Wellbeing Survey 2018 Question Title * 1. How long have you been a resident of this community? less than 1 yr. 2 – 5 yrs. 6 – 10 yrs. 11 – 20 yrs. My whole life OK Question Title * 2. About how many people in your community do you know well enough to ask for a favour? None 1 or 2 people 3 – 9 people 10 or more people OK Question Title * 3. How many close friends or relatives do you feel at ease with, can talk to about what is on your mind, or can call on for support? None 1 or 2 people 3 – 9 people 10 or more people OK Question Title * 4. Do you feel your community is a good place to grow old? Not good Somewhat good Good Very good Excellent OK Question Title * 5. In general, would you say your physical health is: Poor Fair Good Very Good Excellent OK Question Title * 6. In general, would you say your mental health is: Poor Fair Good Very Good Excellent OK Question Title * 7. How many servings of fruits and vegetables do you eat most days? (1 serving = ½ cup of fruit or vegetables) No servings 1 or 2 servings 2 – 6 servings 7 or more servings How often do you exercise per week? For example, biking, walking, swimming, etc? Once per week 2 times per week 3 or more times per week I don’t exercise OK Question Title * 8. How often do you exercise per week? For example, biking, walking, swimming, etc? Once per week 2 times per week 3 or more times per week I don’t exercise OK Question Title * 9. On average how many minutes a day do you spend on physical activity that gets your heart rate up? None 1-15 min. 16-30 min. 31-60 min. More than 60 min. OK Question Title * 10. How would you describe your level of stress? Very low Low Moderate High OK Question Title * 11. How many days last month did a mental health problem or an emotional problem (your mood, your feelings) stop you from doing your work or other usual activities? None 10 or less days 10 – 25 days more than 25days OK Question Title * 12. How easy is it for you to get the services you need? Rate the overall accessibility of health care services. (Questions 12-21).Your doctor or nurse practitioner Poor Fair Good Very Good Excellent Not used OK Question Title * 13. Diagnostic services such as x-ray, ultrasound or lab Poor Fair Good Very Good Excellent Not used OK Question Title * 14. Rehab services such as physiotherapy Poor Fair Good Very Good Excellent Not used OK Question Title * 15. Complementary health practitioners such as: naturopaths, chiropractors Poor Fair Good Very Good Excellent Not used OK Question Title * 16. Programs to help manage a chronic condition such as diabetes or arthritis Poor Fair Good Very Good Excellent Not used OK Question Title * 17. Dental care Poor Fair Good Very Good Excellent Not used OK Question Title * 18. Home health support such as assistance with household tasks Poor Fair Good Very Good Excellent Not used OK Question Title * 19. Home health care such as nursing or physiotherapy Poor Fair Good Very Good Excellent Not used OK Question Title * 20. Mental health services such as counselling, mental health support Poor Fair Good Very Good Excellent Not used OK Question Title * 21. Addictions services such as counseling, Alcoholics Anonymous Poor Fair Good Very Good Excellent Not used OK Question Title * 22. Family violence prevention support Poor Fair Good Very Good Excellent Not Used OK Question Title * 23. In the past 12 months did you volunteer for a community organization or group, either within the community or outside your community (Questions 22-26).Service club such as: Lions, Optimists Yes No OK Question Title * 24. Community agency Yes No OK Question Title * 25. Church council or church committee Yes No OK Question Title * 26. School Yes No OK Question Title * 27. Here at Langs Yes No OK Question Title * 28. Other, please list. OK Question Title * 29. Do decision-makers in your community respect differing opinions raised by local residents. Strongly agree Agree Disagree Strongly disagree Don’t know OK Question Title * 30. I am satisfied with the health of the environment in my community. Strongly agree Agree Disagree Strongly disagree Don’t know OK Question Title * 31. What is the environmental issue you are most concerned about? (please check one) Air quality Water quality Land development Road Safety Not Concerned Other OK Question Title * 32. How safe do you feel in your community doing the following OK Question Title * 33. Walking Not safe Somewhat safe Very safe Do not use OK Question Title * 34. Cycling Not safe Somewhat safe Very safe Do not use OK Question Title * 35. Driving/passenger in a car/van Not safe Somewhat safe Very safe Do not use OK Question Title * 36. On public transportation Not safe Somewhat safe Very safe Do not use OK Question Title * 37. Letting children play outside Not safe Somewhat safe Very safe Do not use OK Question Title * 38. Are your reading, writing and math skills good enough for you to do the following: OK Question Title * 39. Read medication instructions Yes No OK Question Title * 40. Complete a job application Yes No OK Question Title * 41. Balance your cheque book Yes No OK Question Title * 42. Do you have a child or children between the ages of 0-12 years? If yes, please answer the following questions. If no, please go to question 46.I require regular childcare for my child/children Yes No OK Question Title * 43. I am able to find safe and affordable childcare for my child/children Yes No OK Question Title * 44. I use a licensed childcare provider, e.g. day care center Yes No OK Question Title * 45. I use a non-licensed childcare provider, e.g. in your or other’s home Yes No OK Question Title * 46. I attend Early Years and/or family or youth programs Yes No OK Question Title * 47. Does your family income allow you enough opportunity to engage in the activities that you wish to do together as a family? All of the time Most of the time Some of the time Seldom Never OK Question Title * 48. This question is for unpaid caregivers of young children or seniors or both. How well do you balance this role with the other demands in your life? Very well Somewhat well Well Poorly Not well at all Does not apply OK Question Title * 49. Do you have enough time for yourself to maintain your health most of the time? (1 being no adequate time, being always adequate time) 1 2 3 4 5 6 7 8 9 10 OK Question Title * 50. Please respond to these questions about your home.Do you own your home? Yes No OK Question Title * 51. Do you feel your home is in good repair? Yes No OK Question Title * 52. Have you struggled to pay your bills in the past 6 months? Yes No OK Question Title * 53. Is your current home appropriate for your needs? Yes No OK Question Title * 54. Do you think that seniors in your community have adequate and affordable housing options as they Yes No Don’t know OK Question Title * 55. Which one of the following categories would you say best describes your main activity? Employed full-time Retired Employed part-time Household work/caring for children Non-standard employment (e.g., self-employed, contract, seasonal, temporary, multiple jobs) On leave from work(e.g. illness, parental leave) Unemployed, looking for work Going to school OK Question Title * 56. Do you have extended health benefits such as: dental, physiotherapy, etc.? Yes No OK Question Title * 57. This survey is about the factors that affect the wellbeing of people in our community. Are there other factors you would like to mention? OK Question Title * 58. Are you satisfied with customer service and communication at Langs? (Questions 56-64).Courtesy of the person taking your call or greeting you at the reception desk Poor Fair Good Very Good Excellent N/A OK Question Title * 59. Friendliness of the staff Poor Fair Good Very Good Excellent N/A OK Question Title * 60. Amount of time waiting for appointment Poor Fair Good Very Good Excellent N/A OK Question Title * 61. Comfort and safety while waiting Poor Fair Good Very Good Excellent N/A OK Question Title * 62. Neat and clean building Poor Fair Good Very Good Excellent N/A OK Question Title * 63. Knowing where to go within the building Poor Fair Good Very Good Excellent N/A OK Question Title * 64. Adequate parking Poor Fair Good Very Good Excellent N/A OK Question Title * 65. Langs website Poor Fair Good Very Good Excellent N/A OK Question Title * 66. Information television screens at Langs Poor Fair Good Very Good Excellent N/A OK Question Title * 67. Are you satisfied with programs and services at Langs? (Questions 65-71).Accessibility of Langs programs or services Poor Fair Good Very Good Excellent N/A OK Question Title * 68. Another agency or service located at Langs or North Dumfries Poor Fair Good Very Good Excellent N/A OK Question Title * 69. Having access to a variety of services under one roof Poor Fair Good Very Good Excellent N/A OK Question Title * 70. The program or service had impact on my health or well-being Poor Fair Good Very Good Excellent N/A OK Question Title * 71. How well information about programs and services are communicated Poor Fair Good Very Good Excellent N/A OK Question Title * 72. The variety of ways that people can volunteer at Langs Poor Fair Good Very Good Excellent N/A OK Question Title * 73. My volunteer role (if applicable) Poor Fair Good Very Good Excellent N/A OK Question Title * 74. Please rank your satisfaction with the following services at Langs if you have used them? (Questions 72-81).Resource Centre Poor Fair Good Very Good Excellent N/A OK Question Title * 75. Youth and Teen Services Poor Fair Good Very Good Excellent N/A OK Question Title * 76. Early Years Services Poor Fair Good Very Good Excellent N/A OK Question Title * 77. Adult/Older Adult Programs Poor Fair Good Very Good Excellent N/A OK Question Title * 78. Diabetes Education Program Poor Fair Good Very Good Excellent N/A OK Question Title * 79. Social Work Services Poor Fair Good Very Good Excellent N/A OK Question Title * 80. Volunteer Services Poor Fair Good Very Good Excellent N/A OK Question Title * 81. Primary Care Services (seeing your doctor or nurse practitioner) Poor Fair Good Very Good Excellent N/A OK Question Title * 82. Agency Services onsite Poor Fair Good Very Good Excellent N/A OK Question Title * 83. What is your age? 13 – 17 years 18 – 25 years 26 – 45 years 46 – 64 years 65 and over OK Question Title * 84. What gender do you identify with? OK Question Title * 85. Are you? Single (never married) Married Living common-law Separated Divorced Widowed OK Question Title * 86. What is the highest level of education you have completed? Elementary school (up to grade 8) College diploma High school (up to grade 12) University degree (e.g. BA, BSc) Post secondary certificate Graduate degree (e.g. MA, MSc, PhD) OK Question Title * 87. What is your total household income from all sources last year (optional)? Under $10,000 $20,000 - $29,999 $60,000 –$99,999 $10,000 -$19,999 $30,000 –$59,999 $100,000 or greater OK Question Title * 88. How many people are in your household? Myself only 2 people 3 – 5 people 6 or more people OK DONE