Surveys

Allies Against Asthma

• Context Survey
• Asthma Core Caregiver Survey
• Coalition Self Assessment Survey
• Key Informant Interview Guides
• Program Reach Forms
• Evaluation Instruments
• Tool Kit for Assessing Asthma Education Materials
• Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)
• For more information, contact Laurie Lachance at lauriel@umich.edu

Contributing to Managing Epilepsy Well

•  Key Informants Perspectives Interview Questionnaire
• For more information contact Shelley Stoll at scstoll@umich.edu

Head Start Asthma Project

• Parent  Interview for Baseline and Follow-up
• Asthma Health Screen Criteria 1
• Asthma Health Screen Criteria 2:  Survey Scoring Sheet
• Asthma Health Screen - available in Spanish
• Head Start Asthma Screening Form- available in Spanish
• Consent Form – available in Spanish
• A Model of Self-Regulation for Control of Chronic Disease
• Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ)
• Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002
• For more information, please contact Belinda Nelson at belindan@umich.edu

 Physician Asthma Care Education (PACE)

• Parent/Caregiver Telephone Interview Questionnaire
• Physician Questionnaire: Mail-In Survey
• PACE Program Physician Survey
• Guidelines for Diagnosis and Treatment of Asthma

• For more information, contact Noreen Clark at nmclark@umich.edu

 Women Take PRIDE

• Baseline Interview
• 4 month Follow-up Interview
• 12 month Follow-up Interview
• 18 month Follow-up Interview
• The Sickness Impact Profile: Development of an Outcome Measure of Health Care
• An improved questionnaire for assessing quality of life after acute myocardial infarction
• The MOS social support survey

• For more information, contact Julie Dodge at jadodge@umich.edu

Women with Asthma

• Participant Evaluation Survey
• Depression Scale- Question 65
• Evaluation Summary: review of six-question evaluation form- December of 2001
• Women Breathe Free: Program Evaluation Form
• Effect of Self-Regulatory Education on Women with Asthma: Telephone Interview
• Telephone Interview: Baseline
• Telephone Interview: Follow Up 2
• Follow up 2- New questions: Smoking & Kids
• Stress Questions (Q. 68)
• Telephone Interview for Randomly Selected Overweight Minority Participants NOVEMBER 2, 2004
• A Model of Self-Regulation for Control of Chronic Disease
• Guidelines for the Diagnosis and Management of Asthma-Update on Selected Topics 2002 
• Asthma Quality of Life Questionnaire
• Self-regulating childhood asthma: a developmental model of family change
• For more information, contact Molly Gong at mgong@umich.edu

Partnership to Control Asthma in Public Schools

• Questionnaire For Teachers
• Child Baseline Interview
• Child Follow up 1
• Child Follow up 2
• Non-asthma Questionnaire
• Parent/Caregiver Telephone Interview: Baseline
• Parent/ Caregiver Telephone Interview: Follow-up 1
• Parent/ Caregiver Telephone Interview: Follow-up 2
• Parent’s Questionnaire’s Log of normal daily activities
• Screening Questionnaire
• Managing better: children, parents, and asthma
• Communication within low income families and the management of asthma
• A school health education program for children with asthma aged 8-11 years
• For more information, contact Lara Thomas at ljthomas@umich.edu