Las Animas/Huerfano Survey on Population Health and Hospital Services

Intro

Population Health - These questions will focus on the overall health of your community and what does and does not contribute to making it a healthy community for those living in it. This section includes both questions about healthcare and questions on topics like the environment, housing, poverty, etc.

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* 1. What county do you live in?

Las Animas

Huerfano

Other:

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* 2. How would you rate the overall health of your community?

Very Healthy

Healthy

Somewhat Healthy

Unhealthy

Very Unhealthy

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* 3. Why did you select this rating?

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* 4. What does your community do well to help residents be healthy? (physical, mental, emotional, spiritual) Check Yes or No for each item.

	Yes	No
Safe outdoor space	Safe outdoor space Yes	Safe outdoor space No
Availability of medical care ie. doctor, dentist, mental health, prenatal care	Availability of medical care ie. doctor, dentist, mental health, prenatal care Yes	Availability of medical care ie. doctor, dentist, mental health, prenatal care No
Courses and Classes (diabetes prevention class, cooking matters, Tai Chi Class)	Courses and Classes (diabetes prevention class, cooking matters, Tai Chi Class) Yes	Courses and Classes (diabetes prevention class, cooking matters, Tai Chi Class) No
Play grounds	Play grounds Yes	Play grounds No
Walking trails	Walking trails Yes	Walking trails No
Farmer’s Market	Farmer’s Market Yes	Farmer’s Market No
Rotary	Rotary Yes	Rotary No

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* 5. What is your opinion about the following health issues in your community?

Use the following definitions to rank each issue:
Minor Issue: A concern, but much less important that other issues
Moderate Issue: A concern of average importance when compared to other issues
Major Issue: In the top 3 to 5 concerns needing immediate attention

	Not an Issue	Minor Issue	Moderate Issue	Major Issue	Don’t Know
Water Quality	Water Quality Not an Issue	Water Quality Minor Issue	Water Quality Moderate Issue	Water Quality Major Issue	Water Quality Don’t Know
Air Quality	Air Quality Not an Issue	Air Quality Minor Issue	Air Quality Moderate Issue	Air Quality Major Issue	Air Quality Don’t Know
Oral Health	Oral Health Not an Issue	Oral Health Minor Issue	Oral Health Moderate Issue	Oral Health Major Issue	Oral Health Don’t Know
Teen Birth Rates/Teen Pregnancy	Teen Birth Rates/Teen Pregnancy Not an Issue	Teen Birth Rates/Teen Pregnancy Minor Issue	Teen Birth Rates/Teen Pregnancy Moderate Issue	Teen Birth Rates/Teen Pregnancy Major Issue	Teen Birth Rates/Teen Pregnancy Don’t Know
Obesity/Overweight (diabetes, heart disease)	Obesity/Overweight (diabetes, heart disease) Not an Issue	Obesity/Overweight (diabetes, heart disease) Minor Issue	Obesity/Overweight (diabetes, heart disease) Moderate Issue	Obesity/Overweight (diabetes, heart disease) Major Issue	Obesity/Overweight (diabetes, heart disease) Don’t Know
Tobacco Smoking/Vaping	Tobacco Smoking/Vaping Not an Issue	Tobacco Smoking/Vaping Minor Issue	Tobacco Smoking/Vaping Moderate Issue	Tobacco Smoking/Vaping Major Issue	Tobacco Smoking/Vaping Don’t Know
Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl)	Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl) Not an Issue	Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl) Minor Issue	Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl) Moderate Issue	Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl) Major Issue	Substance use/misuse (alcohol, prescription drug use, illicit drugs ie. heroin, meth, fentanyl) Don’t Know
Recreational marijuana use	Recreational marijuana use Not an Issue	Recreational marijuana use Minor Issue	Recreational marijuana use Moderate Issue	Recreational marijuana use Major Issue	Recreational marijuana use Don’t Know
Mental Health (stress)	Mental Health (stress) Not an Issue	Mental Health (stress) Minor Issue	Mental Health (stress) Moderate Issue	Mental Health (stress) Major Issue	Mental Health (stress) Don’t Know
Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence)	Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence) Not an Issue	Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence) Minor Issue	Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence) Moderate Issue	Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence) Major Issue	Injuries (suicide, self-harm, work-related accidents, car accidents, sexual violence) Don’t Know
Safety (domestic violence, community crimes)	Safety (domestic violence, community crimes) Not an Issue	Safety (domestic violence, community crimes) Minor Issue	Safety (domestic violence, community crimes) Moderate Issue	Safety (domestic violence, community crimes) Major Issue	Safety (domestic violence, community crimes) Don’t Know

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* 6. How concerned are you about these other community issues that impact health?
Use the following definitions to rank each issue:
Minor Issue: A concern, but much less important that other issues
Moderate Issue: A concern of average importance when compared to other issues
Major Issue: In the top 3 to 5 concerns needing immediate attention

	Not an Issue	Minor Issue	Moderate Issue	Major Issue	Don’t Know
Presence of Radon in homes	Presence of Radon in homes Not an Issue	Presence of Radon in homes Minor Issue	Presence of Radon in homes Moderate Issue	Presence of Radon in homes Major Issue	Presence of Radon in homes Don’t Know
Lack of Education	Lack of Education Not an Issue	Lack of Education Minor Issue	Lack of Education Moderate Issue	Lack of Education Major Issue	Lack of Education Don’t Know
Availability of Exercise or fitness opportunities	Availability of Exercise or fitness opportunities Not an Issue	Availability of Exercise or fitness opportunities Minor Issue	Availability of Exercise or fitness opportunities Moderate Issue	Availability of Exercise or fitness opportunities Major Issue	Availability of Exercise or fitness opportunities Don’t Know
Availability of jobs	Availability of jobs Not an Issue	Availability of jobs Minor Issue	Availability of jobs Moderate Issue	Availability of jobs Major Issue	Availability of jobs Don’t Know
Support for families with children (day care, safe places to play)	Support for families with children (day care, safe places to play) Not an Issue	Support for families with children (day care, safe places to play) Minor Issue	Support for families with children (day care, safe places to play) Moderate Issue	Support for families with children (day care, safe places to play) Major Issue	Support for families with children (day care, safe places to play) Don’t Know
Income (hard to pay bills)	Income (hard to pay bills) Not an Issue	Income (hard to pay bills) Minor Issue	Income (hard to pay bills) Moderate Issue	Income (hard to pay bills) Major Issue	Income (hard to pay bills) Don’t Know
Access to Healthy Foods (available stores, affordability)	Access to Healthy Foods (available stores, affordability) Not an Issue	Access to Healthy Foods (available stores, affordability) Minor Issue	Access to Healthy Foods (available stores, affordability) Moderate Issue	Access to Healthy Foods (available stores, affordability) Major Issue	Access to Healthy Foods (available stores, affordability) Don’t Know
Transportation	Transportation Not an Issue	Transportation Minor Issue	Transportation Moderate Issue	Transportation Major Issue	Transportation Don’t Know
Travel distance for health care needs	Travel distance for health care needs Not an Issue	Travel distance for health care needs Minor Issue	Travel distance for health care needs Moderate Issue	Travel distance for health care needs Major Issue	Travel distance for health care needs Don’t Know
Quality of Housing	Quality of Housing Not an Issue	Quality of Housing Minor Issue	Quality of Housing Moderate Issue	Quality of Housing Major Issue	Quality of Housing Don’t Know
Availability of Housing	Availability of Housing Not an Issue	Availability of Housing Minor Issue	Availability of Housing Moderate Issue	Availability of Housing Major Issue	Availability of Housing Don’t Know
Housing is affordable	Housing is affordable Not an Issue	Housing is affordable Minor Issue	Housing is affordable Moderate Issue	Housing is affordable Major Issue	Housing is affordable Don’t Know
Bullying (school youth, cyber, social pressure)	Bullying (school youth, cyber, social pressure) Not an Issue	Bullying (school youth, cyber, social pressure) Minor Issue	Bullying (school youth, cyber, social pressure) Moderate Issue	Bullying (school youth, cyber, social pressure) Major Issue	Bullying (school youth, cyber, social pressure) Don’t Know
Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly)	Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly) Not an Issue	Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly) Minor Issue	Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly) Moderate Issue	Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly) Major Issue	Support for special needs populations and their caretakers(ie physically disabled, mentally disabled, and elderly) Don’t Know

Other (please specify)

Hospital Specific - These questions will focus on specific healthcare services available to you in your community, and the type of health services you can access at the hospital.

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* 7. Do you have a primary care provider?

Yes

Unsure

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* 8. Have you or someone in your household delayed healthcare due to lack of money and/or insurance?

Yes

Unsure

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* 9. Where do you receive your healthcare? Check all that apply.

Mt. San Rafael Hospital

Salud Mt. Carmel Clinic

Spanish Peaks Regional Medical Center

St. Mary-Corwin Hospital

Parkview Medical Center in Pueblo

Other (please specify)

Question Title

* 10. Within the last 2 years, what services have you needed and received at another place other than Mt. San Rafael Hospital? Check yes or no for each item.

	Yes	No
Radiological imaging (X-ray, MRI, CT, Ultrasound, Mammogram, Dexa Scan)	Radiological imaging (X-ray, MRI, CT, Ultrasound, Mammogram, Dexa Scan) Yes	Radiological imaging (X-ray, MRI, CT, Ultrasound, Mammogram, Dexa Scan) No
Laboratory	Laboratory Yes	Laboratory No
Physical, Occupational or Speech Therapy	Physical, Occupational or Speech Therapy Yes	Physical, Occupational or Speech Therapy No
Emergency room (ER)	Emergency room (ER) Yes	Emergency room (ER) No
Colonoscopy/Endoscopy	Colonoscopy/Endoscopy Yes	Colonoscopy/Endoscopy No
General Surgery	General Surgery Yes	General Surgery No
Gynecology	Gynecology Yes	Gynecology No

Other (please specify)

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* 11. What specialists have you or someone in your household used in the past 2 years? Check yes or no for each item.

	Yes	No
Allergy	Allergy Yes	Allergy No
Dialysis	Dialysis Yes	Dialysis No
Cardiology/Heart	Cardiology/Heart Yes	Cardiology/Heart No
Asthma	Asthma Yes	Asthma No
Obstetrics-Gynecology	Obstetrics-Gynecology Yes	Obstetrics-Gynecology No
Obesity	Obesity Yes	Obesity No
Orthopedic Surgery	Orthopedic Surgery Yes	Orthopedic Surgery No
Diabetes	Diabetes Yes	Diabetes No
Neurosurgery	Neurosurgery Yes	Neurosurgery No
Podiatry	Podiatry Yes	Podiatry No
Vascular Surgery	Vascular Surgery Yes	Vascular Surgery No
ENT	ENT Yes	ENT No
Dermatology	Dermatology Yes	Dermatology No
Oncology	Oncology Yes	Oncology No
Pain Management	Pain Management Yes	Pain Management No
Urology	Urology Yes	Urology No
Audiology	Audiology Yes	Audiology No

Other (please specify)

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* 12. Do you believe your local hospital, health department or clinic has services that support residents in managing their own health – in other words, helping residents to be more aware of available healthcare resources, home health services, and of disease prevention?

Yes

I don't Know

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* 13. If no, why not?

Availability of providers

Services are too far

Services are too expensive

Medical services are not responsive

Low quality of care

Other (please specify)

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* 14. What is the best way to raise awareness about health services in your community? Check all that apply

Social media (facebook, snapchat, instagram)

Television, news

Mail, paper notifications

Schools

Phone: text or call

Monthly Newsletter by mail

Monthly Newsletter by e-mail

Other (please specify)

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* 15. What is your age?

18-24

25-44

45-64

65+

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* 16. What is the gender you identify with today?

Male

Female

Transgender

Other (please specify)

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* 17. Which one or more of the following would you say is your race? (Choose all that apply.)

White

Hispanic/Latino

Black or African American

Native American/American Indian

Asian / Pacific Islander

Other (please specify)

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* 18. What is the highest degree or level of school you have completed? (If currently enrolled, choose highest degree received.)

Never attended school or only attended kindergarten

Grades 1 through 8 (Elementary)

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)

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* 19. What is your current employment status?

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

Other (please specify)

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* 20. What type of health insurance do you have currently? (Check all that apply)

Uninsured

Employer Sponsored Insurance

Vision Insurance

Private Pay Insurance

Public (Medicaid/Medicare/CHP+)

Dental Insurance

Other (please specify)

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* 21. What is your annual household income range?

Under $25,000

$25,000-$49,000

$50,000-$75,000

Over $75,000