North Carolina Asthma Program: The Burden of Asthma in North Carolina, 2006

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The Burden of Asthma in North Carolina Report: Evaluation Form

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If there is an asterisk "*" at the end of question, it means an answer is required. We ask that you complete questions 1-6. Questions 7, 8, and 9 are optional.

1. What type of organization do you represent (check all that apply): *

Local Health Department
State or Local Coalition
Community Health Organization
Hospital, Clinic, Practice, or Medical Facility
Academic Institution (College, University)
Elementary/Secondary School
Medical/Health Professional Association
Faith Based Organization
Person with Asthma
OTHER (Enter up to 40 characters.)

2. Name of organization: *

3. What is your position in the organization (check all that apply): *

Physician
Nurse
Health Educator
Epidemiologist
Researcher
Faculty
Community Leader
Government Official
Legislator
Administrator
OTHER

4. How will you use this report (check all that apply): *

Grant-writing
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Presentations
OTHER

5. For each statement below, please select the choice that best reflects your opinion: *

a. This report is clear and easy to understand.

b. This report is well-organized.

c. This report has improved my understanding of Asthma in North Carolina.

d. This report will be useful to me in my work.

6. Please rate the usefulness of each section: *

a. The Executive Summary was:

b. The Introduction was:

c. The Asthma Prevalence section was:

d. The Asthma Management and Quality of Life section was:

e. The Health Care Utilization section was:

f. The Mortality section was:

g. The Healthy People 2010 section was:

h. The Discussion, References, and Technical Notes were:

i. The Appendices were:

7. Please list any other content areas that you would like to see in future editions:

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8. Please list any organizations (name, phone #) you feel would benefit from this report:

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9. Other comments/questions/suggestions:

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