Hello, my name is [____________] and we’re here today because we would like your input on the priority health needs from your perspective, the factors that contribute to health that are most important to address, and your current work, or desired work to support health in communities. You have been identified as someone who is able to provide perspective on these factors for those who identify as [____________]. Are you comfortable speaking from this perspective?

First let me tell you a bit about how the information you provide will be used.

The Maine Shared Community Health Needs Assessment is a dynamic public-private partnership that turns data into action in order to 1.] Create Shared Community Health Needs Assessment Reports; 2.] Engage and activate communities, and 3.] Support data-driven health improvement plans and implementation strategies for Maine people.

Please let me know your preference to have your name used in a list of those interviewed or would prefer your name not to be published.  The list of those who give us permission to public their names will appear on the Maine Shared CHNA website, not in the final report, as is the practice with other lists of those involved in this project.  Your feedback and information will be wrapped into a summary report which consists of other primary data we’ve collected in reaction to the Maine Shared CHNA data set.

In order to provide a deeper understanding of the data, we would like your input on the priority health needs from your perspective, the factors that contribute to health that are most important to address. We would also like to know about your current work or desired work to support health in our communities.

Question Title

* 1. We are interested in learning more about the priority health needs for XX population (reference population(s) of expertise of interviewee). How would you characterize the health needs for this population? How are they different than for the general population?

Question Title

* 2. From where you sit and the work you do, what do you feel are the most important health needs to address? Why?

Question Title

* 3. What do you see as the major resource gaps with respect to health and wellness for this population?

Question Title

* 4. Are you currently working on anything that contributes to community health and wellness for this population? Are there any areas of health you would like to work on in partnership with others?

Question Title

* 5. Are there any particular assets or resources to address the needs of this population that can be leveraged?

Question Title

* 6. Interviewer Name

Question Title

* 7. Interviewer organization

Question Title

* 8. Interviewer county

Question Title

* 9. Region interviewee represents in his/her responses (name cities, counties):

Question Title

* 10. Interviewee name and title

Question Title

* 11. Interviewee organization

Question Title

* 12. Special populations the interviewee has expertise in and discussed in this interview:

Question Title

* 13. Please note which of the following the interviewee represents:

T