Exit this survey Brunswick County Community Needs Assessment 2015 1. Question Title 1. In your opinion, what do most people die from in your community? (Check only one) Asthma/Lung Disease Cancer Diabetes Suicide HIV/AIDS Heart Disease Stroke/Cerebrovascular Disease Homicide/Violence Motor Vehicle Deaths Other (Please indicate in comments at end of survey) No Response Question Title 2. In your opinion, what is the biggest health issue of concern in your community? (Check only one) Asthma/Lung Disease Chronic Disease (i.e. Cancer, Diabetes, Heart Disease/Stroke) Child Abuse Dental Health Drug/Alcohol Abuse Gangs/Violence Mental Health Obesity Teen Pregnancy Tobacco Use Vehicle Crashes Other (Please indicate comments at end of survey) No Response Question Title 3. In your opinion, what do you think is the main reason that keeps people in your community from seeking medical treatment? (Check only one) Cultural/Health Beliefs Fear (not ready to face health problem) Health services too far away Lack of insurance/Unable to pay for doctor’s visit Lack of knowledge/understanding of the need None/No Barriers Not Important Transportation No appointments available at doctor when needed/Have to wait too long at doctor’s office No Response Other (please specify) Question Title 4. Which factor do you feel most affects the quality of the health care you or people in your community receive? Ability to read & write/Education Age Economic (Low Income, No Insurance, etc.) Language Barrier/Interpreter/Translator Race Sex/Gender No Response Other Choice Listed Below Other (please specify) Question Title 5. In your opinion, do you feel people in your community lack the funds for any of the following: Food Health Insurance Home/Shelter Utilities (i.e. Electricity, Fuel, Water) Medicine Transportation Other (Please indicate comments at he end of the survey) No Response Other (please specify) Question Title 6. How do you rate your own health? Excellent Very Good Good Fair Poor Don’t Know/Not Sure No Response Question Title 7. What does your community need to improve the health of your family, friends, and neighbors? Additional Health Services After-School Programs Healthier Food Choices Job Opportunities Mental Health Services Recreation Facilities Transportation Wellness Services Safe places to walk/play Substance Abuse Rehabilitation Services Specialty Physicians Other - State Below No Response Physicians or Other Suggestions Next