2019 Community Health Needs Assessment -Henry County Survey

Question Title

* 1. Would you say that, in general, your health is

Excellent

Very Good

Good

Fair

Poor

Don't Know/Not Sure

Question Title

* 2. Do you have a primary care provider? A primary care provider is a health care practitioner who sees people for their common medical needs. This person can be a doctor, physician's assistant or a nurse practitioner, and does NOT include specialists.

Yes

Don't Know/Not Sure

Question Title

* 3. If you don't have a primary care provider, can you tell us why you don't have one. Please check all that apply.

Don't need one

Go to Emergency Room for care

Go to an urgent care center for care

No health insurance

Can't afford it

Transportation is a problem

Other (please specify)

Question Title

* 4. Have you had a test for high blood sugar or diabetes in the last three years?

Yes

Don't Know/Not Sure

Question Title

* 5. If you have high blood pressure and you aren't being treated for it, can you tell us , why is that? Please check all that apply. You may skip this question if you do not have high blood pressure.

I am being treated for my high blood pressure

Cost/No Insurance

Did not know where to go

Did not try

Did not want anyone to know

Difficult to get an appointment

Insurance reasons

Medical provider did not speak my language

No access for people with disabilities

Office wasn't open when I could get there

Poor past experience

Too long a wait for an appointment

Too long a wait in waiting room

Transportation issues

I do not have high blood pressure

Other (please specify)

Question Title

* 6. Preventative care is very important and could save your life. If you have not had the following preventative care screenings, why was that? Please check all that apply.

	Mammogram-women 40 plus to detect breast cancer	Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Colonoscopy-men and women 50 plus to detect colon cancer	Stool test such as Cologuard-men and women 50+ to detect colon cancer	Prostate examination for men
I had it done	I had it done Mammogram-women 40 plus to detect breast cancer	I had it done Pap Smear-women to detect cervical cancer and sexually transmitted diseases	I had it done Colonoscopy-men and women 50 plus to detect colon cancer	I had it done Stool test such as Cologuard-men and women 50+ to detect colon cancer	I had it done Prostate examination for men
Not important	Not important Mammogram-women 40 plus to detect breast cancer	Not important Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Not important Colonoscopy-men and women 50 plus to detect colon cancer	Not important Stool test such as Cologuard-men and women 50+ to detect colon cancer	Not important Prostate examination for men
Nervous about the test	Nervous about the test Mammogram-women 40 plus to detect breast cancer	Nervous about the test Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Nervous about the test Colonoscopy-men and women 50 plus to detect colon cancer	Nervous about the test Stool test such as Cologuard-men and women 50+ to detect colon cancer	Nervous about the test Prostate examination for men
Insurance doesn't cover	Insurance doesn't cover Mammogram-women 40 plus to detect breast cancer	Insurance doesn't cover Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Insurance doesn't cover Colonoscopy-men and women 50 plus to detect colon cancer	Insurance doesn't cover Stool test such as Cologuard-men and women 50+ to detect colon cancer	Insurance doesn't cover Prostate examination for men
Heard it hurts	Heard it hurts Mammogram-women 40 plus to detect breast cancer	Heard it hurts Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Heard it hurts Colonoscopy-men and women 50 plus to detect colon cancer	Heard it hurts Stool test such as Cologuard-men and women 50+ to detect colon cancer	Heard it hurts Prostate examination for men
Doctor didn't recommend it	Doctor didn't recommend it Mammogram-women 40 plus to detect breast cancer	Doctor didn't recommend it Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Doctor didn't recommend it Colonoscopy-men and women 50 plus to detect colon cancer	Doctor didn't recommend it Stool test such as Cologuard-men and women 50+ to detect colon cancer	Doctor didn't recommend it Prostate examination for men
Not appropriate due to either my age or sex	Not appropriate due to either my age or sex Mammogram-women 40 plus to detect breast cancer	Not appropriate due to either my age or sex Pap Smear-women to detect cervical cancer and sexually transmitted diseases	Not appropriate due to either my age or sex Colonoscopy-men and women 50 plus to detect colon cancer	Not appropriate due to either my age or sex Stool test such as Cologuard-men and women 50+ to detect colon cancer	Not appropriate due to either my age or sex Prostate examination for men
I don't know what this test is for	I don't know what this test is for Mammogram-women 40 plus to detect breast cancer	I don't know what this test is for Pap Smear-women to detect cervical cancer and sexually transmitted diseases	I don't know what this test is for Colonoscopy-men and women 50 plus to detect colon cancer	I don't know what this test is for Stool test such as Cologuard-men and women 50+ to detect colon cancer	I don't know what this test is for Prostate examination for men

Question Title

* 7. If you have tried to quit smoking in the past 12 months, what did you try to help you quit? Please check all that apply.

Don't smoke

Cold turkey

Smoking cessation program at a hospital

Indiana Quit Line

Medication

Hypnosis

Question Title

* 8. Have you or a member of your family accessed any of these services in the last 12 months?

	Adult household member	Child household member	Teen household member	Did not need access	Don't know
Alcohol addiction treatment	Alcohol addiction treatment Adult household member	Alcohol addiction treatment Child household member	Alcohol addiction treatment Teen household member	Alcohol addiction treatment Did not need access	Alcohol addiction treatment Don't know
Substance abuse (drugs) treatment	Substance abuse (drugs) treatment Adult household member	Substance abuse (drugs) treatment Child household member	Substance abuse (drugs) treatment Teen household member	Substance abuse (drugs) treatment Did not need access	Substance abuse (drugs) treatment Don't know
Mental health counseling	Mental health counseling Adult household member	Mental health counseling Child household member	Mental health counseling Teen household member	Mental health counseling Did not need access	Mental health counseling Don't know
Smoking cessation classes	Smoking cessation classes Adult household member	Smoking cessation classes Child household member	Smoking cessation classes Teen household member	Smoking cessation classes Did not need access	Smoking cessation classes Don't know
Vaping cessation classes	Vaping cessation classes Adult household member	Vaping cessation classes Child household member	Vaping cessation classes Teen household member	Vaping cessation classes Did not need access	Vaping cessation classes Don't know

Question Title

* 9. In the last 12 months, If you or a member of your household could not get the professional help you needed for an alcohol or substance abuse disorder (drug) problem why was that? Please check all that apply.

Did not need professional help

Cost/No insurance

Did not know where to go

Did not try

Did not want anyone to know

Difficult to get an appointment

Insurance reasons

Medical provider did not speak my language

No access for people with disabilities

Office wasn't open when I could get there

Poor past experience

Too long a wait for an appointment

Too long a wait in waiting room

Transportation issues

Other (please specify)

Question Title

* 10. Now thinking about your mental health, which includes stress, depression and problems with emotions, would you say that, in general, your mental health is:

Excellent

Very good

Good

Fair

Poor

Don't Know/Not Sure

2019 Community Health Needs Assessment -Henry County

Question Title

* 1. Would you say that, in general, your health is

Question Title

* 2. Do you have a primary care provider? A primary care provider is a health care practitioner who sees people for their common medical needs. This person can be a doctor, physician's assistant or a nurse practitioner, and does NOT include specialists.

Question Title

* 3. If you don't have a primary care provider, can you tell us why you don't have one. Please check all that apply.

Question Title

* 4. Have you had a test for high blood sugar or diabetes in the last three years?

Question Title

* 5. If you have high blood pressure and you aren't being treated for it, can you tell us , why is that? Please check all that apply. You may skip this question if you do not have high blood pressure.

Question Title

* 6. Preventative care is very important and could save your life. If you have not had the following preventative care screenings, why was that? Please check all that apply.

Question Title

* 7. If you have tried to quit smoking in the past 12 months, what did you try to help you quit? Please check all that apply.

Question Title

* 8. Have you or a member of your family accessed any of these services in the last 12 months?

Question Title

* 9. In the last 12 months, If you or a member of your household could not get the professional help you needed for an alcohol or substance abuse disorder (drug) problem why was that? Please check all that apply.

Question Title

* 10. Now thinking about your mental health, which includes stress, depression and problems with emotions, would you say that, in general, your mental health is:

Question Title

* 11. In the last 12 months, if you or a member of your household could not get the professional help you needed for mental health services, why was that? Please check all that apply.