Screen Reader Mode Icon
AdventHealth Ottawa is conducting a community health needs assessment in partnership with Franklin County Health Department, Blue Cross Blue Shield of Kansas and Pathways to a Healthy Kansas. 
Your response is valuable to the continued efforts to improve our community.  Your responses will be compiled with other responses and will never directly identify your individual response. We are gathering some demographic information to ensure that we have feedback from a broad representation of individuals in the community, but this will not be shared outside the project team. You can choose to skip questions that you don’t feel comfortable answering and you can stop at any time.  Thank you for participating.

Question Title

* 1. In general, how would you rate the overall health of Franklin County?

Question Title

* 2. In general, my community has sufficient opportunities for healthy eating.

Question Title

* 3. In general, my community has sufficient opportunity for physical activity.

Question Title

* 4. If you could borrow a bike at no cost (bike share), which of the following would you use it for?  (SELECT ALL THAT APPLY)

Question Title

* 5. Approximately which of the following best describes the amount of fresh fruit and / or vegetables you eat per day?

Question Title

* 6. If you could receive 15 pounds of assorted fruits / vegetables for $15 (approximately half the normal cost) available in the town nearest you, how often would you purchase it?

Question Title

* 7. In the past 30 days, which of the following tobacco products have you used? (SELECT ALL THAT APPLY)

Question Title

* 8. Are you aware of efforts in Franklin County to promote smoking cessation (quitting smoking)?

Question Title

* 9. Please rate your level of support for policies that prohibit tobacco use in the following settings:

  Definitely not supportive Not supportive Neutral Supportive Very supportive
Local parks
School grounds
Hospital grounds
Worksite

Question Title

* 10. Are you aware of the Pathways to a Healthy Kansas initiative that is being implemented in Franklin County?

Question Title

* 11. Have you or a family member have been unable to receive mental health or substance abuse treatment?  If so, please select the reasons from the following?  (CHECK ALL THAT APPLY)

Question Title

* 12. How often in the past 12 months would you say you were worried or stressed about your finances?

Question Title

* 13. Was there a time when you needed to see a doctor but could not because of cost?

Question Title

* 14. In the past 12 months have you been worried whether food would run out before you had money to buy more?

Question Title

* 15. In the past 12 months have you experienced a time when the food you bought didn't last and you didn't have money to buy more?

Question Title

* 16. In the past 12 months has the utility company shut off your service for not paying your bills.

Question Title

* 17. Are you worried or concerned that in the next 2 months you may not have stable housing that you own, rent or stay in as part of a household?

Question Title

* 18. Are you afraid you or a family member might be hurt in your apartment building or house?

Question Title

* 19. Do problems getting childcare make it difficult for you to work or study?

Question Title

* 20. How often do you feel?

  Hardly ever Some of the time Often
That you lack companionship
Left out
Isolated

Question Title

* 21. Which age category are you in?

Question Title

* 22. How do you describe yourself?

Question Title

* 23. What is your race?  (SELECT ALL THAT APPLY)

Question Title

* 24. Are you of Hispanic, Latino or Spanish origin?

Question Title

* 25. What is the highest level of school, college or vocational training that you have finished?

Question Title

* 26. What kind of health insurance or health care do you have?

Question Title

* 27. What was your total household income last year before taxes?

Question Title

* 28. How many people are in your household?

Question Title

* 29. What is your zip code?

0 of 29 answered
 

T