This survey is being conducted by a partnership of NMC Health, Prairie View, Inc., Health Ministries Clinic, Inc., Mirror, Inc., Pathways to a Healthy Kansas, Blue Cross and Blue Shield of Kansas initiative, KU COPE Project, Healthy Harvey Coalition, and Harvey County Health Department.
 
Your input matters and will help Harvey County to work on health issues across the county.

Please complete this survey only once. If taking the survey on paper, return the survey to this location.
 
Your responses will not be tracked. We only share the total responses received. By completing this survey, you are agreeing to participate. If you are under 18, do not complete the survey.
 
Watch for a complete report and 3-year plan developed from this and other data on the Harvey County Health Department website. www.harveycounty.com
 
If you have questions regarding this survey or its intended use, please contact Lynnette at 316-283-5667 x 217.  Thank you for your help.

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* 1. COMMUNITY HEALTH
In the following list, what do you think are the three most important factors for a “Healthy Community?” (Those factors which most improve the quality of life in a community.)
Check only three.

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* 2. In general, how would you rate the overall health of your community? Check one.

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* 3. Were you aware of the Pathways to a Healthy Kansas initiative that is being implemented by the Healthy Harvey Coalition in your community?

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* 4. In the following list, what do you think are the three most important “risky behaviors” in Harvey County? (Those behaviors which you believe have the greatest impact on overall community health.) Check only three.

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* 5. Do you have any general concerns about health or health care in Harvey County?

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* 6. How well does your community currently meet the needs of children, including adolescents in the following areas?

  Very Poor: No needs are met Poor: Some needs are met Fair: Many needs are met Good: Most needs are met Very Good: All needs are met
Childcare for children birth to age 5
Basic needs of children/youth
College or career preparation
Dental health
Mental health
Needs for non-English speaking children
Needs of children/youth with disabilities/special needs
Parental support/training
Physical health
Care for pregnant moms and newborns
Quality education
Quality of childcare for children 0-5
Recreational opportunities
Support for single parents
Violence/bullying prevention
Volunteer opportunities

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* 7. In general, my community has sufficient opportunities for physical activity.

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* 8. In general, my community has sufficient options for healthy eating.

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* 9. Please rate your level of support for policies that prohibit use of all commercial tobacco products, including cigarettes, chewing tobacco, vaping products and any other products, in all OUTDOOR spaces that are open to the general public (e.g., parks, trails, sidewalks).

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* 10. Please rate your level of support for policies that prohibit use of all commercial tobacco products, including cigarettes, chewing tobacco, vaping products and any other products, in all INDOOR spaces that are open to the general public, including private businesses where the public may go (e.g., food pantries, restaurants, hospitals).

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* 11. Community conditions (e.g., housing, transportation, education) impact overall health.

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* 12. We would like to know about the problems in the community that can have the greatest impact on people. Which life stressors impact our community members most, in your opinion? Select the top three.

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* 13. Overall, what are the top three mental health needs in the community that should be addressed? Select the top three.

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* 14. What are the top three needs related to income/household budget in your community that should be addressed? Select the top three.

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* 15. What are the top three needs related to housing in the community that should be addressed? Select the top three.

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* 16. What are the top three needs for OLDER ADULTS in the community that should be addressed? Select three.

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* 17. PERSONAL HEALTH
For each of the following health behaviors, check if you have utilized them in the past 12 months:

  Yes No NA
a. Visited a dentist or dental clinic for any reason.
b. Had a flu shot/vaccination.
c. Had a colorectal cancer screening.
d. Had your blood pressure checked.
e. Had your cholesterol checked.
f. Been checked for skin cancer.
g. Had a diabetes screening.
h. Had a routine checkup by a healthcare provider.
i. Had an eye exam to test vision and eye health.
j. Visited mental health professional.
k. Visited substance misuse professional

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* 18. During the last 12 months if you or any member of your household was unable to visit a healthcare provider when needed. Check all that apply.

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* 19. During the past 12 months, was there any time you or any member of your household needed a prescription but did not get it due to the cost?

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* 20. During the past 12 months, have you or any member of your household skipped going to a dentist due to any of the following? Check all that apply.

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* 21. During the past 12 months, have you or any member of your household skipped seeking mental health assistance due to any of the following? Check all that apply.

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* 22. During the past 12 months, have you or any member of your household skipped getting help with a drug use problem due to any of the following? Check all that apply.

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* 23. When you have a question about routine health matters, where do you get most of your information? Check only one.

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* 24. Have you needed specialty medical services that were not available to you in Harvey County?

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* 25. If you’re not satisfied with your current housing, please tell us why? Select all that apply.

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* 26. Do you spend more than 30% of your yearly income on housing (including utilities)?

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* 27. Over the last 12 months, have you had a problem with any of the following? Select the top three.

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* 28. Do you have access to a smart cell phone with internet?

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* 29. Have you ever quit or lost a job because you did not have the childcare you needed?

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* 30. If you are the primary caregiver for a person who is 65 years or older, do you feel you can access assistance for caregiving needs in Harvey County?

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* 31. DEMOGRAPHICS
Mark zip code where you live:

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* 32. Age

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* 33. What is your gender identity?

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* 34. Race (mark all that apply):

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* 35. Ethnicity: Are you of Hispanic, Latin or Spanish origin?

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* 36. Education:

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* 37. What is your annual household income (before taxes)?

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* 38. How long have you lived in Harvey County?

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* 39. Which describes your household?

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