General Program Questions

Step 1 of 4

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The purpose is to get you thinking about your program. Data entered will only be shared with trusted partners and the iPRISM development team to enhance user experience. More info.

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1. Briefly describe the topic of insert-program-name.

What is your email?

1. What is you professional title?

2. Select your PRIMARY ROLE on this project.

Clinician

Quality improvement specialist

Researcher

Public health practitioner

Program manager

Implementation specialist

Clinical administrator (e.g., Medical director)

Academic administrator (e.g., Department chair, dean)

Other

Try to choose only ONE role

How would you describe yourself? - Other

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Are you an assistant facilitator?

Yes

Add your team members.

Team member email address (Required)

What is your team member's professional title?

What is your team member's PRIMARY ROLE on this project?

Clinician

Quality improvement specialist

Researcher

Public health practitioner

Program manager

Implementation specialist

Clinical administrator (e.g., Medical director)

Academic administrator (e.g., Department chair, dean)

Other

Is your team member an assistant facilitator?

Yes

Check this box if your team should complete strategies as individuals.

Yes

Disable Specific Questions

Facilitator questions are only available for Planning, Implementing, and Sustaining stages.

By default all questions will be included for your team in the webtool. If you would like to remove specific questions, check the box next to those question labels

3. Briefly list the goals of insert-program-name (no more than 2 sentences).

4. Which of the following best describes the setting for insert-program-name? (select all that apply)

Community

Clinical

Public health

Other

5. Briefly list the population/recipients of insert-program-name?

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6. How are you completing this tool?

Individually

Team members are completing individually to stimulate discussion

Together as a team

6. Briefly reflect on the following questions.

How would you describe the main components of insert-program-name (program, practice, principle, procedure, product, pill, policy)?
As currently planned, how will you implement these components of insert-program-name?

Stop Here Complete Now

RE-AIM Program Outcome Assessment

The first set of questions ask you to evaluate the likely Reach, Effectiveness, Adoption, Implementation and Maintenance of your program. Answer the following questions, providing your best estimate based on your knowledge at the time of completion. There are no ‘right’ answers. These questions are meant to be thought-generating. USE THE FULL RANGE OF THE SCALE

Data entered will only be stored in aggregate and will not be shared with anyone.
Once you get started, you can save your progress and pick up where you left off later using a unique link that will be emailed to you .
You will also be able to print out and/or download your answers and results at the end.

How likely is it that...

RE-AIM Program Outcome Assessment

Data entered will only be stored in aggregate and will not be shared with anyone.
Once you get started, you can save your progress and pick up where you left off later using a unique link that will be emailed to you .
You will also be able to print out and/or download your answers and results at the end.

To what extent is...

ADOPTION

ADOPTION considers
Number and percent of settings
Similarity of sites participating vs. not
Starting to participate or be trained
Multi-level

1a. ...insert-program-name will be ADOPTED by a high percentage of the intended settings?

1a_N/A

N/A

1a. ...insert-program-name will be ADOPTED by a high percentage of new settings?

1a_N/A

N/A

1a. ...insert-program-name being ADOPTED by a high percentage of the intended settings?

1a_N/A

N/A

1a_notes

1b. ...insert-program-name will be ADOPTED by settings with few resources and that serve socially and economically disadvantaged populations?

1b_N/A

N/A

1b. ...insert-program-name being ADOPTED by settings with few resources and that serve socially and economically disadvantaged populations?

1b_N/A

N/A

1b. ...insert-program-name will be ADOPTED by new settings with few resources and that serve socially and economically disadvantaged populations?

1b_N/A

N/A

1b_notes

1c. …a high percentage of staff will participate in insert-program-name?

1c_N/A

N/A

1c. …a high percentage of staff participating in insert-program-name?

1c_N/A

N/A

1c. …a high percentage of staff will participate in insert-program-name going forward?

1c_N/A

N/A

1c_notes

1d. .…insert-program-name will be ADOPTED by a high percentage of the intended delivery staff?

1d_N/A

N/A

1d. .…insert-program-name being ADOPTED by a high percentage of the intended delivery staff?

1d_N/A

N/A

1d. .…insert-program-name will be ADOPTED by a high percentage of the intended delivery staff going forward?

1d_N/A

N/A

1d_notes

1e. ...staff who participate in insert-program-name will be similar to those who decline?

1e_N/A

N/A

1e. ...staff who participate in insert-program-name similar to those who decline?

1e_N/A

N/A

1e. ...staff who participate in insert-program-name in new settings will be similar to those who decline?

1e_N/A

N/A

1e_notes

IMPLEMENTATION

IMPLEMENTATION considers
Consistency of delivery (fidelity)
Changes made to fit context
Time and costs required

2a. ...staff will consistently deliver the core functions (or components) of insert-program-name with high quality?

2a_N/A

N/A

2a. ...the staff consistently deliver the core functions (or components) of insert-program-name with high quality?

2a_N/A

N/A

2a. ...staff will continue to deliver the core functions (or components) of insert-program-name with high quality?

2a_N/A

N/A

2a_notes

2b. ...insert-program-name can be adapted as needed to fit your setting?

2b_N/A

N/A

2b. ...insert-program-name being adapted as needed to fit your setting?

2b_N/A

N/A

2b. ...insert-program-name can be adapted as needed to fit your setting in the future?

2b_N/A

N/A

2b_notes

2c. ...the costs and resources needed to deliver insert-program-name are feasible for your setting?

2c_N/A

N/A

2c. ...the costs and resources needed to deliver insert-program-name are feasible for your setting?

2c_N/A

N/A

2c. ...the costs and resources needed to deliver insert-program-name are feasible for your setting in the future?

2c_N/A

N/A

2c_notes

REACH

REACH considers
How many persons take part
Similarity of those participating vs. not
Equity of participation

3a. ...insert-program-name will REACH a high percentage of its intended recipients (e.g., patients, employees, students)?

3a_N/A

N/A

3a. ...insert-program-name REACHING a high percentage of its intended recipients (e.g., patients, employees, students)?

3a_N/A

N/A

3a. ...insert-program-name will REACH a high percentage of its intended recipients (e.g., patients, employees, students) in the future?

3a_N/A

N/A

3a_notes

3b. ...insert-program-name will equitably REACH the intended recipients, including populations that are socially and economically disadvantaged?

3b_N/A

N/A

3b. ...insert-program-name equitably REACHING the intended recipients, including populations that are socially and economically disadvantaged?

3b_N/A

N/A

3b. ...insert-program-name will equitably REACH the intended recipients, including populations that are socially and economically disadvantaged in the future?

3b_N/A

N/A

3b_notes

EFFECTIVENESS

EFFECTIVENESS considers
Overall program impact
Equity of program impact
Level of improvement
Who benefits and who does not

4a. ...insert-program-name will be EFFECTIVE?

4a_N/A

N/A

4a. ...insert-program-name EFFECTIVE?

4a_N/A

N/A

4a. ...insert-program-name will be EFFECTIVE in the future?

4a_N/A

N/A

4a_notes

4b. ...insert-program-name will be EFFECTIVE for intended recipients that are socially and economically disadvantaged?

4b_N/A

N/A

4b. ...insert-program-name EFFECTIVE for intended recipients that are socially and economically disadvantaged?

4b_N/A

N/A

4b. ...insert-program-name will be EFFECTIVE for intended recipients that are socially and economically disadvantaged in the future?

4b_N/A

N/A

4b_notes

MAINTENANCE

 MAINTENANCE considers
Level of long-term success
What settings sustain good results vs. not
What persons sustain good results vs. not
Appropriate changes to program for continued success

5a. ...insert-program-name will continue to be delivered over time in a high percentage of participating settings?

5a_N/A

N/A

5a. How likely is it that insert-program-name will continue to be delivered over time in a high percentage of participating settings?

5a_N/A

N/A

5a. ...insert-program-name will continue to be delivered over time in a high percentage of participating settings in the future?

5a_N/A

N/A

5a_notes

5b. To what extent will insert-program-name be adapted as needed so that it continues to produce high quality results?

5b_N/A

N/A

5b. To what extent will insert-program-name continue to be adapted as needed so that it continues to produce high quality results?

5b_N/A

N/A

5b. To what extent will insert-program-name be adapted as needed so that it continues to produce high quality results in the future?

5b_N/A

N/A

5b_notes

5c. ...insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years)?

5c_N/A

N/A

5c. How likely is it that insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years)?

5c_N/A

N/A

5c. ...insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years)?

5c_N/A

N/A

5c_notes

5d. ...insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years) for socially and economically disadvantaged populations?

5d_N/A

N/A

5d. How likely is it that insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years) for socially and economically disadvantaged populations?

5d_N/A

N/A

5d. ...insert-program-name will show SUSTAINED effectiveness (at minimum 1-2 years) for socially and economically disadvantaged populations?

5d_N/A

N/A

5d_notes

PRISM Context Assessment

Next, you will review a set of questions for each domain of PRISM. You will rate each question in terms of how aligned the area is at this stage of your program. There are no ‘right’ answers. These questions are meant to be thought-generating. USE THE FULL RANGE OF THE SCALE

Data entered will only be stored in aggregate and will not be shared with anyone.
Once you get started, you can save your progress and pick up where you left off later using a unique link that will be emailed to you .
You will also be able to print out and/or download your answers and results at the end.

How well does your program, as currently planned, align with the...

PRISM Context Assessment

Data entered will only be stored in aggregate and will not be shared with anyone.
Once you get started, you can save your progress and pick up where you left off later using a unique link that will be emailed to you .
You will also be able to print out and/or download your answers and results at the end.

How well does your program currently align with the...

PRISM Context Assessment

Data entered will only be stored in aggregate and will not be shared with anyone.
Once you get started, you can save your progress and pick up where you left off later using a unique link that will be emailed to you .
You will also be able to print out and/or download your answers and results at the end.

How well does your program align with the...

Program Characteristics from Patient/community member perspective

Program characteristics from the perspective of the PATIENTS and/or COMMUNITY MEMBERS: This domain is concerned with how the people receiving the program find the program’s components to be useful or beneficial.

Think about multiple types of patients and/or community members.

1. ...expectations/perspectives of the PATIENTS and/or COMMUNITY MEMBERS?

1_N/A

N/A

1. ...expectations/perspectives of the PATIENTS and/or COMMUNITY MEMBERS?

1_N/A

N/A

1. ...expectations/perspectives of the PATIENTS and/or COMMUNITY MEMBERS to support future success?

1_N/A

N/A

Examples

1_notes

Program Characteristics from organizational perspective

Program characteristics from the perspective of the ORGANIZATIONAL (setting) PARTNERS: This domain is concerned with how the people receiving the program find the program’s components to be useful or beneficial.

Think about multiple types of organizational (setting) partners - all members of the delivery team.

2. …expectations/perspectives of the ORGANIZATIONAL (setting) PARTNERS?

2_N/A

N/A

2. …expectations/perspectives of the ORGANIZATIONAL (setting) PARTNERS?

2_N/A

N/A

2. …expectations/perspectives of the ORGANIZATIONAL (setting) PARTNERS to support future success?

2_N/A

N/A

Examples

2_notes

PATIENT/COMMUNITY RECIPIENT CHARACTERISTICS

PATIENT and/or COMMUNITY recipient characteristics: This domain is concerned with the characteristics of the patient or community member recipients of the program that is being developed, or implemented, or sustained/scaled. Think about recipients who will be eventual beneficiaries of the program.

3. ...characteristics of the intended PATIENT and/or COMMUNITY MEMBERS?

3_N/A

N/A

3. ...characteristics of the intended PATIENT and/or COMMUNITY MEMBERS?

3_N/A

N/A

3. ...characteristics of the intended PATIENT and/or COMMUNITY MEMBERS to support future success?

3_N/A

N/A

Examples

3_notes

ORGANIZATIONAL RECIPIENT CHARACTERISTICS

ORGANIZATIONAL (setting) recipient characteristics: This domain is concerned with the characteristics of the organizational partners of the program that is being developed, or implemented, or sustained/scaled. Think about recipients who are involved with decision making or delivering the program and consider these recipients at multiple levels. 

4. ...characteristics of the ORGANIZATIONAL PARTNERS?

4_N/A

N/A

4. ...characteristics of the ORGANIZATIONAL PARTNERS?

4_N/A

N/A

4. ...characteristics of the ORGANIZATIONAL PARTNERS to support future success?

4_N/A

N/A

Examples

4_notes

IMPLEMENTATION & SUSTAINABILITY INFRASTRUCTURE

IMPLEMENTATION AND SUSTAINABILITY INFRASTRUCTURE: This domain is concerned with the implementation and sustainability infrastructure for the program that is being developed, or implemented, or sustained/scaled. Think about a diverse set of resources and structures that might influence the success of the initial program or continuing in the future. 

5. ...available resources, staff, workflow, responsibilities and support functions to produce success?

5_N/A

N/A

5. ...available resources, staff, workflow, responsibilities and support functions to produce success?

5_N/A

N/A

5. ...available resources, staff, workflow, responsibilities and support functions to produce future success?

5_N/A

N/A

Examples

5_notes

EXTERNAL ENVIRONMENT

EXTERNAL ENVIRONMENT: This domain is concerned with the external environment of the program that is being developed, or implemented, or sustained/scaled. 

Think about a diverse set of resources and structures that might influence the success of the program. 

6. ...characteristics of the EXTERNAL ENVIRONMENT (e.g., policies, guidelines, norms)?

6_N/A

N/A

6. ...characteristics of the EXTERNAL ENVIRONMENT (e.g., policies, guidelines, norms)?

6_N/A

N/A

6. ...characteristics of the EXTERNAL ENVIRONMENT (e.g., policies, guidelines, norms) to support future success?

6_N/A

N/A

Examples

6_notes

RE-AIM Outcome and PRISM Context Assessment Scores

This page provides a summary of your responses to the questions.

The figures indicate greater LIKELY success and support for your program as you move from the center to the outer parts of the circles

Please take some time to REFLECT on your scores for both RE-AIM and PRISM. What are the general issues or areas in need of improvement?
Areas in the circular/radar figures that are not completely filled (lower scores) are potential areas for improvement

Consider jotting down some notes.

Action Plan

Ready to Create an Action Plan for your Strategies? Click here for a template

Don’t forget to iterate!

After implementing your strategies for improvement, re-assess your program using the PRISM Assessment Tool

IMPORTANT: Once you select “complete”, you will no longer be able to edit your responses.

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