Survey | Memorial Hospital of Sweetwater County | Community Health Needs Assessment (CHNA)

This survey is from Memorial Hospital of Sweetwater County (MHSC) in Rock Springs, Wyoming. MHSC is working on a new Community Health Needs Assessment (CHNA) for 2026. This survey should take about 12-15 minutes to finish.

The purpose of this CHNA project is to find out the main health needs, resources, and problems in our community by collecting and studying information in an organized way.

The results will help MHSC decide how to use its resources to help meet these needs and improve the health of our community over the next three years.

It is very important for us to hear from people like you. Your opinions will help us make sure our solutions fit the real needs of people in our community.

Your answers will be kept private and combined with answers from other people who take the survey. You can share your contact information if you want, but you do not have to.

As you respond to the following questions about local healthcare, please think about the big picture. Not just one doctor, one facility, or health system.

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* 1. Are you 18 years of age or older?

Yes

No - Thank you very much, but we are only asking this survey of people who are ages 18 and older.

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* 2. We want people from all different neighborhoods to take part in this survey. Please tell us the zip code/town where you currently live.

82932 Eden, Farson

82937 Lyman

82942 Point of Rocks

82945 Superior

82322 Bairoil

82941 Pinedale

82933 Fort Bridger

83101 Kemmerer

82929 Little America

82935 Green River

82930 & 82931 Evanston

82336 Wamsutter (Red Desert, Tipton)

82901 & 82902 Rock Springs

84046 Manila, UT

82934 Granger

82939 Mountain View

82301 Rawlins

Other (please specify)

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* 3. How long have you lived in your current location?

Less than 1 year

1-2 years

3-5 years

6-10 years

11-15 years

More than 15 years

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* 4. Which ONE of the following do you believe is the most important issue facing your community today? These may be issues that affect you personally, but please also think about the population as a whole.

Technology (broadband internet access, cell phone signal, etc.)

Housing

Climate

The economy

Healthcare

Jobs

Local leadership

Education

Child care

Transportation

Politics

Infrastructure (roads, utilities, etc.)

Other (please specify)

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* 5. Has your community experienced changes – positive or negative – in the following areas in the last 5 years?

	Positive change	No significant change	Negative change
The economy	The economy Positive change	The economy No significant change	The economy Negative change
Jobs	Jobs Positive change	Jobs No significant change	Jobs Negative change
Politics	Politics Positive change	Politics No significant change	Politics Negative change
Transportation	Transportation Positive change	Transportation No significant change	Transportation Negative change
Housing	Housing Positive change	Housing No significant change	Housing Negative change
Healthcare	Healthcare Positive change	Healthcare No significant change	Healthcare Negative change
Child care	Child care Positive change	Child care No significant change	Child care Negative change
Climate	Climate Positive change	Climate No significant change	Climate Negative change
Education	Education Positive change	Education No significant change	Education Negative change
Infrastructure (roads, utilities, etc.)	Infrastructure (roads, utilities, etc.) Positive change	Infrastructure (roads, utilities, etc.) No significant change	Infrastructure (roads, utilities, etc.) Negative change
Local leadership	Local leadership Positive change	Local leadership No significant change	Local leadership Negative change
Technology (broadband internet access, cell phone signal, etc.)	Technology (broadband internet access, cell phone signal, etc.) Positive change	Technology (broadband internet access, cell phone signal, etc.) No significant change	Technology (broadband internet access, cell phone signal, etc.) Negative change

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* 6. When you think about healthcare in your community, what are two or three words, or a short phrase, that come to mind?

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* 7. In general, how is your physical health?

Poor

Fair

Good

Very good

Excellent

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* 8. In general, how is your mental health?

Poor

Fair

Good

Very good

Excellent

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* 9. For each of the following, please tell us: How important is each of the following issues to you?

Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.

	Not at all important	A little important	Somewhat important	Very important	Extremely important	Don't know
Assistance with basic needs like food, shelter, and clothing	Assistance with basic needs like food, shelter, and clothing Not at all important	Assistance with basic needs like food, shelter, and clothing A little important	Assistance with basic needs like food, shelter, and clothing Somewhat important	Assistance with basic needs like food, shelter, and clothing Very important	Assistance with basic needs like food, shelter, and clothing Extremely important	Assistance with basic needs like food, shelter, and clothing Don't know
Diabetes and high blood sugar	Diabetes and high blood sugar Not at all important	Diabetes and high blood sugar A little important	Diabetes and high blood sugar Somewhat important	Diabetes and high blood sugar Very important	Diabetes and high blood sugar Extremely important	Diabetes and high blood sugar Don't know
Adolescent and child health	Adolescent and child health Not at all important	Adolescent and child health A little important	Adolescent and child health Somewhat important	Adolescent and child health Very important	Adolescent and child health Extremely important	Adolescent and child health Don't know
Obesity	Obesity Not at all important	Obesity A little important	Obesity Somewhat important	Obesity Very important	Obesity Extremely important	Obesity Don't know
Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Not at all important	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah A little important	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Somewhat important	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Very important	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Extremely important	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Don't know
Access to healthy/nutritious foods	Access to healthy/nutritious foods Not at all important	Access to healthy/nutritious foods A little important	Access to healthy/nutritious foods Somewhat important	Access to healthy/nutritious foods Very important	Access to healthy/nutritious foods Extremely important	Access to healthy/nutritious foods Don't know
Heart disease	Heart disease Not at all important	Heart disease A little important	Heart disease Somewhat important	Heart disease Very important	Heart disease Extremely important	Heart disease Don't know
Infant health	Infant health Not at all important	Infant health A little important	Infant health Somewhat important	Infant health Very important	Infant health Extremely important	Infant health Don't know
Crime and violence	Crime and violence Not at all important	Crime and violence A little important	Crime and violence Somewhat important	Crime and violence Very important	Crime and violence Extremely important	Crime and violence Don't know
Virtual care/telehealth	Virtual care/telehealth Not at all important	Virtual care/telehealth A little important	Virtual care/telehealth Somewhat important	Virtual care/telehealth Very important	Virtual care/telehealth Extremely important	Virtual care/telehealth Don't know
Urgent care	Urgent care Not at all important	Urgent care A little important	Urgent care Somewhat important	Urgent care Very important	Urgent care Extremely important	Urgent care Don't know
Dental care	Dental care Not at all important	Dental care A little important	Dental care Somewhat important	Dental care Very important	Dental care Extremely important	Dental care Don't know
Emergency medical services	Emergency medical services Not at all important	Emergency medical services A little important	Emergency medical services Somewhat important	Emergency medical services Very important	Emergency medical services Extremely important	Emergency medical services Don't know
Stopping falls among elderly	Stopping falls among elderly Not at all important	Stopping falls among elderly A little important	Stopping falls among elderly Somewhat important	Stopping falls among elderly Very important	Stopping falls among elderly Extremely important	Stopping falls among elderly Don't know
Teen pregnancy	Teen pregnancy Not at all important	Teen pregnancy A little important	Teen pregnancy Somewhat important	Teen pregnancy Very important	Teen pregnancy Extremely important	Teen pregnancy Don't know
High blood pressure	High blood pressure Not at all important	High blood pressure A little important	High blood pressure Somewhat important	High blood pressure Very important	High blood pressure Extremely important	High blood pressure Don't know
HIV/AIDS (Acquired Immune Deficiency Syndrome)	HIV/AIDS (Acquired Immune Deficiency Syndrome) Not at all important	HIV/AIDS (Acquired Immune Deficiency Syndrome) A little important	HIV/AIDS (Acquired Immune Deficiency Syndrome) Somewhat important	HIV/AIDS (Acquired Immune Deficiency Syndrome) Very important	HIV/AIDS (Acquired Immune Deficiency Syndrome) Extremely important	HIV/AIDS (Acquired Immune Deficiency Syndrome) Don't know
Sexually Transmitted Infections (STIs)	Sexually Transmitted Infections (STIs) Not at all important	Sexually Transmitted Infections (STIs) A little important	Sexually Transmitted Infections (STIs) Somewhat important	Sexually Transmitted Infections (STIs) Very important	Sexually Transmitted Infections (STIs) Extremely important	Sexually Transmitted Infections (STIs) Don't know
Workplace injury	Workplace injury Not at all important	Workplace injury A little important	Workplace injury Somewhat important	Workplace injury Very important	Workplace injury Extremely important	Workplace injury Don't know
Asthma, breathing issues, and lung disease	Asthma, breathing issues, and lung disease Not at all important	Asthma, breathing issues, and lung disease A little important	Asthma, breathing issues, and lung disease Somewhat important	Asthma, breathing issues, and lung disease Very important	Asthma, breathing issues, and lung disease Extremely important	Asthma, breathing issues, and lung disease Don't know
Women’s and maternal health care	Women’s and maternal health care Not at all important	Women’s and maternal health care A little important	Women’s and maternal health care Somewhat important	Women’s and maternal health care Very important	Women’s and maternal health care Extremely important	Women’s and maternal health care Don't know
Cancer	Cancer Not at all important	Cancer A little important	Cancer Somewhat important	Cancer Very important	Cancer Extremely important	Cancer Don't know
School health and wellness programs	School health and wellness programs Not at all important	School health and wellness programs A little important	School health and wellness programs Somewhat important	School health and wellness programs Very important	School health and wellness programs Extremely important	School health and wellness programs Don't know
Hepatitis C/liver disease	Hepatitis C/liver disease Not at all important	Hepatitis C/liver disease A little important	Hepatitis C/liver disease Somewhat important	Hepatitis C/liver disease Very important	Hepatitis C/liver disease Extremely important	Hepatitis C/liver disease Don't know
Substance use disorder/ addiction (including alcohol use disorder)	Substance use disorder/ addiction (including alcohol use disorder) Not at all important	Substance use disorder/ addiction (including alcohol use disorder) A little important	Substance use disorder/ addiction (including alcohol use disorder) Somewhat important	Substance use disorder/ addiction (including alcohol use disorder) Very important	Substance use disorder/ addiction (including alcohol use disorder) Extremely important	Substance use disorder/ addiction (including alcohol use disorder) Don't know
Job placement and employment support	Job placement and employment support Not at all important	Job placement and employment support A little important	Job placement and employment support Somewhat important	Job placement and employment support Very important	Job placement and employment support Extremely important	Job placement and employment support Don't know
Gun violence	Gun violence Not at all important	Gun violence A little important	Gun violence Somewhat important	Gun violence Very important	Gun violence Extremely important	Gun violence Don't know
Access to continuing education and job training programs	Access to continuing education and job training programs Not at all important	Access to continuing education and job training programs A little important	Access to continuing education and job training programs Somewhat important	Access to continuing education and job training programs Very important	Access to continuing education and job training programs Extremely important	Access to continuing education and job training programs Don't know
Infectious diseases (COVID-19, flu, hepatitis)	Infectious diseases (COVID-19, flu, hepatitis) Not at all important	Infectious diseases (COVID-19, flu, hepatitis) A little important	Infectious diseases (COVID-19, flu, hepatitis) Somewhat important	Infectious diseases (COVID-19, flu, hepatitis) Very important	Infectious diseases (COVID-19, flu, hepatitis) Extremely important	Infectious diseases (COVID-19, flu, hepatitis) Don't know
Emergency medical transportation	Emergency medical transportation Not at all important	Emergency medical transportation A little important	Emergency medical transportation Somewhat important	Emergency medical transportation Very important	Emergency medical transportation Extremely important	Emergency medical transportation Don't know
Mental health disorders (such as depression)	Mental health disorders (such as depression) Not at all important	Mental health disorders (such as depression) A little important	Mental health disorders (such as depression) Somewhat important	Mental health disorders (such as depression) Very important	Mental health disorders (such as depression) Extremely important	Mental health disorders (such as depression) Don't know
Affordable housing and homelessness prevention	Affordable housing and homelessness prevention Not at all important	Affordable housing and homelessness prevention A little important	Affordable housing and homelessness prevention Somewhat important	Affordable housing and homelessness prevention Very important	Affordable housing and homelessness prevention Extremely important	Affordable housing and homelessness prevention Don't know
Preventive health services	Preventive health services Not at all important	Preventive health services A little important	Preventive health services Somewhat important	Preventive health services Very important	Preventive health services Extremely important	Preventive health services Don't know
Arthritis/disease of the joints	Arthritis/disease of the joints Not at all important	Arthritis/disease of the joints A little important	Arthritis/disease of the joints Somewhat important	Arthritis/disease of the joints Very important	Arthritis/disease of the joints Extremely important	Arthritis/disease of the joints Don't know

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* 10. From the same list of items, please tell us: how satisfied are you with the current services in your neighborhood to address each issue?

Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.

	Not at all satisfied	A little satisfied	Somewhat satisfied	Very satisfied	Extremely satisfied	Don't know
Access to healthy/nutritious foods	Access to healthy/nutritious foods Not at all satisfied	Access to healthy/nutritious foods A little satisfied	Access to healthy/nutritious foods Somewhat satisfied	Access to healthy/nutritious foods Very satisfied	Access to healthy/nutritious foods Extremely satisfied	Access to healthy/nutritious foods Don't know
Access to continuing education and job training programs	Access to continuing education and job training programs Not at all satisfied	Access to continuing education and job training programs A little satisfied	Access to continuing education and job training programs Somewhat satisfied	Access to continuing education and job training programs Very satisfied	Access to continuing education and job training programs Extremely satisfied	Access to continuing education and job training programs Don't know
Diabetes and high blood sugar	Diabetes and high blood sugar Not at all satisfied	Diabetes and high blood sugar A little satisfied	Diabetes and high blood sugar Somewhat satisfied	Diabetes and high blood sugar Very satisfied	Diabetes and high blood sugar Extremely satisfied	Diabetes and high blood sugar Don't know
Mental health disorders (such as depression)	Mental health disorders (such as depression) Not at all satisfied	Mental health disorders (such as depression) A little satisfied	Mental health disorders (such as depression) Somewhat satisfied	Mental health disorders (such as depression) Very satisfied	Mental health disorders (such as depression) Extremely satisfied	Mental health disorders (such as depression) Don't know
Crime and violence	Crime and violence Not at all satisfied	Crime and violence A little satisfied	Crime and violence Somewhat satisfied	Crime and violence Very satisfied	Crime and violence Extremely satisfied	Crime and violence Don't know
School health and wellness programs	School health and wellness programs Not at all satisfied	School health and wellness programs A little satisfied	School health and wellness programs Somewhat satisfied	School health and wellness programs Very satisfied	School health and wellness programs Extremely satisfied	School health and wellness programs Don't know
Heart disease	Heart disease Not at all satisfied	Heart disease A little satisfied	Heart disease Somewhat satisfied	Heart disease Very satisfied	Heart disease Extremely satisfied	Heart disease Don't know
Urgent care	Urgent care Not at all satisfied	Urgent care A little satisfied	Urgent care Somewhat satisfied	Urgent care Very satisfied	Urgent care Extremely satisfied	Urgent care Don't know
Infectious diseases (COVID-19, flu, hepatitis)	Infectious diseases (COVID-19, flu, hepatitis) Not at all satisfied	Infectious diseases (COVID-19, flu, hepatitis) A little satisfied	Infectious diseases (COVID-19, flu, hepatitis) Somewhat satisfied	Infectious diseases (COVID-19, flu, hepatitis) Very satisfied	Infectious diseases (COVID-19, flu, hepatitis) Extremely satisfied	Infectious diseases (COVID-19, flu, hepatitis) Don't know
Stopping falls among elderly	Stopping falls among elderly Not at all satisfied	Stopping falls among elderly A little satisfied	Stopping falls among elderly Somewhat satisfied	Stopping falls among elderly Very satisfied	Stopping falls among elderly Extremely satisfied	Stopping falls among elderly Don't know
High blood pressure	High blood pressure Not at all satisfied	High blood pressure A little satisfied	High blood pressure Somewhat satisfied	High blood pressure Very satisfied	High blood pressure Extremely satisfied	High blood pressure Don't know
Cancer	Cancer Not at all satisfied	Cancer A little satisfied	Cancer Somewhat satisfied	Cancer Very satisfied	Cancer Extremely satisfied	Cancer Don't know
Dental care	Dental care Not at all satisfied	Dental care A little satisfied	Dental care Somewhat satisfied	Dental care Very satisfied	Dental care Extremely satisfied	Dental care Don't know
Teen pregnancy	Teen pregnancy Not at all satisfied	Teen pregnancy A little satisfied	Teen pregnancy Somewhat satisfied	Teen pregnancy Very satisfied	Teen pregnancy Extremely satisfied	Teen pregnancy Don't know
Sexually Transmitted Infections (STIs)	Sexually Transmitted Infections (STIs) Not at all satisfied	Sexually Transmitted Infections (STIs) A little satisfied	Sexually Transmitted Infections (STIs) Somewhat satisfied	Sexually Transmitted Infections (STIs) Very satisfied	Sexually Transmitted Infections (STIs) Extremely satisfied	Sexually Transmitted Infections (STIs) Don't know
Hepatitis C/liver disease	Hepatitis C/liver disease Not at all satisfied	Hepatitis C/liver disease A little satisfied	Hepatitis C/liver disease Somewhat satisfied	Hepatitis C/liver disease Very satisfied	Hepatitis C/liver disease Extremely satisfied	Hepatitis C/liver disease Don't know
HIV/AIDS (Acquired Immune Deficiency Syndrome)	HIV/AIDS (Acquired Immune Deficiency Syndrome) Not at all satisfied	HIV/AIDS (Acquired Immune Deficiency Syndrome) A little satisfied	HIV/AIDS (Acquired Immune Deficiency Syndrome) Somewhat satisfied	HIV/AIDS (Acquired Immune Deficiency Syndrome) Very satisfied	HIV/AIDS (Acquired Immune Deficiency Syndrome) Extremely satisfied	HIV/AIDS (Acquired Immune Deficiency Syndrome) Don't know
Affordable housing and homelessness prevention	Affordable housing and homelessness prevention Not at all satisfied	Affordable housing and homelessness prevention A little satisfied	Affordable housing and homelessness prevention Somewhat satisfied	Affordable housing and homelessness prevention Very satisfied	Affordable housing and homelessness prevention Extremely satisfied	Affordable housing and homelessness prevention Don't know
Virtual care/telehealth	Virtual care/telehealth Not at all satisfied	Virtual care/telehealth A little satisfied	Virtual care/telehealth Somewhat satisfied	Virtual care/telehealth Very satisfied	Virtual care/telehealth Extremely satisfied	Virtual care/telehealth Don't know
Substance use disorder/ addiction (including alcohol use disorder)	Substance use disorder/ addiction (including alcohol use disorder) Not at all satisfied	Substance use disorder/ addiction (including alcohol use disorder) A little satisfied	Substance use disorder/ addiction (including alcohol use disorder) Somewhat satisfied	Substance use disorder/ addiction (including alcohol use disorder) Very satisfied	Substance use disorder/ addiction (including alcohol use disorder) Extremely satisfied	Substance use disorder/ addiction (including alcohol use disorder) Don't know
Job placement and employment support	Job placement and employment support Not at all satisfied	Job placement and employment support A little satisfied	Job placement and employment support Somewhat satisfied	Job placement and employment support Very satisfied	Job placement and employment support Extremely satisfied	Job placement and employment support Don't know
Infant health	Infant health Not at all satisfied	Infant health A little satisfied	Infant health Somewhat satisfied	Infant health Very satisfied	Infant health Extremely satisfied	Infant health Don't know
Gun violence	Gun violence Not at all satisfied	Gun violence A little satisfied	Gun violence Somewhat satisfied	Gun violence Very satisfied	Gun violence Extremely satisfied	Gun violence Don't know
Women’s and maternal health care	Women’s and maternal health care Not at all satisfied	Women’s and maternal health care A little satisfied	Women’s and maternal health care Somewhat satisfied	Women’s and maternal health care Very satisfied	Women’s and maternal health care Extremely satisfied	Women’s and maternal health care Don't know
Assistance with basic needs like food, shelter, and clothing	Assistance with basic needs like food, shelter, and clothing Not at all satisfied	Assistance with basic needs like food, shelter, and clothing A little satisfied	Assistance with basic needs like food, shelter, and clothing Somewhat satisfied	Assistance with basic needs like food, shelter, and clothing Very satisfied	Assistance with basic needs like food, shelter, and clothing Extremely satisfied	Assistance with basic needs like food, shelter, and clothing Don't know
Adolescent and child health	Adolescent and child health Not at all satisfied	Adolescent and child health A little satisfied	Adolescent and child health Somewhat satisfied	Adolescent and child health Very satisfied	Adolescent and child health Extremely satisfied	Adolescent and child health Don't know
Emergency medical transportation	Emergency medical transportation Not at all satisfied	Emergency medical transportation A little satisfied	Emergency medical transportation Somewhat satisfied	Emergency medical transportation Very satisfied	Emergency medical transportation Extremely satisfied	Emergency medical transportation Don't know
Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Not at all satisfied	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah A little satisfied	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Somewhat satisfied	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Very satisfied	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Extremely satisfied	Cigarette smoking/tobacco use/vaping/e-cigarettes/hookah Don't know
Arthritis/disease of the joints	Arthritis/disease of the joints Not at all satisfied	Arthritis/disease of the joints A little satisfied	Arthritis/disease of the joints Somewhat satisfied	Arthritis/disease of the joints Very satisfied	Arthritis/disease of the joints Extremely satisfied	Arthritis/disease of the joints Don't know
Preventive health services	Preventive health services Not at all satisfied	Preventive health services A little satisfied	Preventive health services Somewhat satisfied	Preventive health services Very satisfied	Preventive health services Extremely satisfied	Preventive health services Don't know
Workplace injury	Workplace injury Not at all satisfied	Workplace injury A little satisfied	Workplace injury Somewhat satisfied	Workplace injury Very satisfied	Workplace injury Extremely satisfied	Workplace injury Don't know
Emergency medical services	Emergency medical services Not at all satisfied	Emergency medical services A little satisfied	Emergency medical services Somewhat satisfied	Emergency medical services Very satisfied	Emergency medical services Extremely satisfied	Emergency medical services Don't know
Asthma, breathing issues, and lung disease	Asthma, breathing issues, and lung disease Not at all satisfied	Asthma, breathing issues, and lung disease A little satisfied	Asthma, breathing issues, and lung disease Somewhat satisfied	Asthma, breathing issues, and lung disease Very satisfied	Asthma, breathing issues, and lung disease Extremely satisfied	Asthma, breathing issues, and lung disease Don't know
Obesity	Obesity Not at all satisfied	Obesity A little satisfied	Obesity Somewhat satisfied	Obesity Very satisfied	Obesity Extremely satisfied	Obesity Don't know

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* 11. Please select the top FIVE biggest barriers that limit your friends and neighbors’ ability to access the general healthcare services they need.

Untreated mental health issues

Discrimination or racism

Limited digital tools and technologies, such as broadband internet access or cell signal

Lack of trust in the system

Lack of insurance coverage

Difficulty getting an appointment when it is needed

Cost of insurance premiums and copayments

The time it takes to get an appointment (for example, if the next available appointment isn’t for two months)

Cost of medications

Difficulty finding a doctor or medical provider

Travel time to appointments

Cultural and language barriers

Only seeking medical care when in pain or very sick

Lack of healthcare services

Quality of medical facilities

Not understanding what services are available or how to access them

Lack of sufficient child care during appointments

Lack of transportation to appointments

Fear of deportation

Limited health knowledge and education (ex. not understanding the importance of regular check-ups)

Cost of care

Inability to leave work to attend appointments

Other (please specify)

I think people generally get the healthcare services they need

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* 12. What THREE behaviors put adults over the age of 18 at risk in your community? Please select the top THREE.

Alcohol use

Illegal drug use

Driving when intoxicated (drugs or alcohol)

Poor eating habits

Overweight or obesity

Tobacco use including vaping

Not accessing preventative care including regular doctor visits and immunizations

Not managing a chronic disease like diabetes or heart disease

Risky sexual behaviors

Unsafe use of firearms

Other (please specify)

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* 13. What THREE behaviors put children and teens under the age of 18 at risk in your community? Please select the top THREE.

Alcohol use

Tobacco use including vaping

Illegal drug use

Risky sexual behaviors

Teen pregnancy

Driving when intoxicated (drugs or alcohol)

Poor eating habits

Overweight or obese

Unsupervised parties

Not getting preventative care, including regular doctor visits, immunizations, etc.

School absences

Unsafe use of firearms

Other (please specify)

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* 14. Over the next 3 years, what would you recommend the hospital and community partners focus on to improve the healthcare you have available in your community?

INDIVIDUAL EXPERIENCE QUESTIONS

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* 15. How much time does it take you to travel to receive basic healthcare in-person? (For example, for a flu shot, an annual wellness visit with your doctor, or treatment for a minor injury or illness)

Less than 30 minutes

35 - 55 minutes

60 – 120 minutes

125 – 180 minutes

More than 3 hours

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* 16. What healthcare services do you/your family use the most?

Primary care

Urgent care/Walk-in clinic

Emergency Department

A specific specialty

Other (key in)

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* 17. The following doctors or providers are available in Sweetwater County. Please tell us if you or your family have any trouble getting an appointment or accessing care with these doctors/providers.

Other (please specify)

Social Determinants of Health

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* 18. During the past 12 months, have you received food stamps, also called SNAP, the Supplemental Nutrition Assistance Program on an EBT card?

Yes

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* 19. During the past 12 months how often did the food that you bought not last, and you didn’t have money to get more?

Always

Usually

Sometimes

Rarely

Never

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* 20. During the last 12 months, was there a time when you were not able to pay your mortgage, rent or utility bills?

Yes

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* 21. Please share any additional information or comments.

DEMOGRAPHIC QUESTIONS

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* 22. What is the current source of your primary health insurance (the one you use most often)?

A plan purchased through an employer or union (including plans purchased through another person's employer)

A private nongovernmental plan that you or another family member buys on your own

Medicare

Medigap

Medicaid

Children's Health Insurance Program (CHIP)

Military related health care: TRICARE (CHAMPUS) /VA health care /CHAMP-VA

Indian Health Services

State sponsored health plan

Other government program

No coverage of any type

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* 23. What is your race and/or ethnicity? (Select all that apply)

American Indian or Alaska Native (For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.)

Asian (For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.)

Black or African American (For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.)

Hispanic or Latino (For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.)

Middle Eastern or North African (For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.)

Native Hawaiian or Pacific Islander (For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.)

White (For example, English, German, Irish, Italian, Polish, Scottish, etc.)

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* 24. What language(s) do you speak at home? (Select all that apply)

English

Spanish

Arabic

French

German

Chinese

Korean

Italian

Vietnamese

Russian

Japanese

Tagalog

Other Native American Languages

Other

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* 25. How well do you speak English?

Very well

Well

Not well

Not at all

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* 26. Which of the following best represents how you think of yourself?

Gay or lesbian

Straight, that is not gay or lesbian

Bisexual

I use a different term

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* 27. How do you currently describe yourself? (Select all that apply)

Woman

Man

Non-binary

Transgender

I use a different term

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* 28. What is your age?

18 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75+

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* 29. What is the highest grade or year of school that you have completed?

Grades 8 (Elementary) or less

Grades 9 through 11 (Some High School)

Grade 12 or GED (High School Graduate)

College 1 year to 3 years (Some college or technical school)

College 4 years or more (College graduate)

Postgraduate (Master's, PhD)

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* 30. Including yourself, how many people usually live or stay in your home or apartment?

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* 31. Are you currently…?

Employed for wages

Self-employed

Out of work for 1 year or more

Out of work for less than 1 year

A homemaker

A student

Retired

Unable to work

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* 32. What is your household’s annual household income from all sources, before taxes, in the last year? By household income we mean the combined income from everyone living in the household including even roommates or those on disability income.

Less than $20,000

$20,000 to $24,999

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 to $199,999

$200,000 or more

SELF-IDENTIFYING QUESTIONS

We invite you to identify yourself and the organization you represent. This is optional. You are not required to identify yourself.

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* 33. First & Last Name

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* 34. Organization

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* 35. Please tell us the type of organization you represent. Select one of the options below. If none of these options apply to you, please select Other and describe the type of your organization in the open response field.

Government

Law Enforcement

Healthcare

Private Sector/Industry/Business

Social Services

Education

Mental Health/Behavioral Health

Public Health

Faith-Based/Religious/Spiritual

Coroner’s Office

Senior Center

First Responders/EMS/Fire Department

Other (please specify)

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* 36. Please tell us if your organization provides services or programs to any of the populations listed below. Please select all that apply.

Individuals over the age of 65

Women and children

Teens

Individuals with chronic disease

Ethnic minorities

Individuals with limited English proficiency

Individuals with mental illness

Individuals who are victims of domestic violence; child abuse and neglect; or elder abuse and neglect

Adults with an addiction to alcohol or drugs, use tobacco products, marijuana, or illegal drugs

Children or teens with mental illness

Homeless

Youth and teens who use alcohol, tobacco products, marijuana, or illegal drugs

Other (please specify)

This is the end of the survey. Thank you very much for your help.

	No trouble getting appointment/accessing care.	Some trouble getting appointment/accessing care.	A lot of trouble getting appointment/accessing care.	Don't know/Not applicable
Plastic Surgery	Plastic Surgery No trouble getting appointment/accessing care.	Plastic Surgery Some trouble getting appointment/accessing care.	Plastic Surgery A lot of trouble getting appointment/accessing care.	Plastic Surgery Don't know/Not applicable
Pulmonology	Pulmonology No trouble getting appointment/accessing care.	Pulmonology Some trouble getting appointment/accessing care.	Pulmonology A lot of trouble getting appointment/accessing care.	Pulmonology Don't know/Not applicable
Pediatrics	Pediatrics No trouble getting appointment/accessing care.	Pediatrics Some trouble getting appointment/accessing care.	Pediatrics A lot of trouble getting appointment/accessing care.	Pediatrics Don't know/Not applicable
Cardiology	Cardiology No trouble getting appointment/accessing care.	Cardiology Some trouble getting appointment/accessing care.	Cardiology A lot of trouble getting appointment/accessing care.	Cardiology Don't know/Not applicable
General Surgery	General Surgery No trouble getting appointment/accessing care.	General Surgery Some trouble getting appointment/accessing care.	General Surgery A lot of trouble getting appointment/accessing care.	General Surgery Don't know/Not applicable
Oncology	Oncology No trouble getting appointment/accessing care.	Oncology Some trouble getting appointment/accessing care.	Oncology A lot of trouble getting appointment/accessing care.	Oncology Don't know/Not applicable
Allergy	Allergy No trouble getting appointment/accessing care.	Allergy Some trouble getting appointment/accessing care.	Allergy A lot of trouble getting appointment/accessing care.	Allergy Don't know/Not applicable
Gastroenterology	Gastroenterology No trouble getting appointment/accessing care.	Gastroenterology Some trouble getting appointment/accessing care.	Gastroenterology A lot of trouble getting appointment/accessing care.	Gastroenterology Don't know/Not applicable
Urology	Urology No trouble getting appointment/accessing care.	Urology Some trouble getting appointment/accessing care.	Urology A lot of trouble getting appointment/accessing care.	Urology Don't know/Not applicable
Ear, Nose, and Throat (ENT)	Ear, Nose, and Throat (ENT) No trouble getting appointment/accessing care.	Ear, Nose, and Throat (ENT) Some trouble getting appointment/accessing care.	Ear, Nose, and Throat (ENT) A lot of trouble getting appointment/accessing care.	Ear, Nose, and Throat (ENT) Don't know/Not applicable
Mental health providers including therapists and counselors	Mental health providers including therapists and counselors No trouble getting appointment/accessing care.	Mental health providers including therapists and counselors Some trouble getting appointment/accessing care.	Mental health providers including therapists and counselors A lot of trouble getting appointment/accessing care.	Mental health providers including therapists and counselors Don't know/Not applicable
Orthopedics	Orthopedics No trouble getting appointment/accessing care.	Orthopedics Some trouble getting appointment/accessing care.	Orthopedics A lot of trouble getting appointment/accessing care.	Orthopedics Don't know/Not applicable
Primary Care	Primary Care No trouble getting appointment/accessing care.	Primary Care Some trouble getting appointment/accessing care.	Primary Care A lot of trouble getting appointment/accessing care.	Primary Care Don't know/Not applicable
Internal Medicine	Internal Medicine No trouble getting appointment/accessing care.	Internal Medicine Some trouble getting appointment/accessing care.	Internal Medicine A lot of trouble getting appointment/accessing care.	Internal Medicine Don't know/Not applicable
Neurology	Neurology No trouble getting appointment/accessing care.	Neurology Some trouble getting appointment/accessing care.	Neurology A lot of trouble getting appointment/accessing care.	Neurology Don't know/Not applicable
Obstetrics	Obstetrics No trouble getting appointment/accessing care.	Obstetrics Some trouble getting appointment/accessing care.	Obstetrics A lot of trouble getting appointment/accessing care.	Obstetrics Don't know/Not applicable
Psychiatry	Psychiatry No trouble getting appointment/accessing care.	Psychiatry Some trouble getting appointment/accessing care.	Psychiatry A lot of trouble getting appointment/accessing care.	Psychiatry Don't know/Not applicable
Gynecology	Gynecology No trouble getting appointment/accessing care.	Gynecology Some trouble getting appointment/accessing care.	Gynecology A lot of trouble getting appointment/accessing care.	Gynecology Don't know/Not applicable
Nephrology	Nephrology No trouble getting appointment/accessing care.	Nephrology Some trouble getting appointment/accessing care.	Nephrology A lot of trouble getting appointment/accessing care.	Nephrology Don't know/Not applicable

Survey | Memorial Hospital of Sweetwater County | Community Health Needs Assessment (CHNA)

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* 1. Are you 18 years of age or older?

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* 2. We want people from all different neighborhoods to take part in this survey. Please tell us the zip code/town where you currently live.

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* 3. How long have you lived in your current location?

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* 4. Which ONE of the following do you believe is the most important issue facing your community today? These may be issues that affect you personally, but please also think about the population as a whole.

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* 5. Has your community experienced changes – positive or negative – in the following areas in the last 5 years?

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* 6. When you think about healthcare in your community, what are two or three words, or a short phrase, that come to mind?

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* 7. In general, how is your physical health?

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* 8. In general, how is your mental health?

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* 9. For each of the following, please tell us: How important is each of the following issues to you? Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.

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* 10. From the same list of items, please tell us: how satisfied are you with the current services in your neighborhood to address each issue?Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.

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* 11. Please select the top FIVE biggest barriers that limit your friends and neighbors’ ability to access the general healthcare services they need.

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* 12. What THREE behaviors put adults over the age of 18 at risk in your community? Please select the top THREE.

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* 13. What THREE behaviors put children and teens under the age of 18 at risk in your community? Please select the top THREE.

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* 14. Over the next 3 years, what would you recommend the hospital and community partners focus on to improve the healthcare you have available in your community?

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* 15. How much time does it take you to travel to receive basic healthcare in-person? (For example, for a flu shot, an annual wellness visit with your doctor, or treatment for a minor injury or illness)

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* 16. What healthcare services do you/your family use the most?

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* 17. The following doctors or providers are available in Sweetwater County. Please tell us if you or your family have any trouble getting an appointment or accessing care with these doctors/providers.

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* 18. During the past 12 months, have you received food stamps, also called SNAP, the Supplemental Nutrition Assistance Program on an EBT card?

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* 19. During the past 12 months how often did the food that you bought not last, and you didn’t have money to get more?

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* 20. During the last 12 months, was there a time when you were not able to pay your mortgage, rent or utility bills?

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* 21. Please share any additional information or comments.

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* 22. What is the current source of your primary health insurance (the one you use most often)?

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* 23. What is your race and/or ethnicity? (Select all that apply)

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* 24. What language(s) do you speak at home? (Select all that apply)

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* 25. How well do you speak English?

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* 26. Which of the following best represents how you think of yourself?

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* 27. How do you currently describe yourself? (Select all that apply)

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* 28. What is your age?

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* 29. What is the highest grade or year of school that you have completed?

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* 30. Including yourself, how many people usually live or stay in your home or apartment?

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* 31. Are you currently…?

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* 32. What is your household’s annual household income from all sources, before taxes, in the last year? By household income we mean the combined income from everyone living in the household including even roommates or those on disability income.

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* 33. First & Last Name

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* 34. Organization

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* 35. Please tell us the type of organization you represent. Select one of the options below. If none of these options apply to you, please select Other and describe the type of your organization in the open response field.

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* 36. Please tell us if your organization provides services or programs to any of the populations listed below. Please select all that apply.

* 9. For each of the following, please tell us: How important is each of the following issues to you?

Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.

* 10. From the same list of items, please tell us: how satisfied are you with the current services in your neighborhood to address each issue?

Access to health care means being able to get the health services you need, when you need them, so you can have the best possible health.