COMMUNITY SURVEY
An online survey was conducted for two months, during the months of April and May of 2022, and was made available in both English and Spanish. Hard copies were distributed at several community events and through informal means to gather representation from groups who may not traditionally engage with online survey platforms or access the internet. A total of 641 responses were received with most respondents identifying as female (72.70%), straight/heterosexual (84.40%), or white, non-Hispanic (54.29%). The range of primary residence by zip code was diverse and inclusive of most zip codes in Washoe County.
Questions designed for the community survey were helpful to capture some of the reasons why nutrition and physical activity were challenges and what could be done to help improve those areas of life. Validated questions were used to assess food security and perceived stress. Other questions assess perceived neighborhood safety, barriers to accessing healthcare, and financial tradeoffs and challenges.
A primary focus of the community survey was to ask for respondents to identify the top health priorities by asking them to select the top three needs from a set list of health topics including mental health, social determinants of health, access to health services, preventive health behaviors, violence, environmental health, substance use, maternal & child health, and built environment and infrastructure. Examples of what might constitute or be included in each of those categories was provided to help the responded develop a shared meaning for each of the topics provided for top three ranking. Mental health most frequently made the top three ranked health topics, followed by access to health services, and social determinants of health.
Although a more detailed breakdown of responses is provided within various sections of the assessment a general summary is provided in this section as well. Refer to topic-specific areas for counts and frequencies of responses to each question.
Just over half (51.65%) of respondents participated in physical activity or exercise three or more days in the past week, with the largest barrier to engaging in more physical activity being lack of time/having too busy of a schedule (30.39%) or being too tired (15.75%). Having support of friends was the most commonly identified (18.05%) resource for increasing physical activity, followed by less expensive gym memberships (16.10%).
Nearly one in three (30.77%) of respondents indicated they ate 3 or more servings of fruit (1/2 cup) each day during the past week, while 44.5% indicated they ate 3 or more servings (1/2 cup) of vegetables each day during the past week. Over half (55.40%) indicated they area fresh meals on 5 or more days in the past week. The most common barriers to eating healthy food more often was healthy foods are too expensive (26.10%) and they take too much time to prepare (15.72%).
A two-question food insecurity screening was asked, and analyses indicated 38.69% of respondents were food insecure, which is a much higher prevalence in comparison to secondary data, however the community survey data were not weighted to represent population by age, income, race/ethnicity, and therefore should not be compared to secondary data sources.
The vast majority (83.04%) of respondents felts their neighborhood was either very safe or somewhat safe from crime. The four-question perceived stress screening indicated most (64.14%) respondents fell into a medium stress level, not on either end of the spectrum high or low.
Too few responses were submitted to do meaningful cross-tabular analyses, which would allow for comparisons of responses to questions by race or ethnicity, sex, sexual orientation, or age.
KEY INFORMANT INTERVIEWS
Four key informants were interviewed about three special interest groups, one for refugee populations, one for the LGBTQ+ community, and two for underhoused or homeless populations. Questions were the same as asked of focus group participants, however, were tailored to the key informant group of interest.
Across all four representatives, the lack of and need for comprehensive and accessible mental health services, lack of affordable and safe housing options, and lack of accessible alternative transportation were all tied as the topmost commonly identified needs specifically for the populations these key informants represented. Having a strong support system was identified as crucial for these populations, however not all representatives provided clear examples of what constitutes a support system specific to the population.
Most of the same top issues identified in the focus groups were the same top issues for the special interest groups, having opportunities to engage with the outdoors to de-stress and engage in physical activity, having basic needs met including access to housing, food, and resources, lack of access to quality health care or services, with specific mentions related to Medicaid and similar barriers for finding a provider who will accept Medicaid patients.\
Differences in comparison to focus group participants included four areas, systemic inequality, discrimination and racism, financial stability, and lack of good education. Examples of systemic inequality, discrimination, and racism included how persons in these populations experience stigma associated with the groups they represent and the perceived inequity of being able to achieve health or the desired outcomes, due to being treated lesser than others. The lack of culturally competent resources and services in the community were mentioned by all key informants as a gap in this region. The key informants also identified financial stability as a key barrier as many persons in the special populations of interest may struggle to have consistent and reliable sources of income, which results in varying and uncertain monetary reliability from month to month. Lack of access to good education, while mentioned in the focus groups, stood out as an emerging theme among the key informant populations although specific examples were not frequently identified.
AGENCY SURVEY
A survey was distributed to representatives of organizations across Washoe County and was designed to capture the populations and clients served, areas of need currently being addressed, the estimated number of persons being reached or served each month, and whether the organization has capacity to serve the number of persons requesting or seeking the services the organization provides. A second group of questions aimed to provide an assessment of diversity and cultural competence within organizations, with questions including if the organization has existing policies, procedures, or trainings on how to work and communicate with persons who speak languages other than English, persons with physical disabilities or persons with intellectual or developmental disabilities. The agency representatives were also asked to indicate if the organization has identified the demographics of their clientele served in terms of race/ethnicity, age, gender, sex, and primary language spoken and if they had compared the composition of their own staff to the clientele served.
A total of 39 agencies responded to the agency survey and detailed results are provided in this section as these results were not included elsewhere in the assessment.
The majority (82.1%) of agencies were a community based or nonprofit organization or company. Nearly half (48.7%) served populations regardless of age and just over half (51.3%) served populations regardless of subgroup. The most common areas being addressed, as reported by responding agencies were emotional, behavioral, or mental health care/services (41.0%), referrals to other organizations or services without direct services to clients (35.9%), with ties between substance use education, screening, or treatment and job acquisition/skills training/employment – both at 30.8%. Just over one in four (28.2%) are involved with food assistance, and another one in four (25.6%) provide transportation services or direct health care/services - medical, dental, or vision.
Organization type |
Count |
Percent |
Individual, not representing any organization |
0 |
0.0% |
Academic/ college/university/education k-12 |
2 |
5.1% |
Governmental |
4 |
10.3% |
Quasi-governmental |
0 |
0.0% |
Philanthropic |
1 |
2.6% |
Community based or nonprofit organization or company |
32 |
82.1% |
For profit organization or company |
1 |
2.6% |
Other______________(please specify) |
1 |
2.6% |
Client Population Served |
Count |
Percent |
All persons regardless of age |
19 |
48.7% |
Infants (0-2 years) |
1 |
2.6% |
Children (ages 3-18 years) |
9 |
23.1% |
Adolescents or young adults (15-24 years) |
6 |
15.4% |
Adults (18 years and older) |
11 |
28.2% |
Seniors (65 years and older) |
8 |
20.5% |
Subgroups Served |
Count |
Percent |
All persons regardless of subgroup |
20 |
51.3% |
Veterans |
3 |
7.7% |
Homeless |
10 |
25.6% |
Low-income |
13 |
33.3% |
Persons with limited English proficiency (English language learners) |
4 |
10.3% |
Minority populations |
7 |
17.9% |
LGBTQ/LGBTQIA Community |
4 |
10.3% |
People with physical disabilities |
5 |
12.8% |
People with intellectual or developmental disabilities |
3 |
7.7% |
Other subgroup ______________(please specify) |
8 |
20.5% |
Only half (50.0%) of agency survey respondents indicated the organization has capacity to serve those in need of the services they provide. When asked about existing policies, procedures, or trainings on how to work and communicate with select groups, 68.42% reported yes for persons who speak language other than English, 67.57% indicated yes for persons with physical disabilities, and 50.00% indicated yes for persons with intellectual or developmental disabilities. The majority (76.32%) of agencies have identified the demographics of clientele served in relation to race/ethnicity, age, gender, sex and primary language spoken, while 65.79% have compared those demographics to the composition of their staff.
The agency survey indicates while many of the respondent organizations are working in areas of top need (e.g. mental health), they may be understaff or under-resourced to meet the demands of the community seeking those services or in need of those services. A large proportion of respondents were staffed at organizations that make referrals and do not provide direct services, and no follow up questions were asked to determine if they evaluate those referral mechanisms, how they make those referrals, or what types of services they refer out to most often. It should be noted the majority of agency survey respondents were representing community based or nonprofit organizations, therefore the agency survey may not indicate the wide variety of organizations serving the residents of Washoe County.