Fibromyalgia Food Access & Health Survey

Fibromyalgia Food Access & Health

This survey was organized by the Support Fibromyalgia Network nonprofit organization, HealtheVoices Impact Fund, HealthMatters, and Nerdy Health in order to better support the Fibromyalgia community. This is for U.S. based residents over the age of 18 years old.

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* 1. What is your 5-digit zipcode?

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* 2. Check all that apply. I've been diagnosed with the following:

Fibromyalgia

Irritable bowel syndrome (IBS)

Migraines

Lupus

Arthritis

Diabetes

High Blood Pressure

Chronic Fatigue Syndrome

Other (please specify)

None of the above

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* 3. In general, how would you rate your overall health?

Excellent

Very good

Good

Fair

Poor

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* 4. During the past 4 weeks, how disruptive was your physical or mental health to your normal social activities with family, friends, neighbors, or groups?

Extremely disruptive

Very disruptive

Somewhat disruptive

Not so disruptive

Not at all disruptive

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* 5. During the past 4 weeks, how disruptive was your physical or mental health to getting groceries, cooking, and any means of getting food for yourself?

Extremely disruptive

Very disruptive

Somewhat disruptive

Not so disruptive

Not at all disruptive

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* 6. How important is it to you to live a healthy lifestyle?

Not at all important

A little important

Somewhat important

Very important

Extremely important

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* 7. Do you live in a food desert?

Yes

Not sure

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* 8. Have you ever experienced food insecurity, that is, not knowing where your next meal is coming from, or involuntarily eating less than you need, on a regular basis, for a period of time lasting more than a month?

Yes

Do you have anything else to share about your answer?

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* 9. Does your neighborhood have too many, too few, or about the right number of grocery stores?

Far too many

Too many

The right amount

Too few

Far too few

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* 10. About how many cups of vegetables do you eat each day? If you don’t know for certain, please provide an estimate.

None

Some, but less than 1 cup

1 to less than 1.5 cups

1.5 cups to less than 2 cups

2 or more cups

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* 11. Please check any of the following services that you currently use:

A food bank

Food assistance available from a church

Food assistance from another local organization

SNAP

WIC

USDA Fresh Fruit and Vegetable Program

None of the above

Other services, or comments on your answer to this question:

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* 12. Do you have financial access to nutritious food?

Yes

Not sure

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* 13. Do you have physical access to nutritious food?

Yes

Not sure

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* 14. Please select any of the following statements that you feel apply to you:

I do not know how to prepare nutritious meals for myself.

I am physically unable to prepare meals for myself.

I am too busy to prepare nutritious meals for myself.

I am not sure whether my meals are nutritious or not.

None of these statements apply to me.

Additional comments for your answer can be added here:

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* 15. Has a medical provider talked to you about nutrion?

Yes

Not sure

Please describe any additional comments here:

Fibromyalgia Food Access & Health Survey