2018 Community Health Needs Assessment

Thank you for participating in this Community Health Needs Assessment for Chesapeake Regional Healthcare! We want your input on health and the many factors that play a role in your, and your family’s, well-being. This survey should only take about 12 minutes and will provide very important information to the hospital regarding its community health services.  Thank you for your time and your participation!
 
After you complete the survey, you can enter your contact information for a chance to win a $50 gift card!  
Your answers will remain anonymous.  
Thank you very much for your feedback!

SECTION A. What do you consider to be the greatest STRENGTHS of our entire community, and where should we FOCUS MORE RESOURCES?
Please choose five (5) areas from the list below that you consider to be our Strengths and five (5) that Need More Resources.  Please then indicate whether  these 10 issues Impact You or Your Family Directly. 

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* 1. Please choose five (5) areas from the list below that you consider to be our Strengths and five (5) that Need More Resources.  Please then indicate whether  these 10 issues Impact You or Your Family Directly. 

  Strength Needs More Resources Impacts Me or My Family Directly
Walk-able, bike-able community
Access to affordable housing for everyone
Access to health care for everyone
Access to medical screenings for everyone
Access to arts and cultural events
Local 24-hour police, fire and rescue services
Meet basic needs of everyone (food, shelter, clothing)
Well prepared for emergencies
Access to parks, recreation and fields
Access to quality school, public education
Working towards ending homelessness
Access to affordable, healthy food in everyone's community (fresh fruits, vegetables)
Jobs and a healthy economy
Safe neighborhoods
Programs, activities and support for youth and teens
Programs, activities and support for the senior community
Programs, activities and support for individuals with special needs
Services and support for everyone needing help during times of stress and crisis
Substance abuse
Low crime
Low violence (domestic and other)
Water quality
Air pollution/Air quality
Mental health services
Other 
SECTION B. Demographic Information: Please tell us about yourself.
What is your home zip code?

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* 2. What is your home zip code?

Are you

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* 3. Are you

What is your age?

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* 4. What is your age?

What is your race?

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* 5. What is your race?

What is your ethnicity?

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* 6. What is your ethnicity?

What is your total household income?

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* 7. What is your total household income?

Please enter the number of people who live at your address for each age group:

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* 8. Please enter the number of people who live at your address for each age group:

What is your highest level of education?

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* 9. What is your highest level of education?

SECTION C. Local Community Issues
Please tell us if any of these are a problem for you or anyone in your household. (Check all that apply).

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* 10. Please tell us if any of these are a problem for you or anyone in your household. (Check all that apply).

SECTION D. Housing
Have you experienced at least 2 episodes of homelessness in the last year?

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* 11. Have you experienced at least 2 episodes of homelessness in the last year?

Do you and your family have consistent, reliable housing?

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* 12. Do you and your family have consistent, reliable housing?

Is it affordable?

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* 13. Is it affordable?

Are you able to regularly pay your monthly bills?

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* 14. Are you able to regularly pay your monthly bills?

SECTION E. Work
Do you work in Chesapeake?

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* 15. Do you work in Chesapeake?

How far do you travel to work?

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* 16. How far do you travel to work?

What factors influence your choice of work? (Check all that apply)

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* 17. What factors influence your choice of work? (Check all that apply)

Is your job fully using your education and skill sets?

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* 18. Is your job fully using your education and skill sets?

SECTION F. Health Services
Do you have access to a physician or a primary care provider for routine care?

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* 19. Do you have access to a physician or a primary care provider for routine care?

Are  you able to afford your prescriptions?

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* 20. Are  you able to afford your prescriptions?

Has a doctor or primary care provider told you that you have a chronic illness?

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* 21. Has a doctor or primary care provider told you that you have a chronic illness?

If yes, check those that apply to you. (Check all that apply).

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* 22. If yes, check those that apply to you. (Check all that apply).

Have you had to use the Emergency Department for routine care in the past year?

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* 23. Have you had to use the Emergency Department for routine care in the past year?

Have you or anyone in your family received mental health services in the past year?

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* 24. Have you or anyone in your family received mental health services in the past year?

Have you or anyone in your family received substance abuse services in the past year?

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* 25. Have you or anyone in your family received substance abuse services in the past year?

If you answered yes to either of the questions above regarding mental health and/or substance abuse services, did you have any problems locating the services you needed?

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* 26. If you answered yes to either of the questions above regarding mental health and/or substance abuse services, did you have any problems locating the services you needed?

How frequently do you exercise each week?

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* 27. How frequently do you exercise each week?

Are you able to walk safely in your neighborhood?

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* 28. Are you able to walk safely in your neighborhood?

Do you have sidewalks in your neighborhood?

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* 29. Do you have sidewalks in your neighborhood?

If you do not have sidewalks in your neighborhood, does this keep you from exercising?

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* 30. If you do not have sidewalks in your neighborhood, does this keep you from exercising?

What screenings have you had in the past year? (Check all that apply).

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* 31. What screenings have you had in the past year? (Check all that apply).

SECTION G. Only answer if you have children under age 18. (Otherwise, skip to Question 37).
If you have children under age 18, are their vaccines up to date?

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* 32. If you have children under age 18, are their vaccines up to date?

If you have children under age 18, have any of them been diagnosed with a chronic illness (such as asthma, diabetes, allergies, sickle cell anemia, cancer, epilepsy, autism)?

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* 33. If you have children under age 18, have any of them been diagnosed with a chronic illness (such as asthma, diabetes, allergies, sickle cell anemia, cancer, epilepsy, autism)?

If you have children under age 18, do they have a pediatrician or health care provider?

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* 34. If you have children under age 18, do they have a pediatrician or health care provider?

If you have children under age 18, where do you get their physicals done?

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* 35. If you have children under age 18, where do you get their physicals done?

If you have children under age 18, how many times have you utilized Urgent Care or the Emergency Department for your children in the past year?

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* 36. If you have children under age 18, how many times have you utilized Urgent Care or the Emergency Department for your children in the past year?

SECTION H. Barriers to Health Services
Have you ever had any of the following problems when trying to use health services in Chesapeake? (Check all that apply)

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* 37. Have you ever had any of the following problems when trying to use health services in Chesapeake? (Check all that apply)

SECTION I. Hospital Services
When seeking hospital care, which hospital would you visit first? (Check only one)

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* 38. When seeking hospital care, which hospital would you visit first? (Check only one)

Please tell us why you chose the hospital above. (Check all that apply).

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* 39. Please tell us why you chose the hospital above. (Check all that apply).

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