10-10138 Qualitative Interview Questions 1-8

PACT Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes 10-10138

20151014_V4_PeerMntorDiab_qualIntrvw_1thru8_7-10-13

Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes

OMB: 2900-0840

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OMB No. 2900-XXXX
Estimated Burden: 1473 hours
Expiration Date: 03/31/2018


Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes Control (CEPACT) PI: J Long


Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes –

PACT Demo Lab VISN 4

VA Form 10-10138





The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not required to respond to, a collection of information unless it displays a valid OMB number. We anticipate that the time expended by all individuals who complete this survey will average 2-45 minutes. This includes the time it will take to follow instructions, gather the necessary facts and respond to questions asked. Customer satisfaction is used to gauge customer perceptions of VA services as well as customer expectations and desires. The results of this telephone/mail survey will lead to improvements in the quality of service delivery by helping to by evaluating the effects of the VA PACT initiative and by testing new, innovative strategies for patient care that can be spread if proven effective. Participation in this survey is voluntary and failure to respond will have no impact on benefits to which you may be entitled.


  1. Baseline Interview for Mentees (who are getting a former mentee as a mentor)


Thank you for agreeing to participate in this study. For the next 20 minutes I would like to talk to you about your expectations of having a mentor.


  1. You have been selected for this study because your diabetes is not in good control; why do you think that is the case?

    1. Probes

      1. What behaviors do you think contributed to not being in good control?

      2. Is there anything else?


  1. How do you think you will gain better control over your diabetes in the next six months?

    1. Probes

      1. Which behaviors do you think you will change?

      2. Is there anything else?


  1. How do you think having a mentor will help you gain better control over your diabetes?

    1. Probes

      1. In what ways do you think your mentor will motivate you?

      2. Is there anything else?


  1. Describe to me how you think the process of having a mentor will go?

    1. Probes

      1. What do you think you will talk about with your mentor?

      2. Is there anything else?


  1. What are you looking forward to about having a mentor?

    1. Probes

      1. Is there anything else?


  1. What concerns do you have about having a mentor?

    1. Probes

      1. Is there anything else?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable. I hope you will be willing to talk to us again like this in 6 months about your experience of having a mentor.


2. Exit Interview for Mentees who are not becoming a Mentor

(Enrolled for 6 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. For the last 6 months you have been assigned a mentor to help you get better control of your blood sugar. For the next 20 - 30 minutes I would like to talk to you about the experience of having a mentor.


  1. Can you tell me about your experience of having a mentor?

    1. Probes

      1. Best parts?

      2. Worst parts?


  1. How do you feel having a mentor helped you gain better control over your diabetes?

      1. What behaviors did you change in the last 6 months?

      2. Why did you pick those behaviors to change?

      3. What helped you make those changes?

        1. In what ways was your mentor involved in choosing those behaviors?

        2. How did your mentor motivate you?

        3. In what ways was your mentor supportive?

      4. What else, if anything, do you wish you’d changed?

      5. How important do you think it was that your mentor had diabetes as well?

      6. Is there anything else?


  1. How was the experience of having a mentor similar to what you were expecting?

    1. Probes

      1. How was it different?

      2. Is there anything else?


  1. Now let’s talk a little bit about a typical interaction with your mentor, can you tell me about that?

    1. Did you and your mentor ever meet face to face?

Yes No

    1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

    1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

    1. How often did you talk? (times per week/month)

_____time per week/month

    1. What specific things did you discuss regarding what you could or would do to improve your diabetes control?

    2. Did you and your mentor talk about goals? If so, did you feel they were realistic?

    3. Do you plan to stay in touch with your mentor over the next 6 months? Do you think you will talk as regularly as you have been talking?

Yes No

    1. If rematched: Can you tell me about what it is like to be rematched with a new mentor?


  1. We would love to hear your perspective about what would make this a better program. What do you think would help?

    1. Probes

      1. Is there anything else?


  1. Do you think if you had been offered this program by your provider and not as part of a study you would have participated?

    1. If yes:

      1. Can you tell me more about that?

      2. Are there any other reasons?

    2. If no:

      1. Can you tell me more about that?

      2. Are there any other reasons?

      3. What would make you interested in a program like this?

    3. How important was the money?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable. I hope you will be willing to talk to us again like this in 6 months about your experience of being a mentee.



3. Exit Interview for Mentors who were not Mentees

(Enrolled for 6 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. For the last 6 months you have been assigned a mentee to help him/her gain better control of his/her blood sugar. For the next 20 – 30 minutes I would like to talk to you about the experience of being a mentor.


  1. Can you tell me about your experience of being a mentor?

    1. Probes

      1. Best parts?

      2. Worst parts?


  1. How did being a mentor affect your diabetes self-care?

    1. Probes

      1. What behaviors did you change?

      2. Why did you pick those behaviors?

      3. How important do you think it was that you were previously in poor control?

      4. What else, if anything, do you wish you had changed?

      5. What things, if any, do you wish you had to make changes?

      6. Is there anything else?


  1. Tell me how the experience of being a mentor matched what you were expecting?

    1. Probes

      1. How was it the same and how was it different?

      2. Is there anything else?


  1. Now let’s talk a little bit about a typical interaction with your mentee, can you tell me about that?

    1. Did you and your mentee ever meet face to face?

Yes No

    1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

    1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

    1. How often did you talk? (times per week/month)

_____time per week/month

    1. What did you usually talk about?

    2. When you talked about diabetes what topics came up?

    3. Did you and your mentee talk about goals? If so, did you feel they were realistic?

    4. How did you try to motivate your mentee?

    5. How effective do you feel you were as a mentor?

      1. Can you tell me more about what worked and what didn’t?

    6. Do you plan to stay in touch with your mentee over the next 6 months? Do you think you will talk as regularly as you have been talking?

Yes No

    1. If rematched: Can you tell me about what it was like to be rematched with a new mentee?


  1. How did you feel about the peer mentor training?

    1. Probes

      1. How was the training that we provided helpful to you?

      2. How prepared did you feel to become a mentor?

      3. In what ways did you feel motivated to become a mentor?

      4. What did you think about the handouts?

      5. What could we have done to make you feel more prepared to become a mentor?

      6. Is there anything else?


  1. We would love to hear your perspective about what would make this a better program. What do you think would help?

    1. Is there anything else?


  1. Do you think if you had been offered this program by your provider and not as part of a study you would have participated?

    1. If yes: why?

      1. Can you tell me more about that?

      2. Are there any other reasons?

    2. If no: Why not?

      1. Can you tell me more about that?

      2. Are there any other reasons?

      3. What would make you interested in a program like this?

    3. How important was it that you could receive $20 a month to be a mentor?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable. I hope you will be willing to talk to us again like this in 6 months about your experience of being a mentor.



4. Exit Interview for Mentors from former Mentees Stage II

(Enrolled for 6 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. For the last 6 months you have been assigned a mentor to help you get better control of your blood sugar. For the next 20- 30 minutes I would like to talk to you about the experience of having a mentor and your thoughts about becoming a mentor.


  1. Can you tell me about your experience of being a mentee?

    1. Probes

      1. Best parts?

      2. Worst parts?


  1. How do you feel having a mentor helped you gain better control over your diabetes?

      1. What behaviors did you change in the last 6 months?

      2. Why did you pick those behaviors to change?

      3. What helped you make those changes?

      4. What else, if anything, do you wish you’d changed?

      5. In what ways was your mentor involved in choosing those behaviors?

        1. How did your mentor motivate you?

        2. In what ways was your mentor supportive?

      6. How important do you think it was that your mentor had diabetes as well?

      7. Is there anything else?


  1. How was the experience of having a mentor match what you were expecting?

    1. Probes

      1. How was it the same and how was it different?

      2. Is there anything else?


  1. Now let’s talk a little bit about a typical interaction with your mentor, can you tell me about that?

    1. Did you and your mentor ever meet face to face?

Yes No

    1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

    1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

    1. How often did you talk? (times per week/month)

_____time per week/month

    1. What did you usually talk about?

    2. When you talked about diabetes what topics came up?

    3. Did your mentor help you set goals? If so, did you feel they were realistic?

    4. Are you still in touch with your mentor?

    5. Do you think you will continue to talk to your mentor? Do you think you will talk as regularly as you have been talking?

Yes No

    1. If rematched: Can you tell me about what it was like to be rematched with a new mentor?

  1. We would love to hear your perspective about what would make this a better program. What do you think would help?

    1. Probes

      1. Is there anything else?


  1. Do you think if you had been offered this program by your provider and not as part of a study you would have participated?

    1. If yes: why?

      1. Can you tell me more about that?

      2. Are there any other reasons?

    2. If no: Why not?

      1. Can you tell me more about that?

      2. Are there any other reasons?

      3. What would make you interested in a program like this?

    3. How important is it that you could receive $20 a month to be a mentor?


  1. How do you feel about becoming a mentor?

    1. Probes

      1. Can you tell me more about that?

      2. What do you plan to do differently? Why?

      3. What do you think you will do the same?

      4. What do you think you will talk about with your mentee?

      5. How do you plan to motivate your mentee?

      6. Is there anything else?


  1. What are you looking forward to as part of your role as a mentor?

    1. Probes

      1. Is there anything else?


  1. What concerns do you have about being a mentor?

    1. Probes

      1. Is there anything else?


  1. How do you think being a mentor will help your diabetes self-care?

    1. Probes

      1. Is there anything else?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable. I hope you will be willing to talk to us again like this in 6 months about your experience of being a mentor.



5. Exit Interview for Mentees who did not become a mentor

(Enrolled for 12 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. 12 months ago you were assigned a mentor to help you get better control of your blood sugar. For the next 20 -30 minutes I would like to talk to you about your experience during the last 6 months.



  1. Let’s talk a little bit about your relationship with your mentor and how it has changed compared to the first 6 months:

    1. Probes

      1. Can you tell me more about that?

      2. Have you stayed in touch with your mentor in the last 6 months? Tell me about that:

-If no:

          1. Did you consider staying in touch?

          2. Do you think it would have been helpful for either of you?

-if yes:

      1. Did you and your mentor meet face to face in the last 6 months?

Yes No

      1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

      1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

      1. How often did you talk? (times per week/month)

_____time per week/month

      1. What did you usually talk about?

      2. When you talked about diabetes what topics came up?

      3. Did your mentor help you set goals? If so, did you feel they were realistic?

      4. Do you think you will continue to talk to your mentor? Do you think you will talk as regularly as you have been talking?

Yes No


  1. What positive changes that you made when you had a mentor have you maintained, if any?

    1. Probes

      1. What do you think helped you to maintain those behaviors?

      2. Is there anything else?


  1. Can you tell me about any behaviors that you have changed in the last 6 months?

    1. Probes

      1. Why did you pick those behaviors to change?

      2. How was your mentor involved in those changes?

      3. How did your mentor motivate you?

      4. What else, if anything, do you wish you had changed?

      5. Is there anything else?


  1. Now that you’ve had a longer time to reflect, what do you think would make this a better program?

    1. Probes

      1. Is there anything else?


  1. Looking back, what was the best part about having a mentor?

    1. Probes

      1. Is there anything else?


  1. Would it be helpful to you if you still had your mentor?

    1. Probes

      1. If yes, how? If no, why not?


  1. Would you consider becoming a mentor?

    1. Probes

      1. Can you tell me more about that? Why would/wouldn’t you?

      2. If yes: What would you do differently? Why would you change that?

        1. What would you do the same?

      3. Is there anything else?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable.



6. Exit Interview for Mentors who were never Mentees

(Enrolled for 12 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. 12 months ago you were assigned a mentee to help him/her gain better control of his/her blood sugar. For the next 20-30 minutes I would like to talk to you about the last 6 months.


  1. Let’s talk a little bit about your relationship with your mentee and how it has changed compared to the first 6 months:

    1. Probes

      1. Can you tell me more about that?

      2. Have you stayed in touch with your mentee since the study ended? Tell me about that:

-If no:

          1. Did you consider staying in touch?

          2. Do you think it would have been helpful for either of you?

-if yes:

      1. Did you and your mentee meet face to face in the last 6 months?

Yes No

      1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

      1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

      1. How often did you talk? (times per week/month)

_____time per week/month

      1. What did you usually talk about?

      2. When you talked about diabetes what topics came up?

      3. Did you and your mentee talk about goals? If so, did you feel they were realistic?

      4. In what ways did you try to motivate your mentee?

      5. How effective do you feel you were as a mentor? Can you tell me more about what worked and what didn’t?

      6. Do you think you will continue to talk to your mentee? Do you think you will talk as regularly as you have been talking?

Yes No


  1. What positive changes that you made while you were a mentor have you maintained, if any?

      1. What do you think helped you to maintain these behaviors?

      2. What motivated you to maintain these behaviors?

      3. Is there anything else?


  1. Can you tell me about any behaviors that you have changed in the last 6 months?

    1. Probes

      1. Why did you pick those behaviors to change?

      2. How did your experience as a mentor help you choose these behaviors to change?

      3. What else, if anything, do you wish you had changed?

      4. Is there anything else?


  1. Now that you’ve had a longer time to reflect, what would make this a better program?

    1. Is there anything else?

    2. Do you wish you had been assigned another mentee?

Yes No

      1. Can you tell me why that is?


  1. Would you be willing to participate in this program again?

Yes No


    1. If yes – would you be willing to participate again if you weren’t going to be paid?

    2. Is there anything else?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable.

7. Exit Interview for Mentors from Former Mentees

(Enrolled for 12 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. For the last 6 months you have been assigned a mentee to help him/her gain better control of his/her blood sugar. For the next 20 – 30 minutes I would like to talk to you about the experience of being a mentor.


  1. Can you tell me about your experience of being a mentor?

    1. Probes

      1. Best parts?

      2. Worst parts?


  1. How did being a mentor affect your diabetes self-care?

      1. What behaviors did you change? Why did you pick those behaviors?

      2. What else do you wish you had changed?

      3. What things do you wish you had to make changes?

      4. How important do you think it was that you were previously a mentee?

        1. How did your experience as a mentee help you to choose behaviors to change?

      5. Which do you think had the greatest impact on your diabetes self-care, being a mentee or being a mentor? Why do you think this had more of an impact?

      6. Is there anything else?


  1. Now let’s talk a little bit about a typical interaction with your mentee, can you tell me more about that?

    1. Did you and your mentee ever meet face to face?

Yes No

    1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

    1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

    1. How often did you talk? (times per week/month)

_____time per week/month

    1. What did you usually talk about?

    2. When you talked about diabetes what topics came up?

    3. Did you and your mentee talk about goals? If so, did you feel they were realistic?

    4. How did you try to motivate your mentee?

    5. How effective do you feel you were as a mentor? Can you tell me more about what worked and what didn’t?

    6. Do you think you will continue to talk to your mentee? Do you think you will talk as regularly as you have been talking?

Yes No

    1. If rematched: Can you tell me about what it was like to be rematched with a new mentee?



  1. How did you feel about the peer mentor training?

    1. Probes

      1. How do you feel the training we provided helped you to be a mentor?

      2. In what ways did you feel prepared to become a mentor?

      3. What did you think about the handouts?

      4. In what ways did you feel motivated to become a mentor?

      5. What could we have done to make you feel more prepared to become a mentor?

      6. Is there anything else?


  1. We would love to hear your perspective about what would make this a better program. What do you think would help?

    1. Is there anything else?


  1. Do you think if you had been offered this program by your provider and not as part of a study you would have participated?

    1. If yes: why?

      1. Can you tell me more about that?

      2. Are there any other reasons?

    2. If no: Why not?

      1. Can you tell me more about that?

      2. Are there any other reasons?

      3. What would make you interested in a program like this?

    3. How important was it that you could receive $20 a month to be a mentor?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable.

8. Exit Interview for Mentors who were former Mentees

(Enrolled for 18 Months)


Date: / /


Thank you for agreeing to talk to us about your experience so far in this study. 12 months ago you were assigned a mentee to help him/her gain better control of his/her blood sugar. For the next 20-30 minutes I would like to talk to you about the last 6 months.


  1. Can you tell me about your experience in the last 6 months regarding this study?

    1. Probes

      1. Is there anything else?

      2. Have you stayed in touch with your mentee since the study ended? Tell me about that:

-If no:

          1. Did you consider staying in touch?

          2. Do you think it would have been helpful for either of you?

-if yes:

      1. Did you and your mentee meet face to face in the last 6 months?

Yes No

      1. Who initiated the meeting? /Who usually called who?

Mentor Mentee

      1. How long was a typical meeting? /How long was a typical call?

_____ Minutes

      1. How often did you talk? (times per week/month)

_____time per week/month

      1. What did you usually talk about?

      2. When you talked about diabetes what topics came up?

      3. Did you and your mentee talk about goals? If so, did you feel they were realistic?

      4. How did you try to motivate your mentee?

      5. How effective do you feel you were as a mentor? Can you tell me more about what worked and what didn’t?

      6. Do you think you will continue to talk to your mentee? Do you think you will talk as regularly as you have been talking?

Yes No


  1. What positive changes that you made while you were a mentor have you maintained, if any?

      1. What do you think helped you to maintain these behaviors?

      2. Is there anything else?


  1. Can you tell me about any behaviors that you have changed in the last 6 months?

    1. Probes

      1. Why did you pick those behaviors to change?

      2. How did your experience as a mentor help you choose these behaviors to change?

      3. What else do you wish you had changed?

      4. Is there anything else?


  1. Now that you’ve had a longer time to reflect, what would make this a better program?

    1. Is there anything else?

    2. Do you wish you had been assigned another mentee?


  1. Would you be willing to participate in this program again?

    1. If yes – would you be willing to participate again if you weren’t going to be paid?

    2. Is there anything else?


  1. Is there anything else you think we should know or you would like to tell us?


Thank you again for your participation. The information you are providing is invaluable.


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