The Office of Institutional Research at LeMoyne-Owen College requests your participation in this survey. The primary purpose of this community survey is to determine what factors need to be considered in planning a health promotion and public education service coordinated by the Shelby County Health Department. The overall goal is to better meet the needs of communities of color in Shelby County and to identify themes that might have a bearing on program development, service location and other pertinent factors. Your responses in this survey will be kept anonymous. The Office of Institutional Research will not share any of your individual responses and will only use summary data for reporting purposes. Thank you for participating in this survey!

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* 1. What is your race?

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* 2. What is your gender?

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* 3. How old are you?

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* 4. What is your home zip code?

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* 5. What is the highest level of education you have completed?

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* 6. What is your marital status?

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* 7. How many people live in your house (including children)?

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* 8. What are your primary sources of income? Check all that apply

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* 9. If you are employed what type of work do you do?

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* 10. What is your annual household income?

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* 11. How close do you live from the nearest health care facility (hospital, urgent care, etc.)?

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* 12. Where do you normally go for your health care needs?

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* 13. How close do you live to the nearest pharmacy?

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* 14. Which of these is the closest pharmacy to you? (or where do you go regularly?)

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* 15. How do you pay for health care?

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* 16. If you pay out of pocket for your health care, why don't you have health insurance?

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* 17. Do you have a Primary Care Physician (PCP)?

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* 18. How many times have you been able to schedule a visit with your Primary Care Physician since March 2020?

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* 19. Do you have internet services?

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* 20. Do you have phone services?

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* 21. Who do you trust the most to provide you with accurate information about COVID-19? Pick the top three

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* 22. Who do you trust the least to provide you with accurate information about COVID-19? Pick the top three

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* 23. What steps have you taken to protect yourself from COVID-19? Check all that apply

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* 24. What is the biggest challenge you have faced during the COVID-19 crisis? Check all that apply.

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* 25. Have you had at least one of the COVID-19 vaccine shots?

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* 26. If you haven't had any of the COVID-19 vaccine shots are you planning to get the vaccine?

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* 27. Given a choice, where would you prefer to receive the COVID-19 vaccine?

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* 28. Please select all the activities you have not been able to do in the past 6 months

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* 29. Do you have any of the following health conditions? Check all that apply

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* 30. How would you rate your mental health over the past 6 months?

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* 31. How would you rate your physical health over the past 6 months?

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* 32. Please select the most appropriate answer option

  Strongly Agree Agree Neutral Disagree Strongly Disagree
I am happy with the house I live in
I am satisfied with the hygiene around the house
My neighbors are good
I am satisfied with the food that I eat
I am satisfied with my personal safety
I pursue at least one hobby
I have a strong support system and network of friends
I live in a safe neighborhood
0 of 32 answered
 

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