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Southeast Chicago Diabetes Community Action Coalition Form D6 IRB Stamp COMMUNITY LEADER QUESTION GUIDE
Introduce yourself EXPLAIN THE PROJECT: ? The Midwest Latino Health Research, Training, and Policy Center, University of Illinois at Chicago, is implementing a community action plan based on a health needs of the southeast Chicago community This is being done with the Healthcare Consortium of Illinois, the Illinois Diabetes Control Program Illinois Department of Human Services, and other organizations This information will be used in an diabetes community action plan that is being developed with community representatives in area We would like your opinions about community health needs, and about the resources and strategies of your organization and community to address the needs of people in general or with diabetes This project is being conducted by the Midwest Latino Health Research, Training, and Policy Center of the Jane Addams College of Social Work, University of Illinois at Chicago UIC under the sponsorship of the National Center for Chronic Disease Prevention and Health Promotion CDC-REACH 2010 Initiative You have been asked to participate in this study because you
work, reside, or provide services to this area and may be eligible to participate We ask that you read this consent form and ask any questions you may have before agreeing to be in the study
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? [ADMINISTER FORM: Consent for Participation in an Interview: Community Leader] ? Again, your participation in this project is voluntary Your decision whether or not to participate will not affect your current or future relations with the University of Illinois, the Healthcare Consortium of Illinois or its members, and Illinois Diabetes Control Program If you decide to participate, you are free to withdraw at any time without affecting that relationship Again, we would like you to agree to allow us to tape record the interview This is to assure that the information reflects what you said accurately However, your identity and that of your agency will be kept confidential None of the information shared with the public will contain your name or any other identifying personal information Tape recordings will be kept for three years, and then destroyed All information obtained will be kept in confidential and secure locked files at UIC
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Southeast Chicago Diabetes Community
Action Coalition
I RESPONDENT DEMOGRAPHICS INTERVIEW DATE: M |___|___|d|___|___|y|___|___|___|___\ INTERVIEWER: _______________________________________________________ |__|__| First, we would like to know something about you Name: Facility/Org: Position\Title: Address: City Telephone 1 State FAX Zipcode
Please tell us something about your training and work experience before working with this organization?
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Do you identify yourself as: G African-American or Black G White non-Hispanic G Hispanic or Latino G Mexican G Mexican-American G Puerto Rican G Other Latino: G Other: ______________________________________________________________ Would you say your age falls in the following categories? G 18-29 G 30-39 G 40-49 G 50-64 G 65 How may years of school have you completed? _______ In what areas: _________________________________________________________________ _________________________________________________________________ Gender: __ Female __ Male How many years have you lived in the southeast Chicago area? |___|___| How many years have you worked in the southeast Chicago area? |___|___| Did you grow up in the southeast Chicago area? G NO G YESTell us about your
experience?
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Southeast Chicago Diabetes Community Action Coalition Form D6 II COMMUNITY PROBLEMS 1 What are some of the strengths of this community? PROBE: some examples might be family unity, active church leaders, strong community-based organizations, unity among residents people helping others
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What are the three main problems confronting residents in this area? A |___|___| B|___|___| C |___|___| 11 Language barriers 12 Hopelessness/Depression 13 Lack of job in area 14 Overcrowded schools 15 Poor quality of education 16 Low income 17 Lack of communication between parents and children 18 Transportation
01 Racism or discrimination 02 Isolation 03 Unemployment 04 Lack of unity among residents 05 Poor housing 06 Air pollution 07 Alcohol drinking 08 Other drug use 09 Gangs 10 Street Crime
19 Other specify: __________________________________________________________ 3 Can you think of some of the health and human resources organizations available to community residents?
4 What gaps in community services exist in the community?
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Southeast Chicago Diabetes Community Action Coalition III COMMUNITY HEALTH 1 What are three of the main health problems of people in
this community? A |___|___| B|___|___| C |___|___| 01 Diabetes 03 Cancer 05 Lung diseases 07 Depression 09 Stroke 02 Heart disease 04 Asthma 06 Liver disease 08 Other mental disorders 10 Alcoholism
Exercise 1 What are some of the benefits of exercising regularly?
2 What are some of the resources in the community that can help a person lead an active lifestyle?
3 Do you exercise regularly? Why or why not? What keeps you people from exercising regularly? 4 Is it easy to recommend exercise to people in this community?
Diet/Nutrition 1 What is a healthy diet? What do people need to eat? Are there things that you should have less of and less often? What do people need to add to their diet? What are the cost implications?
2 Why is it hard to have a healthy diet? What are some of barriers people have to healthy eating?
3 Is hunger or food insufficiency a problem in this community? Who is most affected? Why?
4 Are there foods that are traditional in your community your family which might be 4
Southeast Chicago Diabetes Community Action Coalition considered unhealthy? Do they still eat these foods? How often? Why?
5 What do you recommend to people to stay healthy?
Diabetes
Awareness and Prevention 1 How serious is diabetes in you community? PROBE: Do you think diabetes is increasing or decreasing in this community?
2 Who is affected the most? PROBE: for perceptions of racial/ethnic disparities
3 What do you think are the most important risk factors for diabetes in this community? PROBE: environmental and economic barriers
4 What do you think are some of the policies, social, cultural and environmental factors that influence or modify behaviors\lifestyle factors that contribute to diabetes and chronic diseases in this community? What can be done? What is being done?
5 What kinds of programs do you think people who have risk factors for diabetes need? PROBE: What programs does your institution have?
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Southeast Chicago Diabetes Community Action Coalition Access to Health and Human Services 1 How easy is it to get to hospitals or clinics that people can afford?
2 What kind of health insurance or health plan do people have? PROBE: What have you heard about managed care plans? What are their benefits their problems?
3 Has there ever been cases in which people you know or clients needed to see a doctor or get a medicine but were not able to
afford it?
4 Have you ever needed an interpreter for a client but there was no one available? What is your experience using interpreters? What happened?
5 What do you think is a medical emergency, that is, when do you think people should call an ambulance? Or go to an emergency room? What has been your experience here in southeast Chicago?
Health Promotion 1 What are some of the organizations not necessarily hospitals and clinics that can help different ethnic \racial groups with health issues? List organization and area
2 What can local governments do to make the community healthier?
Program Capacity/Cultural Competence 6
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Southeast Chicago Diabetes Community Action Coalition What are the programs being implemented at this organization?
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Is there a specific set of operating policies for serving non-English speaking clients?
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What do you do to match the language and cultural needs of the clients with employees? What barriers have you encountered?
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How do you deal with diversity in the workforce?
IV CLOSING 1 Are you or is your agency interested in helping to implement the Community Action Plan to address diabetes-related problems in your community? G NO PROBE G
YES
2 What other ideas do you have to deal with or solve diabetes-related problems in this community?
3 Would you and your staff be interested in receiving leadership and other training in diabetes prevention and control, such as program development, exercise, diet/nutrition aspects, case management, resources, etc
Thank you for your participation Additional observations/comments:
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Source:fep.paho.org
