Survey on Rural Community Wealth and Health Care Provision - health provider respondents in pilot study

ANNEX F

HEALTH CARE PROVIDER QUESTIONNAIRE

Health care provider questionnaire

Telephone Survey Introduction

Hello, this is [INTERVIEWER NAME] calling from Iowa State University on behalf of the Community Assets / Community Health research study. May I speak with [RESPONDENT NAME]?

IF NOT AVAILABLE, SCHEDULE A DAY/TIME TO CALL BACK.

Recently we sent you a letter and brochure describing the Community Assets / Community Health study, which is being conducted in 150 rural communities for the US Department of Agriculture’s Economic Research Service.

Intro1.

Did you receive the letter?

1 = YES [GO TO INTRO3.]

2 = NO [GO TO INTRO2.]

Intro2.

I’m sorry. If you’d like, we could send you another copy either by mail or email (or fax) and then call you back after you’ve had a chance to read it. Or we can just continue if you prefer.

1 = Send another letter [VERIFY ADDRESS or EMAIL ADDRESS. SCHEDULE FOLLOW-UP CALLBACK. EXIT CASE.]

2 = CONTINUE [GO TO Intro3.]

Intro3.

As the letter stated, part of the mission of the Economic Research Service is to strengthen the economy and vitality of rural communities in the US. This study is designed to learn, from a community perspective, how rural health care systems and economies affect each other, and how a community’s unique assets can be used to strengthen them both. The information will be valuable for evaluating current and future rural policies, both state-wide and nationally, and for local decision-making in rural areas.

[TOWN, STATE] is one of the communities chosen to participate in this groundbreaking research. During the next several weeks we will be talking with a variety of health care providers and community leaders in your area. We understand that you are a [RESPONDENT TYPE], and we would like to interview you over the telephone for about [IF PROVIDER, 20 to 25 minutes. IF STAKEHOLDER, 15 to 20 minutes]. The interview can be scheduled for a day and time that’s as convenient for you as possible. Your participation is voluntary; however your input is very important to get an accurate understanding of the role that the health care industry plays in your community.

Is this a good time for you, or do you prefer to schedule an appointment?

IF WILLING & AVAILABLE FOR INTERVIEW, CONTINUE BELOW.

IF CALLBACK NEEDED, SCHEDULE A DAY/TIME TO CALL BACK.

IF INTERVIEW IS REFUSED, THANK THE RESPONDENT & CLOSE THE CALL.

Before we begin, I need to assure you that all the information you provide will be used only for this research. Your responses will be kept completely confidential and reported in summary form only.

[IF Intro1 = 2 AND Intro2 = 2, INSERT THE FOLLOWING:

Because you haven’t read the letter yet, I also need to tell you the following disclosures. A Federal agency may not collect information from a private citizen nor is a person required to respond to an information collection unless the collection displays a valid Office of Management and Budget number. The OMB number for this collection is 0536-XXXX. All responses to this information collection are voluntary. The information you provide will be used for statistical purposes only.

In accordance with the Confidential Information Protection provisions of Public Law 107-347, your responses will be kept confidential and will not be disclosed in identifiable form to anyone other than the research team. By law, everyone working on this project has taken an oath and is subject to a jail term of up to 5 years, a fine of up to $250,000, or both if he or she discloses any identifiable information about you.]

This call may be monitored for quality control, and you may refuse to answer any question you choose.

GO TO SURVEY.

Role in the Town, Longevity in Town.

First I would like to verify some information.

1. According to our records you currently work in [TOWN] as a [FILL PROVIDER TYPE (OCCUPATION DESCRIPTION) FROM SAMPLE]. Is that correct?

1 = Yes

2 = No

2. IF Q1 =2 (NO): How should I correct this?

[OPEN TEXT]

[CHECKPOINT: IF RESPONDENT STILL WORKS AS A PROVIDER IN THE SAMPLED COMMUNITY, CONTINUE THE INTERVIEW. IF RESPONDENT RECENTLY STOPPED WORKING AS A PROVIDER IN THE SAMPLED COMMUNITY, CONDUCT THE STAKEHOLDER INTERVIEW. IF NOT CURRENTLY OR PREVIOUSLY A PROVIDER, THANK RESPONDENT AND EXIT THE CASE.]

3. What year did you first start working in that capacity in this town?

________

4. What is the highest degree level that you have earned? Add Ph.D., Certified Nurse Midwife

1 = RN

2 = Nurse Practitioner

3 = PA

4 = MD

5 = DO

6 = DDS

7 = Other (Specify multiple degrees here:_______________________________ )

5. How many years have you lived in this area in total?

_______ Years

6. Do you live within the city limits of [TOWN], within 2 miles of the city limits, 2 to 10 miles from [TOWN], 10 to 20 miles, or more than 20 miles from [TOWN]?

1 = within city limits

2 = within 2 miles of town

3 = 2 to 10 miles from town

4 = 10 to 20 miles or

5 = more than 20 miles from town

7. How knowledgeable are you about town issues or concerns in [TOWN]? On a scale from
1 to 5, if 1 means you are not knowledgeable at all and 5 means you are very knowledgeable, which number would you choose?

Not Knowledgeable at All				Very Knowledgeable
1	2	3	4	5

8. How did you learn about the opportunity to work in this town? Did you hear about it . . .

CHECK ALL THAT APPLY

1 = From family or friends,

2 = From a professional colleague,

3 = From your school faculty,

4 = From a position announcement,

5 = From a town representative or organization,

6 = From a professional recruiter,

7 = Or from someplace else? (Please describe: ___________________________)

Community Assets.

9. Next I will read some statements relating to your town and the people who live there. For each statement, please tell me if you strongly disagree, disagree, agree, or strongly agree. [“NEUTRAL” IS NOT OFFERED IN THE STEM BUT IS AVAILABLE AS A RESPONSE OPTION BY REQUEST.]

		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
a.	This town has a well-maintained infrastructure, including roads, water and sewer, and utilities such as electricity and natural gas.	1	2	3	4	5
b.	This town has good access to telecommunications such as cell phones, cable, and broadband.	1	2	3	4	5
c.	This town invests in outdoor resources like parks, bike paths, and ball parks.	1	2	3	4	5
d.	This town has opportunities to experience arts and cultural activities.	1	2	3	4	5
e.	New small businesses in this town can easily obtain local financing.	1	2	3	4	5
f.	This town has a thriving main-street or downtown area.	1	2	3	4	5
g.	This town has an effective economic development program.	1	2	3	4	5
h.	It is difficult to find people to take leadership roles in local government and town organizations.	1	2	3	4	5
i.	Local leadership includes people of many different backgrounds.	1	2	3	4	5
j.	Local town leaders try to cooperate with nearby communities for the benefit of the greater area.	1	2	3	4	5
k.	There are many opportunities for local residents to express their opinions on the future of the town.	1	2	3	4	5
l.	When something needs to get done in this town, the whole town usually gets behind it.	1	2	3	4	5
		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
m.	Most people in [TOWN] do some type of volunteer work.	1	2	3	4	5
n.	Local leaders in [TOWN] can be trusted to do what is right for the town.	1	2	3	4	5
o.	Some businesses or groups in this town have too much influence on local government leaders.	1	2	3	4	5
p.	This town has nearby natural resources that provide opportunities for outdoor recreation.	1	2	3	4	5
q.	Education is a high priority for most of the people who live in this town.	1	2	3	4	5
r.	It is difficult for newcomers in [TOWN] to be accepted by the long-time residents.	1	2	3	4	5
s.	This town welcomes people of different ethnic and cultural backgrounds.	1	2	3	4	5
t.	The people in this town are hard-working.	1	2	3	4	5
u.	Most people in this town are trustworthy.	1	2	3	4	5

Health Care in Your Town.

10. Now I would like to focus on the issue of health care. Overall, how would you rate the availability of health care in [TOWN]? Would you say it is Poor, Fair, Good, Very Good, or Excellent?

Poor	Fair	Good	Very Good	Excellent
1	2	3	4	5

11. How would you rate the quality of health care in [TOWN]? Would you say it is Poor, Fair, Good, Very Good, or Excellent?

Poor	Fair	Good	Very Good	Excellent
1	2	3	4	5

12. In the past 10 years, has the availability of health care services in [TOWN NAME] declined a lot, declined a little, stayed about the same, improved a little, or improved a lot?

Declined a lot	Declined a little	Stayed about the same	Improved a little	Improved a lot
1	2	3	4	5

13. In the past 10 years, has the quality of health care services in [TOWN NAME] declined a lot, declined a little, stayed about the same, improved a little, or improved a lot?

Declined a lot	Declined a little	Stayed about the same	Improved a little	Improved a lot
1	2	3	4	5

14. IF availability OR quality IMPROVED (Q12 OR 13 = 4 or 5), ASK: We are interested in possible reasons for the improvement. Please tell me which of the following have occurred in [TOWN] in the past 10 years.

		Yes	No
a.	Are there new facilities, equipment, or services at your local hospital or clinic?	1	2
b.	Has a new hospital or clinic opened?	1	2
c.	Are there new health care professionals working in town?	1	2
d.	Is there new access to services through telemedicine?	1	2
e.	Is the improvement due to changes in government policies and programs?	1	2
f.	Is it due to changes in insurance company policies?	1	2
g.	Is the improvement due to changes in insurance coverage due to major employers changing insurance plans, etc?	1	2
h.	Is it due to changes in ownership or management at local health care facilities?	1	2

15. What else has led to improvement in the quality or availability of health care services in this town?

OPEN-ENDED

16. IF availability OR quality DECLINED (Q12 OR 13 = 1 or 2), ASK: We are (also) interested in possible reasons for the decline. Please tell me which of the following have occurred in [TOWN] in the past 10 years.

		Yes	No
a.	Are the facilities, equipment, or services at your local hospital or clinic out of date or inadequate?	1	2
b.	Did a hospital or clinic close?	1	2
c.	Have health care professionals left town or retired?	1	2
d.	Is the decline to changes in government policies and programs?	1	2
e.	Is it due to changes in insurance company policies?	1	2
f.	Is the decline due to changes in insurance coverage, as a result of things like major local employers changing insurance plans?	1	2
g.	Is it due to changes in ownership or management at local health care facilities?	1	2

17. What else has led to this decline in the quality or availability of health care services in this town?

OPEN-ENDED

18. IF ANY CHANGE IN AVAILABILITY OR QUALITY, (Q12 OR 13 = 1, 2, 4 OR 5) ASK:

Think about the changes in the past 10 years in the availability or quality of health care in [TOWN]. [FILL QUESTION] Would you say not at all, a little, some, or a lot?

		Not at All	A Little	Some	A Lot
a.	How much have these changes in health care affected your town’s ability to attract young families?	1	2	3	4
b.	How much have these changes in health care affected your town’s ability to attract retired people?	1	2	3	4
c.	How much have these changes in health care affected your town’s ability to attract new businesses?	1	2	3	4
d.	How much have these changes in health care affected your town’s ability to keep young families from moving away?	1	2	3	4
e.	How much have these changes in health care affected your town’s ability to keep retired people from moving away?	1	2	3	4
f.	How much have these changes in health care affected your town’s ability to keep existing businesses from leaving town?	1	2	3	4

HC Provider Background.

19. Now we have a few questions about your own background and training. What year did you graduate from (medical school/dental school/your medical training)?

_________

20. In what state did you graduate from (medical school/dental school/your medical training)?

____________________

21. Was any part of your (residency/internship/externship) spent in a rural community?

1 = Yes

2 = No [IF NO, GO TO Q23]

22. IF Q21 = 1 (YES), ASK: Was it in [TOWN NAME]?

1 = Yes

2 = No

23. How would you describe your current practice? Are you based mainly . .

1 = in a hospital,

2 = in a clinic,

3 = in an office setting,

4 = in a retail business setting,

5 = or something else? (Please describe:________________________________)

24. Are you the sole owner, a part-owner, or an employee of your practice?

1 = Sole owner

2 = Part-owner

3 = Employee

25. Do you share on-call duties with other health care providers?

1 = Yes

2 = No

3 = Don’t have on-call duties

26. Do you have adequate coverage for your practice while you are on vacation?

1 = Yes

2 = No

27. On average, how many hours do you work per week in [TOWN]?

___ ___ Hrs/week

28. Do you also practice in any nearby communities?

1 = Yes

2 = No [IF NO, GO TO Q30]

29. IF Q28 = 1 (YES), ASK: How many hours per week do you work in those nearby communities?

___ ___ Hrs/week worked in nearby communities

30. Next I will read a list of factors that might have influenced your decision to work in this town. For each one please rate how important it was to you by using a scale from 1 to 5, where 1 means it was not at all important and 5 means it was very important to you.

		Not at all Important				Neutral			Very Important
a.	Your own familiarity with this area		1	2			3	4		5
b.	The influence of your spouse or other family members		1	2			3	4		5
c.	The size of the town		1	2			3	4		5
d.	It’s a good place to raise a family		1	2			3	4		5
e.	Good educational opportunities for children
f.	The presence of a university or college here or nearby		1	2			3	4		5
g.	The natural amenities, such as climate, access to lakes, rivers or ocean, the countryside, scenery, etc.		1	2			3	4		5
h.	Local recreational opportunities		1	2			3	4		5
i.	Churches, synagogues, or other religious organizations available		1	2			3	4		5
j.	Friendliness of the town		1	2			3	4		5
k.	The opportunity to practice within a high quality medical community		1	2			3	4		5
l.	The advice of colleagues		1	2			3	4		5
m.	The opportunity to practice in an area of great need		1	2			3	4		5
n.	The level of taxes		1	2			3	4		5
o.	Good potential for your professional growth		1	2			3	4		5
p.	Offer of a good local recruitment package		1	2			3	4		5
q.	Incentives; such as loan forgiveness, J-1 Visa waivers, or other incentives		1	2			3	4		5
r.	Job opportunities for your spouse or partner		1	2			3	4		5

31. What would you say was the most important factor that drew you to practice in this town?

OPEN-ENDED

32. What would you say was the biggest drawback to coming here to practice?

OPEN-ENDED

33. Have you ever seriously considered moving and practicing in a different location?

1 = Yes

2 = No [IF NO, GO TO Q36]

34. IF Q33 = 1(YES), ASK: What were the main reasons that you considered leaving?

OPEN-ENDED

35. IF Q33 = 1(YES), ASK: What were the main reasons that you decided to stay?

OPEN-ENDED

36. In the past 10 years, have you ever been involved in the recruitment of other health care professionals to your town?

1 =Yes

2 = No

37. In the past 10 years, have you ever been involved in an organized effort to encourage other local health care professionals to stay in your town?

1 =Yes

2 = No

38. In general, what would you say is the most important factor in successfully recruiting or retaining health care providers in [TOWN]?

OPEN ENDED

39. In general, what would you say is the greatest difficulty [TOWN] faces in recruiting or retaining health care providers?

OPEN ENDED

We are interested in changes that might have occurred in your practice in [TOWN] (in the last ten years/since you came to this town). [THE CORRECT PHRASE WILL BE FILLED BY THE COMPUTER DEPENDING ON THE RESPONSE TO Q3]

40. Has the number of hours you work per week increased, decreased, or stayed about the same (in the last ten years/since you came to this town)?

1 = Increased

2 = Decreased

3 = Stayed about the same

41. (In the last ten years/Since you came to this town), have there been any changes in your affiliation with other local providers, such as changes in partnerships or group members?

1 = Yes

2 = No

42. (In the last ten years/Since you came to this town), has your practice either stopped or started accepting certain types of patients, such as Medicaid, uninsured patients, or patients with particular types of private insurance plans?

1 = Yes

2 = No

43. IF Q42 = 1 (YES), ASK: What changes have occurred?

OPEN ENDED

44. (In the last ten years/Since you came to this town), has your practice added more staff, reduced the number of staff, or stayed about the same?

1 = Added more staff

2 = Reduced number of staff

3 = Stayed about the same

45. (In the last ten years/Since you came to this town), have there been any significant upgrades or additions to the facilities or equipment used in your practice?

1 = Yes

2 = No

46. What other significant changes, if any, have occurred in your practice (in the last ten years/since you came to this town)?

OPEN ENDED

47. Thinking about your personal and professional life as a rural health care provider, how satisfied are you with the following aspects of living and working in this town? Please use a scale from 1 to 5, where 1 means you are not at all satisfied and 5 means you are very satisfied.

Overall, how satisfied are you with . . .

		Very Dissatisfied				Neutral			Very Satisfied
a.	Your professional situation as a health care provider in this town?		1	2			3	4		5
b.	The opportunities this town provides for your family?		1	2			3	4		5
c.	The opportunities this town provides for you as an adult?		1	2			3	4		5
d	Your professional interactions with other health care providers in this town?		1	2			3	4		5
e	Your social interactions with other health care providers in this town?		1	2			3	4		5
f	Your social interactions with other people in general in this town?		1	2			3	4		5

48. (In the last ten years/Since you came to this town), how much have you been involved in any town activities related to health care or promoting healthy lifestyles? (This could include things like working with a community group to address a local health problem, participating in a community health fair, speaking to local groups on health issues, etc.) Would you say, ...

1 = Not at all,

2 = Some, or

3 = A Lot?

49. (In the last ten years/Since you came to this town), how much have you been involved in other volunteer community activities, not related to health, such as school, charity, or sports activities? Would you say, . . .

1 = Not at all,

2 = Some, or

3 = A Lot?

IF SAMPLE = GOVT LEADER, ASK Q50-51

50. According to our records, you also currently hold a local government leadership position in [TOWN].

[FILL GOVT POSITION DESCRIPTION FROM SAMPLE] Is that correct?

1 = Yes [IF YES, SKIP Q51. GO TO Q52 IF CIVIC LEADER. IF NOT, GO TO Q54]

2 = No

51. IF Q50 = 2 (NO), ASK: How should I correct this?

OPEN ENDED

IF SAMPLE = CIVIC LEADER, ASK Q52-53

52. According to our records you also currently hold a leadership position in a civic organization in [TOWN]. [FILL CIVIC LEADERSHIP DESCRIPTION FROM SAMPLE] Is that correct?

1 = Yes [IF YES, GO TO Q54]

2 = No

53. IF Q52 = 2 (NO), ASK: How should I correct this?

OPEN ENDED

54. Do you belong to any local organizations or associations in this town, such as churches, service or sports clubs, school or business organizations, or other community groups?

1 = Yes

2 = No [IF NO, GO TO Q57]

55. IF Q54 = 1 (YES), ASK: How many different organizations would you say you belong to? Would you say . . .

1 = One or two,

2 = Three to five,

3 = Six to ten, or

4 = More than ten?

56. IF Q54 = 1 (YES), ASK: Have you ever been in a leadership role or on any committees in any of these organizations?

1 = Yes

2 = No

57. Do you plan to continue practicing medicine in this town for the next 5 years?
Would you say. . .

1 = Definitely not, [GO TO Q 58]

2 = Probably not [GO TO Q 58]

3 = Don’t know, [GO TO Q 60]

4 = Probably will [GO TO Q 60]

5 = Definitely will stay here for the next 5 years? [GO TO Q 60]

58. IF Q57 = 1 or 2, ASK: Within the next 5 years, do you plan to retire, to move your practice to another location, or something else?

1 = Retire [GO TO Q 62]

2 = Move practice

3 = Other

59. IFQ58 = 2 or 3 (MOVE or OTHER), ASK: (Please describe your future plans.)

OPEN ENDED

60. IF Q57 = 3, 4 or 5, ASK: Are you planning any significant changes in your practice within the next 5 years?

1 = Yes

2 = No

3 = Don’t Know, unsure

61. IF Q60 = 1 (Yes), ASK: What changes are you planning to implement?

OPEN-ENDED

DEMOGRAPHICS.

62. CODE GENDER. IF UNSURE, ASK: Are you male or female?

1 = Male

2 = Female

63. What is your current age? ________

64. Where did you primarily grow up? Was it ..

1 = on a farm or in a rural area,

2 = in a town of less than 20,000

3 = in a city of 20,000 to 100,000

4 = in a city or metropolitan area of more than 100,000?

65. In what state and town did you graduate from high school?

Town:_________________ State:___________ Country:__________

66. Are you Hispanic or Latino?

1 =Yes

2 = No

67. Which of the following options best describe your race? Are you . . .

CHECK ALL THAT APPLY

1 = American Indian or Alaska Native,

2 = Asian,

3 = Black or African American,

4 = Native Hawaiian or Other Pacific Islander,

5 = White? (You can choose more than one answer.)

68. What is your current marital status? Are you . . .

1 = married or living as married,

2 = divorced or separated,

4 = widowed, or

5 = single never married?

69. How many people currently live in your household? _______

[IF Q69 = 1, GO TO Q71]

70. IF Q69 > 1, ASK: How many people in your household are less than 18 years old? ______

71. Which of the following categories best describes your household income in 2011? Would you say . . .

1 = Less than $25,000

2 = From $25,000 up to $50,000

3 = From $50,000 up to $75,000

4 = From $75,000 up to $100,000

5 = From $100,000 up to $150,000 or

6 = $150,000 or more?

72. That is all the information we need. Before closing, do you have any other comments you would like to make regarding your experience as a health care provider in [TOWN]?

[OPEN TEXT]

Thank you very much for your time today. Iowa State University and the USDA Economic Research Service greatly appreciate your cooperation and assistance. Preliminary results from these interviews will be sent to each participant sometime within the next year, so you can watch for that in early 2013. Thank you and good bye.