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Second Decade Community Planning Guide - Secondary Stakeholder Survey

Form Approved
OMB No. 0990Exp. Date XX/XX/20XX

Thank you for taking the time to review the Second Decade Project Community Planning Guide (the Guide). The following
survey is intended to gather your feedback and recommendations for improving the Guide for the Office of the Assistant
Secretary of Health (OASH) and others who work with youth 10-19 years of age. Your thoughtful review is appreciated.
Before you complete this survey, please read the following consent form. The survey will take approximately 30
minutes. By completing and submitting this web survey, you are consenting to participate. Your participation in this
survey is completely voluntary; there are no right or wrong answers; and you may contact us with any questions that you
have before, during, or after you complete the survey.
Privacy: Your answers to the survey questions will be kept private except as otherwise required by law. Your name will not
be linked with the information on your survey. The information that we report to OASH will not contain your name. Your name
will not be used in any reports about this evaluation.
Procedures: Secondary stakeholders, specifically adolescent health experts, adolescent health researchers and
practitioners, state/local health department officials, and others who have a stake and interest in working with youth will be
asked to complete this survey. Therefore, your participation is very important. The survey questions will ask you about your
feedback and recommendations for improving the Guide.
Risks: There are few, if any, risks to you by completing this survey. You may stop the survey at any time. You will not be
penalized for stopping. If you stop the survey, at your request, we will destroy your survey.
Contact information: If you have any concerns about completing this survey or have any questions about the study, please
contact Gingi Pica, Project Manager, at 212-941-5555 or gingi.pica@icfi.com.
Thank you in advance for your willingness to participate.
Your responses are very important to us.

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0990-0379. The time required to complete this information collection is estimated to
average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review
the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.
Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports
Clearance Officer

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Second Decade Community Planning Guide - Secondary Stakeholder Survey

INTRODUCTION

The first set of questions are related to the processes the Guide outlines for developing community plans.
Please indicate how effective the Guide is in addressing the following areas:
1. How effective is the Guide in ...
Guide and Community Plan Development
Very
Ineffective

Very
Ineffective

Average

Effective

Effective

Identifying a process and issues to inform development of
comprehensive community plans
Providing guidance to coalitions to set priorities for their
community action plan
Providing guidance to coalitions to address more than one
specific issue impacting adolescents in their community
Providing guidance to coalitions to develop short-term goals
Providing guidance to coalitions to develop long-term goals
Providing guidance to coalitions to assess their goals

2. Please share additional comments on processes included in the Guide to develop a community
plan:

3. Are there elements of the process to developing a community plan that are missing? If so, please
explain?

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Second Decade Community Planning Guide - Secondary Stakeholder Survey

4a. Please indicate your level of agreement with the following statements regarding the clarity of
the directions provided in the Guide.
Guide Format
Strongly
Disagree

No opinion
Disagree

or uncertain

Strongly
Agree

Agree

The main message of the Guide was clearly communicated
The main message of the Guide was easy to identify
The Guide is an appropriate length
The overall objectives of the Guide are clearly
communicated
The Guide clearly explains why the Second Decade is
important to communities
The resources provided in the Guide are current
The resources provided in the Guide are relevant to the
sections
The resources provided in the Guide are easy to identify

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