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Community Health Needs Assessment Survey Libby, Montana

1.How would you rate the general health of our community?
2.In the following list, what do you think are the three most serious health concerns in our community? (Select ONLY 3)
3.Select the three items below that you believe are most important for a healthy community. (Select ONLY 3)
4.How do you rate your knowledge of the health services that are available in Lincoln County?
5.How do you learn about health services available in our community? (Select ALL that apply)
6.What additional healthcare and community services would you use if available locally?
7.Which community health resources, other than the hospital or clinics, have you used in the last three years? (Select ALL that apply)
8.In your opinion, what would improve our community’s access to healthcare? (Select ALL that apply)
9.Which of the following topics would you be most interested in learning about? (Select ALL that apply)
10.Which of the following preventive services have you or someone in your household used in the past year? (Select ALL that apply)
11.In the past three years, was there a time when you or a member of your household thought you needed healthcare services but did NOT get or delayed getting medical services?
12.If yes, what were the three most important reasons why you did not receive healthcare services? (Select ONLY 3)
13.In the past three years, have you or a household member seen a primary healthcare provider such as a family physician, physician assistant or nurse practitioner for healthcare services?
14.Where was that primary healthcare provider located? (Select ONLY 1)
15.Why did you select the primary care provider you are currently seeing? (Select ALL that apply)
16.In the past three years, has anyone in your household received care in a hospital? (i.e. hospitalized overnight, day surgery, obstetrical care, rehabilitation, radiology or emergency care)
17.If yes, which hospital does your household use MOST for hospital care? (Select ONLY 1)
18.Thinking about the hospital you were at most frequently, what were the three most important reasons for selecting that hospital? (Select ONLY 3)
19.In the past three years, have you or a household member seen a healthcare specialist (other than your primary care provider/family doctor) for healthcare services?
20.Where was the healthcare specialist seen? (Select ALL that apply)
21.What type of healthcare specialist was seen? (Select ALL that apply)
22.The following services are available in Lincoln County. Please rate the overall quality for each service by circling your answer. (Please circle N/A if you have not used the service)
Excellent
Good
Fair
Poor
Don't know/Haven't used
Birthing Services
Emergency room
Primary Care
Imaging/Radiology
Laboratory
Physical/speech/occupational therapy
Surgery
Immunization Services
23.To what degree has your life been negatively affected by your own or someone else’s mental health (which includes stress, anxiety, depression, troubling or confusing thoughts, and problems with emotions)?
24.In the past year, how often have you felt lonely or isolated?
25.To what degree has your life been negatively affected by your own or someone else’s substance use issues, including alcohol, prescription or other drugs? Would you say:
26.Please rate your perception of the availability of behavioral health services in the county.
Excellent
Good
Fair
Poor
Don't know/haven't used
Availability of substance use treatment programs
Availability of Alcoholics Anonymous groups
Availability of prevention programs
Availability of mental health services
27.Over the past month, how often have you had physical activity for at least 20 minutes?
28.Has cost prohibited you from getting a prescription or taking your medication regularly?
29.In the past year, did you worry that you would not have enough food?
30.Do you feel that your community has adequate and affordable housing options available?
31.Are you aware of programs that help people pay for healthcare expenses?
32.Do you have (young/dependent) children at home?
33.How can parents/guardians be better supported in the community? (Select ALL that apply)
34.What challenges have you faced with access to childcare? (Select ALL that apply)
35.What have you struggled with as a parent/guardian? (Select ALL that apply)
36.What type of health insurance covers the majority of your household’s medical expenses? (Select ONLY 1)
37.If you do NOT have health insurance, why? (Select ALL that apply) Skip question if you have health insurance.
38.Where do you currently live, by zip code?
39.What is your gender?
40.What age range represents you?
41.What is your employment status?
THANK YOU VERY MUCH FOR YOUR TIME
Please note that all information will remain confidential
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