Center for Innovation and Engagement Evaluation Form | Center for Innovation and Engagement

Name *

First

Last

Affiliation (e.g., Organization, Agency, etc.)

City, State

Position / Role

Email *

Please enter your email, so we can follow up with you.

In what type of setting do you work? Check all that apply.

Behavioral health settings
City/county health department
State health department
Community based organization
Community health center, including Federally Qualified Health Center (FQHC)
Hospital or hospital-based clinic
RWHAP funded clinic or organization
Other (please specify in field below)

Enter setting

Do you work directly with people with HIV?

Yes
No

If yes, in what capacity do you work with this client population? (Check all options that apply.)

Research
Direct Clinical Services (e.g., medical provider)
Non-clinical Services (e.g., case manager)
Legal / Advocacy
Other (please specify in field below)

Enter capacity

How did you hear about the CIE website?

Enter how you heard about the CIE website

What was the purpose of visiting the CIE website? (Check all options that apply.)

Learn more about the Center for Innovation and Engagement
To replicate an intervention
To identify opportunities for collaboration on other projects
Other (please specify in field below)

Enter purpose of visiting the CIE website

Were you able to find what you were looking for on the CIE website?

Yes
No

If no, please specify what would have been helpful to include on the website.

Have you disseminated CIE resources within your organization and/or broader network?

Yes
No

Website Navigation

Please indicate how much you agree or disagree with the following set of statements.

I found the content on the website relevant to my work (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

I could locate the relevant information I was interested in easily. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

Which of the following resources were most useful for you or your organization? (Check all that apply.)

The content and resources on the website were clear and easy to understand. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

Resource Utilization

Are you planning to, or interested in replicating at least one of the highlighted interventions on the website within the next 12 months?

Yes
No

If no, please specify why.

If yes, please select which intervention(s) from the list below:

What HIV care continuum outcomes are you trying to address by replicating the intervention(s) on the website? Check all that apply.

Reach of CIE Website

Please indicate the extent to which you agree or disagree with the following set of statements.

CIE website resources have the potential to improve HIV service delivery models across different health settings. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

CIE website resources can help advance health equity for people with HIV and people disproportionately impacted by the HIVE epidemic. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

CIE website resources adequately equip future intervention replicators with information and tools necessary to implement interventions. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

The Implementation Guides and supplementary resources cana be easily adapted to various settings including coommunity health centers and community-based organizations. (1=strongly disagree; 2=disagree; 3=neither agree or disagree; 4=agree; 5=strongly agree)

Technical Assistance and Peer-to-Peer Engagement

If you are planning to, or interested in replicating at least one of the highlighted interventions, would you be interested in receiving technical assistance?

Yes
No
Not applicable

Improvements

What additional resources should we add to the website?

What barriers or challenges have you encountered with accessing the website and resources?

General comments/questions: