Form 298 HRSA MCHB Resource Center Questionnaire

American Customer Satisfaction Index "Customer Satisfaction Surveys"

2010 298 HRSA MCHB Resource Center Questionnaire_2010 Final.DOC

298 HRSA MCHB Resource Center Satisfaction Survey

OMB: 1090-0007

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HRSA MCHB Resource Center User Satisfaction Questionnaire

Health Resources and Services Administration Maternal and Child Health Bureau

Resource Center User Satisfaction Survey


Survey to be administered via the Web. Items in BOLD will not be seen by the respondents. Questionnaire section headers and question numbers will not appear in the Web survey.

Survey Introduction

The Health Resources and Services Administration’s Maternal and Child Health Bureau is committed to continuous performance improvement. As part of this effort, we are requesting feedback on your experiences with our Resource Centers during the past year.


The survey is hosted via a secure server and your responses will remain strictly confidential and anonymous. This survey is authorized by Office of Management and Budget Control No. 1090-0007.


The survey will take approximately 10 minutes to complete. Thank you in advance for completing the survey.


Please click on the “Next” button below to begin.


Demographic Questions



DEM1 Which Maternal and Child Health Resource Center sent you this survey? (Select one)

  1. Alliance for Information on Maternal and Child Health Child and Adolescent Support Center (www.healthychild.ucla.edu)

  2. Catalyst Center (www.catalystctr.org)

  3. Center for Mental Health in Schools (http://csmh.umaryland.edu)

  4. Champions for Inclusive Communities - ChampionsInc. (www.championsinc.org)

  5. Child Care and Health Partnership Program (www.healthychildcare.org)

  6. Children’s Safety Network (www.childrenssafetynetwork.org)

  7. Combating Autism Initiative - National Interdisciplinary Training Resource Center (LEND Training Grantees) (www.aucd.org/itac)

  8. The Data Resource Center for Child and Adolescent Health (or The Child and Adolescent Health Measurement Initiative) (www.childhealthdata.org www.nschdata.org www.cshcndata.org)

  9. Healthy and Ready to Work National Center (www.hrtw.org)

  10. Maternal and Child Health Library (http://www.mchlibrary.info )

  11. National Adolescent Health Information and Innovation Center (http://nahic.ucsf.edu )

  12. National Center for Cultural Competence (http://www11.georgetown.edu/research/gucchd/nccc/)

  13. National Center for Family/Professional Partnerships

(www.familyvoices.org)

  1. National Center for Hearing Assessment and Management (www.infanthearing.org)

  2. National Center for Medical Home Implementation (www.medicalhomeinfo.org )

  3. National Center for Project Access (http://www.epilepsyfoundation.org/projectaccess/NCPA/)

  4. National Consumer Center for Genetics Resources and Services (www. geneticalliance.org)

  5. National Coordinating and Evaluation Center for the Sickle Cell and Newborn Screening Program (www.sicklecelldisease.net)

  6. National Coordinating Center for the Genetics and Newborn Screening Regional Service Collaborative (www.nccrcg.org)

  7. National Emergency Medical Services for Children Data Analysis Resource Center (www.nedarc.org)

  8. National Emergency Medical Services for Children Resource Center (www.childrensnational.org/EMSC)

  9. National Fetal and Infant Mortality Review Resource Center (www.acog.org/goto/nfimr )

  10. National Healthy Tomorrows Technical Assistance Resource Center

(www.aap.org/commpeds/htpcp/index.html)

  1. National Maternal and Child Oral Health Resource Center (www.mchoralhealth.org)

  2. National MCH Center for Child Death Review (www.childdeathreview.org)

  3. National Newborn Screening and Genetics Resource Center (http://genes-r-us.uthscsa.edu)

  4. National Oral Health Policy Center (www.cdhp.org/programs/national_oral_health_policy_center_cdhp_mchb)

  5. National Resource Center for Health and Safety in Child Care and Early Education (http://nrc.uchsc.edu)

  6. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Program Support Center (www.NSICD-PSC.org )

  7. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Project IMPACT (www.SIDSProjectImpact.com) impact.org)

  8. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center (www.sidscenter.org)

  9. National Training Institute for Child Care Health Consultants (www.nti.unc.edu)

  10. Partnership for State Leadership in Oral Health (www.astdd.org)

  11. Partnership to Promote Adolescent Health in States (www.amchp.org)

  12. Public Policy Analysis and Education Center for Infant and Early Childhood Health - Project Thrive (www.nccp.org/projects/thrive.html)

  13. School Mental Health Program and Policy Analysis Centers (http://smhp.psych.ucla.edu/)

  14. State Adolescent Health Resource Center for Maternal and Child Health Personnel (www.med.umn.edu/peds/ahm/programs/sahrc/home.html)

  15. State Public Health Coordinating Center for Autism (www.amchp.org/spharc)

  16. Traumatic Brain Injury Technical Assistance Center (www.norc.org)



DEM2 Did you utilize the [RC NAME] during the past year?

(Select one)

  1. Yes

  2. No (Thank and terminate)


DEM3 How did you learn about the [RC NAME]? (Select one)

  1. Resource Center website

  2. Maternal and Child Health Library website

  3. Health care provider

  4. Maternal and Child Health Bureau project officer

  5. Maternal and Child Health Bureau website

  6. Work colleague

  7. Teacher/Educator

  8. Internet search

  9. Meeting/Professional conference

  10. A listserv

  11. Other (please specify)


DEM4 What did the [RC NAME] provide for you? (Select all that apply)

      1. Information/data on a specific topic

      2. Training

      3. Training materials/tools

      4. Technical assistance

      5. Literature downloads

      6. Contact information

      7. Other (please specify)

DEM5 How many times did you utilize (viewed website, requested information, attended events, etc.) the [RC NAME] during the past year? (Select one)

  1. 1

  2. 2 to 4

  3. 5 to 7

  4. 8 to 10

  5. More than 10


DEM6 Did you know that the [RC NAME] was funded by the Maternal and Child Health Bureau?

1 Yes

2 No


DEM7 In what role did you contact the [RC NAME]? (Select one)

  1. Student (junior high or high school)

  2. Student (post high school)

  3. Researcher

  4. Health care provider

  5. Federal employee

  6. School teacher/School nurse

  7. College/University employee

  8. Family member

  9. Family organization representative

  10. Health department employee

  11. Local government employee (non health department)

  12. State employee (non health department)

  13. Other (please specify)


DEM8 Are you a grantee of the Maternal and Child Health Bureau? (Select one)

  1. Yes

  2. No (skip to DEM10)


DEM9 Please provide the name of the Maternal and Child Health Bureau program(s) for which you are a grantee. (Capture open-ended response)


DEM10 What is the highest level of education that you have completed? (Select one)

  1. Less than High School

  2. High School/GED

  3. Some College

  4. Vocational Training

  5. 2-Year College Degree (Associates)

  6. 4-Year College Degree (BA/BS)

  7. Master’s Degree

  8. Doctoral Degree

  9. Professional Degree (MD, JD)

Resource Center Contact

  1. How have you accessed the [RC NAME]? Check all that apply.

1 Phone

2 Email

3 In person

4 Website

5 Postal mail

6 Other (please specify)



  1. Have you contacted someone at the [RC NAME] directly during the past year? (Select one)

  1. Yes

  2. No (skip to Q2_1)


Please think about your most recent contact with the [RC NAME]. Using the same 1 to 10 scale, where 1 means Poor and 10 means Excellent, please rate the…

  1. Ease of reaching a [RC NAME] contact

  2. Courteousness of the [RC NAME] contact

  3. Knowledge of the [RC NAME] contact

  4. Timeliness of the [RC NAME] contact’s response to your inquiry or concern

  5. Relevance of the information provided by the [RC NAME] contact

  6. Overall effectiveness of the service provided by the [RC NAME] contact

  7. Was the [RC NAME] contact able to provide you with the information you requested?

      1. Yes (skip to Q2_1)

      2. No


  1. If the [RC NAME] was not able to provide you with the requested information, did the Resource Center contact refer you elsewhere for the information?

      1. Yes

      2. No

Resource Center Information

Please think about the information you last received from the [RC NAME]. Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate…

  1. The timeliness of the information provided

  2. The relevance of the information to your inquiry

  3. The sufficiency of detail to meet your needs

  4. Your ease of understanding the information

  5. The organization of the information provided

  6. The helpfulness of information in guiding your decision-making

Resource Center Website

Q3_1 Have you visited the [RC NAME] website during the past year?

  1. Yes

  2. No (skip to Q4_1)


Q3_2 Is your primary use of the [RC NAME] through its website?

1 Yes

2 No


Please think about your experiences while visiting the [RC NAME] website. Using a scale from 1 to 10, where 1 means Poor and 10 means Excellent, please rate…

Q3_3 The ease of navigation

Q3_4 The overall site design

Q3_5 The relevance of search results

Q3_6 Ability to find the information needed

Training [ONLY IF DEM4=2]

Please think about any training you received while utilizing the [RC NAME]. Using the same 1 to 10 scale, where 1 means Poor and 10 means Excellent, please rate the…

  1. Relevance of the topics covered

  2. Ease of understanding the training

  3. Effectiveness of the training

  4. Appropriate amount of time to complete the training

  5. Ease of obtaining requested training

Training Materials/Tools [ONLY IF DEM4=3]

Please think about any training materials/tools that were provided by the [RC NAME]. Using the same 1 to 10 scale, where 1 means Poor and 10 means Excellent, please rate the…

  1. Relevance of the materials/tools provided

  2. Ease of understanding the materials/tools

  3. Effectiveness of the training materials/tools

  4. Timeliness of providing the materials/tools to you

Technical Assistance [ONLY IF DEM4=4]

Please think about any technical assistance you received while utilizing the [RC NAME]. Using the same 1 to 10 scale, where 1 means Poor and 10 means Excellent, please rate the…

  1. Relevance of the technical assistance provided

  2. Ease of understanding the technical assistance

  3. Effectiveness of the technical assistance

  4. Timeliness of receiving the technical assistance

  5. Ease of obtaining requested technical assistance

ACSI Benchmark Questions

  1. Please consider all of the experiences you have had while utilizing the [RC NAME]. Using a 10-point scale on which 1 means Very Dissatisfied and 10 means Very Satisfied, how satisfied are you with the [RC NAME]?

  2. Using a 10-point scale on which 1 means Falls Short of Expectations and 10 means Exceeds Expectations, to what extent has the [RC NAME] fallen short of or exceeded your expectations?

  3. Imagine an ideal Resource Center providing services to you. How well do you think the [RC NAME] compares with that ideal? Please use a 10-point scale on which 1 means Not Very Close to Ideal, and 10 means Very Close to Ideal.

Outcome Measures

  1. On a scale from 1 to 10 where 1 means Not at All Likely and 10 means Very Likely, how likely are you to visit the [RC NAME] in the future?

  2. On a scale from 1 to 10 where 1 means Not at All Likely and 10 means Very Likely, how likely are you to recommend the [RC NAME] to another person?

  3. Please check all other Resource Centers funded by the Maternal and Child Health Bureau that you utilized during the past year.

  1. Alliance for Information on Maternal and Child Health Child and Adolescent Support Center (www.healthychild.ucla.edu)

  2. Catalyst Center (www.catalystctr.org)

  3. Center for Mental Health in Schools (http://csmh.umaryland.edu)

  4. Champions for Inclusive Communities - ChampionsInc. (www.championsinc.org)

  5. Child Care and Health Partnership Program (www.healthychildcare.org)

  6. Children’s Safety Network (www.childrenssafetynetwork.org)

  7. Combating Autism Initiative - National Interdisciplinary Training Resource Center (LEND Training Grantees) (www.aucd.org/itac)

  8. The Data Resource Center for Child and Adolescent Health (or The Child and Adolescent Health Measurement Initiative) (www.childhealthdata.org www.nschdata.org www.cshcndata.org)

  9. Healthy and Ready to Work National Center (www.hrtw.org)

  10. Maternal and Child Health Library (http://www.mchlibrary.info )

  11. National Adolescent Health Information and Innovation Center (http://nahic.ucsf.edu )

  12. National Center for Cultural Competence (http://www11.georgetown.edu/research/gucchd/nccc/)

  13. National Center for Family/Professional Partnerships

(www.familyvoices.org)

  1. National Center for Hearing Assessment and Management (www.infanthearing.org)

  2. National Center for Medical Home Implementation (www.medicalhomeinfo.org )

  3. National Center for Project Access (http://www.epilepsyfoundation.org/projectaccess/NCPA/)

  4. National Consumer Center for Genetics Resources and Services (www. geneticalliance.org)

  5. National Coordinating and Evaluation Center for the Sickle Cell and Newborn Screening Program (www.sicklecelldisease.net)

  6. National Coordinating Center for the Genetics and Newborn Screening Regional Service Collaborative (www.nccrcg.org)

  7. National Emergency Medical Services for Children Data Analysis Resource Center (www.nedarc.org)

  8. National Emergency Medical Services for Children Resource Center (www.childrensnational.org/EMSC)

  9. National Fetal and Infant Mortality Review Resource Center (www.acog.org/goto/nfimr )

  10. National Healthy Tomorrows Technical Assistance Resource Center

(www.aap.org/commpeds/htpcp/index.html)

  1. National Maternal and Child Oral Health Resource Center (www.mchoralhealth.org)

  2. National MCH Center for Child Death Review (www.childdeathreview.org)

  3. National Newborn Screening and Genetics Resource Center (http://genes-r-us.uthscsa.edu)

  4. National Oral Health Policy Center (www.cdhp.org/programs/national_oral_health_policy_center_cdhp_mchb)

  5. National Resource Center for Health and Safety in Child Care and Early Education (http://nrc.uchsc.edu)

  6. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Program Support Center (www.NSICD-PSC.org )

  7. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Project IMPACT (www.SIDSProjectImpact.com) impact.org)

  8. National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center (www.sidscenter.org)

  9. National Training Institute for Child Care Health Consultants (www.nti.unc.edu)

  10. Partnership for State Leadership in Oral Health (www.astdd.org)

  11. Partnership to Promote Adolescent Health in States (www.amchp.org)

  12. Public Policy Analysis and Education Center for Infant and Early Childhood Health - Project Thrive (www.nccp.org/projects/thrive.html)

  13. School Mental Health Program and Policy Analysis Centers (http://smhp.psych.ucla.edu/)

  14. State Adolescent Health Resource Center for Maternal and Child Health Personnel (www.med.umn.edu/peds/ahm/programs/sahrc/home.html)

  15. State Public Health Coordinating Center for Autism (www.amchp.org/spharc)

  16. Traumatic Brain Injury Technical Assistance Center (www.norc.org)




  1. On a scale from 1 to 10 where 1 means Not at All Likely and 10 means Very Likely, how likely are you to utilize additional Resource Centers funded by the Maternal and Child Health Bureau in the future?

  2. Please provide any comments that will help to clarify your answers to the above questions. (Capture open-ended response)

  3. Do you have any additional comments you would like to share with Health Resources and Services Administration’s Maternal and Child Health Bureau regarding their Resource Centers? (Capture open-ended response)


Thank you for your time. The Health Resources and Services Administration’s Maternal and Child Health Bureau appreciates your input!

____________________________________________________________________________________________

1/30/21 Questionnaire – Page 10

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Last Modified Bysgrow
File Modified2010-02-12
File Created2010-02-12
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