Personal Health Status Assessment

Background and Introduction:

Every 5 years, Panhandle Health conducts a Community Health assessment (CHA) to help determine the primary health-related goals upon which to increase emphasis for the 5 years going forward; the last one was in 2018.

Since we have spent the past two years dealing with a global COVID19 pandemic, we are interested to know how personal health, diet, and physical activity has been impacted for you. These combined data will be used to seek grant funds to help address at least some of the identified issues now, rather than later.

As members of the "senior class" Thank You, in advance, for making time to complete this assessment. We hope that it will encourage you to be more conscious and conscientious about personal health and well-being.

Remember: Completing this survey is totally voluntary. Your answers are not part of a HIPAA-protected medical record. If contact information is collected, it will be kept confidential.

Question Title

* 1. Would you say that your overall health is…

Good

Fair

Poor

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* 2. Please select the top 3 health challenges/concerns you currently face:

Cancer

Diabetes

Overweight/Obesity

Chronic Heart Disease

COPD/Other lung conditions

High blood pressure

Stroke recovery

Joint or back pain

Depression/Anxiety/Memory/Other Mental

Misuse of Alcohol

Use of Tobacco/Nicotine-containing products

Opioid/Other drug misuse

I have no serious health challenges or concerns

Other (please specify)

Question Title

* 3. Thinking about your mental health--including stress, depression, emotional challenges, etc.--how many days in the last 30 days was your mental health not good?

All 30 days

Between 15 and 30 days

Less than 15

I have not experienced challenges with my mental health

All 30 days

Between 15 and 30 days

Less than 15

I have not experienced challenges with my mental health

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* 4. How long since your last visit to a dentist or dental clinic for any reason? [Please include visits to dental specialists, such as orthodontists]

Less than 12 months

1-2 years

2-5 years

5+ years

Cannot remember

Question Title

* 5. In the past 12 months, if you felt mental health treatment or counseling was needed, but you did not receive it, why not? [Check all that apply]

My health insurance does not cover treatment or counseling

I did not know where to go to receive services

I was concerned that I might be admitted to a hospital and/or be pressured to take medication

I never felt that my condition was so bad that treatment was needed

Question Title

* 6. In the past 12 months, if you needed to see a doctor or dentist but could not, why not? [Check all that apply]

Did not need to see a doctor or dentist

I could not afford the cost of the office visit

Lack of time

No doctor appointments were available at the time I needed

Lack of transportation

Did not know where to seek care

Don't know/cannot remember

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* 7. During the past 7 days, have you purposefully done anything that increased your physical activity?

Yes

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* 8. If YES to Q7: How many days were you physically active for 30 minutes or more?
NOTE: The 30 minutes of activity did not need to happen all at one time!

6-7 days

4-5 days

1-3 days

0--Not able to complete 30 minutes of physical activity

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* 9. Do you currently use any type of product(s) containing tobacco or nicotine, i.e., chewing tobacco, cigarettes, cigars, electronic cigarettes, etc?

Yes

None

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* 10. In the past 7 days, how often did you drink at least one 12 oz. beer, 5 oz. of wine, and/or one shot of liquor?

Every day

3 days or less

None

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* 11. During the past 30 days, do you feel that your consumption of fresh, frozen, or canned fruits and vegetables has been adequate to meet the US Dietary Guideline recommendations of:
1) 4--1/2 cup servings of fruit
2) 5--1/2 cup servings of vegetables
NOTE: Do not count juice!

Yes

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* 12. In which county do you live?

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* 13. Please indicate the gender to which you most identify...

Female

Male

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* 14. Please indicate the range that includes your specific age...

55-64

65-70

71-80

80+

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* 15. Please indicate the race/ethnicity to which you most identify...

Asian or Pacific Islander

Black/African-American

Hispanic/Latino

Native American

White/Caucasian

Other (please specify)

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* 16. Are you a veteran or family member of an active-duty serviceman or woman?

Yes

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* 17. If you could work whenever you wanted to work, as a paid volunteer or employee, would you be interested?

Yes, paid volunteer (Call: 208-415-5177)

Yes, paid employee (Call: 208-415-5242)

Not interested in working to supplement my income

Personal Health Status Assessment

Background and Introduction:

Question Title

* 1. Would you say that your overall health is…

Question Title

* 2. Please select the top 3 health challenges/concerns you currently face:

Question Title

* 3. Thinking about your mental health--including stress, depression, emotional challenges, etc.--how many days in the last 30 days was your mental health not good?

Question Title

* 4. How long since your last visit to a dentist or dental clinic for any reason? [Please include visits to dental specialists, such as orthodontists]

Question Title

* 5. In the past 12 months, if you felt mental health treatment or counseling was needed, but you did not receive it, why not? [Check all that apply]

Question Title

* 6. In the past 12 months, if you needed to see a doctor or dentist but could not, why not? [Check all that apply]

Question Title

* 7. During the past 7 days, have you purposefully done anything that increased your physical activity?

Question Title

* 8. If YES to Q7: How many days were you physically active for 30 minutes or more? NOTE: The 30 minutes of activity did not need to happen all at one time!

Question Title

* 9. Do you currently use any type of product(s) containing tobacco or nicotine, i.e., chewing tobacco, cigarettes, cigars, electronic cigarettes, etc?

Question Title

* 10. In the past 7 days, how often did you drink at least one 12 oz. beer, 5 oz. of wine, and/or one shot of liquor?

Question Title

* 11. During the past 30 days, do you feel that your consumption of fresh, frozen, or canned fruits and vegetables has been adequate to meet the US Dietary Guideline recommendations of:1) 4--1/2 cup servings of fruit2) 5--1/2 cup servings of vegetablesNOTE: Do not count juice!

Question Title

* 12. In which county do you live?

Question Title

* 13. Please indicate the gender to which you most identify...

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* 14. Please indicate the range that includes your specific age...

Question Title

* 15. Please indicate the race/ethnicity to which you most identify...

Question Title

* 16. Are you a veteran or family member of an active-duty serviceman or woman?

Question Title

* 17. If you could work whenever you wanted to work, as a paid volunteer or employee, would you be interested?

* 8. If YES to Q7: How many days were you physically active for 30 minutes or more?
NOTE: The 30 minutes of activity did not need to happen all at one time!

* 11. During the past 30 days, do you feel that your consumption of fresh, frozen, or canned fruits and vegetables has been adequate to meet the US Dietary Guideline recommendations of:
1) 4--1/2 cup servings of fruit
2) 5--1/2 cup servings of vegetables
NOTE: Do not count juice!