Faith-Based Community-Engaged Research Network Survey Chicago has an increasing number of partnerships between academic institutions and faith-based organizations currently engaged or interested in collaborative research initiatives. The Center for Faith and Community Health Transformation and Northwestern’s Alliance for Research in Chicagoland Communities recently co-facilitated a discussion meeting around this topic. The interest resulted in the formation of a Faith-Based Community-Engaged Research Network. The purpose of this survey is to gather information from a broader group of possible network members/supporters about this work. Question Title * 1. Contact Information Name Email address Organization Phone number Street Address City Zip code State Question Title * 2. Are you interested in presenting or helping to facilitate a discussion at a future network meeting? (If Yes, enter topic) Question Title * 3. Type of organization you represent (check all that apply) Community Organization Faith Based Network Faith Community/House of Worship Government Health Care Provider University Question Title * 4. If you represent a faith community, what is your congregation's size? 0-50 51-100 101-250 251-500 501-1000 1001-3000 over 3000 N/A Question Title * 5. If you represent a faith community, what is your religious affiliation? Apostolic Baptist Baptist-American Baptist-Missionary Buddhist Catholic-Roman Episcopal Church Evangelical Free Church Hindu Jewish Lutheran-ELCA Methodist-United Muslim Presbyterian-United Presby. Ch of America Reformed-Christian Reformed Church United Church of Christ Question Title * 6. Geographic area your organization serves (check all that apply) Chicago-south Chicago-north Chicago–west Chicago–suburbs-north Chicago-suburbs-northwest Chicago-suburbs-west Chicago-suburbs-southwest Chicago-suburbs-south Chicago-City wide State wide County-Cook County-DuPage County-Lake County-Kane County-McHenry Other (please specify) Question Title * 7. Population your organization serves (check all that apply) Youth Elderly African American Latino Asian Women/girls Men/boys Immigrants/refugees Disability Homeless Question Title * 8. Topical focus of current research or research interests (check all that apply) Access to Health Care Addictions/Substance Abuse Adolescent Health Aging Cancer Cardiovascular Disease Caregiver support Chaplaincy/Spiritual Care Children’s Health Chronic Disease Prevention & Management Community Gardens/Urban Agriculture Dental Health Diabetes Emergency Preparedness End of Life Care Environmental Issues Flu Clinic (e.g. You host a clinic) Food Access Grief and Bereavement Health Fair (e.g. You host a health fair) Health Ministry Development (e.g. You want to develop one) Health Ministry or Formal Structure for Promoting Health (e.g. You have one) HIV/AIDS Immigrant Health Immunization Interfaith Understanding and Collaboration Latino Community Health Concerns Leadership Development Maternal & Child Health Medical Ethics Mental Health Men’s Health Nutrition Parish Nursing/Faith Community Nursing Physical Activity Prayer & Meditation Primary Care Public Policy/Advocacy Recreational Training Research Smoking Social Cohesion Social Support Spiritual Care Spirituality and Healing Violence Prevention and Intervention Wholistic Healing Women’s Health Question Title * 9. Topical Focus that you are interested in, but not currently working Access to Health Care Addictions/Substance Abuse Adolescent Health Aging Cancer Cardiovascular Disease Caregiver support Chaplaincy/Spiritual Care Children’s Health Chronic Disease Prevention & Management Community Gardens/Urban Agriculture Dental Health Diabetes Emergency Preparedness End of Life Care Environmental Issues Flu Clinic (e.g. You host a clinic) Food Access Grief and Bereavement Health Fair (e.g. You host a health fair) Health Ministry Development (e.g. You want to develop one) Health Ministry or Formal Structure for Promoting Health (e.g. You have one) HIV/AIDS Immigrant Health Immunization Interfaith Understanding and Collaboration Latino Community Health Concerns Leadership Development Maternal & Child Health Medical Ethics Mental Health Men’s Health Nutrition Parish Nursing/Faith Community Nursing Physical Activity Prayer & Meditation Primary Care Public Policy/Advocacy Recreational Training Research Smoking Social Cohesion Social Support Spiritual Care Spirituality and Healing Violence Prevention and Intervention Wholistic Healing Women’s Health Question Title * 10. Are you currently involved in faith-based community engaged research (CEnR)? Yes No Question Title * 11. What is your experience with faith-based community-engaged research? None Minimal Some Extensive Question Title * 12. What is your interest in getting involved with this newly forming Faith-based Community-Engaged Research Network? (check all that apply) Networking Capacity building/training Joint collaboration opportunities Question Title * 13. During the kick off meeting, several interest areas related to faith and community health research emerged. Please indicate your interest areas (check all that apply) Caregiver support Mental health Development of a mechanism to measure faith in research Development of Mission/Vision for this Network Other Other Question Title * 14. Are you interested in convening any of the groups? (check all that apply) Caregiver support Mental health Development of a mechanism to measure faith in research Development of Mission/Vision for this Network Other Question Title * 15. What other topics or issues should be discussed at future network meetings? Structure of this network/meetings Example(s) of current faith community-engaged research in Chicago Discussion of issues in the field Question Title * 16. How often should this network meet? (Choose one) Monthly Every other month Quarterly Question Title * 17. What is the best way to distribute information to network members? (Choose all that apply) Email Phone Text Website for this network Question Title * 18. Do you have space to host an in person meeting for a general network meeting (20-25 people)? If yes, please indicate the following: Venue Location Contact person’s name, number, email Parking logistics (free lot, pay lot/price, free street parking, metered street parking) Venue meeting time availability Other If you know of other potential participants for this group, please forward this survey link and ask they complete it too. Thank you for participating in our survey. Feedback from this survey will be presented during an upcoming Chicago Faith Based Community-Engaged Research Network Meeting. If you want to receive mailings and newsletters from The Center for Faith and Community Health Transformation sign up at https://www.chicagofaithandhealth.org/newsletter-signup-form/ Done