Lana’i Community Health Center Community Needs Assessment Survey - English

Community Needs Assessment Survey- English

This survey is being conducted by the Lana’i Community Health Center (LCHC) to ensure that we are doing our best to meet the needs of the Lana’i community. We appreciate your help in answering these survey questions and ask that you be as honest as possible as your answers will be anonymous. Please DO NOT put your name on this survey. Thank you.

LCHC provides integrated services including the following:

Dental Care	Health Education
Medical Care for Elderly	Tele-OB/Gynecology
Mental Health/Behavioral Health	Vision
Children’s Health Care	Tele-Derm
Pregnancy Care	Tele-Psychiatry
Chronic Disease Programs	OB Ultrasound
Tele-GI	Tele-Nephrology
Tele-Pediatrics	Tele-Cardiology
Abdominal Ultrasound, Renal Bladder, Liver, Pelvic, Thyroid, Vascular, Breast, Subcutaneous Masses
Outreach	Eligibility Assistance

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* 1. What additional services would you like to have more available on Lana’i?

Traditional Healing

Support Groups

Pediatrics

Other

Other (please specify)

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* 2. Please pick the top three most important health issues in your community:

Diabetes

High Blood Pressure

Heart Disease

Chronic Pain

Teen Pregnancy

No Insurance

Substance Abuse

Infant Deaths

Poor Oral Health

Low Birth Weight

High Level of Stress

Aging Population

Lack of Health Information

Obesity

Lack of Access to Services

Cancer

Other

Other (please specify)

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* 3. Please pick the top three most important social issues in our community:

Education

Financial Support

Housing Insecurity

Immigration Status

Sexual Orientation

Family Composition/Dysfunction Concerns

Employment

Food Insecurity

Discrimination

Gender Identity

Domestic Violence/Safety Concerns

Public Safety/Neighborhood

Other (please specify)

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* 4. Please identify any barriers that you believe make your access to health care services difficult:

Transportation to/from appointment

Ability to Communicate well with Providers (choose all that apply):

Provider does not listen to me when I am explaining my feelings and problems

Cannot talk with provider when I call

Provider does not return my calls

Provider does not speak my language and does not use an interpreter

Language Translations Services

Financial Limitations (see question 5 below)

None of the above

Other (please specify)

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* 5. Are you aware that LCHC has financial assistance (i.e., sliding fee scale, budget plans, etc.) available for patients who might be reluctant to seek health care services because of financial limitations?

Yes

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* 6. Background Information - Male or Female?

Male

Female

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* 7. Background Information - What is your age?

Infant

120

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 8. Background Information - What is the highest level of education you have completed? Please choose ONE.

Grade school

Middle/Intermediate High school

Some college

College graduate or higher

Graduate or higher

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* 9. Which of the following categories best describes your gross household income during the last year?

0 - $20,000

$20,001 - $40,000

$40,001 - $60,000

$60,001-$80,000

$80,001 - $100,000

Above $100,00

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* 10. How many people live in your home, including yourself?

8 or more

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* 11. Which ethnicity do you identify most with?

Hispanic

Non-Hispanic

Refused to Report

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* 12. Which ethnicity do you identify most with?

American Indian/Alaska Native

Native Hawaiian or Other Pacific Islander

Black or African American

White

Asian

Other Pacific Islander

Refuse to Report

More than 1 Race

Other (please specify)

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* 1. What additional services would you like to have more available on Lana’i?

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* 2. Please pick the top three most important health issues in your community:

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* 3. Please pick the top three most important social issues in our community:

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* 4. Please identify any barriers that you believe make your access to health care services difficult:

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* 5. Are you aware that LCHC has financial assistance (i.e., sliding fee scale, budget plans, etc.) available for patients who might be reluctant to seek health care services because of financial limitations?

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* 6. Background Information - Male or Female?

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* 7. Background Information - What is your age?

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* 8. Background Information - What is the highest level of education you have completed? Please choose ONE.

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* 9. Which of the following categories best describes your gross household income during the last year?

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* 10. How many people live in your home, including yourself?

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* 11. Which ethnicity do you identify most with?

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* 12. Which ethnicity do you identify most with?

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* 13. Health Problems you currently have: (Please list)