Data Collection & Program Fidelity

Data Collection

Below are all the files and instructions for Living Well data collection. In short, WIHA will send a packet with everything you need to do the data collection (instructions and pre-printed surveys) when your Workshop Notification Form is completed. 
Data Collection Packets will be sent 1-2 weeks before the start of the workshop to the person listed on the said form.


Data Collection Instructions  (PDF 7.11.18)

The Health & Demographic Survey is given out at Session One. These surveys will help us to determine who is being reached by this program and how to improve our services.  It also helps our funding agencies show that they are spending their money wisely. They are completely voluntary and is not required to participatein the program. Participants’ names and contact information will be kept confidential.


Tips & Talking Points  (PDF 10.5.2018)

Why Data Collection is so Important  (PDF 10.5.2018)


  • During reminder calls, ask participants to come at least 15 minutes prior to the start time to fill out a short survey.
  • If new participants arrive at the second session, please ask them to fill out the Baseline Questionnaire before you start Session 2.

Talking points to say to participants:

  • This survey asks questions about you and your health.  We would appreciate it if you would complete the survey, but it is up to you.  Feel free to skip any questions you don’t want to answer.
  • We ask you these questions for a few reasons: Understand who comes to the workshops. Help health providers work more effectively with their patients. Understand if we make a difference in your health or how you take care of yourself. And to ask health plans, employers and foundations to help support the program – keeping them low-cost to the community. Completing the Questionnaire is entirely voluntary. If you decide not to complete the Questionnaire you can still participate in this program. 
  • We follow very strict rules to protect all your information and to keep it private. We will maintain these paper forms securely following standard practices for protecting private data.  After a trained person enters your information into a secure computer database, we will destroy the paper forms.
  • While doing the Questionnaire, you may ask us to explain any questions that you find confusing.
Attendance Log  (PDF 8.25.17)
Leaders: Mark on the sign-in sheet who completed the Health & Demographic Survey as well as weekly attendance.
Return completed forms (after the final session) to your Program Coordinator or local organization.
They will send a copy to WIHA:
Living Well Data
Wisconsin Institute for Healthy Aging
1414 MacArthur Road, Suite B Madison, WI 53714


Health & Demographic Survey (PDF 10.4.18)

Make copies and distribute to each participant at the first session.  Leaders will collect completed Demographic Questionnaires, review for completeness, ask individuals to complete any missing sections, and store in a safe place.  Send to WIHA, with a photocopy of the Attendance Log, after the sixth session.  


Post Survey (PDF 7.11.18)
Leaders: Hand out this 1/2 sheet, 1 question follow up to gauge the participants confidence after taking the workshop.
Return this and all completed forms with your attendance log to your Program Coordinator or local organization


The following forms are optional (but encouraged) to administer: 

Provider Feedback Letter template: Optional. Hand out at the end of Session 5. Helps provide feedback about the workshop. Acts as a template for participants to share what they've learned from this workshop with their health care team.

Session Six Evaluation: Optional. Template. Invite each participants to complete at Session Six, then collect and review for your own local purposes.

If you have any questions about the data collection process, please contact us at WIHA right away: or 608-243-5694.

Program Fidelity

Fidelity Tool: Fidelity Coach will use this if/when there is a Fidelity Coaching session being administered - generally conducted at Session 3. They will let you know in advance.