Methods

The 2024-2025 CHOS, based on the 2022 Wake Community Health Needs Assessment, was shortened to reduce the burden on respondents and improve clarity. Questions were combined to minimize repetition, and wording was adjusted for better data collection and equity, such as changing “mental health issues” to “mental health concerns” and “substance abuse” to “substance use.” Feedback from the NCIPH team and workgroups helped refine priority topics and the survey was also reviewed to avoid overlap with the Community Perception Survey launching in November 2024. The CHOS workgroup reviewed the 2024-2025 CHOS and tested it before release. The questionnaire included 30 questions about personal health, access to care and barriers encountered, and other community health issues. See Appendix 2 for the complete CHOS Instrument.

The Community Health Needs Assessment Coordinating Team agreed to combine a probability-based sample with a convenience survey for the 2024-2025 CHOS. The team agreed to a stratified sample across 8 service zones across Wake County. This meant that 3,000 residential addresses were randomly selected with each of the eight service zones of Wake County with an oversample based on the zones with the highest share of historically underserved and underreached demographics. See Appendix 3 for additional details about the CHOS sampling methods. These randomly sampled households received three rounds of postcard mailers with a postcard number and a survey link. Appendix 2 includes a copy of the postcards. The random sample was then supplemented with an open-to-the-public convenience survey administered using the same survey instrument, which was open for anyone to take even if they did not receive a postcard mailer.

The survey was open for a period of about eight weeks between September 3 to October 31, 2024. The communications workgroup created outreach strategies, developed a promotion toolkit including flyers, emails, and social media tiles (see Appendix 1), and worked with the Wake Communications Team to ensure consistency with Live Well Wake materials. The toolkit was shared with the steering committee and community partners for distribution and ongoing promotion, with regular follow-ups to track effectiveness.

Eligible respondents had to 1) be 18 years of age or older, 2) live in Wake County, and 3) agree to participate. Once the survey closed, responses were analyzed, with spam checks ensuring no fraudulent responses.

CHOS Weighted Analysis

After data cleaning CHOS responses for non-spam, informative, and eligible responses, 1,191 CHOS responses were analyzed. One hundred forty-eight responses (12%) were from postcard recipients (randomly sampled households).

The probability-based sample (households receiving postcards) and non-probability sample (all other survey respondents) were combined with a weighted analysis. Weighting survey responses helps the survey data better reflect Wake County’s household data by adjusting for differences in participation across geographic areas and demographics. For this analysis, survey data was weighted based on sample design and the total number of households in each service zone.

Survey results were then stratified and further analyzed based on the subpopulations shown below. When selecting subpopulations for stratification, the LWWAT had to be mindful of how many survey responses were in each subpopulation in order to have statistically meaningful groups to compare to each other.

Where these subpopulations of respondents showed meaningful differences in responses, data tables were generated to compare how subpopulations responded differently.

Limitations

The survey methodology has limitations, as the results only reflect the opinions of those who responded. Since the survey was mostly online, community members with access to a smartphone or computer were more likely to participate. Steering committee members did have access to paper copies of the survey, so respondents could complete those if they did not have access to the internet.

There was some overrepresentation and underrepresentation of demographic groups in the survey compared to the demographics of Wake County as reported by the 2023 American Community Survey (ACS). First, women were overrepresented in the survey, making up 71% of respondents, compared to 51% of the population in Wake County. Second, individuals aged 40-59 were overrepresented in the survey, making up 47% of respondents, compared to 27.5% of the population in Wake County. Lastly, Asian Americans were underrepresented in the survey, making up 2.9% of respondents, compared to 9.4% of the population in Wake County. The weighted analysis helps adjust for the under- and over-representation of demographic groups in the final CHOS results; however, underrepresentation of demographic groups limited which stratifications could be meaningfully analyzed.

Also, while the recruitment toolkit was designed to be accessible, it may not have reached all target groups, especially those not familiar with digital tools or social media.

Overall

Wake County completed a Community Health Needs Assessment in 2022. The 2022 assessment resulted in the following three priority areas: 1) Access to Healthcare, 2) Affordable Housing and Homelessness, and 3) Mental Health. For the 2025 Community Health Opinion Survey, participants were asked “How well do you think Wake County is doing in these areas?” For each priority area, participants selected one option. Access to Healthcare refers to how and why people use and do not use healthcare, how many people have health insurance, how much healthcare is available in the community, and how much information there is about healthcare.  Affordable Housing and Homelessness focuses on cost of housing, housing choices, and persons experiencing homelessness.  Mental Health refers to a person’s condition with regard to their psychological and emotional well-being.

Income

The following tables show survey results stratified by income where there were meaningful differences in responses by subpopulation.

Education

The following tables show survey results stratified by education where there were meaningful differences in responses by subpopulation.