Cooper Clayton Evaluation - Follow-Up Survey September 008 The following assessment instrument was developed to evaluate the Cooper Clayton Smoking Cessation Education program conducted by Louisville Metro Public Health & Wellness and their contractors. This assessment is formatted for use by the professional research firm, Horizon Research located in Louisville, Kentucky. May I speak to (insert client's name)? If that person is not there, ask: When will (that person) be available? If a time is given, say: Thank you. I will call back at that time. If no time is given, say: Thank you. I will try again later. If you speak to the client, say: The Louisville Metro Health Department wants your opinion on the smoking cessation classes. I would like to ask you a few questions. This will only take a few minutes and it will help the Louisville Metro Health Department improve their services. Did you complete a Cooper Clayton class series? ( character) Yes Go to Q No Terminate Call If refused, terminate call. In what year did you last attend the class? ( characters) Where did you last attend the class? ( characters) 0 Park DuValle Community Health Center 0 Family Health Center at Portland 0 Norton Southwest Hospital 0 Norton Surburban Hospital 05 Norton Audubon Hospital 06 Baptist Hospital East 07 Thomas Jefferson Unitarian Church 08 Arch L. Heady Funeral Home 09 South Louisville Christian Church 0 Louisville Metro Public Health & Wellness Interwoven Wellness Other Unknown or Refused Appendix B Program Evaluation Instrument
What was your facilitator's name? (0 characters) 5 How many of the sessions did you attend? 5 ( characters) How many different Cooper Clayton class series have 6 you attended? 7 Why did you attend Cooper Clayton classes? (insert "" for each mentioned) other methods did not work convenient somebody recommended the possibility of free niotine replacement products physician recommended I stop smoking other please list 'other' 8 How did you hear abou the Cooper Clayton class? (insert "" for each mentioned) radio television friend or relative who smokes friend or relative who does not smoke physician's office other please list 'other' 9 Have you used any of the following aids to quit smoking? (insert "" for each mentioned) prescription medication nicotine replacment therapy hypnosis untraditional methods cold turkey Chantix other please list 'other' How many people in your household current smoke 0 tobacco? 9 6 ( characters) 7 (character) 8 (character) 9 (character) 0 (character) (character) (character) (0 characters) (character) 5 (character) 6 (character) 7 (character) 8 (character) 9 (character) 0 (0 characters) (character) (character) (character) (character) 5 (character) 6 (character) 7 (character) 8 (0 characters) 9 ( characters) Have you smoked after completed the Cooper Clayton class? Yes 0 ( character) Appendix B Program Evaluation Instrument
No Are you currently smoking? Yes Go To Q, Q and then Q8 ( character) No Go To Q5, Q6, Q7 and then Q8 Go To Q8 Did you stop smoking while attending Cooper Clayton classes? Yes ( character) No Go To Q8 For how long did you stop? months ( characters) years 5 For how long have you been a non-smoker? months ( characters) years 6 7 Did Cooper Clayton have a direct impact on you not smoking? Yes 5 ( character) No Is there anything else that influenced you to stop smoking? 6 (0 characters) For the next questions, please rate each item on a to scale, with being Excellent and being Poor. 8 The facilitator's ability to train ( through ranking) 9 Your comfort asking questions during class ( through ranking) 0 Other members of your group ( through ranking) 7 (character) 8 (character) 9 (character) Appendix B Program Evaluation Instrument
For the next questions, please rate each item on a to scale, with being Extremely Helpful and being Not Helpful At All The Cooper Clayton DVD 0 (character) ( through ranking) The Cooper Clayton participant materials (character) ( through ranking) Nicotine replacement therapy (character) ( through ranking) Support from other class members (character) ( through ranking) 5 Support from the facilitator (character) ( through ranking) How helpful were the classes to your efforts to quit 6 smoking? ( through ranking) 5 (character) We just have a few more questions 7 Have you ever called the -800-QUIT NOW line? 6 (character) Yes No 8 What is your age? 7 ( characters) 9 9 What is your gender? 8 ( character) Male Female 0 Which one, or more, of the following would you say is your race? (Insert "" for each one mentioned) Black or Africian American White or Caucasian Hawaiian or Pacific Islander 9 ( character) 50 ( character) 5 ( character) Appendix B Program Evaluation Instrument
Asian American Indian or Alaskan 5 ( character) 5 ( character) Is there anything you would change about the smoking cessation classes to make them more effective? 5 (50 characters) Appendix B Program Evaluation Instrument 5
Appendix D Why Respondents Attended Cooper-Clayton Classes Other methods failed Doctor's recommendation Free nicotine replacement Recommended to them Convenient Other 5 6 How Participants Heard About the Class Other % Friend or relative 5% TV or radio 8% Physician's office %
Aids Used to Quit Smoking Chantix Prescription meds other than Chantix None Nicotine replacement therapy 5 6 7 8 9 Facilitator's Ability to Train 8% % = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 9
Participant Was Comfortable Asking Questions in Class 5% = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 95% Other Members of the Group 5% = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 5% 8
The Cooper-Clayton DVD 6% % 5% = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 7% 6 Cooper-Clayton Participant Materials 5% % % = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable % 68%
Nicotine Replacement Therapy 8% 6% = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 7% 7% % Support From Other Class Members 5% 5% % = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable % 76%
Support From Facilitator % % % = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 9% Helpful Classes in Effort to Quit Smoking % % = Excellent/Extremely Helpful to = Poor/Not Helpful at all, = not applicable 5% 79%
Did the Participant Use Quit-Now Telephone Number? 60 50 0 0 0 0 0 Yes No Ages of Participants - Grouped by Decade 5 0 5 0 5 0 0s 0s 0s 50s 60s 70s 80s
Race of Participant 0 5 0 5 0 5 0 5 0 African American White