Erewash Local Place-PCN Alliance Group Community Survey - Autumn 2022

We Want to Hear from You about Your Physical and Mental Health & Wellbeing

We're working together to help to improve the physical and mental health & wellbeing of adults living in Erewash. Health services, social care, the Borough Council and voluntary & community sector partners want to hear from you about what could help to improve your physical and mental health & wellbeing.

To do this we would like you to fill in this survey – it's all about letting us know the things that are most important to you. It shouldn't take very long to complete, and of course everything you tell us is anonymous and confidential. You can either complete the survey online or on paper. And as a thank you for taking part in the survey, we will be giving everyone who takes part the chance to win a £10 voucher. If you want to be in the draw for a prize then make sure you leave your email address at the end of the survey.

Please complete and return the survey by 5pm on Friday 6th January 2023.

Once all the surveys have returned, we will be working together with Erewash people and partners to set our local priorities that we will work on together. Please let us know at the end of the survey if you would like to be involved in the work. All survey findings will be published on the Erewash Voluntary Action CVS 'News' website page: https://www.erewashvoluntaryaction.org.uk/news.

Thank you for taking part, and for helping us to understand what adults in Erewash need to live their best lives.

GDPR Statement - Erewash Voluntary Action CVS is working with health services, social care, Erewash Borough Council and voluntary & community sector partners to gather information about the physical and mental health & wellbeing of adults living in Erewash. Erewash Voluntary Action complies with GDPR. By completing this survey and providing your details you are giving us permission to hold your data physically and digitally. We will only ever use this data for the purposes set out above. Should you wish to remove your data from our records, please contact Kyle Robinson-Payne by emailing: kyle@erewashcvs.org.uk.

SECTION A - ABOUT YOUR PHYSCIAL AND MENTAL HEALTH AND WELLBEING

Please tell us about your current physical and mental health and wellbeing

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* 1. How would you describe your physical and mental health and wellbeing? (Please choose only one).

Very fit and well

Fit and well most of the time

Fit and well some of the time

Not very fit and well

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* 2. Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?

Yes

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* 3. Has your physical and mental health and wellbeing changed over the last 12 months?

Yes

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* 4. If yes, why do you think that is? Please tell us in the box below...

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* 5. Who helps you keep well?

I look after myself

I have informal support from my family, close friends/neighbours

I am supported by formal carers that visit me to support my everyday care needs on a daily basis

I am supported regularly by healthcare staff (such as District Nurses) who support healthcare

I have support from other services (voluntary sector, wardens/carers on site, etc.)

Other (please tell us in the box below)

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* 6. What helps, or negatively affects, your physical and mental health and wellbeing? (Please tell us in the box below)

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* 7. What would help to improve your physical and mental health and wellbeing? (Please choose up to three, ranking them 1, 2 and 3 - with 1 being the most important to you).

	1	2	3
Access to transport	Access to transport 1	Access to transport 2	Access to transport 3
Better access to GP/health care services	Better access to GP/health care services 1	Better access to GP/health care services 2	Better access to GP/health care services 3
Better access to local service/activities	Better access to local service/activities 1	Better access to local service/activities 2	Better access to local service/activities 3
Better housing	Better housing 1	Better housing 2	Better housing 3
Better links to my local community	Better links to my local community 1	Better links to my local community 2	Better links to my local community 3
Better local surroundings - such as parks and green spaces	Better local surroundings - such as parks and green spaces 1	Better local surroundings - such as parks and green spaces 2	Better local surroundings - such as parks and green spaces 3
Feeling safe - at home/in your community	Feeling safe - at home/in your community 1	Feeling safe - at home/in your community 2	Feeling safe - at home/in your community 3
Financial stability	Financial stability 1	Financial stability 2	Financial stability 3
Lifestyle changes, such as help to stop smoking, move more, eat a healthy balanced diet or reduce alcohol intake?	Lifestyle changes, such as help to stop smoking, move more, eat a healthy balanced diet or reduce alcohol intake? 1	Lifestyle changes, such as help to stop smoking, move more, eat a healthy balanced diet or reduce alcohol intake? 2	Lifestyle changes, such as help to stop smoking, move more, eat a healthy balanced diet or reduce alcohol intake? 3
More time with family and friends	More time with family and friends 1	More time with family and friends 2	More time with family and friends 3
Training opportunities	Training opportunities 1	Training opportunities 2	Training opportunities 3

Other (please specify)

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* 8. Thinking about question 7, please let us know more in the box below, giving any examples of what would help to improve your physical and mental health and wellbeing...

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* 9. Anything else you'd like to add? Please tell us in the box below...

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* 10. Whereabouts in Erewash do you live? (Please tick one)

Cotmanhay

Ilkeston

Kirk Hallam

Long Eaton

Petersham

Sandiacre

Sawley

West Hallam

Other (please specify)

SECTION B - EQUALITY MONITORING FORM (STRICTLY CONFIDENTIAL)

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* 11. Your age

18 - 25

25 - 49

50 - 64

65 or over

I prefer not to say

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* 12. Do you have a disability of any kind? Please tick all that apply:

Hearing impairment

Learning difficulty/disability

Mental health condition

No disability

Physical disability

Visual impairment

Other limiting long-term illness/health condition

I prefer not to say

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* 13. How would you describe your racial or ethnic group? (please tick one)

Asian Bangladeshi

Asian - Indian

Asian - Pakistani

Asian - Other

Black - African

Black - Caribbean

Black - Other

Chinese

Dual Heritage - White and Black African

Dual Heritage - White and Black Afro-Carribean

Dual Heritage - White and Asian

Dual - Other

White British

White Irish

White - Other

I prefer not to say

Other (please specify)

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* 14. Your faith or religion

Atheist

Buddhist

Christian

Hindu

Islam

Judaism

Sikh

No religion

Other (please specify)

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* 15. Sexual Orientation

Bisexual

Gay man

Heterosexual

Lesbian

I prefer not to say

Other (please specify)

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* 16. Gender: How do you identify?

Male

Non-binary

Female

I prefer not to say

Prefer to self-describe, below

Self-describe:

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* 17. Have you gone through/do you intend to go through any part of a process to change from the sex you were described as at birth to the gender you identify with?

Yes

I prefer not to say

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* 18. As a thank you for taking part, we want to offer you the chance to win a £10 voucher. If you would like to be entered into the draw then please leave your phone number or email address in the box below.

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* 19. If you would like to be involved in this work in the future, then please leave your name and phone number or email address in the box below.

Thank you for completing this online survey.