Mapping questionnaire

1. Please provide main address details:

1a. Please provide other contact details:

Telephone:
Fax:
E-mail:
Website:

Worldwide	Africa	Europe
Middle East	North America	Central and South America
South/South East Asia	Western Pacific

Specific countries (Please list)

3. In which languages does your organisation work?

4. Which of the following categories best describe the nature of your organisation? (Please tick as many as are relevant)

Academic/Research institution	Commercial organisation / private business
Community-based organisation	Consumer organisation
Government dept/ organisation	International/Regional NGO
Professional association	National/Local NGO
Religious organisation	Self-employed
UN agency	Hospital/clinic

Other (Please specify)

4a. Please give us the name of any networks to which you belong:

5. Which subject areas are the main focus of your organisation's activities? (If many apply please tick main 5.)

advocacy	appropriate technology	child health
communicable diseases	community based rehabilitation	community health care
conflict situations	development	diarrhoeal diseases
disability and rehabilitation	education	electronic communication
emergency health care	environmental health	essential drugs
family planning	gender issues	health care of the elderly
health planning and management	health policy	health communication/ education/promotion
health sector reform	health services	HIV/AIDS
human rights for health	immunisation	information management
literacy	maternal health	mental health
NGOs	non-communicable diseases	non-formal education
nutrition/malnutrition	organisational management/ development	parasitic diseases
population	poverty and health	primary health care
sexual/reproductive health	traditional health care	training
urban health	water and sanitation	women’s health

Others (please specify)

5a. If you ticked disability and rehabilitation in question 5, please tell us which aspects:

hearing impairment	learning impairment	moving impairment
sensation impairment	speaking impairment	vision impairment

Other (please specify)

6. What does your organisation do? (If many apply, please tick main five)

advise/provide technical support	advocacy	broadcasting
consultancies	counselling	emergency/refugee health
evaluation	funding	health communication
health service provision	information management	networking
publish/ distribute/ translate/adapt material	rehabilitation/ disability services	research
training/capacity development

Other (please specify)

6a. If you ticked publish/distribute/translate/adapt material, health communication or broadcasting in question 6, please tell us what types(s) of materials or media or channels you use (if many apply, please tick main five)

audio cassettes	books	CD-ROMs
databases	directories	e-mail
newsletters	print materials	radio
resource lists	social marketing	TV
theatre	training materials	videos
website	workshops

Other(please specify)

6b. In what form do you produce/distribute these materials?

print only

electronic only

both print and electronic

6c. If you ticked rehabilitation/disability services in question 6, please tell us which aspects

occupational therapy	orthoses/prostheses	physiotherapy
speech therapy	assistive devices

7. Does your organisation have a library or resource centre?

Yes

No

If yes, is it open to the public?

Yes   No

8. Which specific groups of people does your organisation work with or for? (If many apply, please tick the main five)

children 0-5	children 6-10	children (all ages)
community health workers	doctors	elderly
government personnel	health educators	injecting drug users
journalists/media	men	mothers
NGOs	nurses	organisations of disabled people
outreach workers	parents/families	people living with HIV/AIDS
people with disabilities	policy-makers	programme planners
refugees/displaced people	rural communities	school children
sex workers	street children/ street youth	teachers/educators
trainers	urban communities	youth
women

Other (Please specify)

9. Please state briefly the main aims and objectives of your organisation (Write approximately 50 - 100 words)

10. E-communications: within your organisation do you have, or will you have, access to the following?:

	Now			Within 3 years
	Yes	No	With difficulty	Yes	No
E-mail access from a shared address
E-mail access from own individual address
Internet access from a shared computer
Internet access from own computer
CD-ROM

10a. If not, why do you not have access to Internet/e-mail/CD-ROM?

cannot afford computer equipment	phone system unreliable
connection costs too expensive	need training in how to set up access

Other (Please explain) 

10b. Which Internet browser does your organisation use? Please give version number (For example: Netscape Navigator 4; Internet Explorer 3.1)

10c: Do you use the Internet to: (Tick as many as apply)

view websites	follow/contribute to e-mail discussion groups	follow/contribute to web-based discussion groups
access e-mail bulletins/ newsletters	search web-based databases	access journals/ newsletters/ bulletins on the web
participate in distance learning/education programmes	read and/or download full text documents as: pdf (portable document format) files html (hyper-text mark-up language) files

Other (please explain):

Mapping health communication: Lessons learned
What is your organisation doing to document learning in health communication activities? Who are you working with and why? Are you evaluating your work and do you want support? Exchange is currently working to 'map' (find out who is doing what, where) activities in health communication and the ways people document and share their lessons learned. This 'mapping' of lessons learned will also identify opportunities for collaboration and support. For more information, see Mapping guidelines.

11. What methods do you use to facilitate learning, within your organisation?

action learning	action research/ participatory research	capacity development/training
communities of practice/cross-site learning	ethnographic research/ participant observation	face-to-face
focus groups	formative evaluation	Frierian methods/ popular education
impact studies	information/knowledge management	learning workshops
life histories	needs assessment/ situation analysis	networking
outcome mapping	process evaluation	project evaluation
qualitative research	quantitative research	review meetings
semi-structured interviews	staff exchanges	storytelling
surveys	other:

11b. Please outline below how you are documenting and sharing lessons learned in your health or disability communication work:

11a. Please give details or any publications or resources related to these lessons learned:

IMPORTANT   We intend to include the information in this questionnaire on a database which will be publicly available on the Exchange website. Please tick if you do not want this information to be included on our website 

We would like to keep you up-to-date with Exchange’s work and may send you related information. If you would NOT like to receive such information, please indicate this by ticking the box 

Name of person completing this form:
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Date: