CHNA Public Survey for Piatt County Residents

For Piatt County Citizens:

We ask that the adult (18 years of age or older) in your household who has the most recent birthday complete this questionnaire.

These questions help assess the health needs and available services of Piatt County. Your information and the opinions you provide are very important in helping us determine where resources and services are needed.

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* 1. What is the zip code of your residence?

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* 2. Would you say your overall general health is

Excellent

Very good

Good

Fair

Poor

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* 3. Do you currently have any of the following types of healthcare coverage? Please make a selection for EACH row.

	Yes	No	Do not know
Medicaid	Medicaid Yes	Medicaid No	Medicaid Do not know
Medicare	Medicare Yes	Medicare No	Medicare Do not know
Private (employer based, self-insured)	Private (employer based, self-insured) Yes	Private (employer based, self-insured) No	Private (employer based, self-insured) Do not know
Public (Marketplace, Obamacare)	Public (Marketplace, Obamacare) Yes	Public (Marketplace, Obamacare) No	Public (Marketplace, Obamacare) Do not know

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* 4. When was the last time you saw a healthcare provider (like a doctor or nurse practitioner, etc.)? Select only one.

Within the past 6 months

Within the past year

Within the past 2 years

Within the past 5 years

Don't know/Unsure

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* 5. Do you have a person you think of as your personal doctor or healthcare provider?

Yes

Do not know

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* 6. Within the past 12 months, have your received any of the following health-related services? Select one answer for EACH row.)

	Yes	No	Do not know
Dental care	Dental care Yes	Dental care No	Dental care Do not know
Mental health care	Mental health care Yes	Mental health care No	Mental health care Do not know
Drug or alcohol treatment	Drug or alcohol treatment Yes	Drug or alcohol treatment No	Drug or alcohol treatment Do not know
Tobacco/smoking cessation	Tobacco/smoking cessation Yes	Tobacco/smoking cessation No	Tobacco/smoking cessation Do not know
Getting prescription medications	Getting prescription medications Yes	Getting prescription medications No	Getting prescription medications Do not know
Getting immunizations, such as a flu shot or others	Getting immunizations, such as a flu shot or others Yes	Getting immunizations, such as a flu shot or others No	Getting immunizations, such as a flu shot or others Do not know
Care related to birth control	Care related to birth control Yes	Care related to birth control No	Care related to birth control Do not know
Prenatal or well-baby care	Prenatal or well-baby care Yes	Prenatal or well-baby care No	Prenatal or well-baby care Do not know
Women, Infants & Children (WIC) supported services	Women, Infants & Children (WIC) supported services Yes	Women, Infants & Children (WIC) supported services No	Women, Infants & Children (WIC) supported services Do not know
Food Stamps or SNAP	Food Stamps or SNAP Yes	Food Stamps or SNAP No	Food Stamps or SNAP Do not know
Chronic disease care, such as for diabetes or heart disease	Chronic disease care, such as for diabetes or heart disease Yes	Chronic disease care, such as for diabetes or heart disease No	Chronic disease care, such as for diabetes or heart disease Do not know
Acute care, such as for an ear infection, cough, injury or fall	Acute care, such as for an ear infection, cough, injury or fall Yes	Acute care, such as for an ear infection, cough, injury or fall No	Acute care, such as for an ear infection, cough, injury or fall Do not know
Annual routine physical examination	Annual routine physical examination Yes	Annual routine physical examination No	Annual routine physical examination Do not know

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* 7. During the past 12 months, were there any times you needed prescription medicine but did not get it because you could not afford it?

Yes

Do not know

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* 8. Some things in life make it easier for us to be healthy and other things make it harder for us to be healthy. How would you rate the following in terms of how they impact your ability to be healthy?

	Makes it easier for me to be healthy	Does not have any influence on my health	Makes it more difficult for me to be healthy	Does not exist in my community
Access to health insurance coverage	Access to health insurance coverage Makes it easier for me to be healthy	Access to health insurance coverage Does not have any influence on my health	Access to health insurance coverage Makes it more difficult for me to be healthy	Access to health insurance coverage Does not exist in my community
Availability of transportation	Availability of transportation Makes it easier for me to be healthy	Availability of transportation Does not have any influence on my health	Availability of transportation Makes it more difficult for me to be healthy	Availability of transportation Does not exist in my community
Access to parks, trails or outdoor activities	Access to parks, trails or outdoor activities Makes it easier for me to be healthy	Access to parks, trails or outdoor activities Does not have any influence on my health	Access to parks, trails or outdoor activities Makes it more difficult for me to be healthy	Access to parks, trails or outdoor activities Does not exist in my community
Access to community recreational centers	Access to community recreational centers Makes it easier for me to be healthy	Access to community recreational centers Does not have any influence on my health	Access to community recreational centers Makes it more difficult for me to be healthy	Access to community recreational centers Does not exist in my community
Access to public libraries	Access to public libraries Makes it easier for me to be healthy	Access to public libraries Does not have any influence on my health	Access to public libraries Makes it more difficult for me to be healthy	Access to public libraries Does not exist in my community
Access to churches or faith based organizations	Access to churches or faith based organizations Makes it easier for me to be healthy	Access to churches or faith based organizations Does not have any influence on my health	Access to churches or faith based organizations Makes it more difficult for me to be healthy	Access to churches or faith based organizations Does not exist in my community
Access to providers (doctors, clinics, etc.) in my community	Access to providers (doctors, clinics, etc.) in my community Makes it easier for me to be healthy	Access to providers (doctors, clinics, etc.) in my community Does not have any influence on my health	Access to providers (doctors, clinics, etc.) in my community Makes it more difficult for me to be healthy	Access to providers (doctors, clinics, etc.) in my community Does not exist in my community
Availability of fresh fruits and vegetables at stores near me, community gardens or markets	Availability of fresh fruits and vegetables at stores near me, community gardens or markets Makes it easier for me to be healthy	Availability of fresh fruits and vegetables at stores near me, community gardens or markets Does not have any influence on my health	Availability of fresh fruits and vegetables at stores near me, community gardens or markets Makes it more difficult for me to be healthy	Availability of fresh fruits and vegetables at stores near me, community gardens or markets Does not exist in my community
Access to workplace or employee wellness	Access to workplace or employee wellness Makes it easier for me to be healthy	Access to workplace or employee wellness Does not have any influence on my health	Access to workplace or employee wellness Makes it more difficult for me to be healthy	Access to workplace or employee wellness Does not exist in my community
Availability of family support services, such as those related to domestic or relationship violence or family social services	Availability of family support services, such as those related to domestic or relationship violence or family social services Makes it easier for me to be healthy	Availability of family support services, such as those related to domestic or relationship violence or family social services Does not have any influence on my health	Availability of family support services, such as those related to domestic or relationship violence or family social services Makes it more difficult for me to be healthy	Availability of family support services, such as those related to domestic or relationship violence or family social services Does not exist in my community

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* 9. Which of the following best describes how you or your family used social services in the past 12 months?

	I did not feel the need for this type of service.	I felt I needed help in this area but did not look or ask for help.	I tried to find help in this area, but did not know who/where to ask or could not find help.	I sought and received this kind of service.
Food pantry	Food pantry I did not feel the need for this type of service.	Food pantry I felt I needed help in this area but did not look or ask for help.	Food pantry I tried to find help in this area, but did not know who/where to ask or could not find help.	Food pantry I sought and received this kind of service.
Homeless shelter	Homeless shelter I did not feel the need for this type of service.	Homeless shelter I felt I needed help in this area but did not look or ask for help.	Homeless shelter I tried to find help in this area, but did not know who/where to ask or could not find help.	Homeless shelter I sought and received this kind of service.
Free or emergency childcare help	Free or emergency childcare help I did not feel the need for this type of service.	Free or emergency childcare help I felt I needed help in this area but did not look or ask for help.	Free or emergency childcare help I tried to find help in this area, but did not know who/where to ask or could not find help.	Free or emergency childcare help I sought and received this kind of service.
Domestic abuse services	Domestic abuse services I did not feel the need for this type of service.	Domestic abuse services I felt I needed help in this area but did not look or ask for help.	Domestic abuse services I tried to find help in this area, but did not know who/where to ask or could not find help.	Domestic abuse services I sought and received this kind of service.
Employment services	Employment services I did not feel the need for this type of service.	Employment services I felt I needed help in this area but did not look or ask for help.	Employment services I tried to find help in this area, but did not know who/where to ask or could not find help.	Employment services I sought and received this kind of service.
Prenatal programs or breast feeding support	Prenatal programs or breast feeding support I did not feel the need for this type of service.	Prenatal programs or breast feeding support I felt I needed help in this area but did not look or ask for help.	Prenatal programs or breast feeding support I tried to find help in this area, but did not know who/where to ask or could not find help.	Prenatal programs or breast feeding support I sought and received this kind of service.
Mental/behavioral health programs	Mental/behavioral health programs I did not feel the need for this type of service.	Mental/behavioral health programs I felt I needed help in this area but did not look or ask for help.	Mental/behavioral health programs I tried to find help in this area, but did not know who/where to ask or could not find help.	Mental/behavioral health programs I sought and received this kind of service.
Rural transit or city bus services	Rural transit or city bus services I did not feel the need for this type of service.	Rural transit or city bus services I felt I needed help in this area but did not look or ask for help.	Rural transit or city bus services I tried to find help in this area, but did not know who/where to ask or could not find help.	Rural transit or city bus services I sought and received this kind of service.
Walk in healthcare clinic	Walk in healthcare clinic I did not feel the need for this type of service.	Walk in healthcare clinic I felt I needed help in this area but did not look or ask for help.	Walk in healthcare clinic I tried to find help in this area, but did not know who/where to ask or could not find help.	Walk in healthcare clinic I sought and received this kind of service.
Financial help with bills (utility bills, etc.)	Financial help with bills (utility bills, etc.) I did not feel the need for this type of service.	Financial help with bills (utility bills, etc.) I felt I needed help in this area but did not look or ask for help.	Financial help with bills (utility bills, etc.) I tried to find help in this area, but did not know who/where to ask or could not find help.	Financial help with bills (utility bills, etc.) I sought and received this kind of service.
Financial help paying medical bills	Financial help paying medical bills I did not feel the need for this type of service.	Financial help paying medical bills I felt I needed help in this area but did not look or ask for help.	Financial help paying medical bills I tried to find help in this area, but did not know who/where to ask or could not find help.	Financial help paying medical bills I sought and received this kind of service.
Legal help	Legal help I did not feel the need for this type of service.	Legal help I felt I needed help in this area but did not look or ask for help.	Legal help I tried to find help in this area, but did not know who/where to ask or could not find help.	Legal help I sought and received this kind of service.
STI/STD testing, treatment or prevention	STI/STD testing, treatment or prevention I did not feel the need for this type of service.	STI/STD testing, treatment or prevention I felt I needed help in this area but did not look or ask for help.	STI/STD testing, treatment or prevention I tried to find help in this area, but did not know who/where to ask or could not find help.	STI/STD testing, treatment or prevention I sought and received this kind of service.
Help with my health insurance (regardless of how it is provided)	Help with my health insurance (regardless of how it is provided) I did not feel the need for this type of service.	Help with my health insurance (regardless of how it is provided) I felt I needed help in this area but did not look or ask for help.	Help with my health insurance (regardless of how it is provided) I tried to find help in this area, but did not know who/where to ask or could not find help.	Help with my health insurance (regardless of how it is provided) I sought and received this kind of service.
Substance abuse services	Substance abuse services I did not feel the need for this type of service.	Substance abuse services I felt I needed help in this area but did not look or ask for help.	Substance abuse services I tried to find help in this area, but did not know who/where to ask or could not find help.	Substance abuse services I sought and received this kind of service.

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* 10. How do you learn about help for things you need, like food pantries, housing or energy assistance programs, mental health services, or other support (check all that apply).

Newspapers

Television

Internet

Radio

Pamphlets or Hand Outs

Friends or Family

Health Clinics

Other

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* 11. Does Piatt County provide all the support and help that you or your family needs?

Yes

Sometimes

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* 12. If you answered no to number 11, where do you go for things you or your family need?

Decatur

Champaign

Clinton

Mattoon/Charleston

Effingham

None of the above

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* 13. Please consider the strengths of Piatt County healthcare (hospital, clinics, wellness). What are the things Piatt County does well?

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* 14. What health-related opportunities or problems in Piatt County are not being adequately addressed?

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* 15. What do you think are the FIVE most important health issues in your community?

Basic needs: food, shelter, safety, transportation, access to medical care

Access to care: medical/healthcare and health care coverage

Injuries: gun related, car accidents, 4-wheeler accidents, falls

Substance abuse: tobacco, alcohol, meth, heroin, prescription drugs

Child abuse/Safety: child abuse or neglect

Chronic diseases: diabetes, cancer, heart disease, stroke, high blood pressure, high cholesterol

Infectious diseases: HIV, chlamydia or other STDs, Hepatitis, food poisoning

Well-baby: prenatal care, after care for mother and newborns, teen pregnancy, unintended or unplanned pregnancy

Obesity: eating unhealthy foods, lack of healthy foods

Lack of exercise: physical inactivity, poor access to walking paths, sidewalks, parks, recreational activities

Mental/behavioral health: depression, stress, anxiety

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* 16. What is your gender?

Male

Female

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* 17. What is your year of birth?

2000 or after

1990-1999

1980-1989

1970-1979

1960-1969

1950-1959

Before 1950