HNA 2018 Shropshire


Welcome to the Health Needs Audit. This survey asks clients questions about their health needs and access to health services in your local area. Please refer to the Guidance to help you carry out the survey. Make sure that the client has read Appendix Two of the Guidance, Information for participants and that they understand how this information will be used. Some questions are mandatory. If the client does not wish to answer, please tick the 'Client did not answer' option.


  A note on privacy
This survey is anonymous.
The record kept of your survey responses does not contain any identifying information about you unless a specific question in the survey has asked for this. If you have responded to a survey that used an identifying token to allow you to access the survey, you can rest assured that the identifying token is not kept with your responses. It is managed in a separate database, and will only be updated to indicate that you have (or haven't) completed this survey. There is no way of matching identification tokens with survey responses in this survey.
 

INTRODUCTION

Before you get started, please ask the client to confirm that they understand how their data will be used, and that they have not already completed a survey for the current audit:



*Please confirm you are happy to proceed
Check any that apply
A FEW QUESTIONS ABOUT YOU
1. HOW OLD ARE YOU?

Only numbers may be entered in this field

2. WHICH OF THESE CATEGORIES BEST DESCRIBES YOU AT PRESENT?

Choose one of the following answers
*3. HAVE YOU EVER (IN YOUR LIFETIME) DONE ANY OF THE FOLLOWING? IF YES, PLEASE INDICATE THE AGE AT WHICH THIS FIRST OCCURRED.
Check any that apply
*4. WHERE ARE YOU CURRENTLY SLEEPING? (if this frequently changes, please say where you slept last night)
Choose one of the following answers
5. THINKING ABOUT THE MOST RECENT TIME YOU BECAME HOMELESS, WHAT WAS THE MAIN REASON FOR THIS? Please give one primary reason and one secondary reason if applicable.
  Primary reason Secondary reason
Parents / care-givers no longer able or willing to accommodate
Other relatives or friends no longer able or willing to accommodate
Non-violent relationship breakdown with partner
Abuse or domestic violence
Overcrowded housing
Eviction or threat of eviction
Rent or mortgage arrears
Other debt-related issues
End of tenancy (social housing)
End of tenancy (private rented sector)
Financial problems caused by benefits reduction
Unemployment
ASB or crime
Drug or alcohol problems
Mental or physical health problems
Leaving institutional care (e.g. hospital, prison, care etc.)
Other (please state)
6. DO YOU HAVE ANY OF THE FOLLOWING BACKGROUNDS? (This helps us to understand how your past experience may have affected your health or services you’ve been able to access)
Check any that apply
*7. WHAT IS YOUR GENDER?
Choose one of the following answers

8. WHICH OF THE FOLLOWING BEST DESCRIBES YOUR SEXUAL ORIENTATION?
Choose one of the following answers

*9. WHAT IS YOUR ETHNIC GROUP?
Choose one of the following answers

10. WHAT IS YOUR IMMIGRATION STATUS?
Choose one of the following answers

11. DO YOU HAVE RECOURSE TO PUBLIC FUNDS (BENEFITS)?
Choose one of the following answers

*12. DO YOU HAVE ANY LONG-STANDING ILLNESS, DISABILITY OR INFIRMITY? By long-standing I mean anything that has troubled you over a period of time or that is likely to affect you over a period of time?
Choose one of the following answers

SOME QUESTIONS ABOUT YOUR PHYSICAL HEALTH
*13. HAS A DOCTOR OR HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE ANY OF THE FOLLOWING PHYSICAL HEALTH PROBLEMS?
  Yes, in the last 12 months Yes, more than 12 months ago No Client did not answer
Heart problems (heart attack, angina, murmur or abnormal heart rhythm)
Chronic breathing problems (bronchitis, emphysema or obstructive airways disease)
Asthma
Cancer
High blood pressure
Joint aches/problems with bones and muscles
Difficulty seeing/eye problems
Skin/wound infection or problems
Problems with feet
Fainting/blackouts
Urinary problems/infections/incontinence
Circulation problems/blood clots
Liver problems
Stomach problems, including ulcers
Dental/teeth problems
Diabetes
Epilepsy/seizures
HIV
Tuberculosis (TB)
Hepatitis C
Other (please state)
14. WAS THERE ANY TIME DURING THE LAST TWELVE MONTHS WHEN, IN YOUR OPINION, YOU NEEDED A MEDICAL EXAMINATION OR TREATMENT FOR A PHYSICAL HEALTH PROBLEM BUT YOU DID NOT RECEIVE IT?
Choose one of the following answers

*15. DO YOU SMOKE CIGARETTES, CIGARS OR A PIPE?
Choose one of the following answers

SOME QUESTIONS ABOUT MENTAL HEALTH AND DEVELOPMENT
*16. HAS A DOCTOR OR HEALTH PROFESSIONAL EVER TOLD YOU THAT YOU HAVE ANY OF THE FOLLOWING MENTAL HEALTH OR BEHAVIOURAL CONDITIONS?
  Yes, in the last 12 months Yes, more than 12 months ago No Client did not answer
Depression
Anxiety disorder or phobia
Psychosis (including schizophrenia or bipolar disorder)
Personality disorder
Post traumatic stress disorder (PTSD)
Eating disorder
Dual diagnosis with a drug or alcohol problem. Dual diagnosis means a mental health problem alongside drug or alcohol use
ADHD (attention deficit hyperactivity disorder)
Learning disability or difficulty
Autism/aspergers
Other mental health or developmental condition (please state)
17. WAS THERE ANY TIME DURING THE LAST TWELVE MONTHS WHEN, IN YOUR OPINION, YOU PERSONALLY NEEDED AN ASSESSMENT OR TREATMENT FOR A MENTAL HEALTH PROBLEM BUT YOU DID NOT RECEIVE IT?
Choose one of the following answers

18. DO YOU USE DRUGS OR ALCOHOL TO HELP YOU COPE WITH YOUR MENTAL HEALTH – this can be called ‘self-medicating’?
SOME QUESTIONS ABOUT DRUG AND ALCOHOL USE
*19. IN THE LAST 12 MONTHS HAVE YOU TAKEN ANY OF THE FOLLOWING?
Check any that apply
20. DO YOU TAKE METHADONE, SUBUTEX OR ANY OTHER SUBSTITUTE DRUGS?
Choose one of the following answers

*21. DO YOU HAVE OR ARE YOU RECOVERING FROM A DRUG PROBLEM?
Choose one of the following answers

*22. HOW OFTEN HAVE YOU HAD AN ALCOHOLIC DRINK DURING THE LAST 12 MONTHS?
Choose one of the following answers
*24. DO YOU HAVE OR ARE YOU RECOVERING FROM AN ALCOHOL PROBLEM?
Choose one of the following answers

SOME QUESTIONS ABOUT YOUR ACCESS TO SERVICES
*25. ARE YOU REGISTERED WITH THESE SERVICES IN YOUR LOCAL AREA?
  Yes No Client did not answer
GP or homeless healthcare service
Dentist
26. HAVE YOU BEEN REFUSED REGISTRATION TO A GP/HOMELESS HEALTHCARE SERVICE OR DENTIST IN THE PAST 12 MONTHS?
  Yes No
GP/homeless health care service
Dentist
*27. IN THE LAST 12 MONTHS HAVE YOU:-
  No Once Twice 3 Times Over 3 times Client did not answer
Been to a GP or homeless healthcare service?
Been to A&E?
Used an ambulance?
Been admitted to hospital?
SOME QUESTIONS ABOUT STAYING HEALTHY
28. BY PLACING A TICK IN ONE BOX IN EACH GROUP BELOW, PLEASE INDICATE WHICH STATEMENTS BEST DESCRIBE YOUR OWN HEALTH STATE TODAY:
*MOBILITY
Choose one of the following answers

*SELF-CARE
Choose one of the following answers

*USUAL ACTIVITIES
Choose one of the following answers

*PAIN/DISCOMFORT
Choose one of the following answers

*ANXIETY/DEPRESSION
Choose one of the following answers

*28a. To help people say how good or bad a health state is, we have a scale on which the best state you can imagine is 100 and the worst state you can imagine is marked 0. We would like you to indicate on this scale how good or bad your own health is today, in your opinion. Please do this by saying where on this scale your health state is today.

Only numbers may be entered in this field

29. COMPARED TO TWELVE MONTHS AGO, HOW WOULD YOU SAY YOUR HEALTH IS NOW?
Choose one of the following answers

30. ARE YOU TAKING ANY MEDICATION PRESCRIBED FOR YOU AT THE MOMENT? This includes medicines, pills, syrups, ointments, puffers or injections.
31. HAVE YOU BEEN VACCINATED AGAINST HEPATITIS B?
Choose one of the following answers

32. HAVE YOU BEEN VACCINATED AGAINST FLU?
Choose one of the following answers

34. HAVE YOU HAD A SEXUAL HEALTH CHECK IN THE PAST 12 MONTHS?
Choose one of the following answers

35. DO YOU KNOW WHERE TO ACCESS FREE CONTRACEPTION?
36. DO YOU KNOW WHERE TO ACCESS ADVICE ABOUT SEXUAL HEALTH?
39. ON AVERAGE, HOW MANY MEALS DO YOU EAT A DAY? If this is difficult, please think about the meals you ate yesterday.
Choose one of the following answers

40. HOW MANY PORTIONS OF FRUIT AND VEG DO YOU USUALLY EAT PER DAY? If this is difficult, please think about what you ate yesterday.
Choose one of the following answers

41. HOW OFTEN PER WEEK DO YOU EXERCISE FOR 30 MINS OR MORE? (Activity that raises your heart rate and makes you breathe faster).
Choose one of the following answers

42. IS THERE ANYTHING ELSE YOU WOULD LIKE TO TELL US ABOUT YOUR HEALTH & THE SUPPORT YOU RECEIVE?