Black, Asian and minority ethnic population : health survey NHS

Question Title

* 1. This survey is anonymous, but please provide us with the first part of your postcode (e.g. NG3) so we know where services are working and where they may need improvement

Question Title

* 2. How many times in the last year have you been to your GP (Doctors) surgery?

None

1-5

Over 5

Question Title

* 3. Was it easy to make the appointment?

Not applicable

Yes

No (please say why)

Question Title

* 4. If you were unable to make an appointment where do you go to get help or advice? (please tick all that apply)

Local pharmacy (chemist)

Phone 111 (urgent, non-emergency medical number)

Emergency department

Urgent care centre

Other (please say where)

Question Title

* 5. Please say how important the following are to you:
(1 = not important, 2 = slightly important, 3 = important, 4= very important, 5 = extremely important)

	1	2	3	4	5
Booking a same day appointment for urgent problems	Booking a same day appointment for urgent problems 1	Booking a same day appointment for urgent problems 2	Booking a same day appointment for urgent problems 3	Booking a same day appointment for urgent problems 4	Booking a same day appointment for urgent problems 5
Seeing the same named doctor or nurse	Seeing the same named doctor or nurse 1	Seeing the same named doctor or nurse 2	Seeing the same named doctor or nurse 3	Seeing the same named doctor or nurse 4	Seeing the same named doctor or nurse 5
Having the option to speak to my doctor/nurse over the phone	Having the option to speak to my doctor/nurse over the phone 1	Having the option to speak to my doctor/nurse over the phone 2	Having the option to speak to my doctor/nurse over the phone 3	Having the option to speak to my doctor/nurse over the phone 4	Having the option to speak to my doctor/nurse over the phone 5
Having the option to get results over the telephone from the doctor/nurse	Having the option to get results over the telephone from the doctor/nurse 1	Having the option to get results over the telephone from the doctor/nurse 2	Having the option to get results over the telephone from the doctor/nurse 3	Having the option to get results over the telephone from the doctor/nurse 4	Having the option to get results over the telephone from the doctor/nurse 5

Question Title

* 6. Please say what the best thing about your GP surgery is and what is the worst thing

The best thing about my GP surgery is...

The worst thing about my GP surgery is...

Question Title

* 7. Do you currently feel that you self-care for common problems (i.e. a cold, headache, stomach-ache, small cuts and grazes) without attending the GP?

Yes

No (please say what you would attend for)

Question Title

* 8. If you do visit your GP for a common problem, why is that? (please tick all that apply)

To be reassured that it is nothing serious

Lack of knowledge: not sure whether it's routine or not

Its been going on for more than a couple of days

Worried it might get worse if I don't

Other (please say what)

Question Title

* 9. How do you currently access self-help information? (please tick all that apply)

GP website or surgery (i.e. posters, leaflets)

Internet (including social media i.e. Facebook, twitter)

Local community (i.e. self help groups, posters, library)

I don't access any self-help information

Other (please say what)

Question Title

* 10. If you were to access self-care information where would you want to access it? (please tick all that
apply)

GP website or surgery

Internet

Local community

Other (please say where)

Question Title

* 11. Would you want any further information to help you self-care with any of the following? (please tick all that apply)

Eating well

Being active

Quitting smoking

Drinking less

Reducing stress

Sleeping well

Managing medication

Other (please say what)

Question Title

* 12. As a Black, Asian or minority ethnic (BAME) member of the community, do you feel your health needs are addressed?

Yes

No or sometimes (please say more)

Question Title

* 13. Are there any areas where the health service does not address your needs?

	Yes	No
Culturally specific needs	Culturally specific needs Yes	Culturally specific needs No
Language (i.e.access to interpreters, leaflets in other languages)	Language (i.e.access to interpreters, leaflets in other languages) Yes	Language (i.e.access to interpreters, leaflets in other languages) No
Health professionals that understand different family or cultural needs	Health professionals that understand different family or cultural needs Yes	Health professionals that understand different family or cultural needs No
Other	Other Yes	Other No

Question Title

* 14. If yes to any of the previous question please say more

Question Title

* 15. Where do you go for most of your health needs? (please tick all that apply)

Family/friends

Pharmacy/chemist

Emergency department

Other (please specify)

Question Title

* 16. Would you be happy to be contacted to take part in a one to one interview to share more of your
experiences of the health services as a BAME member of the community?

Yes (please leave a contact phone number or email and you will be contacted to make arrangements that are suitable for you)

It would be really useful if you could fill in the next 8 questions so we can adapt our services according to need

Question Title

* 17. Gender

Male

Female

I do not wish to disclose

Question Title

* 18. Age

Question Title

* 19. Do you have a disability?

Yes

Question Title

* 20. Ethnicity

White - British

White - Irish

Black or Black British - Caribbean

Black or Black British - African

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Chinese

Mixed - White & Black Carribbean

Mixed - White & Black African

Mixed - White & Asian

Question Title

* 21. Religion and belief

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

No religion/belief

I do not wish to disclose

Other (please specify)

Question Title

* 22. Sexual orientation

Heterosexual

Lesbian

Gay

Bisexual

Prefer not to say

Question Title

* 23. Marital status and civil partnership

Civil partnership

Divorced

Living with someone

Married

Separated

Single

Widowed

Prefer not to say

Question Title

* 24. Is your gender the one assigned to you at birth

Yes

Prefer not to say

Question Title

* 1. This survey is anonymous, but please provide us with the first part of your postcode (e.g. NG3) so we know where services are working and where they may need improvement

Question Title

* 2. How many times in the last year have you been to your GP (Doctors) surgery?

Question Title

* 3. Was it easy to make the appointment?

Question Title

* 4. If you were unable to make an appointment where do you go to get help or advice? (please tick all that apply)

Question Title

* 5. Please say how important the following are to you:(1 = not important, 2 = slightly important, 3 = important, 4= very important, 5 = extremely important)

Question Title

* 6. Please say what the best thing about your GP surgery is and what is the worst thing

Question Title

* 7. Do you currently feel that you self-care for common problems (i.e. a cold, headache, stomach-ache, small cuts and grazes) without attending the GP?

Question Title

* 8. If you do visit your GP for a common problem, why is that? (please tick all that apply)

Question Title

* 9. How do you currently access self-help information? (please tick all that apply)

Question Title

* 10. If you were to access self-care information where would you want to access it? (please tick all that apply)

Question Title

* 11. Would you want any further information to help you self-care with any of the following? (please tick all that apply)

Question Title

* 12. As a Black, Asian or minority ethnic (BAME) member of the community, do you feel your health needs are addressed?

Question Title

* 13. Are there any areas where the health service does not address your needs?

Question Title

* 14. If yes to any of the previous question please say more

Question Title

* 15. Where do you go for most of your health needs? (please tick all that apply)

Question Title

* 16. Would you be happy to be contacted to take part in a one to one interview to share more of your experiences of the health services as a BAME member of the community?

Question Title

* 17. Gender

Question Title

* 18. Age

Question Title

* 19. Do you have a disability?

Question Title

* 20. Ethnicity

Question Title

* 21. Religion and belief

Question Title

* 22. Sexual orientation

Question Title

* 23. Marital status and civil partnership

Question Title

* 24. Is your gender the one assigned to you at birth

Question Title

* 25. If you would like to go into a draw to win a £15 shopping voucher, please write your name and email so we can contact you

* 5. Please say how important the following are to you:
(1 = not important, 2 = slightly important, 3 = important, 4= very important, 5 = extremely important)

* 10. If you were to access self-care information where would you want to access it? (please tick all that
apply)

* 16. Would you be happy to be contacted to take part in a one to one interview to share more of your
experiences of the health services as a BAME member of the community?