2025 VGH Community Health Needs Assessment (CHNA) Survey
This survey will help VGH and community partners identify key health concerns, improve services, and develop strategic plans to support our residents. (Survey is anonymous - approx. 10 min)
1.
What is your gender?
Male
Female
Prefer not to say
Other (please specify)
2.
What is your zip code?
3.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65-74
75-84
85+
4.
What is your race/ethnicity?
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Other (please specify)
5.
What is your highest level of education?
Less than high school
High school diploma or GED
Some college
Associate degree
Bachelor's degree
Graduate or professional degree
6.
What is your employment status?
Employed full-time
Employed part-time
Self-employed
Unemployed
Retired
Student
Homemaker
7.
What is your yearly income range?
Under $25,000
Between $25,000 and $49,999
Between $50,000 and $74,999
Between $75,000 and $99,999
Over $100,000
8.
What type of health insurance coverage do you have?
No Insurance
Employer-Provided Insurance
Private Insurance
Government (Medicare/Medicaid/Iowa Health and Wellness Plan)
Other (please specify)
9.
How long have you lived in Benton County?
Less than 1 year
1 - 5 years
6 - 10 years
Over 10 years
I do not live in Benton County
10.
Do you have a primary health care provider?
Yes
No
11.
Where do you usually go when you are sick or need health advice?
Medical Clinic
Emergency Room
Telehealth
Urgent Care
Other (please specify)
12.
What barriers have you experienced when accessing health care?
Cost
Transportation
Availability
Lack of insurance
Language or communication barriers
None
Other (please specify)
13.
Have you delayed or avoided medical care in the past year?
Yes
No
If yes, why?
14.
How easy is it for you to get an appointment when you need one?
Very easy
Easy
Somewhat easy
Neither easy nor difficult
Somewhat difficult
Difficult
Very difficult
Not applicable
15.
How often do you exercise each week?
0 times
1 - 2 times
3 - 4 times
5 or more times
16.
How would you describe your diet?
Very healthy
Somewhat healthy
Not very healthy
Not sure
17.
Do you use tobacco products?
Yes
No
Used to, but quit
18.
How many hours of sleep do you typically get per night?
Less than 4 hours
4 - 5 hours
6 - 7 hours
8 or more hours
19.
When was your last routine check-up or physical exam?
Within the past year
1 - 2 years ago
More than 2 years ago
I have never had one
20.
Do you receive regular screenings for the following? (Please select all that apply)
Blood Pressure
Cholesterol
Cancer (e.g., mammogram, colonoscopy)
Diabetes (A1C test)
Dental checkups
None of the above
21.
In the past year, how often have you felt stressed or anxious?
Daily
Weekly
Monthly
Rarely
Never
22.
Have you ever accessed mental health services
Yes - frequently
Yes - occassionally
No
I wanted to, but couldn't
Other (please specify)
23.
If you needed mental health care today, would you know where to go?
Yes
No
Not sure
24.
What improvements would you like to see at VGH? What services would you like to see added?
25.
What do you feel are the 3 most pressing health issues in Benton County? Select up to three (3) choices
Tobacco
Alcohol and other Drugs/Substances
Gambling
Mental Health
Heart Disease and Stroke
Cancer
Asthma
Diabetes
Arthritis
Elderly Wellness
Family Planning
Infant, Child, and Family Health
Nutrition
Oral Health
Physical Activity
Pregnancy and Birth
Other (please specify)
26.
Which of the following issues have affected your health or well-being in the past year? (Select all that apply)
Housing insecurity
Food insecurity
Financial stress
Lack of internet or phone access
Childcare availability
Transportation issues
Social isolation
None of the above
27.
Do you feel your community has the resources and services needed to live a healthy life?
Yes
Somewhat
No
Not sure
Please explain (optional)
28.
Do you have additional comments or suggestions for improving health services in our community?
1 / 1
100%