Community Health Needs Assessment Survey

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* 1. What are the biggest health issues or concerns in our community? (check all that apply)

Mental Health / Depression

Chronic Pain

Dental Problems

Diabetes

Cancer

Maternity Care

Asthma / Lung Disease

Heart Disease

Hypertension

Stroke

HIV/AIDS

Other (please specify)

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* 2. What barriers do people face when they want to access medical, mental health, dental, or other healthcare services? (check all that apply)

Lack of insurance

Health Services too far away

Not ready to face health problem

Frequent turnover of doctors

Limited access to specialty care services

Limited access to mental health care services

Financial barriers

Limited access to primary care doctors

Fear

Navigation of the healthcare system

Transportation

Long wait times to get an appointment

Co-pay and deductible costs

Prescription costs

Doctors not taking new patients

Appointment availability

No same day appointments available

Balancing work, home, kids’ schedules, and time constraints

Finding a provider covered by insurance plan

Knowledge of available services

Do not understand the need to see a doctor

Appointment schedule options versus work schedule

Language barriers / do not speak my language

Childcare

Cultural or religious beliefs

None/No barriers

Other (please specify)

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* 3. What is needed to improve the health of your family and neighbors? (Check all that apply)

Preventative Care

Housing

Timely, available, affordable primary care access

Infant & Maternal Health

Mental heath services

Senior services

Dental care

Job opportunities

Wellness services

Specialty physicians

Substance abuse rehabilitation services

Youth services

Healthy food

Less stress

Help navigating the health care system

Low-cost transportation

Recreation facilities

Health advocates

Access to gym

Nutrition counseling, meal planning

Physical fitness

Parks and green spaces

Safe places to walk

Longer clinic hours to access care before or after work

Smoking cessation

Work-life balance

Grief support

Healthy choices at restaurants

Safe neighborhood

Other (please specify)

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* 4. Where do you and your family get most of your health information? (check all that apply)

Doctor or health professional

Internet

Family or friends

Hospital

Newspaper or magazines

Community announcements

Television

Health Department

Library

Radio

School

Health fairs

Social Workers

Religious Organizations

Other (please specify)

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* 5. What healthy changes have you made in the past year to improve your health? (check all that apply)

Eating more fruits and vegetables

Drinking more water

Eating less sugar, salt, and processed foods

Annual check-up

No soda

Taking Vitamins

Dental Exam

Eating more organic foods

Flu or pneumonia vaccine

Walking more

More sleep

Eating less meat

Reduced stress

Smaller portions

Checking food labels for calories

Mental health counseling

Weight loss

Reducing carbohydrates

Started exercising

Stopped smoking

Other (please specify)

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* 6. What health goals are you planning on working on in 2021? (check all that apply)

Stay fit and active

Eat healthier

Decreased stress

Lose weight, weight control

Healthy lifestyle

More “me” time, self-care

Improve sleep

Meditate daily

Control blood pressure

Pain control

Start a new exercise program

Manage chronic diseases

Less screen time

Break a habit

Stop smoking

Other (please specify)

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* 7. If you or someone in your family were ill and required medical care, where would you go?

Clinic

Doctor’s office

Hospital Emergency Department

Urgent Care Center

Would not seek care

Other (please specify)

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* 8. Have you had a physical exam in the past two years?

Yes

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* 9. Are your immunizations up to date?

Yes

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* 10. Will you get a COVID-19 vaccination when it is available?

Yes

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* 11. Which of the following describes the primary household members employment situation?

Government benefits or pension (Social Security, Pension, Unemployment benefits)

Hourly employee

Retired

Self-employed

Had multiple jobs or multiple sources of income

Salaried employee

No income / unemployed

Other (please specify)

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* 12. What is the primary language spoken at home?

English

Spanish

Chinese

Tagalog

Vietnamese

Russian

French

Japanese

Korean

Arabic

Other (please specify)

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* 13. What is the total household income before taxes last year?

Less than $20,000

$20,000 - $50,000

$50,000 - $80,000

$80,000 - $100,000

Over $100,000

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* 14. Does the household participate in any of the following programs? (check all that apply)

SNAP/Food Stamps

WIC

TANIF

None

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* 15. Do you rent or own your home?

Rent

Own

Other (please specify)

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* 16. What is your zip code?

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* 17. What is your gender? (check all that apply)

Male

Female

Transgender

Gender neutral

Non-binary

Agender

Pangender

Genderqueer

Two-spirit

Third gender

Prefer not to say

Other (please specify)

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* 18. What category below includes your age?

Under 18

18-29

30-39

40-49

50-59

60-69

70-79

80-89

90 or older

Prefer not to say

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* 19. What is your racial/ethnic identification?

White/Caucasian

Black/African American

Latinx / Chicano

Asian

American Indian or Alaskan Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 20. What is your highest level of education?

Some high school

High school equivalent - GED

High school diploma

Some college

Associate’s degree

Bachelor’s degree

Master’s degree

Doctorate

Other (please specify)

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* 21. Do you have health insurance?

Medicare

Medi-Cal

San Francisco Health Plan (SFHP)/Healthy SF

Affordable Care Act/Covered California

Veterans Health

Employer-sponsored private insurance

Non-Employer sponsored health insurance

No insurance

Other (please specify)

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* 22. For the following sections select all that applied to you in 2020:

Wages and Employment

Earned less money

My workload increased

Worked fewer hours

Worked more hours

Lost job

Had to take off work without pay

Had to close business

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* 23. Medical and Health

Received medical services (non-emergency)

Nervous to go into a health center or hospital

Received dental services

Had one or more telehealth visits

Had a COVID-19 test

Received mental health services

Had a medical emergency

Had an increase in medical expenses

Could not get daily medication refilled

Other (please specify)

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* 24. Family and Wellbeing

Felt like you could not leave your home

Not much change

Felt isolated

Could not relax

Worried about child’s socialization

Felt hopeless

More conflict in the household

Had to provide care to an elder

Did not have household goods (soap, paper towels, toilet paper, cleaning supplies)

Someone moved into the household

Needed help with childcare

Someone moved out of the household

There was not enough food

Felt one or more of these because of COVID-19

Other (please specify)

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* 25. Education and Schooling

Had a child at home because a school/childcare/college closed

Worried students would not be ready for the next school year

Did not have Wi-Fi or internet at home

Lacked information from school district

Did not have a computer, tablet, or other device for doing schoolwork

Other (please specify)

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* 26. Do you have any other comments about the health of our community?

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* 27. If you are interested in participating in a focus group centered around discussing the needs of the Bayview community, please leave your name and contact information below.

Community Health Needs Assessment Survey

Question Title

* 1. What are the biggest health issues or concerns in our community? (check all that apply)

Question Title

* 2. What barriers do people face when they want to access medical, mental health, dental, or other healthcare services? (check all that apply)

Question Title

* 3. What is needed to improve the health of your family and neighbors? (Check all that apply)

Question Title

* 4. Where do you and your family get most of your health information? (check all that apply)

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* 5. What healthy changes have you made in the past year to improve your health? (check all that apply)

Question Title

* 6. What health goals are you planning on working on in 2021? (check all that apply)

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* 7. If you or someone in your family were ill and required medical care, where would you go?

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* 8. Have you had a physical exam in the past two years?

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* 9. Are your immunizations up to date?

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* 10. Will you get a COVID-19 vaccination when it is available?

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* 11. Which of the following describes the primary household members employment situation?

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* 12. What is the primary language spoken at home?

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* 13. What is the total household income before taxes last year?

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* 14. Does the household participate in any of the following programs? (check all that apply)

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* 15. Do you rent or own your home?

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* 16. What is your zip code?

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* 17. What is your gender? (check all that apply)

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* 18. What category below includes your age?

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* 19. What is your racial/ethnic identification?

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* 20. What is your highest level of education?

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* 21. Do you have health insurance?

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* 22. For the following sections select all that applied to you in 2020:

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* 23. Medical and Health

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* 24. Family and Wellbeing

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* 25. Education and Schooling

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* 26. Do you have any other comments about the health of our community?

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* 27. If you are interested in participating in a focus group centered around discussing the needs of the Bayview community, please leave your name and contact information below.

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* 28. Comments