Form 1 CERV-Net 3-Month Follow-Up Test

Introduction

Thank you again for participating in the CERV-Net Learning Series. Please complete the
following survey by September 30th, 2024 to help the CERV-Net team evaluate the impact
of this training.

Public Burden Statement:
On behalf of HRSA OWH, NORC is evaluating the CERV-Net Learning Series to determine the impact
of the learning series on providers’ knowledge, skills, and intention to change their behavior related to
cervical cancer care. This Pre-Test is one form of data collection being used for this evaluation. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a currently valid OMB control number. The OMB control number for this
information collection is 0906-0084 and it is valid until 02/27/2027. This information collection is
voluntary. Participant information provided as a part of this evaluation will be kept confidential on
NORC’s secure servers and will only be accessible by project team members. Participant name, role,
organization, and contact information will be provided to HRSA, the Federal Cervical Cancer
Collaborative, and others in the learning series to improve collaboration even after the learning series
ends. Public reporting burden for this collection of information is estimated to average 15 minutes per
response, including the time for reviewing instructions, searching existing data sources, and completing
and reviewing the collection of information. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this burden, to HRSA
Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857
or paperwork@hrsa.gov.

Demographics

What is your first name?

What is your last name?

CERV-Net Pre-Test

Rate your knowledge of (or skill in) the following topics after the course: 
Not at all
knowledgeable
or skilled
Recall HPV
vaccination guidelines
and understand when
deviations are
appropriate
Feel confident making
a strong
recommendation

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Apply strategies for
discussing
vaccination and
addressing common
concerns with
patients and parents
Understand how to
adapt Community
Guide recommended
vaccination
interventions in a
safety-net setting
Discuss real-world
facilitators and
barriers to
intervention
implementation for
different settings
Identify opportunities
for forming
partnerships to
improve vaccination
rates

Rate your knowledge of (or skill in) the following topics after the course: 

Very
knowledgeable
or skilled

Describe the
spectrum of diverse
patient needs and the

importance of
providing patientcentered exams
Incorporate best
practices for
describing and

delivering services for
special populations
into routine care
Use inclusive and
trauma-informed
language to describe
screening tests and
results

Recall and apply
routine screening
guidelines for Pap
and Primary HPV,
eligibility and exit
criteria

Feel confident
training other
providers about

screening guidelines
and eligibility and exit
criteria

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Understand how to
adapt Community
Guide recommended
screening
interventions in a
safety-net setting

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Rate your knowledge of (or skill in) the following topics after the course: 

Discuss real-world
facilitators and
barriers to
implementing
interventions for
different settings

Apply 2019 ASCCP
management
guidelines and
understand changes
from previous
guidance

Recognize
appropriate
surveillance needs
after treatment of
CIN2 or CIN3

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Apply management
guidelines and
assess individual risk
using available tools
(ASCCP app)
Explain test types and
results to patients
Understand how to
adapt Community
Guide recommended
management
interventions in a
safety-net setting

Rate your knowledge of (or skill in) the following topics after the course: 
Not at all
knowledgeable
or skilled
Discuss real-world
facilitators and
barriers to
implementing
interventions for
different settings
Use tools for
assessing capacity
and readiness for
change and quality
improvement

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Not at all
knowledgeable
or skilled

Slightly
knowledgeable
or skilled

Moderately
knowledgeable
or skilled

Very
knowledgeable
or skilled

Identify organizational
QI needs and

implement QI
exercises
Identify change
management
strategies and
sustaining practice
change

Describe emerging
innovations (e.g., selfsampling) and

potential impact on
safety-net settings of
care

3-Month Follow-Up

Please rate your level of agreement with the following statements:

I can apply the
knowledge I learned in

this ECHO series to
my work.
I am confident in my
ability to leverage the
skills gained in this
series to improve
cervical cancer care.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
agree

After participating in
this series, I am more
committed to
improving cervical
cancer care in my
practice.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
agree

Agree

Strongly
agree

I have the information
I need to make
improvements to

cervical cancer care in
my practice.

Please rate your level of agreement with the following statements:

I believe that I can
apply the knowledge I
learned in this course
to contribute to
system-level changes
for improving cervical
cancer care (e.g.,
implement

interventions, improve
data collection,
protocols, and
procedures,
implement training,
form partnerships,
increase community
engagement).

Strongly
disagree

Disagree

Neutral

I am confident in my
ability to contribute to
system-level changes
for improving cervical
cancer care.

I am committed to
contributing to
system-level changes
for improving cervical
cancer care.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
agree

As a result of participating in CERV-Net, I have (select all that apply):
Improved patient-centered care (e.g., reflective of patient values, needs, and preferences).
Implemented new EBIs evidence-based interventions for cervical cancer care.
Improved existing cervical cancer prevention, screening, and management approaches.

As a result of participating in CERV-Net, I have (select all that apply):
Shared the lessons I’ve learned in CERV-Net with others in my practice.
Advocated for changes to policies and practices within my practice.
Changed policies and practices within my organization.
Implemented an evidence-based intervention.
Improved delivery of patient care.
Other, please specify:
I have not made any changes as a result of participating in CERV-Net.

Click to write the question text
Please provide more information below.
Shared the lessons
I’ve learned in CERVNet with others in my
practice.
Changed policies and
practices within my
practice.
Implemented a
cervical cancer
evidence-based
intervention.
Improved delivery of
patient care.

What factors helped you use the content discussed in CERV-Net in your work? Select all
that apply.
I was reminded of key learning concepts or skills.
I was given the resources I need to make changes.
I had opportunities to use what I learned.
I had time to apply what I learned.
My colleagues supported me in using what I learned.
Other (please specify):

If you have not made any changes as a result of the CERV-Net Learning Series, what

factors kept you from using the content of this course in your work? Select all that apply.
None, I have used this content in my work.
I need additional training in the subject matter.
I do not have the resources I need in my workplace.
I have not been provided opportunities to use what I learned.
I do not have the time to use what I learned.
My supervisor does not support me in using what I learned.
My colleagues do not support me in using what I learned.
The course content is not relevant to my current work.
Other (please specify):

Please let us know what additional training would be helpful in the space below.

Please rate your level of agreement with the following statements:
Strongly
disagree
I feel more connected
to colleagues working
in other safety-net
settings.

Disagree

Neutral

Agree

Strongly
agree

I feel comfortable
reaching out to
colleagues working in
other safety-net
settings with
questions about
improving CERVICAL
CANCER prevention,
screening, and
management.

Strongly
disagree

Disagree

Neutral

Agree

Strongly
agree

Block 4

The following questions were also asked in the survey you took at the end of the CERV-Net
series. Please feel free to add additional reflections below or skip over these questions if
you do not have any.

What, if anything, do you plan to use from CERV-Net?

What part of this course was most helpful to your learning?

How could this course be improved to make it a more effective learning experience?

Anything else you’d like us to know?

OMB No. 0906-0084
ICR expiration date: 02/27/2027
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