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Example 1: Douglas County Community Health Concerns Survey

This survey was conducted in partnership with the Lawrence-Douglas County Health Department, the Douglas County Community Health Improvement Partnership, and the University of Kansas Center for Community Health and Development.

The purpose of the concerns survey was to obtain community members’ feedback about the importance of — and their satisfaction with — various community health issues. A 40-item survey was developed by members of the Community Health Assessment Steering Committee that consisted of a number of statements that described community issues. Participants were asked to rate the importance of each issue and their personal satisfaction with how well that issue was being addressed. Surveys were administered via paper collection and online. Outreach was conducted to promote completion of the survey (paper or online), at such sites as WellCommons, public libraries, Health Care Access, local faith organizations, schools and businesses. The results will be used to make recommendations to bring about improvements in community health.

Surveys were completed by 1,355 Douglas County residents, The graphs below reflect the demographic characteristics of participants:

It should be noted that the sample of Douglas County residents who completed the concerns survey was similar to the population of Douglas County residents for many demographic characteristics, including racial and ethnic distribution, educational attainment and income categorization. The sample’s distribution by gender and age did not reflect the general population (e.g., the percentage of women completing the survey was about 69% while only 50.7% of Douglas County residents are women; youth were excluded from participation).

Additional analysis was conducted to examine how responses from men and women were different. Issues that were identified as top problems by women also appeared on the top problems list for men, but the order in which they appeared did vary. For example, when listed in order, the indicator “Healthy foods are available and affordable for all” was listed third on the list of top problems for women and fourth on the list of top problems for men. Generally, the lists of top strengths for women and men included the same indicators in different orders, although women ranked, “Home-based and hospice services are available in the county” as a top strength, while men did not.

Responses from the survey about perceptions of importance and satisfaction with the issues were used to determine the relative strengths and problems. When an issue was rated as very important and people indicated satisfaction with the community’s efforts to address the issue, that issue was identified as a relative strength. Conversely, when an issue was rated as very important and people were unsatisfied with the community’s efforts to address the issue, the issue was identified as a relative problem. The lists below reflect the top strengths and problems identified by community members.

Relative Strengths (Higher importance and higher satisfaction)

Please note the order reflects the ranking based on responses.

  1. Victims of rape and sexual assault get the help they need.
  2. Quality education is available for all.
  3. Children and youth have access to basic medical services.
  4. Pregnant women access early prentatal care.
  5. Our youth graduate from high school.
  6. An adequate number of health professionals are available to serve the county.
  7. Pregnant women and new mothers adopt healthy behaviors (e.g., breastfeeding, avoid smoking or using alcohol or drugs, eat healthy foods).
  8. Local air, water, and soil are free from pollutants.

Relative Problems (Higher importance and lower satisfaction)

Please note the order reflects the ranking based on responses. The text below reflects how the indicator was stated in the concerns survey. All indicators were framed positively and to reflect that, the indicators are perceived to be problems text (in brackets) was added.

  1. Health insurance is [not] available for all.
  2. Health care is [not] available for all.
  3. Children and youth are [not] free from abuse.
  4. Healthy foods are [not] available and affordable for all.
  5. People do not drink alcohol and drive. [The problem is that people do drink and drive.]
  6. Safe and affordable housing is [not] available.
  7. Dental care and preventative screenings are [not] available for all.
  8. Mental health problems are [not] recognized and treated in our community.

Although these problems were included in the list of top problems across Douglas County residents, other indicators did appear as top concerns for some sub-groups (e.g., low-income, seniors, uninsured, residents of one of the smaller towns in the county), including:

  • Individuals are free from physical or verbal abuse from their spouses or partners. [Indicated by low-income residents, respondents between 18-44, Eudora residents and uninsured respondents]. Eudora residents also rated, “Children and adults do not engage in aggressive or threatening behavior” as a top problem.
  • Adults in our community have the necessary life skills to be successful. [Indicated by low-income residents and uninsured respondents]. Additionally, the uninsured respondents rated, “People have opportunities to receive education or skills training” as a top problem.
  • Youth and adults do not binge drink (four or more drinks in about two hours). [Indicated by respondents between age 45 and older and insured respondents].
  • Children, youth and adults maintain healthy weights and active lifestyles. [Indicated by Eudora and Lecompton residents and uninsured respondents].
  • Individuals are aware of and know how to access health care services. [Indicated by Lecompton residents].

​View the Douglas County Community Health Assessment Report.


Example 2: Sample concerns survey cover letter

Fredville Community Health Coalition

9876 Maple St., Fredville, CO 12345

Fredville needs your help!

Your opinion about the health concerns here in Fredville is important, so we're asking for your help. The information you can give us will be used to develop laws and policies and improve services that can benefit you. Please take a few minutes of your time right now to complete and return the enclosed survey.

This survey identifies community health issues that may be important to people in your community. If you need help reading or completing the survey, please ask a friend or a family member to assist you. You don't have to complete this survey to receive any services or benefits you get. It is completely voluntary on your part, and your answers will be kept confidential.

Instructions: In the first column, circle the number that shows how important each issue is to you. In the second column, circle the number that shows how satisfied you are with your community's efforts to address the issue.

  How important is this issue to you? How satisfied are you with the
community's efforts in this area?
  Not                                            Very Not                                            Very
1. Free childcare is available for all low-income
parents with children under 6 years of age
0           1           2           3           4 0           1           2           3           4

 In the example, if free child care for low-income kids was really very important to you and you are unhappy with the community's efforts in providing that child care, you would circle 4 on the first part of the question and 0 on the second part.

Please read each of the items in this survey, and circle the numbers to indicate the importance of each issue and your satisfaction with the community's efforts. The last part of the survey asks for information about you. This information will be kept confidential; it just helps us know what sort of concerns are most important to different groups of people. Please return the completed survey to us in the enclosed postpaid envelope.

Thank you for taking the time to complete the survey. We hope to use this information to improve the health of citizens of Fredville. We appreciate your help.






Example 3: Sample brief report of community health strengths and problems

Health Concerns Survey, Fredville, Colorado

Concerns Brief Report: Top Strengths and Top Problems

Survey Question Average Importance Average Satisfaction
Relative strengths    
Vaccinations are available and affordable 91% 81%
The City of Fredville sponsors free public health fairs offering cholesterol and blood pressure checks 89% 83%
Emergency medical services are adequate in the City of Fredville 92% 73%
Older adults in Fredville can remain in their own homes if they wish 88% 69%
Basic health care services (such as regular check-ups) are available and affordable 89% 67%
Relative problems    
Kids do not have access to drugs or alcohol in Fredville 90% 35%
Health insurance is available and affordable to all people in Fredville 87% 39%
Parents know how to talk to their kids about drugs and alcohol 86% 53%
Financial help is available for people with chronic health issues 86% 53%
In Fredville, toxic wastes are disposed of safely 70% 49%


Example 4: interview with Dr. Glen White on his experience with concerns surveys

Dr. Glen White wears many hats at the University of Kansas. In addition to his position as an Associate Professor in the Department of Human Development and Family Life, he is Co-Director of the Research and Training Center on Independent Living. Dr. White has worked extensively with the concerns report method and we asked him to relate some of his experiences.

CTB: I wondered if maybe you could relate any experiences you've had with how a community initiative or coalition has used concerns surveys to advance their work.

Dr. White: I worked on one recently constructed concerns survey that's the beauty of this method; it's so easy to modify. A lot of people don't understand it, they think it's too simple... but it's a very effective tool. I worked on one looking at health issues for all of Osage County, an area that's pretty much rural. And we did a lot of structured interviews. Consumers did most of the surveys to help us find out what their needs were. In addition, we conducted structured interviews with key agencies in or around that county: Meals on Wheels, nursing homes, community centers, business associations, the area agency on aging, organizations like that. Just to get a composite kind of a mosaic, if you will picture of what the needs were. So it wasn't a formal coalition-building going on with that case, but it was just one part of that mosaic that really helped us. The results were accredited in a national report.

CTB: Really!

Dr. White: So I did surveys with three sites, one in Puyallup, Washington; one in a place called Polson, Montana; and then the area of Osage County. Then we came up with a number of different needs assessments, which were corroborated with the kind of concerns report that was sent out. We went to an independent living center in Osage City, where there's a food distribution point. People can receive their Cheerios or whatever the government is providing that week. They had people fill out surveys when they came in. So we had about 125 surveys from that center alone.

Another application with the concerns report method was in Atlanta, Georgia, looking at people with head injury, brain injury survivors.

Another thing we've used concerns reports for is health promotion for women with disabilities, because a lot of these women that want to be healthy find there are a lot of barriers that prevent them from being healthy. We paid for transportation for them to come in to have a pretty representative group. Our survey return rate wasn't as high as we wanted it to be but we thought that it was pretty good. The survey responders identified a number of health issues and physical barriers, attitudinal barriers that women encountered. Trying to stay healthy, several noted that health fitness clubs and centers are not accessible. One of the issues that women brought up in the group that's not something that I would have known anything about without their input is the issue of spandex! Not everybody looks like a Barbie doll. For some women with disabilities, especially if they don't have any muscle tone in their legs, how they looked in exercise wear was really a big barrier for them in terms of physical activity. You know, all of those other Barbies jumping around in spandex can be very intimidating.

CTB: I would think there probably isn't a lot of exercise wear designed for people with disabilities.

Dr. White: Right in addition to the spandex issue, women identified the lack of available equipment. Also, restrooms and showers are often not accessible. We sent out the survey broadly to places like community centers, vocational and rehabilitative organizations and disability groups like the MS society or whatever. And we received a moderate amount of responses.

But then we convened a group of women about 50 of them - at the Holidome over in Topeka. We talked about issues, broke up into groups and came up with certain solutions or thoughts involving actions about how to resolve their concerns. So that was a very positive experience.

CTB: Have you ever had the results of a concerns survey really surprise you?

Dr. White: One I remember in particular was kind of interesting, one we did with Kansans with developmental disabilities. We wanted to do a concerns survey with people with mental retardation, people with psychiatric disabilities, and one with people traumatic brain injury three populations of people we were really very interested in learning more about. We didn't want to set our own agenda for doing what they were doing. So we wanted to have them determine the direction.

At any rate there was a national survey done by the President's council or the ARC, the Association for Retarded Citizens, and what they had set were certain priorities that were quite different than what was articulated from the Kansans. One thing that I thought was really interesting, especially for people with mental retardation, was a big interest in adaptive equipment or assistive technology. So we broke up into the sessions where we talked about the issues. We had the consumers the people with mental retardation talk about the results themselves and then we had support providers like personal attendants and family members going to another group, so they wouldn't exert undue influence on the consumers with mental retardation. Then we had each group process what were the issues and concerns, and they were a little bit different. Some of the main issues were addressed in both groups, but the priorities of the issues were different. And that was kind of a neat thing. That's one reason that it's so important what we're doing with the Community Tool Box the idea of a empowerment.

CTB: Definitely.

Dr. White: We have one concerns survey we're starting on right now we just received a big grant in which one of the first things we're going to be doing is looking at dissemination and utilization of research information. There's a lot of research out there right now on disability issues that isn't understandable for consumers with disabilities its written for professional consumption. So we're going to develop and send out a concerns report. We'll send it out broadly at the national level and find out from consumers their concerns are regarding accessing disability research information that would be valuable to them. As far as how it is assessed, how it's delivered to them. What type of research information are they interested in, how can they best utilize it. So I think that's going to be really exciting and it will help us set our research agenda for the next five years.

Chris Hampton