These surveys can be use to measure elements or components of an implementation project.

School Nurse Survey – Asthma Care Plans, ESD105

Publisher: Educational Service District 105, Washington State

Description: The survey will establish a baseline to understand the way in which school nurses decide when to get a care plan for students with Asthma, how they identify students that need a care plan, and what policies or procedures they have in place to collect and/or update care plans.

Audience: School District Nurses and Nurse Corps Members

Notes: This survey focuses on policies and procedures and barriers for documenting care plans in public school districts. Questions can also be found as stand alone questions in other sections of this question bank.

Building Capacity for Equity Informed Planning and Evaluation (BCEIPE) Project

Publisher: Alliance for Healthier Communities  Alliance pour des communautés en santé

Description: The survey will establish a baseline that reflects your current state and allow a valuable comparison to a new state after the completion of capacity building activities have taken place and identified with post-test survey findings.

Audience: Community  Health Centers in Canada

Notes: This survey focuses on capacity and skills for address health equity issues. Some of the generic questions can also be found as stand alone questions in other sections of this question bank.

The Bree Collaborative use this survey to create a pre-assessment for participants in our Health Equity Action Collaborative.

Health Equity Skills for Public Health Professionals Survey

Publisher: National Association of Chronic Disease Directors (NACDD) Health Equity Council

Description: The following brief questionnaire will provide information that will be used to help you achieve success in moving toward health equity in your public health practice.

Audience: Public health, organization staff

Notes: This survey was originally developed for public health and is validated for the following positions: Manager, Program Coordinator, Epidemiologist or Research Investigator, Operational Support. These questions can be adapted for other types of organizations however, the Bree Collaborative recommends further validation.

Focus Group Questions

Publisher: AAMHCS

Description: These questions are used to obtain client feedback with respect to accessibility, efficiency, equity, patient centeredness and satisfaction within a focus group setting. It includes sample questions and probes to evoke conversation and feedback in situations where participants are offering limited feedback.

Scale or Measurement: N/A

Status: in use, no information on validity

Audience: Community health organization staff

Notes: 

Primary Care Experience Survey

Publisher: Health Quality Ontario

Description: This survey documents:
– A patient’s experience contacting the organization
– A patient’s experience arriving and waiting at the organization
– The performance of the health care provider they dealt with during their most recent visit
– A patient’s overall experience during their most recent visit
– A patient’s experiences visiting with the organization over the last year or so
– A patient’s context/ demographics
– A patient’s feedback with respect to successes and opportunities for improvement.

Scale or Measurement: Likert scales included for each question.

Status: in use, no information on validity

Audience: Intake staff at AHACs and CHCs

Notes: 

Adolescent and Young Adult Health Outcomes and Patient Experience Survey

Publisher: National Cancer Institute

Description: For the Adolescent and Young Adult (AYA) Cancer Survivors Study, the National Cancer Institute (NCI) developed a survey that examines the quality of care and related outcomes among AYA in the first year following their cancer diagnosis. 112 tested questions.

Status: in use

Audience: Patients

Notes: 

Continuing Survey of Food Intakes by Individuals

Publisher: United States Department of Agriculture (USDA)

Description: The U.S. Department of Agriculture (USDA) has collected national food consumption data for more than 70 years. Initially designed to help people achieve economical and nutritious diets, USDA’s food consumption surveys gradually broadened in scope and purpose. The most recent surveys, called the Continuing Survey of Food Intakes by Individuals (CSFII) were combined with USDA’s Diet and Health Knowledge Survey (DHKS), to measure knowledge and attitudes about diet and health. 54 tested questions

Status: in use

Audience: Patients

Notes: 

Health Survey for England

Publisher: HHS

Description: The Health Survey for England is a major monitoring tool looking at the nation’s health. It is used by the Government to plan health services and make important policy decisions that have an impact on us all. 89 tested questions.

Status: in use

Audience: Patients and consumers

Notes: 

Healthcare Systems Scorecard (HSSC)

Publisher: CDC

Description: 2016 CDC Healthcare Systems Scorecard (HSSC) Assessment Tool for Primary Care Practices. 15 questions.

Status: unknown

Audience: Primary care practices

Notes: 

National Electronic Health Records Survey

Publisher: CDC

Description: The National Electronic Health Records Survey is affiliated with the National Ambulatory Medical Care Survey (NAMCS). The purpose of the survey is to collect information about the adoption of electronic health records/electronic medical records (EHRs/EMRs) in ambulatory care settings. 41 tested questions

Status: in use

Audience: Health care practices and health systems

Notes: