QuestionPro Survey - PBRN AFFILIATE MEMBERS SURVEY

The PBRN National Coordinating Center (NCC) would like to support your efforts in developing a public health practice-based research network via our affiliate PBRN membership. Affiliate PBRN members will have access to a number of resources including: periodic webinars, newsletters, research summaries, conference presentations, research opportunities, funding announcements, and guidance documents. In order to support your efforts, we would like to obtain information about you and your organization via this very brief survey.

Contact Information

First Name :

Last Name :

Title :

Institute or organization completing survey :

Address :

City :

State, Zip code :

Phone :

Email Address :

1. Organizational size and capacity of affiliate public health PBRN

Name of lead organization:

Type of lead organization (select the best category):

State government agency

Local government agency

Nonprofit professional association

Academic institution

Freestanding policy or research institute

Health care institution (e.g. hospital, clinic)

Community-based organization

Please indicate your organization’s current stage of development in creating a public health PBRN.

No intention to develop a public health PBRN at this time

Contemplating development of a PBRN but seeking more information and advice

Preparing to develop a PBRN, including active discussions with potential members

Actively developing a PBRN, including recruitment of members and identification of research interests

Implementing research studies through an existing PBRN

Expanding an existing PBRN through recruitment of additional members

Reinvigorating a research network that existed previously

Please indicate the number of organizations that have agreed to participate in your network currently and the number you plan to recruit for participation in your network over the next year.

Types of Participating Organizations

	Current Participants (#)	Planned Participants (#)
State health agencies

Local health departments

Universities

Community-based Organizations

Others

List the names and locations of the local health departments that have agreed to participate actively in your network to date (e.g. name, city, county, state).

List the state government agencies and/or divisions that have agreed to participate actively in your network to date (e.g. name and state).

2. Engaging practitioners in practice-based research efforts

What is your organization’s level of experience in forming collaborations and partnerships with state or local public health agencies?

no experience at all

very little experience

moderate experience

high level of experience

In thinking about the state and local public health agencies that have agreed to participate in your network, how would you characterize their history of collaboration on the following types of activities?

Public Health Partners’ Collaborative Experience

	No Experience At All	Very Little Experience	Moderate Experience	High Level of Experience
Assessing community health needs

Planning programs and services to address needs

Delivering programs and services to address needs

Developing and advocating for policies to address needs

Sharing or exchanging funding to support public health programs

Educating and training the public health workforce

Conducting research on public health problems and solutions

Disseminating research findings and evidence-based guidelines, and helping agencies translate and integrate evidence into practice

How would you characterize your organization’s level of experience in designing and conducting public health research projects?

no experience at all

very little experience

moderate experience

high level experience

What resources are available to your network for developing the PBRN and implementing collaborative research studies? (Mark all that apply)

Funds provided to the network from one or more participating organizations

Funds provided to the network from extramural sources (e.g. grants, gifts, etc.)

Staff time dedicated to network activities from one or more participating organizations

Access to data resources provided to the network from one or more participating organizations

Enthusiasm, ideas and goodwill but no tangible resources

3. Identifying and accessing your organization’s specific technical assistance needs in developing a PBRN

Please indicate how useful the following resources would be in your efforts to develop a practice-based research network.
Types of resources

	Highest Interest	Considerable Interest	Moderate Interest	Little Interest	No Interest
Periodic webinars highlighting research designs and methods suitable for public health PBRNs

Newsletters summarizing developments and funding opportunities for PBRNs in the field of public health services and systems

Research summaries of exemplary studies relevant to public health PBRNs

Conference presentations relevant to public health PBRN research

Notification of opportunities for collaboration in large research studies

Funding announcements

Guidance documents for developing and implementing PBRNs

Web-based discussion board for communicating and networking with other PBRNs

Has your research network published any findings from studies completed through the network to date?

Yes

Has your research network received extramural funding specifically to implement research studies within the network?

Yes

Please list the general areas of research your network is interested in conducting:

Please use this space to provide any additional information and/or comments: