Community Themes and Strengths - Nassau 2015

The Partnership for a Healthier Nassau needs your help to better understand the health of our community. Please fill out this survey to tell us about health services and the quality of life in Nassau County. The survey results will go into a Health Needs Assessment which will be made available to the public at a future date.

This survey is completely voluntary. It should take 5-10 minutes to complete. Your individual answers will not be shared in the report. All individual responders will remain anonymous. If you have any questions about this survey, please contact Dawna Cornelissen at (904) 261-0701 or dcornelissen@nassaucountycoa.org.

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1. How do you rate your overall health?

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2. Please rate the following features by how important you feel they are to a healthy community:

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3. How old are you?

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4. What is your gender?

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5. Which race/ethnicity best describes you? (Please choose only one.)

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6. What language do you mainly speak at home?

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7. What is the highest level of education you have completed?

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8. Which of the following categories best describes your employment status?

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9. What is your approximate average household income?

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10. How do you rate your overall health?

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11. How much physical activity do you get each week?

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12. Do you have trouble paying for utilities? (water, electric, internet, etc.)

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13. Do you have easy access to healthy food options, such as fresh fruit and vegetables?

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14. Do you currently experience discrimination in Nassau County based on any of the following factors?

  Yes No
Age
Disability
Ethnicity
Gender
Income
Language
Pregnancy
Race
Religion
Sexual Orientation

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15. How difficult is it for YOU to obtain the following services in your community?

  Very Difficult Difficult Neutral Easy Very Easy
Alternative Therapy (Herbals, Acupuncture, etc.)
Dental/Oral
Emergency Room Care
Family Planning/ Birth Control
Lab Work
Mammograms
Medical Supplies
Mental Health Counseling
Physical/ Rehabilitative Therapy
Prescriptions
Preventative Care (Wellness Checks, Physicals, etc.)
Primary Care
Specialty Doctor Care
Substance Abuse Services
Vision Care
X Rays/ Imaging

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16. What keeps YOU from getting the health care you need?

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17. Where do you get your prescription medications?

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18. How do you receive health insurance?

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19. Where would you go if you or one of your family members were sick and needed a Doctor's advice about your or their health?

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20. Where is your Primary Care Doctor located?

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21. How often do you receive a wellness check (Physical/ Annual Exam)?

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22. Over the last two weeks, how often have you been bothered by any of the following problems?

  Not at all Less than 7 days More than 7 days Everyday
Feeling sad or empty
Feelings of worthlessness
Less ability to think or concentrate
Less interest in daily activities
Sleeping More or Less than usual
Thoughts of Death or suicide
Weight loss or gain when not dieting

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23. If you felt bothered by any of the previous problems, what did you do?

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24. Do you have difficulty completing any of the following tasks?

  Very Difficult Difficult Neutral Easy Very Easy
Bathing
Driving or Navigating Public Transit
Feeding Yourself
Grooming Yourself
Housework and basic Home Maintenance
Managing Medications
Moving from Bed to Wheelchair
Prepping Meals
Putting on Clothes
Shopping
Using the Telephone and Other Communications Devices
Using the Toilet
Walking

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25. Rate the following social services you believe are most important to a healthy Community?

  Very Important Important Neutral Somewhat Important Not Important
Access to Healthcare Services
Churches/ Places of Worship
Clean and Healthy Environment
Educational opportunities
Housing
Low Crime/Safe neighborhoods
Parks and Recreation
Public Transportaion
Quality Day Care Centers
Quality Jobs
Volunteer Opportunities

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26. What Health items listed below do you believe are important in Nassau County?

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27. How do you rate the quality of heath services in Nassau County?

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28. What do you think would help make Nassau County a healthier community?

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29. Please rate the following features by how important you feel they are to a healthy community:

 
Access to Healthcare Services

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30. What do you think would improve the quality of life in Nassau County?

T