VI.

Appendices
a. Appendix A (Physician/CBO/Staff survey)
HHART: HIV/AIDS Hypertension Awareness Raising Team
Needs Assessment
Instruction Page
Hi, my name is ________________________. I am part of a student team from the
Health Science Center working on a community project to raise awareness of high blood
pressure in the HIV/AIDS community. You have received an email from my project
mentors, Dr. Veronica Young and Dr. Delia Bullock, asking for your help. I want to thank
you for agreeing to support us on this project. This project is sponsored by the Bexar
County Department of Community Resources Ryan White Program led by Charlene
Doria-Ortiz.
[Is this a good time for me to ask you a few questions? The interview is going to take
about 10-15 minutes.]
If employees decline to participate: Well thank you very much for your time. If you
should reconsider completing the survey, I can be reached at ____. Have a great day.
If bad time: Thank you very much for your time. I will call back on _____. I appreciate
your willingness to help and look forward to speaking to you. Have a great day.
I want to briefly describe the goals of our service project. The focus is to raise
awareness of high blood pressure among individuals living with HIV. This gap in
education was identified by a federally funded program in San Antonio. In response to
this gap, our student team has been asked to develop educational materials for HIV
clients with high blood pressure. The aim is to develop materials written at an
appropriate literacy level for clients served by the many HIV organizations and clinics in
South Texas, and should address concerns/barriers relevant to your clients.
In order for us to meet this need, we need your help to answer a few questions. Your
answers and opinions will help us develop educational tools that are specific for your
clients. The finalized materials will be distributed for your organization/clinic to use
through the Ryan White Program.

Are you ready? (Question 1-4 completed by Student interviewer)

1.

Date of interview:

2.

Name of organization/clinic:

3.

Name of person interviewed:

4.

Contact information for interviewee (email/phone):

------------------------------------------------------------------------------------------------------------------------------5.
What is the title of your job position? Could you tell me a little bit
about your job role in the organization?
6.
Could you please describe the HIV/AIDS clientele you serve?
*Note for student interviewers: In addition to the interviewees response, please ask
about the following:
6a. age/age range/average age
6b. gender
6c. estimated literacy level
6d. multiple chronic medical conditions
6e. insurance status (private, public, no insurance)
6f. any prescription coverage/how do they get their medicines

7.
Do you currently counsel clients/patients with high blood pressure
about this medical condition?
Yes

No

7a. If YES: What do you use to counsel your clients/patients (e.g., brochures?
flyers? wall poster?)
[Script: If brochure or flyer, would it be possible to get a copy?]
Fax:
Mail:

7b. Do you find these tools helpful? Why or why not?

Okay. In this next section, I am going to read to you four statements, one at a time, to
see if you agree or disagree with each one. Each statement will be followed by an openended question. Are you ready?
Here is the first statement.
8.
a) I believe there are barriers to clients/patients taking their high
blood pressure medicines.
Strongly Disagree
Disagree
Agree
Strongly Agree
b) What barriers do you feel clients/patients face when managing their high blood
pressure?

Here is the next statement.

9.
a) Most of my clients/patients have a low level of knowledge about
high blood pressure and its management.
Strongly Disagree
Disagree
Agree
Strongly Agree
b) What details about high blood pressure do you feel could help patients manage
their blood pressure?

Okay. Here is the third statement.

10.
a) There are misconceptions about the importance of taking high
blood pressure medicines.
Strongly Disagree
Disagree
Agree
Strongly Agree
b) What myths/misconceptions about high blood pressure have been brought to your
attention by clients/patients?

Here is the last statement.

11.
a) I feel comfortable explaining high blood pressure management
to my clients/patients.
Strongly Disagree
Disagree
Agree
Strongly Agree
b) What barriers have you encountered when trying to explain high blood pressure or
managing high blood pressure to clients/patients?

12. Have you ever received training on high blood pressure

management? If so, has it helped you talk to clients/patients about high blood
pressure? [Script: If not, why not?]
[Script: Would you be interested in a training session if one were available?]

13. Does your organization/clinic offer any support or resources that

will help a client/patient adhere to his/her medicines or make healthy lifestyle
choices (i.e., food choices, lower salt intake, exercise)?

14. Do you have any suggestions for materials that will promote
adherence to blood pressure management?

15. After we develop a draft of the educational tools, would you like to look at it and give
us feedback so we can make improvements?
Yes
No

After survey: Thank you so much for answering this survey today and helping us in
developing educational materials that you can use to educate clients/patients in high
blood pressure. I really appreciate your time, and I know how busy you are. If you have
any questions, feel free to contact me at ______ or youngv@uthscsa.edu. Have a great
day!

b. Appendix B (Client Survey)

Student Instruction Sheet

Hi, my name is ______. I am here with a team of students from who are
working on raising awareness of high blood pressure in the HIV/AIDS
community. We are developing educational materials to help you better
understand high blood pressure. I am here to see if you would be interested
in completing a short survey that will help us develop these materials.
Completion of this survey is OPTIONAL. You are NOT REQUIRED to complete
this survey to receive help or care.

Peoples Caucus: If anybody is interested, please raise your hand.

HHART: HIV/AIDS Hypertension Awareness Raising

Team
Needs Assessment

Todays Date: ________

Purpose of Survey: The purpose of this survey is to gather opinions from

clients living with HIV/AIDS regarding their perceptions of high blood pressure
and managing this medical condition. The information will be used to
develop educational materials for organizations and clinics serving the HIV
community in South Texas. Completion of this survey is OPTIONAL. You are
NOT REQUIRED to complete this survey to receive help or care.

General
1.
What is your highest level of education? (Circle the last
level you completed)
8th Grade or Below
Some High School
High School
Diploma/GED
Some College
College Degree
Post-Graduate School

2. What is your age? (Circle one)

Under 18
18-24 yrs old
65+ yrs old

25-44 yrs old

45-65 yrs old

Attitudes
3. Managing HIV/AIDS is a priority. (Circle one)
Strongly Disagree

Disagree

Agree

Strongly

Agree

4. Managing high blood pressure is a priority. (Circle one)

Strongly Disagree

Disagree

Agree

Strongly

Agree

5. Managing high blood pressure is as important as managing HIV/AIDS.

(Circle one)
Strongly Disagree

Disagree

Agree

Strongly

Agree

6. High blood pressure affects a persons ability to take care of him/herself.

(Circle one)
Strongly Disagree

Disagree

Agree

Strongly

Agree

7. I find that managing high blood pressure is inconvenient. (Circle one)

N/A

Strongly Disagree

Disagree

Agree

Strongly

Agree

8. I understand what health problems can be caused by high blood pressure.

(Circle one)
Strongly Disagree

Disagree

Agree

Strongly

Agree

9. There are obstacles to managing high blood pressure. (Circle one)

Strongly Disagree

Disagree

Agree

Strongly

Agree

10. I have problems remembering to take my high blood pressure medicine.

(Circle one)
N/A

Strongly Disagree

Disagree

Agree

Strongly

Agree

11. How to manage my high blood pressure has been explained to me.
(Circle one)

N/A

Strongly Disagree

Disagree

Agree

Strongly

Agree

Please answer the following questions:

12. What health problems can be caused by not managing high blood
pressure?

________________________________________________
________________________________________________
________________________________________________
________________________________________________
______________________________
13. What may prevent a person from managing his/her high blood pressure?
Examples of managing high blood pressure include taking medicines correctly
and watching ones diet.

________________________________________________
________________________________________________
________________________________________________
________________________________________________
______________________________

14. Please list anything you think would help a person manage their high
blood pressure (Examples: handouts, classes, conversations, etc.),

________________________________________________
________________________________________________
________________________________________________
________________________________________________
______________________________

c. Appendix C (Brochure Pre/Post Survey)

Pre-survey:
Student Instruction Sheet
Hi, my name is ______. I am here with a team of students from who are
working on raising awareness of high blood pressure in the HIV/AIDS
community. I am here to see if you would be interested in completing a short
survey that will help us improve a brochure we have developed about
hypertension. You will be asked to look at a brochure after the survey, and
then you will be asked to take the survey again. Completion of this survey is
OPTIONAL. You are NOT REQUIRED to complete this survey to receive help or
care.
Peoples Caucus: If anybody is interested, please raise your hand.
HHART: HIV/AIDS Hypertension Awareness Raising Team
Pre Survey
Todays Date: ________

ID Number: ________

Purpose of Survey: The purpose of this survey is to gather opinions from

clients living with HIV/AIDS regarding their perceptions of high blood
pressure. Completion of this survey is OPTIONAL. You are NOT REQUIRED to
complete this survey to receive help or care.
General
1. What is your age? (Circle one)
Under 18
18-24 yrs old
65+ yrs old

25-44 yrs old

45-65 yrs old

2. Gender (Circle one)

Male
Female

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3. Race (Circle one)

White (Non-Hispanic)
Other

Hispanic

African American

Asian

4. What is your highest level of education? (Circle the last level you
completed)
8th Grade or Below
Some High School
High School
Diploma/GED
Some College
College Degree
Post-Graduate
School
Attitudes
5. High blood pressure is easy to manage. (Circle one)
Strongly Disagree
Disagree
Agree

Strongly Agree

6. I plan to talk to my doctor about high blood pressure. (Circle one)

Strongly Disagree
Disagree
Agree
Strongly Agree
Knowledge
7. You can feel when your blood pressure is high. (Circle one)
Strongly Disagree
Disagree
Agree
Strongly Agree
8. Only people with certain risk factors can have high blood pressure. (Circle
one)
Strongly Disagree
Disagree
Agree
Strongly Agree
9. Blood pressure medicine only has to be taken when a person feels bad.
(Circle one)
Strongly Disagree
Disagree
Agree
Strongly Agree

10. What health problems can be caused from having high blood pressure?
(Circle all that apply)
Stroke
Kidney Failure
Vision Loss
Diabetes
High Cholesterol
Obesity
Heart Attack
Erectile Dysfunction
11. What are some factors that put people at risk for having high blood
pressure? (Circle all that apply)
Asian
Stress
Smoking
Low fat diet
Women
Age
Sun exposure
Family History
12. What are some good ways for people to manage their risk of high blood
pressure? (Circle all that apply)
Low sodium diet
Take medicine

11

Gain weight
Drink beer
Pill box

Stop smoking
Support from others
Limit physical activity

13. I have measured my own blood pressure using a blood pressure

monitoring machine at home or somewhere else such as a pharmacy.
Yes
No
sure
14. A blood pressure of 140/90 is considered:
Low
Normal
Not Sure

Not

High

15. Have you ever been told by your doctor you have high blood pressure?
Yes
No
Not
sure

Post-survey:
Student Instruction Sheet
Hi, my name is ______. I am here with a team of students from UTHSCSA who
are working on raising awareness of high blood pressure in the HIV/AIDS
community. I am here to see if you would be interested in completing a short
survey that will help us improve a brochure we have developed about
hypertension. You will be asked to look at a brochure after the survey, and
then you will be asked to take the survey again. Completion of this survey is
OPTIONAL. You are NOT REQUIRED to complete this survey to receive help or
care.
Peoples Caucus: If anybody is interested, please raise your hand.

HHART: HIV/AIDS Hypertension Awareness Raising Team

Pre Survey
Todays Date: ________

ID Number: ________

Purpose of Survey: The purpose of this survey is to gather opinions from

clients living with HIV/AIDS regarding their perceptions of high blood

12

pressure. Completion of this survey is OPTIONAL. You are NOT REQUIRED to

complete this survey to receive help or care.

Attitudes
1. High blood pressure is easy to manage. (Circle one)
Strongly Disagree
Disagree
Agree

Strongly Agree

2. I plan to talk to my doctor about high blood pressure. (Circle one)

Strongly Disagree
Disagree
Agree
Strongly Agree
Knowledge
3. You can feel when your blood pressure is high. (Circle one)
Strongly Disagree
Disagree
Agree
Strongly Agree
4. Only people with certain risk factors can have high blood pressure. (Circle
one)
Strongly Disagree
Disagree
Agree
Strongly Agree
5. Blood pressure medicine only has to be taken when a person feels bad.
(Circle one)
Strongly Disagree
Disagree
Agree
Strongly Agree

6. What health problems can be caused from having high blood pressure?
(Circle all that apply)
Stroke
Kidney Failure
Vision Loss
Diabetes
High Cholesterol
Obesity
Heart Attack
Erectile Dysfunction
7. What are some factors that put people at risk for having high blood
pressure? (Circle all that apply)
Asian
Stress
Smoking
Low fat diet
Women
Age
Sun exposure
Family History
8. What are some good ways for people to manage their risk of high blood
pressure? (Circle all that apply)
Low sodium diet
Take medicine
Gain weight
Stop smoking
Drink beer
Support from others
Pill box
Limit physical activity
9. A blood pressure of 140/90 is considered:
Low
Normal
Not Sure

High

13

Feedback
10. The information in the brochure is easy to understand. (Circle one)
Strongly Disagree

Disagree

Agree

Strongly Agree

11. The brochure addressed concerns I have about hypertension. (Circle one)
Strongly Disagree

Disagree

Agree

Strongly Agree

12. What do you think was the most important point of the brochure?

13. What did you like or dislike about this brochure?

(font/length/content/color/graphics...)

d. Appendix D (Brochure- English & Spanish Versions)

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15

e. Appendix E (Pocket guide)

16

(Front and back)

f. Appendix F (Physician/CBO/Staff Training PowerPoint)

17

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