Community Health Needs Assessment 2018

Olean General Hospital and the Cattaraugus County Health Department are interested in learning about the health of the residents in Cattaraugus County.  Your input in this process is very important.  

We are asking that you complete this survey to help us to identify the needs of our community in order that we can work together to address those needs.  The survey should take approximately 5-10 minutes to complete, and we ask that you
please complete by October 31, 2018.

Your responses are important and will provide us with information that will allow us to identify the most pressing needs of our community so that we might all work together to address those needs.  

Please note that your responses are completely anonymous.  If you have questions regarding the survey, or need assistance completing this survey please contact Jacqui or Kathy at 1-866-480-8003.

To thank you for your participation you will be entered into a drawing for a chance to win one of two $50 Chamber Gift Cards.  Upon completion of the survey, you will be directed to a separate page to input your contact information for a chance to win one of these prizes.

Thank you for your participation!
1. How would you rate your (personal) overall health?
2. Overall, how would you rate the health status of your community?
3. What is your gender?
4. During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, aerobics, golf, gardening, or walking for exercise?
5. How often do you participate in a physical activity or exercise?
6. Which, if any, of the following would  help you become more active?  Check all that apply.
7. Do you have any kind of health care coverage or health insurance?
8. How do you pay for your Health Care?  Check all that apply.
9. Where do you get most of your health information?  Select up to three (3) choices.
   
10. How often do you see  your primary care provider (doctor)?
11. In the past year, was there any time that you needed medical care but could not - or did not - get it?
   
12. What were the main reasons you did not get the medical care you needed? Please choose all that apply.
   
13. Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems.  Have you ever had either of these exams?
14. Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all?  (Note: snus [Swedish for snuff] is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum)
15. Do you currently smoke?
16.
17. Have you ever been told by a doctor, nurse, or other health care professional that you have high blood pressure?
18. Have you ever been told by a doctor that you have diabetes?  
19. About how long has it been since you last had your blood pressure checked by a doctor, nurse, or other health care provider?
   
20. About how long has it been since you last visited a doctor for a routine checkup?  A routine checkup is a physical exam, not an exam for a specific injury, illness, or condition.
21. About how long has it been since you last visited a dentist or dental clinic for any reason? (Include visits to specialists, such as orthodontists)
22. About how long has it been since you last had your cholesterol checked?
23. How long has it been since your last Pap test?  
24. How long has it been since your last mammogram?  
25. A prostate-specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer.  How long has it been since your last PSA test?
26. During the past month, not counting juice, how many times per day, week, or month did you eat fruit? (Count fresh, frozen or canned fruit)                                      
   
   
   
27. During the past month, how many times per day, week, or  month did you eat dark green vegetables (for example broccoli or leafy greens including romaine, chard, collard greens, or spinach)?                                                                                                                                                                                                                                
   
   
   
28.
29.
30.
31. Over the past two weeks, how often have you been bothered by little interest or pleasure in doing things?
32. Over the past two weeks, how often have you been bothered by feeling down, depressed, or hopeless?
33. Over the past two weeks, how often have you had trouble falling asleep or staying asleep or sleeping too much?
34.
35. About how tall are you without shoes?  
   
   

Social and Environmental Issues

36. Have the following directly affected you or your family in the last 2 years?
  Very Serious Affect   Serious Affect   Somewhat of an Affect   Small Affect   No Affect   Not Applicable  
  Affordable and Adequate Housing            
  Homelessness            
  Employment Opportunities/Lack of Jobs            
  Poverty            
  Lack of Recreational Opportunities            
  Lack of Safe Roads and Sidewalks            
  Lack of Early Childhood Care            
  Lack of Quality After School Programs/Care            
  Access to Affordable Healthy Foods            
  Access to Fresh, Available Drinking Water            

Behaviors

37. Have the following directly affected you or your family in the last 2 years?
  Very Serious Affect   Serious Affect   Somewhat of an Affect   Small Affect   No Affect   Not Applicable  
  Alcohol Abuse            
  Prescription Drug Abuse            
  Illegal Drug Use            
  Crime            
  Delinquency/Youth Crime            
  Domestic Violence/Abuse            
  Sexual Abuse            
  Child Physical Abuse            
  Child Sexual Abuse            
  Child Emotional Abuse            
  Child Neglect            
  Violence            
  Gun Violence            
  Lack of Exercise/Physical Activity            
  Sexual Behaviors (unprotected, irresponsible/risky)            
  Teenage Pregnancy            
  Tobacco Use            
  Tobacco Use in Pregnancy            
  Driving Under the Influence of Drugs or Alcohol            
  Texting and Driving            
  Motor Vehicle Crash Deaths            
  Gambling            

Access

38. Have the following directly affected you or your family in the last 2 years?  (Consider things like coverage under your health benefit plan, cost of service, location, transportation, knowledge of providers, etc...)
  Very Serious Affect   Serious Affect   Somewhat of an Affect   Small Affect   No Affect   Not Applicable  
  Access to Insurance Coverage            
  Access to Adult Immunizations            
  Access to Childhood Immunizations            
  Access to General Health Screenings (including blood pressure, cholesterol, colorectal cancer and diabetes)            
  Access to Mental Health Care Services            
  Access to Prenatal Care            
  Access to Transportation to Medical Care Providers and Services            
  Access to Women's Health Services            
  Access to Primary Medical Care Providers            
  Availability of Specialists/Specialty Medical Care            
  Access to Affordable Health Care (related to copays and deductibles)            
  Access to Dementia Care Services            
  Access to Dental Care            
  Access to Emergency Shelter in the Area            
39. Was there a time in the past 12 months when you experienced any of the following:
  Yes   No   Don't Know  
  Could not fill a prescription due to cost      
  Could not seek medical treatment because of cost      
  Could not get health care services because of lack of transportation      
40.

Health Problems

41. Have the following directly affected you or your family in the last 2 years?
  Very Serious Affect   Serious Affect   Somewhat of an Affect   Small Affect   No Affect   Not Applicable  
  Asthma/COPD related issues            
  Cancer            
  Diabetes            
  Influenza and Pneumonia            
  Heart Disease            
  Obesity and Overweight            
  Childhood Obesity            
  Cardiovascular Disease and Stroke            
  High Cholesterol            
  Hypertension/High Blood Pressure            
  Dental Hygiene/Dental Problems            
  Allergies            
  Chronic Depression            
42. What do you feel are the top three health problems in the community you live in? (For Example: Cancer, Diabetes, Obesity, Etc...) Your response does not need to be limited to the topics previously listed.
   
   
   
43. What do you feel are the top three social or environmental problems in the community you live in? (For Example: High Rates of Drug Use, Poor Weather Conditions, Lack of Jobs, Etc...) Your response does not need to be limited to the topics previously listed.
   
   
   
44.
The following are for statistical purposes only:
45. What is the zip code where you currently live?
   
46.
47. Which one or more of the following would you say is your race?   Please check all that apply.
48. Are you Hispanic or Latino?
49. What is the highest grade or year of school you completed?
50. What is your annual household income?
51. What is your marital status?
52. What is your employment status?
   
53. If you are currently employed how many minutes do you travel for work one way?
54. What is your age?
Thank you very much for your time and input!
 
dividing line
Snap Survey Software Clear Answers from this Page