","1, Project no longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance with design | 6, Need additional assistance with implementation | 7, IRB problems or delays | 8, Other",Check all that apply,,,,,[na_admin] = '0' and [which_consult_serv(5)] = '1',y,,,,,
na_why_not_other,longterm_follow_up_post_consultation,,notes,What other reason was the needs assessment not administered?,,,,,,,[na_why_not(8)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
na_numbers,longterm_follow_up_post_consultation,,radio,"Approximately, how many people completed the needs assessment? ","1, 0-25 | 2, 26-50 | 8, 51-100 | 9, 101-500 | 10, 501-1000 | 11, over 1000",Range: approximate number of people,,,,,[na_admin] = '1' and [which_consult_serv(5)] = '1',y,,,,,
na_data_used,longterm_follow_up_post_consultation,,notes,How was the needs assessment data used?,,,,,,,[na_admin] = '1' and [which_consult_serv(5)] = '1',y,,,,,
na_project_outcomes,longterm_follow_up_post_consultation,,checkbox,"Did your needs assessment project have any of the following outcomes?
(Check all that apply)","1, Developed a new project or program | 2, Developed a class/course | 3, Submitted a grant application | 4, Expanded an existing project or program | 5, Did a quality improvement (QI) project | 6, Other",,,,,,[na_admin] = '1' and [which_consult_serv(5)] = '1',y,,,,,
program_devel_na,longterm_follow_up_post_consultation,,notes,What new program did you develop?,,,,,,,[na_project_outcomes(1)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
program_outlook_na,longterm_follow_up_post_consultation,,radio,What is the future outlook for the new program?,"1, Program is sustained long-term | 2, Program was one-time only | 3, Program is being expanded | 4, Program needs additional help/resources to become sustaining",,,,,,[na_project_outcomes(1)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
program_expd_na,longterm_follow_up_post_consultation,,radio,What is the future outlook for the expanded program?,"1, Program is sustained long-term | 2, Program was one-time only | 3, Program is being expanded even further | 4, Program needs additional help/resources to become sustaining",,,,,,[na_project_outcomes(4)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
help_addit_sust_na,longterm_follow_up_post_consultation,,notes,What additional help/resources could we provide to help your program be sustaining?,,,,,,,[which_consult_serv(5)] = '1' and [program_expd_na] = '4' or [program_outlook_na] = '4',y,,,,,
program_who_benefit_na,longterm_follow_up_post_consultation,,notes,Please describe who will benefit from this program:,,,,,,,"[which_consult_serv(5)] = '1' and [program_outlook_na] = ""1"" or [program_outlook_na] = ""2"" or [program_outlook_na] = ""3"" or [program_expd_na] = ""1"" or [program_expd_na] = ""2"" or [program_expd_na] = ""3""",y,,,,,
course_developed_na,longterm_follow_up_post_consultation,,notes,What class/course did you develop?,,,,,,,[na_project_outcomes(2)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
qi_program_na,longterm_follow_up_post_consultation,,notes,What quality improvement (QI) project did you perform?,,,,,,,[na_project_outcomes(5)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
qi_completed_na,longterm_follow_up_post_consultation,,yesno,Was your quality improvement (QI) project completed?,,,,,,,[na_project_outcomes(5)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
qi_impact_na,longterm_follow_up_post_consultation,,yesno,Has your QI project had an impact on quality?,,,,,,,[qi_completed_na] = '1' and [which_consult_serv(5)] = '1',y,,,,,
qi_impact_yes_na,longterm_follow_up_post_consultation,,notes,"Briefly, please describe how your QI project had an impact on quality:",,,,,,,[qi_impact_na] = '1' and [which_consult_serv(5)] = '1',y,,,,,
qi_addit_help_na,longterm_follow_up_post_consultation,,notes,"What additional help could we provide to assist your QI project? (Briefly, please describe)",,,,,,,[qi_completed_na] = '0' or [qi_impact] = '0' and [which_consult_serv(5)] = '1',y,,,,,
other_outc_result_na,longterm_follow_up_post_consultation,,notes,Other outcome has resulted - please describe:,,,,,,,[na_project_outcomes(6)] = '1' and [which_consult_serv(5)] = '1',y,,,,,
grant_app_title_yn_na,longterm_follow_up_post_consultation,,yesno,Was the title of your grant application different than your needs assessment title?,,,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1',y,,,,,
grant_applic_title_na,longterm_follow_up_post_consultation,,notes,Please provide your grant title:,,Grant title,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1' and [grant_app_title_yn_na] = '1',y,,,,,
funding_agency_na,longterm_follow_up_post_consultation,,checkbox,"Which grant funding agency did you apply to?
(Check all that apply)","1, NIH | 2, CTSC annual pilot funding | 3, CTSC core utilization pilot funding | 4, CTSC themed pilot grants | 5, Practice-Based Research Network (PBRN) micro pilot grant funding | 6, Other",Check all that apply,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1',y,,,,,
other_grant_na,longterm_follow_up_post_consultation,,text,"Which other funding agency did you apply to?
",,,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1' and [funding_agency_na] = '6',y,,,,,
grant_status_na,longterm_follow_up_post_consultation,,radio,What is the current status of your grant application?,"1, Funded | 2, In submission | 3, Not Submitted | 4, Other",,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1',y,,,,,
grant_other_explain_na,longterm_follow_up_post_consultation,,notes,Other status of grant application - please explain:,,,,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1' and [grant_status_na] = '4',y,,,,,
grant_amount_na,longterm_follow_up_post_consultation,,text,What was the dollar amount of the funded grant?,,,number,,,,[which_consult_serv(5)] = '1' and [na_project_outcomes(3)] = '1' and [grant_status_na] = '1',y,,,,,
helpful_how_na,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your needs assessment objectives?",,,,,,,[which_consult_serv(5)] = '1',,,,,,
dc_purpose,longterm_follow_up_post_consultation,Data Collection,checkbox,1. In what specific area(s) did you receive assistance in data collection? (check all that apply),"1, Data collection | 2, Data input and analysis | 3, Report writing | 4, Database development",,,,,,[which_consult_serv(6)] = '1',y,,,,,
dc_needs_met,longterm_follow_up_post_consultation,,yesno,Were your data collection needs met?,,,,,,,[which_consult_serv(6)] = '1',y,,,,,
dc_data_used,longterm_follow_up_post_consultation,,notes,Please describe: What was the purpose of collecting the data?,,,,,,,[which_consult_serv(6)] = '1',y,,,,,
dc_reasons_not_met,longterm_follow_up_post_consultation,,checkbox,"What are the reasons that your data collection needs were not met?
(Check all that apply)","1, Project no longer of interest | 2, Lack of funding | 10, Lack of time | 3, Lack of personnel | 4, Need additional assistance with design | 5, Need additional assistance with implementation | 6, IRB problems or delays | 7, Data collection problems | 8, Data analysis problems | 9, Other",check all that apply,,,,,[dc_needs_met] = '0' and [which_consult_serv(6)] = '1',y,,,,,
dc_not_reason_other,longterm_follow_up_post_consultation,,notes,Other reason data collection needs were not met - please explain:,,,,,,,[dc_reasons_not_met(9)] = '1' and [which_consult_serv(6)] = '1',y,,,,,
helpful_how_data,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your data collection objectives?",,,,,,,[which_consult_serv(6)] = '1',,,,,,
eval_prog_name,longterm_follow_up_post_consultation,Program Evaluation,text,What was the name of the program you were evaluating?,,,,,,,[which_consult_serv(7)] = '1',y,,,,,
eval_target_pop,longterm_follow_up_post_consultation,,checkbox,Who was the target population?,"1, General Public | 2, Specific Race/Ethnicity | 3, Specific Gender | 4, Specific Age | 5, Specific Sexual Orientation",Check all that apply,,,,,[which_consult_serv(7)] = '1',y,,,,,
eval_specific_sex,longterm_follow_up_post_consultation,,radio,"Which specific sexual orientation?
(Check all that apply)","1, Lesbian | 2, Gay | 3, Bisexual",check all that apply,,,,,[which_consult_serv(7)] = '1' and [eval_target_pop(5)] = '1',y,,,,,
eval_target_race_ethnic,longterm_follow_up_post_consultation,,checkbox,"Which race/ethnicity was the target population?
(Check all that apply)","1, American Indian or Alaskan Native | 2, Asian | 3, Black or African American | 4, Native Hawaiian or Other Pacific Islander | 5, White | 6, Hispanic or Latino | 7, Not Hispanic or Latino",Check all that apply,,,,,[eval_target_pop(2)] = '1' and [which_consult_serv(7)] = '1',y,,,,,
eval_target_gender,longterm_follow_up_post_consultation,,checkbox,"Which gender was the target population?
(Check all that apply)","8, Male | 9, Female | 10, Transgender",Check all that apply,,,,,[eval_target_pop(3)] = '1' and [which_consult_serv(7)] = '1',y,,,,,
eval_target_age,longterm_follow_up_post_consultation,,checkbox,"Which age group was the target population?
(Check all that apply)","11, Under 18 | 12, 19-29 | 13, 30-49 | 14, 50-64 | 15, 65 and older",Check all that apply,,,,,[eval_target_pop(4)] = '1' and [which_consult_serv(7)] = '1',y,,,,,
eval_topic,longterm_follow_up_post_consultation,,checkbox,"What was the program's topic area?
(check all that apply) ","1, No specific health condition | 2, Health and wellness | 3, Heart conditions | 4, Diabetes | 5, Obesity | 6, Alzheimer/dementia | 7, Neurological conditions | 8, Cancer | 9, Mental health | 10, Asthma | 11, Nutrition/Physical activity | 12, Infectious Disease | 13, Alcohol or other drug use | 14, Physical or mental disability | 15, Gender identity or sexual orientation | 16, Environmental issues | 18, Child Health | 17, Other",Check all that apply,,,,,[which_consult_serv(7)] = '1',y,,,,,
eval_other_topic,longterm_follow_up_post_consultation,,notes,What other topic area were you evaluating?,,,,,,,[which_consult_serv(7)] = '1' and [eval_topic(17)] = '1',y,,,,,
eval_area,longterm_follow_up_post_consultation,,checkbox,"In what specific area did you receive assistance in program evaluation?
(check all that apply)","1, Developing/refining the evaluation tool | 2, Data analysis | 3, Data input",check all that apply,,,,,[which_consult_serv(7)] = '1',y,,,,,
eval_admin,longterm_follow_up_post_consultation,,yesno,Was the evaluation of the program successfully completed?,,,,,,,[which_consult_serv(7)] = '1',y,,,,,
eval_numbers,longterm_follow_up_post_consultation,,radio,"Approximately, how many people were included in the program evaluation? ","1, 0-25 | 2, 26-50 | 8, 51-100 | 9, 101-500 | 10, 501-1000 | 11, over 1000",Range: approximate number of people,,,,,[which_consult_serv(7)] = '1' and [eval_admin] = '1',y,,,,,
eval_why_not,longterm_follow_up_post_consultation,,checkbox,"Why was the program not evaluated?
(check all that apply)","1, Project no longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance with design | 6, Need additional assistance with implementation | 7, IRB problems or delays | 8, Other",Check all that apply,,,,,[eval_admin]='0' and [which_consult_serv(7)] = '1',y,,,,,
eval_other_reason,longterm_follow_up_post_consultation,,notes,"Other reason that program was not evaluated -
please explain:",,,,,,,[which_consult_serv(7)] = '1' and [eval_why_not(8)] = '1',y,,,,,
helpful_how_eval,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your program evaluation objectives?",,,,,,,[which_consult_serv(7)] = '1',,,,,,
bp_project_name,longterm_follow_up_post_consultation,Best Practices,notes,What was the name of the project/program in which you were developing or seeking best practice information?,,,,,,,[which_consult_serv(8)] = '1',y,,,,,
bp_identified,longterm_follow_up_post_consultation,,notes,What best practice(s) did you identify?,,,,,,,[which_consult_serv(8)] = '1',y,,,,,
bp_adopted_yn,longterm_follow_up_post_consultation,,yesno,Were the best practices adopted?,,,,,,,[which_consult_serv(8)] = '1',y,,,,,
bp_adopted,longterm_follow_up_post_consultation,,notes,What best practice(s) did you adopt?,,,,,,,[which_consult_serv(8)] = '1' and [bp_adopted_yn] = '1',y,,,,,
bp_addit_assist,longterm_follow_up_post_consultation,,notes,What additional assistance could we provide to help with adoption of the best practices?,,,,,,,[which_consult_serv(8)] = '1' and [bp_adopted_yn] = '0',y,,,,,
helpful_how_bp,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your best practices objectives?",,,,,,,[which_consult_serv(8)] = '1',,,,,,
df_which_ones,longterm_follow_up_post_consultation,Dissemination of Findings,notes,What findings were you disseminating?,,,,,,,[which_consult_serv(9)] = '1',y,,,,,
df_admin,longterm_follow_up_post_consultation,,yesno,Were your findings successfully disseminated? ,,,,,,,[which_consult_serv(9)] = '1',y,,,,,
df_how,longterm_follow_up_post_consultation,,checkbox,"How were the findings disseminated?
(check all that apply)","1, Newsletter | 2, Presentation | 3, Digital media (website, social media) | 4, Published paper | 5, Other",check all that apply,,,,,[which_consult_serv(9)] = '1' and [df_admin] = '1',y,,,,,
df_numbers_other,longterm_follow_up_post_consultation,,notes,Other dissemination - please explain:,,,,,,,[which_consult_serv(9)] = '1' and [df_admin] = '1' and [df_how(5)] = '1',y,,,,,
df_numbers,longterm_follow_up_post_consultation,,radio,"Approximately, how many people received your disseminated findings? ","1, 0-25 | 2, 26-50 | 8, 51-100 | 9, 101-500 | 10, 501-1000 | 11, over 1000",Range: approximate number of people,,,,,[which_consult_serv(9)] = '1' and [df_admin] = '1',y,,,,,
df_why_not,longterm_follow_up_post_consultation,,checkbox,"Why were your findings not disseminated?
(check all that apply)","1, No longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance with design | 6, Need additional assistance with implementation | 7, IRB problems or delays | 8, Other",Check all that apply,,,,,[df_admin]='0' and [which_consult_serv(9)] = '1',y,,,,,
df_why_not_other,longterm_follow_up_post_consultation,,notes,Other reason for not disseminating findings - please explain:,,,,,,,[which_consult_serv(9)] = '1' and [df_admin] = '0' and [df_why_not(8)] = '1',y,,,,,
helpful_how_df,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your dissemination of findings objectives?",,,,,,,[which_consult_serv(9)] = '1',,,,,,
st_title,longterm_follow_up_post_consultation,Spanish Translation,notes,What was the title of your document(s) for translation?,,,,,,,[which_consult_serv(10)] = '1',y,,,,,
st_format,longterm_follow_up_post_consultation,,radio,What was the format of your document(s)?,"1, Informed Consent Form | 2, Flyer or Brochure | 3, Survey or Questionnaire | 4, Other",,,,,,[which_consult_serv(10)] = '1',y,,,,,
st_other_format,longterm_follow_up_post_consultation,,text,What other format were your documents?,,,,,,,[which_consult_serv(10)] = '1' and [st_format] = '4',y,,,,,
st_admin,longterm_follow_up_post_consultation,,yesno,"Were the translated document(s)
successfully used or distributed? ",,,,,,,[which_consult_serv(10)] = '1',y,,,,,
st_numbers,longterm_follow_up_post_consultation,,radio,Approximately how many people received your translated documents? ,"1, 0-25 | 2, 26-50 | 8, 51-100 | 9, 101-500 | 10, 501-1000 | 11, over 1000",Range: approximate number of people,,,,,[st_admin] = '1' and [which_consult_serv(10)] = '1',y,,,,,
st_why_not,longterm_follow_up_post_consultation,,checkbox,"Why was your translated document(s) not used/distributed?
(Please check all that apply)","1, No longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance from Consult Service | 6, IRB Problems or delays | 7, Other",Check all that apply,,,,,[st_admin]='0' and [which_consult_serv(10)] = '1',y,,,,,
st_other_why_not,longterm_follow_up_post_consultation,,notes,Other reason for not disseminating the translated documents - please explain:,,,,,,,[st_admin] = '0' and [which_consult_serv(10)] = '1' and [st_why_not(7)] = '1',y,,,,,
helpful_how_st,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your Spanish Translation objectives?",,,,,,,[which_consult_serv(10)] = '1',,,,,,
fgd_title,longterm_follow_up_post_consultation,Focus Group Development,notes,What was the title of the focus group?,,,,,,,[which_consult_serv(11)] = '1',y,,,,,
fgd_pop,longterm_follow_up_post_consultation,,checkbox,"Who was your target population?
(Check all that apply)","1, General Public | 2, Specific Race/Ethnicity | 3, Specific Gender | 4, Specific Age | 5, Specific Sexual Orientation",Check all that apply,,,,,[which_consult_serv(11)] = '1',y,,,,,
fgd_specific_sex,longterm_follow_up_post_consultation,,radio,"Which specific sexual orientation?
(Check all that apply)","1, Lesbian | 2, Gay | 3, Bisexual",check all that apply,,,,,[which_consult_serv(11)] = '1' and [fgd_pop(5)] = '1',y,,,,,
fdg_pop_ethnic,longterm_follow_up_post_consultation,,checkbox,"What race/ethnicity was the target population?
(check all that apply)","1, American Indian or Alaskan Native | 2, Asian | 3, Black or African American | 4, Native Hawaiian or Other Pacific Islander | 5, White | 6, Hispanic or Latino | 7, Not Hispanic or Latino",Check all that apply,,,,,[which_consult_serv(11)] = '1' and [fgd_pop(2)] = '1',y,,,,,
fgd_pop_gender,longterm_follow_up_post_consultation,,checkbox,"What gender was the target population?
(check all that apply)","1, Female | 2, Male | 3, Transgender",Check all that apply,,,,,[fgd_pop(3)] = '1' and [which_consult_serv(11)] = '1',y,,,,,
fgd_pop_age,longterm_follow_up_post_consultation,,checkbox,"What age(s) were the target population?
(check all that apply)","1, Under 18 | 2, 19-29 | 3, 30-49 | 4, 50-64 | 5, 65 and older",Check all that apply,,,,,[fgd_pop(4)] = '1' and [which_consult_serv(11)] = '1',y,,,,,
fgd_topic,longterm_follow_up_post_consultation,,checkbox,What was the topic of the focus group?,"1, No specific health condition | 2, Health and wellness | 3, Heart conditions | 4, Diabetes | 5, Obesity | 6, Alzheimer/dementias | 7, Neurological conditions | 8, Cancer | 9, Mental health | 10, Asthma | 11, Nutrition/Physical activity | 12, Infectious Disease | 13, Alcohol or other drug use | 14, Physical or mental disability | 15, Gender identity or sexual orientation | 16, Environmental issues | 18, Child health | 17, Other",Check all that apply,,,,,[which_consult_serv(11)] = '1',y,,,,,
fdg_topic_other,longterm_follow_up_post_consultation,,text,Other topic(s) of the focus group - please explain.,,,,,,,[fgd_topic(17)] = '1' and [which_consult_serv(11)] = '1',y,,,,,
fgd_conduct,longterm_follow_up_post_consultation,,yesno,Was the focus group(s) successfully conducted?,,,,,,,[which_consult_serv(11)] = '1',y,,,,,
fgd_number_grps,longterm_follow_up_post_consultation,,text,"How many focus groups were conducted?
",,Enter a whole number,integer,,,,[fgd_conduct] = '1' and [which_consult_serv(11)] = '1',y,,,,,
fgd_people_number,longterm_follow_up_post_consultation,,text,"Approximately, how many individuals participated in the focus group(s)?
(Total number of people in all groups, combined)",,Enter a whole number,integer,,,,[fgd_conduct] = '1' and [which_consult_serv(11)] = '1',y,,,,,
fgd_conduct_no,longterm_follow_up_post_consultation,,checkbox,"Why were the focus groups not conducted?
(Please check all that apply)","1, Project no longer of interest | 2, Lack of funding | 3, Lack of time | 4, Lack of personnel | 5, Need additional assistance with design | 6, Need additional assistance with implementation | 7, IRB problems or delays | 8, Other",Check all that apply,,,,,[fgd_conduct] = '0' and [which_consult_serv(11)] = '1',y,,,,,
fgd_conduct_no_other,longterm_follow_up_post_consultation,,notes,Other reason that the focus groups were not conducted - please explain:,,,,,,,[fgd_conduct_no(8)] = '1' and [which_consult_serv(11)] = '1',y,,,,,
helpful_how_fg,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your focus group objectives?",,,,,,,[which_consult_serv(11)] = '1',,,,,,
pr_title,longterm_follow_up_post_consultation,Participant Recruitment,notes,What was the title of the study for which you were recruiting?,,,,,,,[which_consult_serv(12)] = '1',y,,,,,
pr_pop,longterm_follow_up_post_consultation,,checkbox,"Who was your target population?
(Check all that apply)","1, General Public | 2, Specific Race/Ethnicity | 3, Specific Gender | 4, Specific Age | 5, Specific Sexual Orientation",Check all that apply,,,,,[which_consult_serv(12)] = '1',y,,,,,
pr_specific_sex,longterm_follow_up_post_consultation,,radio,"Which specific sexual orientation?
(Check all that apply)","1, Lesbian | 2, Gay | 3, Bisexual",check all that apply,,,,,[which_consult_serv(12)] = '1' and [pr_pop(5)] = '1',y,,,,,
pr_pop_ethnic,longterm_follow_up_post_consultation,,checkbox,"What race/ethnicity was the target population?
(check all that apply)","1, American Indian or Alaskan Native | 2, Asian | 3, Black or African American | 4, Native Hawaiian or Other Pacific Islander | 5, White | 6, Hispanic or Latino | 7, Not Hispanic or Latino",Check all that apply,,,,,[which_consult_serv(12)] = '1' and [pr_pop(2)] = '1',y,,,,,
pr_pop_gender,longterm_follow_up_post_consultation,,checkbox,"What gender was the target population?
(check all that apply)","1, Female | 2, Male | 3, Transgender",Check all that apply,,,,,[which_consult_serv(12)] = '1' and [pr_pop(3)] = '1',y,,,,,
pr_pop_age,longterm_follow_up_post_consultation,,checkbox,"What age(s) were the target population?
(check all that apply)","1, Under 18 | 2, 19-29 | 3, 30-49 | 4, 50-64 | 5, 65 and older",Check all that apply,,,,,[which_consult_serv(12)] = '1' and [pr_pop(4)] = '1',y,,,,,
pr_strategies,longterm_follow_up_post_consultation,,checkbox,"What recruitment strategies did you use?
(check all that apply)","1, Focus groups | 2, Print Advertisement (flyers, brochures) | 3, Digital Media Advertisement (website, social media) | 4, Clinical Tracking Database (electronic medical records) | 5, Presentations | 6, Participant Incentives | 7, Research Match | 8, Research Education Awareness and Learning (REAL) Program | 9, Other",Check all that apply,,,,,[which_consult_serv(12)] = '1',y,,,,,
pr_strategies_other,longterm_follow_up_post_consultation,,notes,What other strategies did you use?,,,,,,,[which_consult_serv(12)] = '1' and [pr_strategies(9)] = '1',y,,,,,
service_helped,longterm_follow_up_post_consultation,,radio,To what degree do you think the consult service helped you achieve your desired recruitment outcomes?,"1, Not at All Helpful (1) | 2, Somewhat Helpful (2) | 3, Neutral (3) | 4, Helpful (4) | 5, Very Helpful (5)",,,,,,[which_consult_serv(12)] = '1',,,,pr_recruit_helpful,,
pr_other_help,longterm_follow_up_post_consultation,,notes,What other assistance could we provide to help with the recruitment process? ,,,,,,,[which_consult_serv(12)] = '1',,,,,,
helpful_how_pr,longterm_follow_up_post_consultation,,notes,"Comments:
How were we helpful in meeting your participant recruitment objectives?",,,,,,,[which_consult_serv(12)] = '1',,,,,,
os_service1,longterm_follow_up_post_consultation,Overall Satisfaction with Consult Service,radio,1. Consultation team was available when assistance was needed.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,os_service,,
os_service2,longterm_follow_up_post_consultation,,radio,2. Consultation team addressed all questions and concerns.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,os_service,,
os_service3,longterm_follow_up_post_consultation,,radio,3. Consultation team was courteous and professional.,"1, Strongly Disagree (1) | 2, Disagree (2) | 3, Neutral (3) | 4, Agree (4) | 5, Strongly Agree (5)",,,,,,,y,,,os_service,,
os_howhelpful1,longterm_follow_up_post_consultation,,radio,"Overall, how helpful was the Community-Based Research Consult Service to you?","1, Not At All Helpful (1) | 2, Somewhat Helpful (2) | 3, Neutral (3) | 4, Helpful (4) | 5, Very Helpful (5)",,,,,,,y,,,os_howhelpful,,
os_recommend1,longterm_follow_up_post_consultation,,radio,How likely are you to recommend this service to someone else?,"1, Extremely Unlikely (1) | 2, Unlikely (2) | 3, Neutral (3) | 4, Likely (4) | 5, Extremely Likely (5)",,,,,,,y,,,os_recommend,,
os_comments,longterm_follow_up_post_consultation,,notes,Please list any additional comments or suggestions you have regarding our Consult Service.,,,,,,,,,,,,,
end_thankyou,longterm_follow_up_post_consultation,,descriptive,Thank you for taking the time to complete this survey!,,,,,,,,,,,,,