FY26 IIID Health Promotion & Disease Prevention Survey
1.
Who provides your health promotion activity?
TCCAA - Oldham
TCCAA - Henry
TCCAA - Trimble
Highlands Community Ministries
Jewish Family & Career Services
Active Choices Instructor
2.
Health Promotion Program attended:
Bingosize
Tai Chi for Arthritis
Walk with Ease
A Matter of Balance (MOB)
Active Choices
3.
What is your age?
4.
What is your gender?
Female
Male
5.
What is your race?
America Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
6.
Has a health care provider ever told you that you have any of the following chronic conditions? Please mark all the apply.
Yes
No
Alzheimer's or related Dimentia
Yes
No
Arthritis/ Rheumatic Disease
Yes
No
Breathing/ Lung Disease (Asthma, Emphysema, etc.)
Yes
No
Cancer or Cancer Survivor
Yes
No
Chronic Pain
Yes
No
Depression or Anxiety Disorders
Yes
No
Diabetes
Yes
No
Heart Disease
Yes
No
High Cholesterol
Yes
No
Hypertension (High Blood Pressure)
Yes
No
Multiple Sclerosis
Yes
No
Osteoporosis (Low Bone Density)
Yes
No
Stroke
Yes
No
Other Chronic Condition
Yes
No
None ( If No Chronic Condition - Check No )
Yes
No
7.
I found this Health Promotion Program useful.
Strongly agree
Agree
Disagree
Strongly disagree
Please provide an explanation:
8.
As a result of this program, I feel I have more skills.
Strongly agree
Agree
Disagree
Strongly disagree
Please provide an explanation:
9.
As a result of this program, my daily behaviors have improved or changed.
Strongly agree
Agree
Disagree
Strongly disagree
Please provide an explanation:
10.
Have you applied the skills you learned in your daily activities?
Strongly agree
Agree
Disagree
Strongly disagree
Please provide an explanation:
11.
As a result of this program, I feel more comfortable increasing my daily activity.
Strongly Agree
Agree
Disagree
Strongly Disagree
Please provide an explanation:
Current Progress,
0 of 11 answered