SRH in the Heartland

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Sexual & Reproductive Health in the Heartland

Sexual & Reproductive Health in the Heartland

RHCN is conducting an assessment to explore strengths and needs related to sexual and reproductive health across the state. Your responses to this confidential, anonymous survey will help organizations and agencies across Nebraska enhance efforts to meet these needs.

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1. Have you been to a medical professional to receive any of the following sexual and reproductive health services?
Yes, in the past 12 months
Yes, over 12 months ago
No
Birthing care
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Breast, cervical, or testicular cancer screening
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Contraception/birth control
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Fertility/infertility counseling, testing, or treatment
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Gender affirming care
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Pregnancy detection and early pregnancy management
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Pregnancy termination
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
STI/HIV testing or treatment
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Perimenopausal or menopausal care
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Prenatal care
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Postnatal care
Row 10, Column 0
Row 10, Column 1
Row 10, Column 2
Birthing care
Breast, cervical, or testicular cancer screening
Contraception/birth control
Fertility/infertility counseling, testing, or treatment
Gender affirming care
Pregnancy detection and early pregnancy management
Pregnancy termination
STI/HIV testing or treatment
Perimenopausal or menopausal care
Prenatal care
Postnatal care
Yes, in the past 12 months
Row 0, Column 0
Yes, over 12 months ago
Row 0, Column 1
No
Row 0, Column 2
Yes, in the past 12 months
Row 1, Column 0
Yes, over 12 months ago
Row 1, Column 1
No
Row 1, Column 2
Yes, in the past 12 months
Row 2, Column 0
Yes, over 12 months ago
Row 2, Column 1
No
Row 2, Column 2
Yes, in the past 12 months
Row 3, Column 0
Yes, over 12 months ago
Row 3, Column 1
No
Row 3, Column 2
Yes, in the past 12 months
Row 4, Column 0
Yes, over 12 months ago
Row 4, Column 1
No
Row 4, Column 2
Yes, in the past 12 months
Row 5, Column 0
Yes, over 12 months ago
Row 5, Column 1
No
Row 5, Column 2
Yes, in the past 12 months
Row 6, Column 0
Yes, over 12 months ago
Row 6, Column 1
No
Row 6, Column 2
Yes, in the past 12 months
Row 7, Column 0
Yes, over 12 months ago
Row 7, Column 1
No
Row 7, Column 2
Yes, in the past 12 months
Row 8, Column 0
Yes, over 12 months ago
Row 8, Column 1
No
Row 8, Column 2
Yes, in the past 12 months
Row 9, Column 0
Yes, over 12 months ago
Row 9, Column 1
No
Row 9, Column 2
Yes, in the past 12 months
Row 10, Column 0
Yes, over 12 months ago
Row 10, Column 1
No
Row 10, Column 2
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2
2. Have you experienced discrimination or judgment while receiving sexual and reproductive health services in the past?
Yes, in the past 12 months
Yes, longer than the past 12 months
No
I have not received sexual and reproductive health services in the past
3
3. Were the materials and/or services available in the language you are most comfortable speaking?
Yes
No
I have not received sexual and reproductive health services in the past
4
4. How likely are you to receive sexual or reproductive health services in the next 12 months?
Very likely
Somewhat likely
Not very likely
Not at all likely
5
5. If you needed to see a medical professional for sexual or reproductive health services today, which of the following, if any, would make it difficult to do so?
Would make it difficult
Would not make it difficult to
Clinic availability
Row 0, Column 0
Row 0, Column 1
Clinic distance
Row 1, Column 0
Row 1, Column 1
Concerns about privacy and confidentiality
Row 2, Column 0
Row 2, Column 1
Cost
Row 3, Column 0
Row 3, Column 1
Embarrassment or fear of judgment
Row 4, Column 0
Row 4, Column 1
Insurance coverage
Row 5, Column 0
Row 5, Column 1
Negative past experience(s) at clinic(s)
Row 6, Column 0
Row 6, Column 1
Transportation
Row 7, Column 0
Row 7, Column 1
Unsure of where to go
Row 8, Column 0
Row 8, Column 1
Clinic availability
Clinic distance
Concerns about privacy and confidentiality
Cost
Embarrassment or fear of judgment
Insurance coverage
Negative past experience(s) at clinic(s)
Transportation
Unsure of where to go
Would make it difficult
Row 0, Column 0
Would not make it difficult to
Row 0, Column 1
Would make it difficult
Row 1, Column 0
Would not make it difficult to
Row 1, Column 1
Would make it difficult
Row 2, Column 0
Would not make it difficult to
Row 2, Column 1
Would make it difficult
Row 3, Column 0
Would not make it difficult to
Row 3, Column 1
Would make it difficult
Row 4, Column 0
Would not make it difficult to
Row 4, Column 1
Would make it difficult
Row 5, Column 0
Would not make it difficult to
Row 5, Column 1
Would make it difficult
Row 6, Column 0
Would not make it difficult to
Row 6, Column 1
Would make it difficult
Row 7, Column 0
Would not make it difficult to
Row 7, Column 1
Would make it difficult
Row 8, Column 0
Would not make it difficult to
Row 8, Column 1
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6
6. If you needed to see a medical professional for sexual or reproductive health services today, how far would you have to travel to do so?
Less than 30 minutes
30 to 60 minutes
More than an hour, less than three hours
More than three hours, less than five hours
More than five hours
7
7. If you needed information about sexual or reproductive health, how likely would you be to text or call a confidential nurse line with your questions?
Very likely
Somewhat likely
Not very likely
Not at all likely
8
8. How important do you think sexual and reproductive health is as a part of overall wellbeing?
Very important
Somewhat important
Not very important
Not at all important
9
9. The 'age of majority' means when a child legally becomes an adult. In Nebraska, the age of majority is currently 19. How much do you support or oppose lowering the age of majority in Nebraska from 19 to 18 years old?
Strongly support
Somewhat support
Neither support nor oppose
Somewhat oppose
Strongly oppose
10
10. How strongly do you support or oppose pregnancy termination in Nebraska?
Strongly support
Somewhat support
Neither support nor oppose
Somewhat oppose
Strongly oppose
11
11. How easy or difficult would it be for you to access the following if you needed to?
Very easy
Somewhat easy
Somewhat difficult
Very difficult
Condoms
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Emergency contraception (e.g., Plan B)
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Over-the-counter contraception/birth control (e.g., Opill)
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Condoms
Emergency contraception (e.g., Plan B)
Over-the-counter contraception/birth control (e.g., Opill)
Very easy
Row 0, Column 0
Somewhat easy
Row 0, Column 1
Somewhat difficult
Row 0, Column 2
Very difficult
Row 0, Column 3
Very easy
Row 1, Column 0
Somewhat easy
Row 1, Column 1
Somewhat difficult
Row 1, Column 2
Very difficult
Row 1, Column 3
Very easy
Row 2, Column 0
Somewhat easy
Row 2, Column 1
Somewhat difficult
Row 2, Column 2
Very difficult
Row 2, Column 3
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12
12. How confident are you in the following areas?
Very confident
Somewhat confident
Not very confident
Not at all confident
Understanding information medical professionals tell you
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Navigating healthcare systems
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Advocating for yourself in healthcare settings
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Understanding information medical professionals tell you
Navigating healthcare systems
Advocating for yourself in healthcare settings
Very confident
Row 0, Column 0
Somewhat confident
Row 0, Column 1
Not very confident
Row 0, Column 2
Not at all confident
Row 0, Column 3
Very confident
Row 1, Column 0
Somewhat confident
Row 1, Column 1
Not very confident
Row 1, Column 2
Not at all confident
Row 1, Column 3
Very confident
Row 2, Column 0
Somewhat confident
Row 2, Column 1
Not very confident
Row 2, Column 2
Not at all confident
Row 2, Column 3
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13
13. How would you rate the adequacy care in your community?
Very adequate
Somewhat adequate
Not very adequate
Not at all adequate
Prenatal care
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Birthing care
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Postnatal care
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Prenatal care
Birthing care
Postnatal care
Very adequate
Row 0, Column 0
Somewhat adequate
Row 0, Column 1
Not very adequate
Row 0, Column 2
Not at all adequate
Row 0, Column 3
Very adequate
Row 1, Column 0
Somewhat adequate
Row 1, Column 1
Not very adequate
Row 1, Column 2
Not at all adequate
Row 1, Column 3
Very adequate
Row 2, Column 0
Somewhat adequate
Row 2, Column 1
Not very adequate
Row 2, Column 2
Not at all adequate
Row 2, Column 3
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14
14. What year were you born?
15
15. What is your current gender?
Male
Female
Other
16
16. Which of the following best represents how you think of yourself?
Lesbian or gay
Straight, that is not gay or lesbian
Bisexual
Other
17
17. Were you born in Nebraska, another state, or a foreign country?
Nebraska
Another state
Foreign country
18
18. What type of health insurance do you have?
Private health insurance (e.g., BlueCross, Medica)
Public health insurance (e.g., Medicaid, Medicare)
I do not have health insurance
19
19. What is your zip code?
20
20. What is your race/ethnicity?Select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
21
21. Would you like to be contacted with the results of this research and additional opportunities to be involved?
No
Yes
22
22a. If you would like to be contacted in the future, please complete the following fields. If you would not like to be contacted, please leave the following fields blank and press "Submit."
First Name
Last Name
23
22b. Phone Number
Please enter a valid phone number.
24
22c. Email
example@example.com
Should be Empty:

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