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Table of Contents >
   Part B. Community Assessment, Agenda Setting, and Choice ... >
      Chapter 3. Assessing Community Needs and Resources >
         Section 10. Conducting Concerns Surveys >
             Tools & Checklists - A checklist that summarizes the major points contained in the section. >

Conducting Concerns Surveys

  

Tools & Checklists

 Contributed by Chris Hampton Edited by Bill Berkowitz and Jerry Schultz

Tools

Tool #1: Possible categories for questions on the concerns survey
Tool #2: Possible selections for the demographics section of the concerns survey

Checklist

Tools

Tool #1: Possible categories for questions on the concerns survey

Use the following categories to help you brainstorm for possible questions for your survey:

  • AIDS and sexually transmitted diseases
  • Alcohol and drug abuse
  • Cancer
  • Heart disease
  • Injury prevention home and recreational safety
  • Injury prevention motor vehicles
  • Injury prevention occupational safety
  • Injury prevention public safety
  • Mother and child health
  • Smoking and tobacco use
  • Teenage pregnancy
  • Basic health issues
  • Domestic violence

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Tool #2: Possible selections for the demographics section of the concerns survey


1.

What is your county of residence?

2.

What is your gender?

Male(___)1

Female(___)2

3.

What is your race?

White/Caucasian

(___)1

Black/African-American

(___)2

Hispanic/Latino/Latina

(___)3

Native American

(___)4

Asian/Pacific Islander

(___)5

Biracial/Other

(___)6

4.

Are you a registered voter?

Yes(___)1

No(___)2

5.

Are you employed?

Yes(___)1

No(___)2

6.

Please check your age group:

Under 18

(___) 1

18 - 24

(___) 2

25 - 34

(___) 3

35 - 54

(___) 4

55 - 64

(___) 5

65 or older

(___) 6

7.

What is your household's annual income?

Under $5,000

(___) 1

$5,000 to $10,000

(___) 2

$10,000 to $15,000

(___) 3

$15,000 to $25,000

(___) 4

Over $25,000

(___) 5

8.

How many people does this income support?

1

(___) 1

2

(___) 2

3

(___) 3

4

(___) 4

5

(___) 5

6 or more

(___) 6

9.

Source(s) of income please check all that apply:

Earnings from job

(___) 1

SSI or SSDI

(___) 2

Retirement

(___) 3

Other disability benefits, worker's compensation

(___) 4

Sheltered workshop

(___) 5

Self-employed

(___) 6

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Checklist

Here, you'll find a checklist which summarizes the major points contained in the text.


____You understand what a concerns survey is.

____You understand how a concerns survey is part of the concerns report method.

____You understand the reasons why you might want to conduct a concerns survey.

____You understand that a concerns survey should usually be done with a broad cross-section of the community as a whole.

____You have considered the budget and decided what sort of resources and supplies you'll need to complete the survey.

____You have put together a working group to develop the survey.

____You have met with your working group to come up with survey items.

____Invite selected decision makers to submit additional survey items

____You have prepared your survey questions, using two types of questions for every selected issue: how important the issue is to citizens and how much satisfaction citizens have with the community's efforts on the issue.

____You have narrowed your list of survey items down to approximately 30.

____You have decided what demographic information to ask for in the survey.

____You have gathered the items you'll need to do a direct mailing.

____You have completed the cover letter.

____You have made enough copies of the survey, demographic sheet, and cover letter for each survey recipient.

____You have prepared and stamped the two business-size envelopes for each person.

____You have stuffed the envelopes that have the recipient's mailing address with all the survey material.

____ If you want to track the surveys in any way, you have coded your envelopes.

____You have mailed your surveys out, by bulk mail if possible.

____You have considered whether to employ any other methods of distributing or collecting surveys.

____You have gathered incoming surveys collected at participating site

____You have reviewed returned surveys, checking for incomplete surveys or those returned for having an improper mailing address.

____You have secured a larger return, if necessary.

____You have figured out the results by averaging the importance and satisfaction reported for each item or issue.

____You have written a brief report summarizing the strengths and problems as well as an overall approval rating for the community based on the average satisfaction score for all items and identifying five to ten strengths and five to ten problems in terms of health risks, services, and public perceptions of health

____You have shared this information with your staff, gotten their feedback, and discussed whether any further surveying needs to be done before completing.

____You have conducted a public meeting to discuss the results and brainstorm for solutions.

____You have written a one-page narrative for each issue discussed by the group.

____You have written a concerns report consisting of an executive memo, brief report, data table, the problem-solving discussion report, demographic data and other displays, and suggestions on how to use the report in the planning process

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