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In order to continue to assess the health needs of our community, UK King’s Daughters is asking you to provide your thoughts and opinions on your health and the health of your community. By taking this brief survey we can learn about health needs, concerns and barriers, which in turn will allow us to devise improvement strategies. Your participation in this assessment is completely voluntary and confidential. There will be no individual responses shared. We appreciate your time and input.

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* 1. How would you rate your overall health?

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* 2. Do these health issues affect YOU or your family?

  Yes No Prefer not to answer
Alcohol use
Drug use
Smoking/tobacco use/vaping
Cancer
Breathing disorders (COPD, asthma, etc.)
Diabetes/sugar levels
Stroke
Heart disease
High blood pressure
Developmental disability
Mental health
Obesity/overweight (adult/Childhood)
Dental health/access to dentist
Physical disabilities
Suicide

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* 3. Most of my healthcare support/advice comes from:

  Disagree Neutral Agree
My medical provider
My family
My friends
My co-workers
My church family
I avoid healthcare
The internet
Social media

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* 4. Within the past year, where did you go most often for healthcare?

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* 5. What are your barriers to healthcare? (check all that apply)

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* 6. Please choose your age group.

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* 7. What is your primary language?

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* 8. Please choose a race/ethnicity that best represents you.

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* 9. What is your employment status?

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* 10. What is the highest degree or level of school you have completed?

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* 11. What is your annual household income?

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* 12. Community Resources and Health Behaviors: With regard to your community, please indicate how strongly you agree or disagree with each statement.

  Disagree Agree Does not apply
I have access to immunizations for children in my community
I have access to vaccinations for adults in my family
I have access to five fruits and vegetables each day
I have access to primary care physicians that are available in a timely manner
I have access to transportation to/from medical appointments
I have access to healthcare in my community that adequately meets the needs of children
I have access to cancer services that meets the needs of the community
I usually exercise 30 minutes a day, three to five days a week
I have access to affordable child care
I have access to support groups for health issues that are important to me
I have access to services that address drug addiction and alcohol abuse
I have access to assistance with activities of daily living for seniors
I have access to home health care services
When I visit a health care provider, I feel my family and I are being treated equitably/fair
I have access to healthcare in my community that adequately meets the needs of adults for primary care
In the past 12 months, I have delayed healthcare due to cost and/or lack of insurance coverage
I have access to family, friends and others as a support system
I have access to resources that I need in the community
I have access to affordable housing in our community

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* 13. What has had a positive impact on the health of the community over the last three years?

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* 14. When was your last medical checkup (routine physical)?

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