• Research Health Equity Project Part 1

    Approximately 15 minutes

  • Instructions: Please answer each question as accurately and as honestly as possible. Your identity will remain private and confidential. Take as many breaks as needed if you start to feel tired answering questions. If answering any of the questions makes you uncomfortable or very stressed, please stop completing the survey immediately.

  • Are you fluent with reading or speaking English?*
  • Do you have access to a computer with a microphone?*

  • Group List:

    • 65 years of age or older
    • Veteran
    • Low income
    • Non-white(e.g. Black, Asian)
    • LGBTQIA+
    • Disability
    • Previously unhoused/homeless
    • Previously incarcerated/inmate
    • HS Diploma, GED, or didn't finish high school
  • Do you represent any of the groups listed above?*

  • DEMOGRAPHICS

  • Race/Ethnicity (check all that apply):*
  • Highest level of education:*
  • What type of community do you reside in?*
  • Do you currently reside in Baltimore City or County, MD?*
  • Which group membership do you most closely identify with?*
  • Please indicate all the group memberships you represent (check all that apply):*

  • MEDICAL HISTORY

  • Do you have a history of any of the following(checking all that apply)?*
  • Have you received medical treatment for any of the conditions you selected(check all that apply)?*
  • If you selected yes to speech therapy, please indicate for which conditions:*

  • We would like to ask you for some background information and personal history. Please fill in the appropriate answers.

  • What is your sex?*
  • What is your current marital status?*

  • This section will ask you about your medical history.

  • Have you ever been told by a doctor or other health professional that you have diabetes or have high sugar levels in your blood or urine?*
  • Have you ever been told by a doctor or other health professional that you have high cholesterol levels in the past 2 years or your cholesterol level is higher than 6.5?*
  • Have you ever had a head injury where you lost consciousness for more than 15 minutes?*

  • For each of the following statements, please say if you felt that way during the past week.

    The options are:

    • Rarely or none of the time (less than one day)
    • Some or a little of the time (1-2 days)
    • Occasionally or a moderate amount of time (3-4 days)
    • Most or all of the time (5-7 days)

    Choose the best answer for each question based on the past week.

  • I was bothered by things that usually don’t bother me.*
  • I had trouble keeping my mind on what I was doing.*
  • I felt depressed.*
  • I felt that everything I did was an effort.*
  • I felt hopeful about the future.*
  • I felt fearful.*
  • My sleep was restless.*
  • I was happy.*
  • I felt lonely.*
  • I could not "get going".*

  • The following questions will ask you about the time you spent being physically active in the last 7 days.

  • Think about all the vigorous and moderate activities that you did in the last 7 days. Vigorous physical activities refer to activities that take hard physical effort and make you breathe much harder than normal. Moderate activities refer to activities that take moderate physical effort and make you breathe somewhat harder than normal.

    Select "None" if activities not performed. 

  • During the last 7 days, on how many days did you do vigorous physical activities like heavy lifting, digging, aerobics, or fast bicycling? Think about only those physical activities that you did for at least 10 minutes at a time. (ex. 3 Days Per Week)

     Days Per Week
           

  • How much time in total did you usually spend on one of those days doing vigorous physical activities? (ex. 4 Hours Per Day)

     Hours Per Day
     Minutes Per Day
          

  • Again, think only about those physical activities that you did for at least 10 minutes at a time. During the last 7 days, on how many days did you do moderate physical activities like carrying light loads, bicycling at a regular pace, or double tennis? Do not include walking. (ex. 2 Days Per Week)

     Days Per Week
          

  • How much time in total did you usually spend on one of those days doing moderate physical activities? (ex. 2 Hours Per Day)

     Hours Per Day
     Minutes Per Day
             

  • During the last 7 days, on how many days did you walk for at least 10 minutes at a time? This includes walking at work and at home, walking to travel from place to place, and any other walking that you did solely for recreation, sport, exercise or leisure. (ex. 3 Days Per Week)

       Days Per Week
       

  • How much time in total did you usually spend walking on one of those days? (ex. 45 Minutes Per Day)

     Hours Per Day
     Minutes Per Day
             

  • The following questions will ask you about the time your leisure activities.

  • During the past year, how much time did you spend reading each day, including online reading?*

  • During the past year, how often were you engaging in...

    The options are:

    • Once a year or less
    • Several times a year
    • Several times a month
    • Several times a week
    • Every day or almost every day
  • Reading books*
  • Reading newspaper/articles*
  • Reading magazines*
  • Playing games (word game, checkers, mind teasers, etc)*
  • Writing letters or emails*
  • Use online social network activities*
  • Participating in ‘brain training’ activities*
  • Visiting a museum*
  • Attending a concert, play or musical*
  • Visiting a library*

  • The following questions will ask you about your friends and relatives.

  • Considering all of your friends including those who live in your neighborhood:

  • How many of your friends do you see or hear from at least once a month?*
  • Are you satisfied with your relationships with friends and relatives?*
  • How often do you participate in religious services or social, political or community groups?*
  • Do you live alone or with other people?*

  • The following questions will ask you about the time your food, drink and habits.

  • In the Past 12 Months:

  • How often did you eat fish or seafood that is not fried?*

  • The next questions are concerned with your alcohol consumption.


    Example of Standard Drink

    Drink Examples

  • How often do you have a drink containing alcohol?*

  • How many drinks do you have on a typical day when you are drinking?

       Drinks
          

  • The following questions ask about use of tobacco or nicotine products.

  • Do you, or have you ever, smoked cigarettes, cigars, pipes or any other tobacco products?*

  • The following questions ask about exposure to toxins.

  • Have you ever been involved in occupations that require you to mix, apply or load any pesticides, herbicides, weed killers, fumigants or fungicides?*

  • Please tell us whether you have had any of the experiences listed below, as they may be affecting your health today or may affect your health in the future.

  • Below is a list of 10 categories of Adverse Childhood Experiences (ACEs). From the list below, please place a checkmark next to each ACE category that you experienced prior to your 18th birthday.
  • Do you believe that these experiences have affected your health?*
  • If you answered 'Some' or 'A Lot' in the previous question, what part of your health do you think they negatively affected as an adult? (check all that apply)
  • If you selected 'Communication Health' to the previous question, what part of your communication health do you think your childhood experiences negatively affected as an adult?

  • Thank you for completing Part 1 of 2 of this project. Please continue to Part 2.

  • Research Health Equity Project Part 2

    Approximately 20 minutes

  • Instructions: Below is a list of statements dealing with your general feelings about the healthcare system. Read each item carefully and circle whether you strongly agree, agree, feel neutral, disagree, or strongly disagree with each statement based on the group membership you most strongly identify with.

  • Which group membership do you most closely identify with? (This should match your response to this question on Part 1).*
  • Doctors and healthcare workers sometimes hide information from patients who belong to my group.*
  • Doctors have the best interests of people of my group in mind.*
  • People of my group should not confide in doctors and healthcare workers because it will be used against them.*
  • People of my group should be suspicious of information from doctors and healthcare workers.*
  • People of my group cannot trust doctors and healthcare workers.*
  • People of my group should be suspicious of modern medicine.*
  • Doctors and healthcare workers treat people of my group like “guinea pigs”.*
  • People of my group receive the same medical care from doctors and healthcare workers as people from other groups.*
  • Doctors and healthcare workers do not take the medical complaints of people of my group seriously.*
  • People of my group are treated the same as people of other groups by doctors and healthcare workers.*
  • In most hospitals, people of different groups receive the same kind of care.*
  • I have personally been treated poorly or unfairly by doctors or healthcare workers because of the group I represent.*

  • Over the last 2 weeks, how often you been bothered by any of the following problems?

  • Little interest or pleasure in doing things.*
  • Feeling down, depressed, or hopeless.*
  • Trouble falling or staying asleep, or sleeping too much.*
  • Feeling tired or having little energy.*
  • Poor appetite or overeating.*
  • Feeling bad about yourself - or that you are a failure or have let yourself or your family down.*
  • Trouble concentrating on things, such as reading the newspaper or watching television.*
  • Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.*
  • If you selected any of the problems above, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?*
  • Feeling nervous, anxious, or on edge.*
  • Not being able to stop or control worrying.*
  • Worrying too much about different things.*
  • Trouble relaxing.*
  • Being so restless that it's hard to sit still.*
  • Becoming easily annoyed or irritable.*
  • Feeling afraid as if something awful might happen.*
  • If you selected any of the problems above, how difficult have these made it for you to do your work, take care of things at home, or get along with other people?*

  • Instructions: For this next section, you are asked to tell us about your healthcare experiences via audio recording.

  • Please answer each question as accurately and as honestly as possible. Your identity will remain private and confidential. While it is important to provide details (for example, your experience was based on receiving speech therapy services for a head injury) please do not use names or anything directly identifying specific organizations when discussing your personal experiences. If you do accidently include names or other identifying information, it will be removed for confidentiality.

     

    Take as many breaks as needed if you start to feel tired answering questions. If answering any of the questions makes you uncomfortable or very stressed, please stop completing the survey immediately.


    Helpful Tips:

    • When possible, your answers to the next set of questions should be based on information you provided in the medical history section and the group you most closely identify with.
    • There is no set length to how long each of your responses should be; however, we ask that each of your responses be at least 1 minute long.
    • If you don’t have a personal experience to share for a question, you may provide what you might think or expect your experience would be.
    • Don’t worry about sounding perfect. We just need your responses to be loud and clear so we can understand/hear what you're saying.
  • What aspects of your identity or background have had an impact on your interactions with healthcare professionals and facilities?*
  • How satisfied have you been with the healthcare assessments and treatments you've received? What specific factors, such as cultural respect or understanding, contributed to your satisfaction or dissatisfaction?*
  • Are there any cultural or alternative healthcare practices that you believe should be more integrated into the healthcare system? How do you think this integration could improve healthcare experiences for you?*
  • In your opinion, what changes or improvements could healthcare providers and facilities make in their interactions with you to better address your needs and make you more engaged in your health?*
  • Should be Empty: