Table 1

Selected items from a social determinants of health survey

On a scale from 1 to 5, please rank your level of confidence for each of the following areas as they exist in your community.
1 No confidence 2 Rarely confident 3 Confident 4 Somewhat confident 5 Extremely confident
□ Education□ Community activities□ Language
□ Employment/job skills□ Police□ Family
□ Health care□ Personal space□ Substance abuse
□ Healthy eating□ Legal issues□ Mental health
□ Parks/green space□ Insurance□ Physical activity
□ Community safety□ Transportation□ Housing
□ Workplace safety
The biggest challenge I see in this community is: ___________________________________
What are the greatest strengths of your community? (Check boxes for all that apply.)
□ Education□ Police□ Mental health treatment access
□ Employment□ Personal space□ Substance abuse treatment access
□ Health care□ Insurance□ Affordable housing options
□ Healthy eating□ Transportation□ Parks
□ Workplace safety□ Community safety□ English
□ Community activity□ Family
Other: ________________________________________
What are the greatest weaknesses of your community? (Check boxes for all that apply.)
□ Education□ Lack of community activities□ Poor access to health care
□ Job skills□ Police□ Insurance
□ Employment□ Lack of personal space□ Limited transportation
□□ Substance abuse□ Lack of affordable housing□ Workplace safety
□ Mental health□ Legal issues□ Language skills
□ Lack of healthy food□ Family□ Minimal recreation and green spaces
□ Community safety
Other: _________________________________________
On a scale from 1 to 4, please rank the level of need in the following areas as they exist in your community.
1 High 2 Low 3 No need 4 Don’t know
Health Care: what is the greatest health care need?
 □ Primary care□ Substance abuse
 □ Specialty care□ Mental health
 □ Dental care□ Transportation to health care
 □ Eye care□ Appointment
Nutrition: what is the greatest nutritional need?
 □ Access to affordable healthy foods□ Access to healthy food in stores
 □ Access to healthy food in school□ Cooking classes
Stress: what is a source of stress in your daily life?
 □ Relationships□ Access to transportation
 □ Fear of domestic violence□ Access to safe housing
 □ Access to health care service□ Access to education
 □ Access to food□ Community violence
Transportation: what is the greatest transportation need?
 □ Transportation to health care□ Affordable transportation
 □ Transportation to work□ Transportation to community activities
 □ Transportation to grocery stores□ Reliable, scheduled transportation
Language: what language barriers do you experience in your community?
 □ Access to multi-lingual services
 □ Access to language skill education
 □ Access to employment in your first language
Substance abuse: what is the greatest substance abuse need?
 □ Prevention programs□ Reduction of alcohol use
 □ Reduction of drug use□ Drug specific treatment
 □ Reduction of prescription drug use□ Access to treatment-outpatient
 □ Access to treatment-residential
Mental health: what is the greatest mental health need?
 □ Residential mental health treatment□ Prevention
 □ Mental health professionals□ Access to treatment
Quality of life: what would improve the quality of life for you in your community?
 □ Educational opportunities□ Community activities
 □ Housing□ After school programs
 □ Recreational opportunities□ Partnership with local police department
 □ Community safety□ Connections to resources/community agencies
 □ Health care access□ Access to local parks and community classes
 □ Dental care access□ Trails and paths
 □ Public transportation□ Substance abuse support
 □ Mental health services□ Employment opportunities
Housing: what is the greatest housing need?
 □ Resident advocacy□ Access to loans
 □ Senior housing□ Financial literacy
 □ Affordable housing
Employment: what is the greatest employment need?
 □ Job search and placement assistance
 □ Income-generating skills
 □ Internships, paid, leadership, or volunteer work opportunities
Education: what is the greatest education need?
 □ Childhood development□ Parenting classes
 □ Youth development□ Health education
 □ Access to the outdoors□ Adult education
 □ Nutrition and physical exercise□ Day care
 □ Life skills training□ Quality of available education
  • Note: The survey is used with permission from the Colorado Community Health Network ( Demographic items are not included here. The full survey is available from the corresponding author.