1.How would you describe yourself?

Woman

Man

Non-binary

Prefer not to answer

Not listed, please share more:

2.How old are you?

15-24

25-34

35-44

45-54

55-64

65+

3.What is your race/ethnicity?

White

Black/African American

Hispanic/Latinx

Asian or Asian American

American Indian/Alaska Native

Native Hawaiian/other Pacific Islander

More than 1 race

Prefer not to answer

Other 

4.What is your education level?

Less than 9th grade

9th - 12th grade, no diploma

High school graduate (GED)

Associate degree or trade school

Some college (no degree)

Bachelor's degree

Graduate or professional degree

5.What is your household income?

$10,000 to $19,999

$20,000 to $24,999

$25,000 to $34,999

$35,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 or more

6.How many people are living in your home?

1-2

3-4

5-6

7-8

More than 9

7.What are the top 3 issues that impact your quality of life?

Low income/poverty

Dropping out of school

Housing conditions (poor housing, housing prices)

Violent crime

Drugs/alcohol/substance use

Abuse (rape/sexual assault, child abuse)

Transportation

Health insurance

Lack of access to enough food

COVID-19

Other:

8.What are the top 3 services that you feel are not available or need improvement in Franklin County?

Animal control

Childcare

Elder care

Services for people living with a disability

Affordable health services 

Healthy food choices

Housing (poor housing, housing prices)

Number of healthcare providers

Culturally appropriate health services 

Mental health and behavioral health/support groups

Recreational facilities (parks, trails, community centers)

Substance misuse services/recovery support

Healthy family/teen activities

Transportation

Other:

9.What are the top 3 health behaviors that you need more information on?

Eating well/nutrition

Using child safety car seats

Exercising/fitness

Suicide prevention

Mental/behavioral health

Domestic violence prevention

Positive parenting

Rape/sexual abuse prevention

Preventative care (going to a dentist/doctor for check-ups and screenings, getting flu shots and other vaccines)

Substance misuse prevention

Quitting smoking/tobacco use

Breastfeeding

Getting prenatal care during pregnancy

Caring for family members with special needs/disabilities

Preventing pregnancy and sexually transmitted diseases (STDs)

Other:

10.Where do you get most of your health related information?

Friends and family

Internet

Social Media

Employer

Television

Radio

Healthcare provider (doctor, nurse, PA, NP)

My child's school

Help lines

Pharmacist

Books/magazines

Church

Health department

Health fairs/community events

Community health worker

Newspaper

Other:

11.What is stopping you from getting the care you need?

No health insurance

Insurance did not cover what I needed

My share of the cost (deductible, co-pay) was too high

My insurance of Medicaid was not accepted

No way to get there

Did not know where to go

Could not get an appointment

The wait was too long

Did not speak my language

Could not miss work to go

Hours did not work with my availability

No childcare options

Other:

12.What services do you use at the health department?

Home health

Environmental health

Health education

STD/STI treatment

Child health

Maternal health

Adult health

Family planning clinic

Childhood vaccines

Women, infants, and children (WIC)

None of the above

13.Is there anything else you would like us to know about your community?

14.What other services do you wish the health department offered?