Exit
Beyond Housing is conducting a community health needs assessment in efforts to expand our community health program initiatives in the Normandy School District area. We are asking you to complete this survey on behalf of your household. This survey is anonymous and no information will be reported from particular respondents. At the end of the survey, you will be asked if you would like to participate in focus groups, which will open a separate survey where you can provide contact information. If you have any questions or concerns regarding the survey, please contact Manyi Ayuk (mayuk@beyondhousing.org).

Question Title

* 1. How familiar are you with Beyond Housing?

Question Title

* 2. How familiar are you with Beyond Housing's Community Health Worker Program

Question Title

* 3. What is your zip code?

Question Title

* 4. Does your household

Question Title

* 5. How many years have you lived at your present address?

Question Title

* 6. How many people live with you in your household. Please include everyone who sleeps at your residence, including yourself?

Question Title

* 7. How many people in your household, including yourself, fall into each age group?

Question Title

* 8. What best describes your household's race/ethnicity? Check one.

Question Title

* 9. Do you or anyone in your household smoke tobacco, e-cigarettes, or vape in the house?

Question Title

* 10. Do you or anyone in your household drink excessively (For men, consuming 15 drinks or more per week. For women, consuming 8 drinks or more per week)?

Question Title

* 11. Please pick the response that is closest to your opinion regarding to your household:

  Strongly disagree Somewhat disagree Somewhat agree Strongly Agree
We feel safe walking around our neighborhood
We often go to local, neighborhood parks
We have access to a grocery store within 20 minutes from our home

Question Title

* 12. Using the list below, rank the top three places members of your household go when they become sick, with 1 being the place you go the most. Leave blank if members of your family don’t go to the doctor.

Question Title

* 13. Check if any members of your household suffer from the following health issues.

Question Title

* 14. How confident do you feel managing your household's health?

Question Title

* 15. How does your household pay for your health care? Check all that apply.

Question Title

* 16. Please check if any member of your household in the last year:

Question Title

* 17. Please check all the barriers that you face while trying to manage your family’s health.

Question Title

* 18. Please list any other barriers you have faced in managing your family’s health.

Question Title

* 19. Please indicate if your household might need these additional supports and resources to assist with your household’s health conditions.

Question Title

* 20. Are there any concerns that have not been addressed in this survey that impact your household's health?

Page1 / 1
 
 100% of survey complete.

T