Community Needs Assessment Survey

Hemphill County Hospital District is asking residents and key stakeholders to complete a short 5-8 minute survey to gauge the needs of their community. The feedback from this survey will be a key factor in our continued strategic planning process. All responses are completely anonymous.

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* 1. What is your age?

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* 2. What is your gender?

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* 3. What is your ethnicity? (Please select all that apply.)

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* 4. What city are you currently living in?

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* 5. What is your role in the community? (Ex: business owner, church leader, health care provider, resident)

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* 6. Please rank the following health issues from most important (1) to least important (5)

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* 7. Access to Care

  Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
Residents in the area are able to access a primary care provider when needed (Family Doctor, Pediatrician, General Practitioner)
Residents in the area are able to access a medical specialist when needed (Cardiologist, Dermatologist, Neurologist, etc.)
Residents are able to access a dentist when needed
There is a sufficient number of providers accepting Medicaid/Medical Assistance in the area
There is a sufficient number of bi-lingual providers in the area
There is a sufficient number of mental/behavioral health providers in the area
Transportation for medical appointments is available to area residents when needed

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* 8. Please rank the following barriers to health care from most significant (1) to least significant (10)

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* 9. Are there specific populations in this community that you think are not being adequately served by local health services?

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* 10. Identify which populations you think are underserved.

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* 11. In general, where do you think most uninsured and underinsured individuals living in the area go when they are in need of medical care?

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* 12. Please rank the following resources from most needed (1) to least needed (11)

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* 13. What challenges do people in the community face in maintaining a healthy lifestyle and/or managing chronic conditions like diabetes or heart disease?

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* 14. In your opinion, what is being done well in the community in terms of health and quality of life?

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* 15. What recommendations or suggestions do you have to improve health and quality of life in the community?

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* 16. Please share any additional comments.

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