COMMUNITY HEALTH NEEDS ASSESSMENT 2018

Fulton County Medical Center and its community partners Fulton County Family Partnership and Tri-State Community Health Center are interested in learning about the health of the residents in Fulton County.  Your input in this process is very important.  We are asking that you complete this survey that will help us identify the needs of our community so that we can work together to address those needs.  The survey should take approximately 10-15 minutes to complete, and we ask that you please complete by August 10, 2018.  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 eight participants will be selected to win one of the following:  
(1) $250 Visa Gift Card
(7) $50 Giant Gift Card

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!

Q1 How would you rate your (personal) overall health?
Q2 Overall, how would you rate the health status of your community?
Q3 In general, how satisfied are you with your quality of life?
Q4 What would improve the quality of life within your community? Please check all that apply.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
Q5 A wellness center was recently opened in the community.  Please rate your level of agreement with the following statements:
  Strongly Agree   Agree   Neutral   Disagree   Strongly Disagree   Don't Know  
  The classes offered meet my needs            
  The hours are convenient            
  The cost is affordable            
Q6
Q7 Do you or someone in your home have a need for adult education, vo-tech, or training programs to help further your/their education or career opportunities?
Q8
Q9 Stress means a situation in which a person feels tense, restless, nervous, or anxious, or is unable to sleep at night because his/her mind is troubled. Within the last 30 days, how often have you felt any kind of stress?
Q10 Looking at the following items think about what causes stress in your daily life. Stress could be caused from not having the following, or being able to find them, or not having the preferred quality. Please check all that apply.
 
 
 
 
 
 
 
 
 
 
   
Q11 Was there a time in the past 12 months when you experienced any of the following?
  Yes   No   Don't Know  
  Ate less food than you felt you should because there wasn't enough money for food?      
  Used a food pantry/soup kitchen, or received a food donation?      
  Ran out of food and did not have enough money to purchase more?      
  Been unable to purchase healthy foods due to cost?      
  Had your utility company shut off your service for not paying your bills?      
  Needed to see a doctor, but could not because of cost?      
  Gone without health care because you did not have a way to get there?      
  Gone without medications due to cost?      
  Gone without health care because of the cost of your copay or deductible?      
  Been unable to pay your rent or mortgage?      
  Slept outside, in a shelter, or in a place not meant for sleeping?      
  Moved in with a family member or friend because you did not have anywhere else to stay?      
  Spent a few nights with family members or friends because you did not have anywhere else to stay?      
  Gone without needed childcare items (such as diapers, formula, car seat, crib, etc.)?      
  Been unable to make home repairs due to cost?      
Q12 As a child (during the first 18 years of life) did you experience any of the following?
  Yes   No   Don't Know  
  Did you or anyone in your family ever experience physical or emotional abuse?      
  Did you ever feel alone, isolated, or have no one to talk to?      
  Did you experience the separation, divorce, or breakup of a family?      
Q13 Are you personally, or is anyone in your family currently experiencing any of the following? Please check all that apply.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
   
Q14 How safe from crime do you consider the following?
  Extremely Unsafe   Unsafe   Safe   Extremely Safe   Don't Know  
  Your Neighborhood          
  Your Workplace          
  Your Local School(s)          
  Your Home          
Q15 How much of a problem are the following related to housing in your community?
  Not a Problem
(1)
  (2)   Somewhat of a Problem
(3)
  (4)   Big Problem
(5)
 
  Landlords not maintaining properties resulting in poor living conditions          
  Run down or abandoned properties          
  Individuals moving in with a relative because of cost of housing          
  Several families living in one house          
  People "couch surfing", spending a few nights at several people's homes but do not have their own home          
Q16 Please rate your level of confidence in the following emergency services:
  Not at all Confident
(1)
  (2)   Somewhat Confident
(3)
  (4)   Extremely Confident
(5)
 
  An ambulance would respond quickly to my home if I needed it          
  The fire department would respond quickly to my home if I needed it          
  The police department would respond quickly to my home if I needed it          
Q17 Please rate your level of agreement with the following statements:
  Strongly Agree   Agree   Neutral   Disagree   Strongly Disagree   Don't Know  
  Underage drinking is a problem in our community            
  Underage drug use is a problem in our community            
  A minor would be caught by the police if they were drinking or using drugs            
  Parents in our community do not tolerate underage drinking            
  It is easy for minors in our community to get alcohol            
  It is easy for minors in our community to get drugs            
  Youth crime/delinquency is a problem in our community            
Q18 Please rate your level of agreement with the following statements:
  Strongly Agree   Agree   Neutral   Disagree   Strongly Disagree   Don't Know  
  I have taken someone else's prescription pain medication            
  I have given someone else medication that was prescribed to me            
  Prescription drug abuse is a problem in our community            
  Prescription drug abuse is a problem in my family            
  NARCAN should be available for use in homes            
Q19 NARCAN (naloxone) is a prescription medication used for the treatment of an opioid emergency such as an overdose or possible overdose. Have you or do you know anyone who has done the following?:
  Yes   No   Don't Know  
  I have had it given to me to stop an overdose      
  I know someone who has had it given to them to stop an overdose      
  I have personally given it to stop someone from overdosing      
  I know someone who has given it to stop someone from overdosing      
Q20 Do you currently use e-cigarettes or vaping pens?
Q21 Do you currently use chewing tobacco, snuff, or snus? (Note: snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum)
Q22 Do you currently smoke cigarettes?
Q23
Q24 Which of the following describes  your health insurance coverage?  Please check all that apply.
Q25
Q26 Who is the coverage provided through?  Please check all that apply.
 
 
 
 
 
 
 
   
Q27 Did you purchase your health insurance through the marketplace (i.e healthcare.gov)?
Q28
Q29

Health Care

Q30 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Primary Care        
  Speciality Care        
  Kidney/Renal Care        
  Alternative Care (i.e. chiropractor, holistic treatment, acupuncture, etc.)        
  Women's Health Care        
  Dental Care        
  Eye Care        
  Cancer Care        
  Heart Care        
Q31 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Primary Care        
  Speciality Care        
  Kidney/Renal Care        
  Alternative Care (i.e. chiropractor, holistic treatment, acupuncture, etc.)        
  Women's Health Care        
  Dental Care        
  Eye Care        
  Cancer Care        
  Heart Care        

Nutrition

Q32 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Access to affordable healthy foods        
  Access to healthy foods in school        
  Access to healthy foods in stores        
Q33 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Access to affordable healthy foods        
  Access to healthy foods in school        
  Access to healthy foods in stores        

Transportation

Q34 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Transportation to health care        
  Transportation to work        
  Transportation to grocery stores        
  Reliable, scheduled transportation        
  Affordable transportation        
  Transportation to community activities        
Q35 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Transportation to health care        
  Transportation to work        
  Transportation to grocery stores        
  Reliable, scheduled transportation        
  Affordable transportation        
  Transportation to community activities        

Substance Abuse

Q36 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Prevention programs        
  Reduction of illegal drug use        
  Reduction of prescription drug use        
  Reduction of alcohol use        
  Access to treatment        
  Recovery programs and support        
Q37 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Prevention programs        
  Reduction of illegal drug use        
  Reduction of prescription drug use        
  Reduction of alcohol use        
  Access to treatment        
  Recovery programs and support        

Housing

Q38 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Affordable housing        
  Loans and other financial assistance for housing        
Q39 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Affordable housing        
  Loans and other financial assistance for housing        

Senior Services

Q40 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Senior housing        
  Nursing home        
  Assisted living facility        
  Personal care home        
  Retirement village        
Q41 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Senior housing        
  Nursing home        
  Assisted living facility        
  Personal care home        
  Retirement village        

Infant and Youth

Q42 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Infant/toddler childcare        
  Preschool/early childhood education        
  Before/after school programs for school aged children        
  Early Intervention services        
Q43 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Infant/toddler childcare        
  Preschool/early childhood education        
  Before/after school programs for school aged children        
  Early Intervention services        

Mental Health/Disabilities

Q44 How much of a need do you think there is for the following?
  High Need   Low Need   No Need   Don't Know  
  Access to mental health services        
  Access to intellectual disability/developmental disability services        
  Access to autism services        
Q45 How likely would you be to use the following if they were available?
  Very Likely   Somewhat Likely   Not Likely   Don't Know  
  Mental health services        
  Intellectual disability/developmental disability services        
  Autism services        
Q46 Have you ever been told by a doctor that you have diabetes?
Q47 How are you managing your symptoms?  Please check all that apply.
   
Q48 Have you ever been told by a doctor that you have high blood pressure?
Q49 How are you managing your symptoms?  Please check all that apply.
   
Q50 What do you feel are the top three health problems in the county you live in? (For example: Cancer, Diabetes, Obesity, Etc.). Your response does not need to be limited to the topics previously listed.
   
   
   
Q51 What do you feel are the top three social or environmental problems in the county 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.
   
   
   
Q52
Q53 Are you the primary caregiver of a grandchild(ren) (i.e. child lives with you, you provide 50% or more financial support, you are the primary decision maker)?
   
Q54 Are you the primary caregiver of a parent or other relative (i.e. individual lives with you and/or you are responsible for the daily care of this individual?)
   
Q55 A Power of Attorney is a legal document you use to allow another person to act for you.  Please check all that apply.
Q56 Have you ever served on active duty in the U.S. Armed Forces?
Q57 Do you have access to the internet at home?
Q58 What type of internet do you have at home?  Please check all that apply.
Q59 Do you have cell phone reception at your home?
Q60 How do you like to receive information on upcoming community events?  Please check all that apply.
   

The following are for statistical purposes only:

Q61
Q62 What county do you currently live in?
   
Q63 Which one or more of the following would you say is your race?  Please check all that apply.
   
Q64 Are you Hispanic or Latino?
Q65 What is the highest grade or year of school you completed?
Q66 What is your total annual household income?
Q67
Q68
Q69 Which of the following best describes you?
Q70
Q71 What is your marital status?
Q72 What is your employment status?
   
Q73 Please check any of the following statements that describe your current work situation:
Q74 If you are currently employed how many minutes do you travel for work one way?

Thank you very much for your time and input!

 
   
Clear Answers from this Page Snap Survey Software