SEWARD COUNTY COMMUNITY HEALTH SURVEY

 

 
Please take a few minutes to complete the survey below. The purpose of this survey is to get your opinions about the health problems in our community and help us to figure out how to address these issues. Please only one survey per person. Remember your opinion is important to us! All information will remain confidential. We will first start with a little information about yourself.
1. Which community do you reside in?
2. What is your gender?
3. What is your age?
4. How would you describe yourself? Please mark all that apply.
5. What language do you mainly speak at home?
6. During the last 12 months, what was the TOTAL income of ALL members of your household?
7. What is the highest level of education you have completed?
8. How many children under the age of 18 live in your household?
9. Do you have a healthcare provider?
10. If yes, who is your healthcare provider?
11. Where do you get your health information (resources and educational information) from? Please mark all that apply.
12. Is anyone in your household currently having difficulty getting medical care? If so, please mark all that apply.
13. Does everyone in your household have medical insurance coverage?
14. Does everyone in your household have dental insurance?
15. Who in your household LACKS dental and/or health insurance? Please mark all that apply.
16. Why do the above marked people in your household NOT have dental and/or health insurance? Please mark all that apply.
17. In the past 5 years, has anyone in your household been affected by any of the following issues listed below. Mark all that apply.
18. In the past 5 years, has anyone in your household been affected by any of the chronic diseases listed below. Please mark all that apply.
19. In the past 5 years, has anyone in your household been affected by any mental health issues listed below. Please mark all that apply.
20. In the past 5 years, has anyone in your household been affected by any safety issues listed below. Please mark all that apply.
21. In the past 5 years, has anyone in your household been affected by any of the infectious disease conditions listed below? Please mark all that apply.
22. In the past 5 years, has anyone in your household been affected by vaccine or immunization issues listed below. Please mark all that apply.
23. In the past 5 years, has anyone in your household been unable to get adequate physical activity due to the following listed below? Please mark all that apply.
24. In the past 5 years, has anyone in your household been affected by any environmental conditions listed below? Please mark all that apply.
25. In the past 5 years, has anyone in your household been affected by the nutrition issues listed below? Please mark all that apply.
26. Do you believe that tobacco use is a problem in Seward County? Please mark all that apply.
27. Do you believe that alcohol is a problem in Seward County? Please mark all that apply.
28. Do you believe that the use of drugs is a problem in Seward County? Please mark all that apply.
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29. Overall, what do you think are the 3 most important health problems in Seward County? Please select 3 and number them 1 to 3 with 1 being the most important.
TOGETHER WE ARE CHANGING LIVES ONE HAND AT A TIME. WE APPRECIATE YOU TAKING THE TIME TO COMPLETE THE SURVEY. THIS WILL ASSIST US IN FINDING A WAY TO HELP CORRECT THE IDENTIFIED HEALTH ISSUES/CONCERNS IN OUR COMMUNITY. IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO CONTACT THE SEWARD COUNTY HEALTH DEPARTMENT AT (620) 626-3369. THANK YOU FOR YOUR ASSISTANCE AND TIME.
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