Community Health Needs Assessment Survey

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* 1. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 2. When you envision a strong, vibrant, healthy community, what are the most important features to you? (Choose up to 3)

Access to healthy food choices

Access to public transportation

Affordable housing

Clean environment

Drug/alcohol free communities

Good schools

Economic opportunity

Good childcare

Health care services

Livable wages

Mental health services

Public safety

Recreation resources, like parks & playgrounds

Senior services

Sense of community

Walkable, bike-friendly communities

Youth Services

Other (please specify)

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* 3. When you think about the challenges in the community where you live, what are you most concerned about? (Choose up to 3)

Access to health care services

Lack of public transportation

Access to mental health services

Availability of social supports

Crime/Vandalism

Domestic/child abuse

Drug & alcohol abuse

Homelessness

Lack of affordable housing

Access to healthy foods

Racial/Cultural discrimination

Polluted environment

Lack of good schools

Lack of pedestrian infrastructure

Lack of economic opportunites

Lack of recreation resources

Lack of support for seniors

Lack of support for youth

Not enough childcare options

Other (please specify)

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* 4. Which of the following lifestyle factors have the largest impact on overall community health in Lancaster County? (Choose up to 3)

Alcohol abuse

Being overweight

Dropping out of school

Drug abuse

Lack of exercise

Lack of maternity care

Not getting "shots" to prevent disease

Not using birth control

Unsecured firearms

Poor eating habits

Tobacco use

Unsafe sex

Not using seat belts/child safety seats

Other (please specify)

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* 5. What keeps people in your community from seeking medical treatment? (Choose up to 3)

Child care problems

Cultural/religious beliefs

Don't know how to find doctors

Don't understand need to see doctor

Fear (not ready to face health problem)

Health services too far away

Lack of insurance

Language barrier/do not speak my language

No access to primary care physicians/doctors

No appointments available

Too long of a wait at doctor's office

Too long of a wait to get an appointment

Transportation problems

Unable to pay co-pays or deductibles

None/no barriers

I don't know

Other (please specify)

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* 6. Have you every delayed getting care, or decided not to, because of high out of pocket costs?

Yes

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* 7. Where is the first place you seek medical care?

Clinic

Doctor's office

Emergency room

Pharmacy

Urgent Care

Other (please specify)

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* 8. What is your main form of transportation?

Public transportation

My car

Family/friend's car

Taxi/Cab/Uber/Lyft

Walk

Bicycle

Other (please specify)

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* 9. How safe from crime do you think your neighborhood/community is?

Extremely safe

Somewhat safe

Not at all Safe

Don't know

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* 10. If you don't feel safe, why don't you feel safe? (Check all that apply)

Unsafe neighborhood

Domestic violence

Drug use/selling drugs

Sexual violence

Crime/gun violence

Poorly lit streets

Other (please specify)

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* 11. Have you ever been told by a doctor/healthcare professional that you may have mental health concerns?

Yes

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* 12. In the past 12 months, have you ever needed, but not received, services or treatment for mental health?

Yes

No (skip to Question 14)

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* 13. If answered YES to the previous question, why did you not receive the services/treatment you needed? (Check all that apply)

My insurance does not cover mental health

Services needed have limited coverage

I didn't know where to go for services

I preferred alternative forms of treatment

I wanted to make it on my own without treatment

I was afraid to seek the services

I became overwhelmed/confused by the system

It took too long to get an appointment

The counseling/medication is too expensive

Treatment options did not meet my culture or religious needs

Other (please specify)

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* 14. What gender do you describe yourself as?

Male

Female

Non-binary/third gender

Prefer not to answer

Prefer to self-describe

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* 15. Transgender is an umbrella term that refers to people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. Other identities considered to fall under this umbrella can include non-binary, gender fluid, and genderqueer – as well as many more.

Do you identify as transgender?

Yes

Prefer not to say

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* 16. What sexual orientation do you describe yourself as?

Straight/Heterosexual

Gay or Lesbian

Bisexual

Prefer not to say

Prefer to self-describe

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* 17. What is your race or origin? (Check all that apply)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Hispanic, Latino, or Spanish origin

Native Hawaiian or other Pacific Islander

White or Caucasian

Prefer not to answer

Other race (please specify)

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* 18. What is your highest level of education?

High school (grades 9-12, no degree)

High school graduate (GED or equivalent)

Some college

Associate's degree

Bachelor's degree

Master's degree or more

Prefer not to answer

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* 19. What is your annual household income?

Less than $5,000

$5,000 to $24,999

$25,000 to $49,999

$50,000 to $99,999

More than $100,000

Prefer not to answer

Other (please specify)

Community Health Needs Assessment Survey - Office of Aging

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* 1. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 2. When you envision a strong, vibrant, healthy community, what are the most important features to you? (Choose up to 3)

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* 3. When you think about the challenges in the community where you live, what are you most concerned about? (Choose up to 3)

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* 4. Which of the following lifestyle factors have the largest impact on overall community health in Lancaster County? (Choose up to 3)

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* 5. What keeps people in your community from seeking medical treatment? (Choose up to 3)

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* 6. Have you every delayed getting care, or decided not to, because of high out of pocket costs?

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* 7. Where is the first place you seek medical care?

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* 8. What is your main form of transportation?

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* 9. How safe from crime do you think your neighborhood/community is?

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* 10. If you don't feel safe, why don't you feel safe? (Check all that apply)

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* 11. Have you ever been told by a doctor/healthcare professional that you may have mental health concerns?

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* 12. In the past 12 months, have you ever needed, but not received, services or treatment for mental health?

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* 13. If answered YES to the previous question, why did you not receive the services/treatment you needed? (Check all that apply)

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* 14. What gender do you describe yourself as?

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* 16. What sexual orientation do you describe yourself as?

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* 17. What is your race or origin? (Check all that apply)

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* 18. What is your highest level of education?

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* 19. What is your annual household income?

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* 20. Do you have any other comments?

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* 1. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

Question Title

* 2. When you envision a strong, vibrant, healthy community, what are the most important features to you? (Choose up to 3)

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* 3. When you think about the challenges in the community where you live, what are you most concerned about? (Choose up to 3)

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* 4. Which of the following lifestyle factors have the largest impact on overall community health in Lancaster County? (Choose up to 3)

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* 5. What keeps people in your community from seeking medical treatment? (Choose up to 3)

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* 6. Have you every delayed getting care, or decided not to, because of high out of pocket costs?

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* 7. Where is the first place you seek medical care?

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* 8. What is your main form of transportation?

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* 9. How safe from crime do you think your neighborhood/community is?

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* 10. If you don't feel safe, why don't you feel safe? (Check all that apply)

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* 11. Have you ever been told by a doctor/healthcare professional that you may have mental health concerns?

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* 12. In the past 12 months, have you ever needed, but not received, services or treatment for mental health?

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* 13. If answered YES to the previous question, why did you not receive the services/treatment you needed? (Check all that apply)

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* 14. What gender do you describe yourself as?

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* 16. What sexual orientation do you describe yourself as?

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* 17. What is your race or origin? (﻿Check all that apply﻿)

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* 18. What is your highest level of education?

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* 19. What is your annual household income?

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* 20. Do you have any other comments?

* 17. What is your race or origin? (Check all that apply)