Community Health Needs Assessment 2021 Thank you for taking the time to fill out this survey! Each participant who completes a survey will be entered into a drawing to win 1 of 4 $25 gift card prizes! Question Title * 1. Geographical Information County City Question Title * 2. Which of the below groups have the greatest healthcare needs not met? Please rank them in order: 1 has the most needs NOT met, where 6 has the least needs NOT met. 1 2 3 4 5 6 Children (0-12) 1 2 3 4 5 6 Teens (13-17) 1 2 3 4 5 6 Adults (18-64) 1 2 3 4 5 6 Senior Citizens (65+) 1 2 3 4 5 6 Families 1 2 3 4 5 6 Minorities Question Title * 3. If you believe that the following group's health needs are NOT met, please choose which category best fits their needs. (Please only choose one answer per group) Access to Primary Care Preventative Health & Wellness Chronic Disease Management Health Needs Met Children (0-12) Children (0-12) Access to Primary Care Children (0-12) Preventative Health & Wellness Children (0-12) Chronic Disease Management Children (0-12) Health Needs Met Teens (13-17) Teens (13-17) Access to Primary Care Teens (13-17) Preventative Health & Wellness Teens (13-17) Chronic Disease Management Teens (13-17) Health Needs Met Adults (18-64) Adults (18-64) Access to Primary Care Adults (18-64) Preventative Health & Wellness Adults (18-64) Chronic Disease Management Adults (18-64) Health Needs Met Senior Citizens (65+) Senior Citizens (65+) Access to Primary Care Senior Citizens (65+) Preventative Health & Wellness Senior Citizens (65+) Chronic Disease Management Senior Citizens (65+) Health Needs Met Families Families Access to Primary Care Families Preventative Health & Wellness Families Chronic Disease Management Families Health Needs Met Minorities Minorities Access to Primary Care Minorities Preventative Health & Wellness Minorities Chronic Disease Management Minorities Health Needs Met Question Title * 4. For each group, what do you feel are the greatest needs? (Please only choose one answer per group) Insurance Available Physicians Cost of Medication Drugs, Alcohol & Tobacco Exercise / Healthy Eating Mental Health Vaccinations Preventative Screenings Children (0-12) Children (0-12) Insurance Children (0-12) Available Physicians Children (0-12) Cost of Medication Children (0-12) Drugs, Alcohol & Tobacco Children (0-12) Exercise / Healthy Eating Children (0-12) Mental Health Children (0-12) Vaccinations Children (0-12) Preventative Screenings Teens (13-17) Teens (13-17) Insurance Teens (13-17) Available Physicians Teens (13-17) Cost of Medication Teens (13-17) Drugs, Alcohol & Tobacco Teens (13-17) Exercise / Healthy Eating Teens (13-17) Mental Health Teens (13-17) Vaccinations Teens (13-17) Preventative Screenings Adults (18-64) Adults (18-64) Insurance Adults (18-64) Available Physicians Adults (18-64) Cost of Medication Adults (18-64) Drugs, Alcohol & Tobacco Adults (18-64) Exercise / Healthy Eating Adults (18-64) Mental Health Adults (18-64) Vaccinations Adults (18-64) Preventative Screenings Senior Citizens (65+) Senior Citizens (65+) Insurance Senior Citizens (65+) Available Physicians Senior Citizens (65+) Cost of Medication Senior Citizens (65+) Drugs, Alcohol & Tobacco Senior Citizens (65+) Exercise / Healthy Eating Senior Citizens (65+) Mental Health Senior Citizens (65+) Vaccinations Senior Citizens (65+) Preventative Screenings Families Families Insurance Families Available Physicians Families Cost of Medication Families Drugs, Alcohol & Tobacco Families Exercise / Healthy Eating Families Mental Health Families Vaccinations Families Preventative Screenings Minorities Minorities Insurance Minorities Available Physicians Minorities Cost of Medication Minorities Drugs, Alcohol & Tobacco Minorities Exercise / Healthy Eating Minorities Mental Health Minorities Vaccinations Minorities Preventative Screenings Other (please specify) Question Title * 5. Are you involved in any organization/program that addresses the above group's needs in any way? (Please choose as many answers which may apply) Church Civic Community School Not Involved Other (please specify) Question Title * 6. Do people have to travel outside of your community to have their healthcare needs met? Yes No Hospital Services Hospital Services Yes Hospital Services No Primary Care Physicians Primary Care Physicians Yes Primary Care Physicians No Specialty Care Services Specialty Care Services Yes Specialty Care Services No Question Title * 7. Overall, what general healthcare needs are NOT met in your community? (Please choose as many answers which may apply) Lack of Hospitals Lack of Doctors Lack of Clinics Lack of Healthy Foods Mental Health Services Drug & Alcohol Prevention Preventative Screenings (i.e. PSA & Mammogram) Vaccinations (i.e. Pneumonia & Flu) Exercise Resources Other (please specify) Question Title * 8. Has Unity Health (formerly White County Medical Center and Harris Hospital) or the Advanced Care Hospital of White County had a positive impact on your community? Yes No Question Title * 9. What would you add to your community to make it more achievable to live a healthy lifestyle? (Please choose as many answers which many apply) Bike/Walking Trail Exercise Classes Farmer's Market Healthy Cooking Classes Parks Other (please specify) Question Title * 10. Do you have any other comments/concerns about how Unity Health (formerly White County Medical Center and Harris Hospital) or the Advanced Care Hospital of White County could improve your community? Question Title * 11. Optional (In order to win the gift card prize, you must leave a name and way to be contacted) Name Email Address Phone Number Thank you! Unity Health and the Advanced Care Hospital of White County look forward to continuing our goal of making your community healthier! Done
