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Cape Girardeau County Community Needs and Quality of Life Survey
*
1. What is the
zip code
in which you live?
(Required.)
63739 Burfordville
63701 Cape Girardeau
63702 Cape Girardeau
63703 Cape Girardeau
63743 Daisy
63744 Delta
63745 Dutchtown
63747 Friedheim
63752 Gordonville
63755 Jackson
63766 Millersville
63769 Oak Ridge
63770 Old Appleton
63779 Pocahontas
63785 Whitewater
Other zip code
*
2. Identify up to
three health issues
you have had in 2022.
(Required.)
Alcohol Misuse
Alzheimer’s Disease
Assault (Injuries)
Cancer
Injuries From a Motor Accident
Chronic Obstructive Pulmonary Disease (COPD)
COVID-19
Crohn’s Disease/Ulcerative Colitis
Diabetes
Drug Misuse
Heart Disease
High Cholesterol
HIV/AIDS
Hypertension
Infectious Diseases
Influenza/Pneumonia
Kidney Disease
Liver Disease
Lung Disease
Mental Health Disorders (e.g., depression, anxiety, schizophrenia, self-harm)
Stroke
Unintentional Injury (e.g., fall, traffic accident, poisoning, suffocation, burn, drowning, natural/environmental, machinery, pedestrian, cyclist, firearm, overexertion).
Other Issue
None of the above
3. How would you rate your
quality of life in 2022
using the scale of "thumbs" from 1 (poor) to 5 (best)?
A. Material and Physical Well-being (e.g., material well-being and enough income, personally felt safe)
1
1 thumb
2
2 thumbs
3
3 thumbs
4
4 thumbs
5
5 thumbs
B. Relationships with other People (e.g., parents, siblings, other relatives, spouse or significant other, friends; having and raising children)
1 thumb
2 thumbs
3 thumbs
4 thumbs
5 thumbs
C. Social, Community, and Civic Activities (e.g., joined activities to help others in my community; involved in local and national government)
1 thumb
2 thumbs
3 thumbs
4 thumbs
5 thumbs
D. Personal Development and Fulfillment (e.g., tried to learn new things; tried to learn more about myself; have a rewarding job where I am valued and able to contribute; ability to express myself creatively)
1 thumb
2 thumbs
3 thumbs
4 thumbs
5 thumbs
E. Recreation (e.g., spending time with others having fun; participating or watching sports, games, activities)
1 thumb
2 thumbs
3 thumbs
4 thumbs
5 thumbs