OCAITHB - Tribal Needs Assessment 1. Tribal Needs Assessment Survey The Tribal Epidemiology Center has developed this Tribal Needs Assessment to assess the health priorities in your community. The Tribal Epidemiology Center is a program of the Oklahoma City Area Inter-Tribal Health Board (OCAITHB). The OCAITHB is a non-profit, tribal organization representing the tribes in Oklahoma, Kansas, and Texas on health matters. Please take a few moments to complete this survey to help create a list of top priorities. The information gathered through this survey is for our internal use only and will not be published with names of any tribes or positions of the person completing the survey. Question Title * 1. What is the name of your tribe and/or facility? Question Title * 2. What is your position at the tribe and/or facility? Health Director Community Health Representative Public Health Nurse Health Board Member Chief Medical Officer Other (please specify) Question Title * 3. How long have you been in your current position? Less Than One Year 1-2 Years 3-4 Years 5 or more Years Question Title * 4. In your opinion, public health comprises the following programs: Epidemiology Surveillance Research Data Management Diabetes Prevention Screening All of the Above None of the Above Question Title * 5. Please tell us the top 10 health issues/diseases that are most concerning in your community. Rank from 1 to 10, with number 1 being your highest concern. Asthma/Respiratory Disease Cancer Cardiovascular Disease Dental Health Diabetes Disability Elder Care Environmental Health Flu/Pneumonia Getting or Paying for Medication Getting Transportation to a Clinic Injuries (Unintentional and Violence) Kidney Disease or Dialysis Liver Disease Mental Health Obesity Oral Health Sexual Health Substance Abuse Suicide Tobacco Use (non-traditional) Question Title * 6. Please tell us why you ranked your #1 as the top priority. Question Title * 7. Please tell us the four most common types of cancer in your community. Breast Cancer Prostate Cancer Kidney Cancer Cervical/Uterine Cancer Skin Cancer Colorectal Cancer Lung Cancer Stomach Cancer Question Title * 8. In your opinion, what is the most common barrier to cancer screening by community members? Lack of Education Lack of Physician Recommendations Anxiety about Screening Lack of Transportation Distance to Nearest Screening Facility Lack of Time Other (please specify) Question Title * 9. Which of the following types of injuries do you feel is the greatest concern in your community? Unintentional Injuries Domestic Violence Homicide Suicide Other (please specify) Question Title * 10. In your opinion, do your community members have easy access to healthy foods, such as fresh fruits and vegetables? Yes No Additional Comments Question Title * 11. In your opinion, do your community members have access to places where they can exercise? (Safe places to walk, fitness centers, parks) Yes No Additional Comments: Question Title * 12. In your opinion, do members in your community have access to smoking cessation programs? Yes No Additional comments Question Title * 13. In your opinion, which of the following factors is most influencial in determining the health of your community? Education Socioecomonic Status Employment Status Access to Care Other (please specify) Question Title * 14. How can the Tribal Epidemiology Center support your programs? Training Survey Development Needs Assessment Data Analysis Evaluation Searching for Funding Question Title * 15. Additional comments: Done