Survey questionnaire

We are conducting a survey to better understand the health care needs in our community. Data from this survey will help improve the overall health and wellness of our community by establishing priorities for programs and services, and implementing strategies to address gaps between critical needs and services.
 
This survey is anonymous, we will not know who has completed a survey. The survey should take 5-7 minutes.
 
Thank you for your interest. It will help us to identify and prioritize the needs of our community. Your input will help us ensure that SSM Health will continue to meet the health and wellness needs of our citizens today and for years to come.

What is your age?

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* 1. What is your age?

You are

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* 2. You are

What is your county of residence?

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* 3. What is your county of residence?

Race/Ethnicity (Please select all that apply):

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* 4. Race/Ethnicity (Please select all that apply):

In general, how would you rate your overall health? (Please select one)

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* 5. In general, how would you rate your overall health? (Please select one)

Select the diseases, challenges or conditions that you have been diagnosed with by a health care provider (Please select all that apply)

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* 6. Select the diseases, challenges or conditions that you have been diagnosed with by a health care provider (Please select all that apply)

Do you feel that you have resources to manage these conditions?
    If "YES", please go to question 9.

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* 7. Do you feel that you have resources to manage these conditions?
    If "YES", please go to question 9.

If "No"  What do you think you need to help you manage these conditions?

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* 8. If "No"  What do you think you need to help you manage these conditions?

Please select the option that best describes your health insurance provider.

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* 9. Please select the option that best describes your health insurance provider.

Where do you go most often for health care when you are sick?

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* 10. Where do you go most often for health care when you are sick?

Where do you go when you need your yearly check-up or physical? (Please select all that apply)

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* 11. Where do you go when you need your yearly check-up or physical? (Please select all that apply)

Have you visited a doctor (primary care) in the past 12 months?

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* 12. Have you visited a doctor (primary care) in the past 12 months?

Have you visited a specialist (cardiologist, neurologist, pulmonologist, etc) in the past 12 months?

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* 13. Have you visited a specialist (cardiologist, neurologist, pulmonologist, etc) in the past 12 months?

Was there a time in the past 12 months when you needed to see a doctor but didn’t?

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* 14. Was there a time in the past 12 months when you needed to see a doctor but didn’t?

If "YES" to question 14, why didn't you see a doctor?

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* 15. If "YES" to question 14, why didn't you see a doctor?

Select the diseases, challenges or conditions that you think are a concern for our community (Please select all that apply)

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* 16. Select the diseases, challenges or conditions that you think are a concern for our community (Please select all that apply)

Which of the following is the top ACCESS issue impacting health in our community?

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* 17. Which of the following is the top ACCESS issue impacting health in our community?

Which of the following is the top LIFESTYLE issue impacting health in our community?

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* 18. Which of the following is the top LIFESTYLE issue impacting health in our community?

Which of the following is the top SOCIAL ISSUE impacting health in our community?

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* 19. Which of the following is the top SOCIAL ISSUE impacting health in our community?

The recommendation for physical activity is 30 minutes a day 5 days a week (2.5 hours per week). Which of the following reasons prevent you from getting this much physical activity? (select all that apply)

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* 20. The recommendation for physical activity is 30 minutes a day 5 days a week (2.5 hours per week). Which of the following reasons prevent you from getting this much physical activity? (select all that apply)

One recommendation to maintain a healthy lifestyle is to eat at least 5 servings of fruits and vegetables a day (not french fries or potato chips).  Which would you consider the main reason that you do not eat this way?  (select only one)

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* 21. One recommendation to maintain a healthy lifestyle is to eat at least 5 servings of fruits and vegetables a day (not french fries or potato chips).  Which would you consider the main reason that you do not eat this way?  (select only one)

Please select the highest level of education you have completed.

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* 22. Please select the highest level of education you have completed.

What are the major strengths/resources in our community related to health care?

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* 23. What are the major strengths/resources in our community related to health care?

What resources could be used differently to improve health care?

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* 24. What resources could be used differently to improve health care?

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