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2026 Van Buren County Health Needs Assessment Survey
1.
Do you live in Van Buren County?
Yes
No
2.
What county do you work in?
3.
Select option that includes your age.
Less than 18 years
18-25 years
26-35 years
36-45 years
46-55 years
56-64 years
65 years or older
4.
Please select the types of insurance you currently have. (S
elect all that apply
)
Medical/Health
Dental
Vision/Optical
I do not have insurance
I do not know
5.
If you do not have health insurance, what is the primary reason?
Lost job or unemployed
Part-time or temporary employee, and I have no benefits
My employer stopped offering health insurance
Divorced and can't afford it
Spouse recently died
Insurance company refused coverage
Lost Medicaid eligibility
Can't afford it
Do not know how to get insurance
Choose not to have insurance
Question does not apply to me, I have insurance
Other (please specify)
6.
How would you rate you current health status?
Poor
Fair
Good
Very Good
Excellent
7.
During the past 30 days, how many days were you too sick (physically or mentally) to work or do your normal activities?
None
1-2 days
3-5 days
6-10 days
More than 10 days
8.
Was there a time in the past year when you or a family member needed to see a doctor, but could not?
Yes
No
9.
If you answered "yes" to the question above, select the primary reason you or your family member could not visit the doctor. (Please select the single most important answer.)
Did not want to go (afraid, anxious)
Did not have time/too busy
Could not get time off from work
Could not get an appointment
No transportation to get to the doctor
No childcare or care for other family members
Could not afford/uninsured
Doctor did not accept my insurance
Other (please specify)
10.
During the past year, have you or a family member gone to the emergency department for a non-emergency illness/injury because you could not afford to go to a doctor's office or had no insurance for the individual?
Yes
No
11.
Do you utilize the clinics at Van Buren County Hospital?
Yes
Yes, but the days and hours for the clinics are not convenient with my schedule
No, the days and hours are not convenient with my schedule
No, I do not use the clinics
12.
Out of the following services, please mark if you utilize these services in Van Buren County or outside of Van Buren County. (Please select the appropriate box.)
In Van Buren County
Outside of Van Buren County
NA
Primary care (family doctor, pediatrician, etc.)
In Van Buren County
Outside of Van Buren County
NA
Medical specialists (heart doctor, lung doctor, kidney doctor, surgeon, etc.)
In Van Buren County
Outside of Van Buren County
NA
Inpatient hospital care
In Van Buren County
Outside of Van Buren County
NA
Vision care/ophthalmologist/optometrist
In Van Buren County
Outside of Van Buren County
NA
Substance use counseling/rehabilitation/treatment
In Van Buren County
Outside of Van Buren County
NA
Mammogram (women only)
In Van Buren County
Outside of Van Buren County
NA
Family planning services
In Van Buren County
Outside of Van Buren County
NA
Behavioral health services
In Van Buren County
Outside of Van Buren County
NA
VBCH Physical Therapy
In Van Buren County
Outside of Van Buren County
NA
VBCH Occupational Therapy
In Van Buren County
Outside of Van Buren County
NA
Home Health Services (such as Van Buren Co. Public Health)
In Van Buren County
Outside of Van Buren County
NA
Other (please specify)
13.
If you travel outside of Van Buren County for health care, for what reason(s) do you do so?
(Please select all that apply)
Service not available in Van Buren County
Better quality of care elsewhere
Local doctor does not accept my insurance
Closer to work
Privacy or confidentiality reasons
I do not travel outside of Van Buren County for health care
Other (please specify)
14.
Do you use any electronic health portal such as MyChart?
Yes
No
15.
When answer best describes you?
(please select the appropriate choice)
Always
Often
Rarely
Never
Does not apply
You wear a seatbelt
Always
Often
Rarely
Never
Does not apply
You eat at least 5 servings of fruits and vegetables daily
Always
Often
Rarely
Never
Does not apply
You eat fast food more than once a week
Always
Often
Rarely
Never
Does not apply
You exercise or are physically active at least 30 minutes a day
Always
Often
Rarely
Never
Does not apply
You get a flu shot every year
Always
Often
Rarely
Never
Does not apply
You practice safe sex to prevent unwanted pregnancy or sexually transmitted infections
Always
Often
Rarely
Never
Does not apply
You perform self exams for cancer (example: breast, testicular, skin exams)
Always
Often
Rarely
Never
Does not apply
You get enough sleep to feel rested
Always
Often
Rarely
Never
Does not apply
You feel satisfied with your life
Always
Often
Rarely
Never
Does not apply
You feel socially isolated
Always
Often
Rarely
Never
Does not apply
You worry about losing your job
Always
Often
Rarely
Never
Does not apply
You worry about losing your home or being homeless
Always
Often
Rarely
Never
Does not apply
You feel safe in your community
Always
Often
Rarely
Never
Does not apply
You worry about your level of skills or knowledge for today's workforce
Always
Often
Rarely
Never
Does not apply
16.
In the past 30 days, have you:
Yes
No
Had at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor?
Yes
No
Had 5 alcoholic beverages (men) or 4 alcoholic beverages (women) in two hours or less on an occasion?
Yes
No
Used any nicotine products, i.e. Smoked cigarettes, Chewed tobacco, or Used electronic cigarettes/vape?
Yes
No
Used marijuana, cannabis, THC, consumable hemp, or CBD products?
Yes
No
Used a prescription drug not prescribed to you?
Yes
No
Used methamphetamine?
Yes
No
17.
How many families live in your household?
1
2
3 or more
18.
How many children under the age 18 years live in your household?
1 child
2 children
3 children
4 children
5 children
6 children
7 children
8 or more children
No children
19.
If some members of your household do not have health insurance, select who is NOT currently covered.
(Select all that apply)
Entire family is not covered
1 or more adults not covered, children are covered
Children age 6 years or older not covered
Children less than age 6 years not covered
Does not apply--all members of household have insurance
Do not know
Other (please specify)
20.
Please rate the following issues and concerns for you and your family.
(Please check the appropriate box).
Serious Problem
Moderate Problem
Not a problem
Not sure
Alcohol/drug use
Serious Problem
Moderate Problem
Not a problem
Not sure
Alzheimer's disease or dementia
Serious Problem
Moderate Problem
Not a problem
Not sure
Ambulance service (available, response)
Serious Problem
Moderate Problem
Not a problem
Not sure
Cancer
Serious Problem
Moderate Problem
Not a problem
Not sure
Child care
Serious Problem
Moderate Problem
Not a problem
Not sure
Child abuse
Serious Problem
Moderate Problem
Not a problem
Not sure
Dental care (access_
Serious Problem
Moderate Problem
Not a problem
Not sure
Diabetes
Serious Problem
Moderate Problem
Not a problem
Not sure
Domestic violence
Serious Problem
Moderate Problem
Not a problem
Not sure
Elder abuse
Serious Problem
Moderate Problem
Not a problem
Not sure
Elderly in home care
Serious Problem
Moderate Problem
Not a problem
Not sure
Gambling
Serious Problem
Moderate Problem
Not a problem
Not sure
Healthy foods (availability)
Serious Problem
Moderate Problem
Not a problem
Not sure
Health care (access)
Serious Problem
Moderate Problem
Not a problem
Not sure
Heart disease
Serious Problem
Moderate Problem
Not a problem
Not sure
Housing
Serious Problem
Moderate Problem
Not a problem
Not sure
Illicit (illegal) Substance use
Serious Problem
Moderate Problem
Not a problem
Not sure
Jobs (availability)
Serious Problem
Moderate Problem
Not a problem
Not sure
Mental illness
Serious Problem
Moderate Problem
Not a problem
Not sure
Nursing home care (access)
Serious Problem
Moderate Problem
Not a problem
Not sure
Obesity
Serious Problem
Moderate Problem
Not a problem
Not sure
Prenatal care (access, awareness)
Serious Problem
Moderate Problem
Not a problem
Not sure
Prescription drug misuse
Serious Problem
Moderate Problem
Not a problem
Not sure
Recreational opportunities (access)
Serious Problem
Moderate Problem
Not a problem
Not sure
Secondhand smoke
Serious Problem
Moderate Problem
Not a problem
Not sure
School violence
Serious Problem
Moderate Problem
Not a problem
Not sure
Services for disabled (access)
Serious Problem
Moderate Problem
Not a problem
Not sure
Sexually transmitted diseases
Serious Problem
Moderate Problem
Not a problem
Not sure
Smoking/Vaping tobacco and/or nicotine
Serious Problem
Moderate Problem
Not a problem
Not sure
Stroke
Serious Problem
Moderate Problem
Not a problem
Not sure
Substance use (prevention, treatment, and/or recovery)
Serious Problem
Moderate Problem
Not a problem
Not sure
Suicide
Serious Problem
Moderate Problem
Not a problem
Not sure
Teen pregnancy
Serious Problem
Moderate Problem
Not a problem
Not sure
Traffic crashes (alcohol & drug related)
Serious Problem
Moderate Problem
Not a problem
Not sure
Transportation (public and personal access)
Serious Problem
Moderate Problem
Not a problem
Not sure
Other issue you consider to be a serious problem (please specify)
21.
What services would like to see improved in Van Buren County?
(Please comment on any of the following)
Health-related
Nutrition/Fitness/Recreation-related
Education-related
Transportation-related
Other
Thank you for completing the survey!
Current Progress,
0 of 21 answered
