Community Health Needs Assessment Survey (Mobile, AL)

1. In your opinion, what is the health related issue that most people die from in your community?

In your opinion, what is the health related issue that most people die from in your community? Asthma/Lung Disease Cancer Chronic Kidney Disease Diabetes Heart Disease HIV/Aids	Obesity Stroke Substance Abuse Suicide Tobacco Use I don't know
Other (please specify)

2. In your opinion, what is the biggest health issue or concern in your community?

In your opinion, what is the biggest health issue or concern in your community? Access to Health Services Cancer Chronic Kidney Disease Diabetes Heart Disease	Maternal, Infant, and Child Health Mental Health and Mental Disorders Nutrition and Weight Status Older Adults Respiratory Diseases	Stroke Substance Abuse Tobacco Use
Other (please specify)

3. In your opinion, what do you think is the main reason people in your community do not seek medical care?

In your opinion, what do you think is the main reason people in your community do not seek medical care? Cultural/Religious beliefs Fear (not ready to face health problem) Health services too far from home Lack of insurance Long wait time at the doctor's office	No appointments available at the doctor when needed Not enough access to primary care physicians None/No barriers Transportation I don't know
Other (please specify)

4. In your opinion, which factor most affects the quality of health care you or people in your community receive?

In your opinion, which factor most affects the quality of health care you or people in your community receive? Ability to read and write Age Economic factors Gender	Language barrier Race I don't know
Other (please specify)

5. In your opinion, which of the following do you feel people in your community lack the funds to purchase?

In your opinion, which of the following do you feel people in your community lack the funds to purchase? Clothing Food Health Insurance Home/Shelter	Medication Transportation Utilities I don't know
Other (please specify)

6. Which of the following does your community need in order to improve the health of your family, friends, and neighbors?

Which of the following does your community need in order to improve the health of your family, friends, and neighbors? Affordable health insurance Affordable medications Healthier food choices Job opportunities Mental health services	Recreation facilities Safe places to walk and play Substance abuse rehabilitation services Transportation I don't know
Other (please specify)

7. Which of the following are problems for you and/or your family?

Which of the following are problems for you and/or your family? Alcohol Abuse Automobile Accidents Child Abuse Drugs Eating Disorders Economy (loss/lack of jobs) Elder Abuse (abuse of those age 55+) Environmental Conditions Homelessness Infant Mortality Increasing Elderly Population	Lack of Exercise Literacy (ability to read and write) Obesity Poor Diet Spousal Abuse (domestic violence) Stress Suicide Teen Pregnancy Tobacco Use Unemployment
Other (please specify)

8. What health screenings or education/information services are needed the most in your community?

What health screenings or education/information services are needed the most in your community? Blood pressure Cancer Cholesterol Diabetes Dental screenings	Exercise/physical activity Heart disease HIV Mental health Nutrition	Peripheral vascular disease (PVD) Prenatal care Substance abuse Vaccinations/Immunizations I don't know
Other (please specify)

9. Where do you or your family receive most of your health information?

Where do you or your family receive most of your health information? Church Doctor/health professional Family or friends Hospital Hospital newsletter Internet Newspaper	Magazines Library Local health department Radio Television I don't know
Other (please specify)

10. When seeking care, which hospital would you visit first?

When seeking care, which hospital would you visit first? University of South Alabama Medical Center Providence Hospital Mobile Infirmary Springhill Medical Center	North Baldwin Infirmary Thomas Hospital South Baldwin Regional Medical Center
Other (please specify)

11. Which of the following healthy lifestyle habits do you incorporate into your daily living?

Which of the following healthy lifestyle habits do you incorporate into your daily living? Exercise at least 30 minutes each day Eat a variety of fruits and vegetables with each meal Eat lean, low-fat meals Limit foods and beverages high in sugar and calories Drink alcohol none or in moderation (1-2 drinks/day)	Choose and prepare foods with little or no salt Select fat-free, 1%, and low-dairy products Limit saturated fat and trans fat I do not incorporate healthy lifestyle habits into my daily living
Other (please specify)

12. Please select your gender

Please select your gender Male

Female

13. Please select your age

Please select your age Under 18

18-24

25-34

35-44

45-54

55-64

65-74

75 or older

14. My zip code is

My zip code is 36571 36575 36601 36602 36603 36604 36605 36606 36607 36608 36609 36610	36611 36612 36615 36616 36617 36618 36619 36625 36628 36630 36633 36640	36641 36644 36652 36660 36663 36670 36671 36675 36685 36693 36695
Other (please specify)

15. I live in

I live in Mobile County

Baldwin County

Other (please specify)

16. My racial/ethnic identification is

My racial/ethnic identification is African American/Black Asian Caucasian/White Hispanic	Multi-racial Native American Vietnamese
Other (please specify)

17. Community Representation

Community Representation Business Owner/Manager

Farming/Agriculture Industry

Government Official/Agency

Healthcare Professional

Law Enforcement

Medically Underserved

Nonprofit/Community Agency

Physician

Public Health Official

Religious Leader

Retail

Teacher/Educator

Young Adult/Student

Other (please specify)

18. What do you perceive as the most important problems facing the community in the health care services area?

What do you perceive as the most important problems facing the community in the health care services area?

19. What can a hospital do to improve the quality of life in the community?

What can a hospital do to improve the quality of life in the community?

20. What is your vision for a healthy community?

What is your vision for a healthy community?

21. We appreciate any comments you may have about this survey or health needs in your community.

We appreciate any comments you may have about this survey or health needs in your community.

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