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Closing the Gap Survey

Cities of Albany, Cohoes, and Watervliet

The Closing the Gap Survey's purpose is to learn more about ways to improve Built Environments and support Community-Clinical Linkages within the Cities of Albany, Cohoes, and Watervliet.

Only residents of Albany, Cohoes, and Watervliet are asked to complete the survey. Responses are anonymous. Provision of your phone number is optional if you wish to be entered into a drawing for a gift card; however, responses will not be linked to your number if provided.

The Closing the Gap Survey should take participants about 5 minutes to complete. Participants are eligible for $25 gift cards from Market 32/Price Chopper and will be chosen at random.

All survey responses must be received by 5pm on Friday, November 17, 2023. 

 
1. City you live in: *This question is required.
2. Do you rent or own a house? *This question is required.
3. Age group: *This question is required.
4. Race:
5. Ethnicity:
6. How serious a public health problem in your community is each of the following: *This question is required.
Space Cell Not at all seriousNot too seriousSomewhat seriousVery serious
Asthma
Diabetes
Obesity
7. Select all that are difficult for someone in your community to access:
  • * This question is required.
8. Where do you and your family get most of your health information? Check all that apply. *This question is required.
  • * This question is required.
9. What kind of health services do you want more available in your community: *This question is required.
  • * This question is required.
10. In general your health is: *This question is required.
11. In a typical month, do you walk to get from one place to another? *This question is required.
12. In a typical month, do you ride a bike to get from one place to another? *This question is required.
13. Check all obstacles in your neighborhood that make it difficult for you to be physically active: *This question is required.
  • * This question is required.
15. During the past 12 months, has a lack of reliable transportation kept you from medical appointments, meetings, work, or getting things needed for daily living? *This question is required.
16. Check all obstacles in your neighborhood that make it difficult for you to use healthcare services: *This question is required.
  • * This question is required.
18. How long has it been since you visited a primary care provider for a routine health checkup? *This question is required.
19. Were any of the following reasons that you did not visit a primary care provider? *This question is required.
  • * This question is required.
20. Has your primary care provider ever referred you to community services to help you manage your care? *This question is required.
22. For which health issues is there a need for greater consumer supports: *This question is required.
  • * This question is required.
23. Which of the following would you like to support your health: *This question is required.
  • * This question is required.
25. Optional: Are you willing to participate in a focus group located in your city?
Focus group participants receive a gift card for their time. If yes, please provide your phone number so we may contact you if chosen.
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