2012 Community Health Needs Assessment Survey. Thanks for your Participation!

 
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1. What is your Zip code?
2. What is your gender?
3. What is your race?
4. Are you Hispanic?
5. What language do you speak at home?
6. What is your age group?
7. Have you seen a primary care provider in the past 12 months?
8. Have you used the emergency room in the past 12 months for yourself or another adult in your household?
9. Have you used the emergency room in the past 12 months for a child under your care?
10. The last time you had to use the emergency room, what was the reason?
11. Where do you go when you can’t see your regular healthcare provider?
12. When you need to travel for health services, how do you get there?
13. Using the scale below, please check the box for each issue that you think is a big barrier(s) to health care in Louisville Metro/Jefferson County.
a) Strongly Agreeb) Agree c) Neither Agree or Disagree d) Disagree e) Strongly Disagree f) No Opinion
1. Doctor’s Office Hours
2. Transportation
3. Knowing Where to go in a Healthcare Facility
4. Cost or Expenses
5. Discrimination/Bias
6. Health Knowledge
7. Health Beliefs
8. Insurance Issues
9. Stigma
10. Culture and Language
11. Medicaid Rules
12. Fear of Deportation
14. When I need health information, most often I rely upon the following source:
15. Do you have access to preventive health services (i.e., vaccination/shots, family planning, mammography or any other screenings, etc.)?
16. When you visit a health care facility for services do you feel you have enough information to know what to expect?
17. The last time you came home from a healthcare facility, did you feel that discharge instructions were clear enough for you and your family to help you recover?
18. Do you feel that health providers provide you with the education and resources you may need?
19. How often do you feel that when you have a medical appointment (i.e. diagnostic test, medical exam, doctor’s visit) you are seen in a timely manner during your visit?
20. Is ADDICTION a big health problem in your neighborhood? If so, what type? (Please choose one answer)
21. Is MENTAL ILLNESS a big health problem in your neighborhood? If so, what type? (Please choose one answer)
22. Is RESPIRATORY ILLNESS a big health problem in your neighborhood? If so, what type? (Please choose one answer)
23. Is CANCER a big health problem in your neighborhood? If so, what type? (Please choose one answer)
24. Is one of the following types of CHRONIC DISEASE a big health problem in your neighborhood? If so, what type? (Please choose one answer)
25. Are other EMERGING ISSUES a big health problem in your neighborhood? If so, what type? (Please choose one answer)
26. Do you feel the various health organizations in your community are meeting the health and wellness needs of your community?
27. Do you think there are people in your community that need care but cannot get it?
28. In your opinion, what is the best way to address the health needs of people in your community? Please choose one option.
29. How can community/business leaders and heath care organizations work together to meet wellness goals? Please choose one option.
30. Which group do you feel needs the most help with access to health care?
31. In order to improve children’s health in Louisville Metro/Jefferson County what do we need to do?
32. What did we miss or not ask you about health related issues in our county? Please comment..
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