Survey on Rural Community Wealth and Health Care Provision - community leaser respondents in full study

ANNEX G

COMMUNITY LEADERS/OTHER STAKEHOLDERS QUESTIONNAIRE

Community leaders/other stakeholders 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 Community, Longevity in Community.

First I would like to verify some information.

IF SAMPLE = GOVT LEADER, ASK Q1-2.

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

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

1 = Yes [GO TO Q10]

2 = No

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

OPEN ENDED

[NOTE: IF STILL APPROPRIATE TO INTERVIEW THIS RESPONDENT, CONTINUE WITH NEXT QUESTION.
IF NOT APPROPRIATE, THANK RESPONDENT AND EXIT CASE.]

IF SAMPLE = CIVIC LEADER, ASK Q3-4.

3. According to our records you currently hold a leadership position in a civic organization in [TOWN].

[FILL CIVIC LEADERSHIP DESCRIPTION FROM SAMPLE] Is that correct?

1 = Yes [GO TO Q10]

2 = No

4. IF Q3 = 2 (NO), ASK: How should I correct this?

OPEN ENDED

[NOTE: IF STILL APPROPRIATE TO INTERVIEW THIS RESPONDENT, CONTINUE WITH NEXT QUESTION.
IF NOT APPROPRIATE, THANK RESPONDENT AND EXIT CASE.]

IF SAMPLE OCCUPATION = HEALTH ADMIN, ASK Q5-7.

5. According to our records you currently work in [TOWN] as a [FILL OCCUPATION DESCRIPTION FROM SAMPLE]. Is that correct?

1 = Yes [GO TO Q7, SKIP Q8-11, AND THEN GO TO Q12]

2 = No

6. IF Q5 = 2 (NO), ASK: How should I correct this?

OPEN ENDED

[NOTE: IF STILL APPROPRIATE TO INTERVIEW THIS RESPONDENT, CONTINUE TO Q7.
IF NOT APPROPRIATE, THANK RESPONDENT AND EXIT CASE.]

7. How many years have you worked in [TOWN] in that capacity?

________

IF SAMPLE OCCUPATION or CHECKPOINT IN PROVIDER SURVEY = FORMER PROVIDER, ASK Q8-9.

8. According to our records you have worked as a health care provider in [TOWN] in the past. Is that correct?

1 = Yes [GO TO Q10]

2 = No

9. IF Q8 = 2 (NO), ASK: How should I correct this?

OPEN ENDED

[NOTE: IF STILL APPROPRIATE TO INTERVIEW THIS RESPONDENT, CONTINUE WITH NEXT QUESTION.
IF NOT APPROPRIATE, THANK RESPONDENT AND EXIT CASE.]

IF SAMPLE OCCUPATION IS NOT HEALTH ADMIN, ASK Q10-11.

10. What is your current occupation?

OPEN ENDED

11. Do you work in [TOWN]?

1 = Yes

2 = No

ASK EVERYONE:

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

________

13. 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

14. How knowledgeable are you about community 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

Community Assets.

15. Next I will read some statements relating to your community 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.	New small businesses in this town can easily obtain local financing.	1	2	3	4	5
e.	This town has a thriving main-street or downtown area.	1	2	3	4	5
f.	This town has an effective economic development program.	1	2	3	4	5
g.	It is difficult to find people to take leadership roles in local government and town organizations.	1	2	3	4	5
h.	Local leadership includes people of many different backgrounds.	1	2	3	4	5
i.	Local town leaders try to cooperate with nearby communities for the benefit of the greater area.	1	2	3	4	5
j.	There are many opportunities for local residents to express their opinions on the future of the town.	1	2	3	4	5
k.	When something needs to get done in this town, the whole town usually gets behind it.	1	2	3	4	5
l.	Most people in [TOWN] do some type of volunteer work.	1	2	3	4	5
m.	Local leaders in [TOWN] can be trusted to do what is right for the town.	1	2	3	4	5
n.	Some businesses or groups in this town have too much influence on local government leaders.	1	2	3	4	5
o.	This town has nearby natural resources that provide opportunities for outdoor recreation.	1	2	3	4	5
p.	Education is a high priority for most of the people who live in this town.	1	2	3	4	5
q.	It is difficult for newcomers in [TOWN] to be accepted by the long-time residents.	1	2	3	4	5
r.	This town welcomes people of different ethnic and cultural backgrounds	1	2	3	4	5
s.	The people in this town are hard-working.	1	2	3	4	5
t.	Most people in this town are trustworthy.	1	2	3	4	5

Health Care in Your Town.

16. 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

17. 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

18. We would like to know your opinion of the overall quality of the health care professionals practicing in [TOWN]. This would include physicians, physician assistants, nurse practitioners, nurse midwives, nurses, dentists, pharmacists, optometrists, and other providers working in the field of health care. Would you say the overall quality of health care professionals in your community is poor, fair, good, very good, or excellent?

Poor	Fair	Good	Very Good	Excellent
1	2	3	4	5

19. 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

20. 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

21. IF availability OR quality IMPROVED (Q19 OR 20 = 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

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

OPEN-ENDED

23. IF availability OR quality DECLINED (Q19 OR 20 = 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 due 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

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

OPEN-ENDED

25. IF ANY CHANGE IN AVAILABILITY OR QUALITY, (Q19 OR 20 = 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

Physician Recruitment/Retention.

26. Has there been any active recruitment of health care providers to work in [TOWN] in the past 10 years?

1 = Yes [IF YES, ASK Q27 THROUGH 43 SERIES]

2 = No [IF NO, SKIP Q27-30, ASK Q31 & 32, THEN SKIP TO Q40]

27. IF Q26 = 1 (YES), ASK: In the past 10 years, have you been involved in the recruitment of health care providers to your town?

1 = Yes

2 = No [IF NO, GO TO Q29]

28. IF Q27 = 1 (YES), ASK: What was your primary role in the recruitment process?

OPEN-ENDED

29. IF Q26 = 1 (YES), ASK: Overall, how successful has [TOWN] been (in the past 10 years) in recruiting high quality health care providers? On a scale from 1 to 5, where 1 means very unsuccessful and 5 means very successful, what number would you choose?

Very Unsuccessful				Very Successful
1	2	3	4	5

30. IF Q26 = 1 (YES), ASK: How successful has [TOWN] been (in the past 10 years) in helping new health care providers integrate into the community so they feel at home? On a scale from 1 to 5, where 1 means very unsuccessful and 5 means very successful, what number would you choose?

Very Unsuccessful				Very Successful
1	2	3	4	5

31. Overall, how successful has [TOWN] been (in the past 10 years) in retaining its health care providers? On a scale from 1 to 5, where 1 means very unsuccessful and 5 means very successful, what number would you choose?

Very Unsuccessful				Very Successful
1	2	3	4	5

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

1 = Yes

2 = No

33. Think of the last time [TOWN] was involved in recruiting new health care providers.

What year or years did that recruitment occur?

__________________

34. What types of providers were you recruiting? Were you looking for a . . .

		Yes	No
a.	Primary care physician?	1	2
b.	Physician specialist?	1	2
c.	Physician’s Assistant or Nurse Practitioner?	1	2
d.	Dentist?	1	2
e.	Nurse?	1	2
f.	Different type of provider? (g. Describe:____________________________ )	1	2

35. Who in your town was actively involved in the recruitment process? Did the recruitment effort involve . . .

		Yes	No
a.	Administrators of local health care facilities?	1	2
b.	The mayor or other city government leaders?	1	2
c.	County government leaders?	1	2
d.	Representatives from a local economic development group?	1	2
e.	Local business leaders?	1	2
f.	Chamber of Commerce or other civic group leaders?	1	2
g.	Anyone else? (h. Describe:____________________ )	1	2

RECRUITMENT SERIES (Q33-40) FOR UP TO 3 PROVIDER TYPES RECRUITED IN Q31. [Ask for Q31a, b, c, d, e in that order. Only take three.)

36. IF Q26 = 1 (YES) and Q34b = 1 (YES), ASK: What type(s) of physician specialist were you recruiting?

OPEN ENDED

37. Were you successful in hiring a [FILL FROM Q34]?

1 = Yes [GO TO Q38]

2 = No [GO TO Q43]

38. IF Q37 = 1 (YES), ASK: How many did you hire?

_______

39. IF Q37 = 1 (YES), ASK: (Is this provider / Are these providers) still working within your local health care system?

1 = Yes

2 = No [IF NO, GO TO Q41]

3 = Both (One or more still there, one or more left)

40. IF Q39 = 1 OR 3 (YES or BOTH) ASK: What would you say were the most challenging aspects of this recruitment process?

OPEN ENDED

[IF Q39 = 1, GO TO Q44 AFTER ANSWERING Q40. IF Q39 = 3, GO TO Q41 AFTER ANSWERING Q40]

41. IF Q39 = 2 OR 3 (NO or BOTH), ASK: Did this provider (that is, the one who left) . . .

1 = Retire,

2 = Move to another location to practice,

3 = Stay in the community but work in another capacity,

4 = Or do something else? (Specify:____________________________ )

42. IF Q41 = 2, ASK: What would you say is the main reason that this provider left the area to practice in another location?

OPEN ENDED

43. IF Q37 = 2 (NO), ASK: What would you say are the main reasons that this recruitment process was unsuccessful?

OPEN ENDED

[REPEAT ITEMS 36-43 FOR UP TO 3 PROVIDER TYPES RECRUITED.]

44. In the last 10 years, have any health care providers such as physicians, physicians assistants, nurse practitioners, or dentists stopped working in [TOWN]?

1 = Yes

2 = No [IF NO, GO TO Q47]

45. About how many health care providers have stopped working here in the past 10 years, for reasons other than retirement?

________ providers have stopped working in town

46. What do you think are the main reasons that (this provider / these providers) stopped working here?

OPEN ENDED

47. Are you aware of any plans to recruit health care providers to [TOWN] within the next 5 years?

1 = Yes

2 = No

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

OPEN ENDED

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

OPEN ENDED

DEMOGRAPHICS.

Finally, I have a few background questions about you.

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

1 = Male

2 = Female

51. What is your current age? ________

52. What is the highest level of education you have completed?

1 = Less than high school

2 = High school graduate (INCLUDES GED)

3 = Associates or technical school degree

4 = Attended college

5 = Bachelor's degree

6 = Graduate degree (MS, MBA, PhD, MD, etc.)

53. IF 52 ≠1, ASK: In what state and town did you graduate from high school?

Town:_________________ State:___________ Country:_______________

54. Are you Hispanic or Latino?

1 = Yes

2 = No

55. 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.)

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

1 = married or living as married,

2 = divorced or separated,

3 = widowed, or

4 = single never married?

57. How many people currently live in your household? ________

[IF Q57 = 1, GO TO Q59]

58. IF Q57 > 1, ASK: How many people living in your household are less than 18 years old? ________

59. 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?

60. That is all the information we need. Before closing, do you have any other comments you would like to make regarding the role that the health care industry plays in [TOWN]?

OPEN ENDED

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.