Community Health Needs Assessment 2025
1.
How would you rate your mental health?
Excellent
Good
Fair
Poor
2.
How easy is it for you to access mental health care services in our community?
Very Easy
Easy
Hard
Very Hard
3.
What barriers exist to accessing mental health services in our community?
Unsure who to ask or where to go
Mental health services are not covered by my insurance,
No childcare available,
I don’t know what mental health services are
Distrust with providers/systems
Lack of time (works multiple jobs, long work hours)
Other activities are more important
No motivation
Other medical issues are more urgent
Not a priority right now
Unreliable transportation
4.
Are you aware of services like therapy, counseling, and crisis intervention are available for you and your family?
Yes
NO
5.
Do you feel that there is a stigma surrounding mental health in your community?
Yes
NO
6.
How comfortable are you discussing mental health concerns with family members, friends, or your healthcare provider?
Very Comfortable
Comfortable
Somewhat Comfortable
Not Comfortable
7.
Are you aware of mental health resources and services available in your community?
Yes
No
8.
Do you feel that you have the support you need when facing mental health challenges?
No
Yes
9.
How would you rate the overall health of your community? Please rate the importance of the following factors for a "healthy community"?
Very healthy (Provides excellent health care services, services are very easy to access, residents are very physically active, high focus on local fresh foods, excellent education, and a lot of resources are available to better health)
Healthy (Provides good health care services, services are easy access, residents are physically active, a focus on local fresh foods, good education, and has resources available to better health)
Unhealthy (Provides poor health care services, services are not easy to access, residents are physically inactive, little focus on local fresh foods, poor education, and few resources available to better health)
Very Unhealthy (Provides very poor health care services, services are very difficult to access, residents are very physically inactive, very little focus on local fresh foods, very poor education, and no resources available to better health)
10.
Please select the following factors you believe are important for a “healthy community?”
Access to healthcare (example: family doctor, hospital, other health services)
Access to healthy food
Affordable housing
Arts and cultural events
Clean environment
Addressing climate change
Available Jobs
Safe place to raise children
Before and after school programming
Available K-12 schools
Racial equity
Healthy behaviors and lifestyles
Low rates of adult cancer, diseases, and death
Low crime rate/ safe neighborhoods
Low levels of gun/firearm violence
Low infant death rates
Low level of child abuse
Parks and recreational activities
Places of worship
Walk-ability and Bike Paths
Other (please specify)
11.
Promoting healthy living includes many things. Select the factors you believe are important for healthy living
prevention and treatment of addictive behaviors (tobacco, alcohol, other drugs, gambling)
chronic disease prevention (mental health, heart disease and stroke, cancer, asthma, diabetes, arthritis, etc.);
elderly wellness;
family planning; pregnancy and birth
infant, child and family health;
nutrition;
oral health;
physical activity;
12.
How often do you engage in physical activity (e.g. walking, exercise, sports)?
5 or more times per week
3-5 times per week
1-2 times per week
Less than 1 time per week
13.
What barriers prevent you from being more physically active (e.g. lack of time, access to facilities, health issues?)
Gym fear / anxiety
Cannot afford gym membership,
No childcare available,
No gym access where I live
I do not like gym that is available
Lack of time (works multiple jobs, long work hours,
Other activities are more important
No motivation
Mental health issues
Not a priority right now
I do not want to be healthier
Unsure how to be healthier
Outdoor factors (lighting issues, lack of trails, sidewalks)
Physical health is too poor
Unsafe neighborhood
14.
Are there recreational spaces or facilities (e.g. parks, gyms, walking trails) in our community?
Yes
No
15.
In regards to your community's physical environment, select all that apply.:
We have parks and clean green space for recreation and leisure.
We have a safe public walking trail.
We have an inclusive or handicap accessible playground.
We have access to low cost, fresh foods in our community.
We do not have any parks or clean green space for recreation and leisure. We do not have a safe public walking trail.
Not all members of our community have an indoor option for physical activity. We do not have an inclusive or handicap accessible public playground.
We do not have access to low cost, fresh foods in our community.
16.
Please mark all that you see within your community.:
Limited options for seniors to exercise safely in all weather conditions.
Limited before and after school programs.
Cost for healthy meals.
Cost of fitness memberships
Lack of outdoor trail systems.
Unsafe public areas.
Lack of knowledge on how to lose weight.
Lack of knowledge on how to eat right.
Lack of transporation.
Some community members do not see a doctor once a year.
17.
Have you or anyone in your household been diagnosed with a chronic disease, cancer, or obesity (e.g. diabetes, hypertension)?
Yes
No
18.
Do you have access to preventive care services (e.g. screenings, vaccinations) in your community?
Yes
No
19.
How easy is it for you to access healthy and affordable food options in your community?
Very Easy
Easy
Hard
Very Hard
20.
Do you have access to fresh fruits and vegetables regularly?
Yes
No
21.
Are there community food programs (e.g., food banks, farmer’s markets) that help with access to healthy foods?
Yes
No
22.
What are the biggest challenges you face in maintaining a healthy diet (e.g., cost of healthy food, lack of time to cook, limited options)?
23.
Does your community provide enough affordable options for healthy eating (e.g., low-cost grocery stores, healthy meal delivery services)?
Yes
No
24.
How would you rate your overall personal health?
Very healthy (I feel great physically, mentally and emotionally most days)
Healthy (I feel good physically, mentally and emotionally most days)
Unhealthy (I feel unwell physically, mentally and emotionally most days)
Very unhealthy (I feel very unwell physically, mentally and emotionally most days)
25.
On your last routine/regular health care visit, where did you go?
Family Doctor/General medical practitioner
Urgent Care
Emergency Department
Telemedicine
I don’t receive routine care.
Please tell us why you don’t receive routine care
26.
When you get sick, how do you access care?
Family doctor / General medical practitioner
Urgent care
Emergency department
Telemedicine (remote delivery of healthcare services)
I do not go anywhere.
27.
Please help us understand why you don't receive care:
28.
In the last year, was there a time you needed care from a doctor or general medical practitioner but were unable to access it?
Yes
No
29.
In the last year, was there a time you needed dental care but were unable to access it?
Yes
No
30.
In the last year, was there a time you needed mental health care but were unable to access it?
Yes
No
31.
How satisfied are you with your ability to make appointments and get in to see primary healthcare services (e.g., general practitioners, specialists)?
Very Satisfied
Satisfied
Somewhat Satisfied
Not Satisfied
32.
Is transportation a barrier to accessing healthcare services in your community?
Yes
No
33.
Are healthcare services (e.g., doctor’s visits, emergency care) affordable for you and your family?
Yes
No
34.
Do you feel that affordable housing is accessible in your community?
Yes
No
35.
Are there any challenges related to housing that affect your health and well-being (e.g., overcrowding, unsafe living conditions)?
Yes
No
Please share what those challenges are
36.
Do you feel transportation is a barrier to accessing essential services (e.g., healthcare, grocery stores, employment)?
Yes
No
37.
How often do you feel isolated from others?
Always
Sometimes
Never
38.
Do you feel safe in your community?
Yes
No
39.
What is your home Zip Code:
40.
What is your age range:
Under 18
18 - 24
25 - 44
45 - 64
65 - 74
75 - 84
85 and Over
41.
Gender
Male
Female
Transgender
Nonbinary / Nonconforming
Prefer Not to Answer
42.
Race / Ethnicity :
African American
American Indian or Alaska Native
Caucasian / White
Hispanic
Other
Prefer Not to Answer
43.
Yearly Income:
Less than $25,000
$25,000 - 50,000
$51,000 - 75,000
$76,000 - 100,000
Over $100,000
44.
Current Health Insurance Coverage:
No Health Insurance
Insurance Through Your Employer or a Family Member's Employer
Private Health Insurance
Government Program (Medicare, Medicaid, etc.)
Other (please specify)
