Location:
Date:
ID:
1.) Are you a resident of the West End neighborhood?
Yes
No
2.) Are you the main person who buys food for your family?
Yes
No
Sometimes
3.) Please rank 3 food stores and their location starting with where you shop most often
1.) Store name:Location:
2.) Store name:Location:
3.) Store name:Location:
4.) How do you usually get to the food store you shop at most often? Please check all that apply
Bus/RIPTA
Taxi/Car Service
Trolley
Walk
Personal car
Bike
Friends Vehicle
Other
5.) About how much time does it take you to get there?
1-5 minutes
6-10 minutes
11-15 minutes
16-30 minutes
31-60 minutes
60+ minutes
6.) At the store you shop at most often how important are…
Most Important Somewhat important Least Important
Low prices
Quality
Location
Have the foods I like
Other reason:
7.) At the store you go to most often, are there fresh fruits and vegetables available to buy?
YesNo
- How do you feel about the prices of the fruits and vegetables
Cheap OK/fineToo expensive
- What is the quality of the fruits and vegetables
LowModerateHigh
8.) What best describes your race/ethnicity?
African American
African Diaspora /Country of origin:
African Caribbean /County of origin:
Caucasian/White Non-Hispanic / Country of origin:
Hispanic/Latino /Country of origin:
Native American/American Indian
Asian/ Country of origin:
Multi-racial/Ethnic
Other, please specify:
9.) Are foods related to your culture important to you?
Yes
No
(If answer No, skip question 11)
10.) Where do you find foods most appropriate for your cultural tastes?
a.) I don’t find foods that meet my cultural needs
b.) I order from ______
c.) I travel to…
Name and location of stores:
______
______
11.) Would you be willing to spend more money for food that met your cultural tastes if it were available in your community?
Yes
No
12.) If you shop at a farmers market, which market do you shop at?
a. Armory Park
b. Downtown-Kennedy Plaza
c. Broad Street
d. Hope Street-Lippitt Park
e. Pawtucket –Wintertime market
f. Other______
g. I do not shop at farmers markets
(If answer G. skip to question 15.)
13.) How often to you buy fruits and vegetables at a farmers’ market?
Weekly
Monthly
Rarely
Never
(If answer weekly or monthly-skip to question 16)
14.) If you don’t shop at a farmers market, why don’t you?
I was not aware they existed
I do not know when or where they are
Produce is too expensive there
Days and times are inconvenient
They don’t carry the foods that I like to eat/cook
Location is too far
I don’t like the quality of the produce
I don’t like carrying heavy bags on public transit
Other:
15.) Overall, how would you rate the prices of fruits and vegetables in the West End?
CheapOK/fineToo Expensive
16.) Do any of the following make it difficult for you to buy fruits and vegetables in the west end?
Lack of availability in local stores
Cost of fruits and vegetables
I don’t know how to prepare meals with fruits/vegetables
Fruits/vegetables in local stores are low quality
I don’t like fruits and vegetables
Other (please specify)______
Nothing/it is easy for me to buy fruits and vegetables in the west end
17.) Please list specific fruits and vegetables (fresh or processed) that are hard for you to find in the West End Stores
1.
2.
3.
4.
5. I don’t shop in West End Stores
18.) On a typical day, how many servings of fruits and vegetables(canned, fresh or frozen) do you eat? (i.e; one apple or banana, a cup of carrots, ½ cup of cooked spinach)
a. 1-2
b. 3-5
c. 5+
19.) How often do you eat restaurant prepared meal?
Every meal
1-2 per day
4 or more times per week
1-3 times per week
Less than weekly
(If answer less than weekly meal skip to question 21)
20.) If you eat restaurant-prepared meals more than once a week, what are some of the reasons why you purchase restaurant meals? Check all that apply:
Not enough time to cook
I like the taste
It’s inexpensive
Don’t have a kitchen appropriate for cooking
Don’t know how to cook
My children like it
Like to treat myself/reward
Other
21.) List three (3) restaurants or food places you go to most often:
Restaurant or fast food place name:
Restaurant or fast food place name:
Restaurant or fast food place name:
21.) Do you currently grow food in a garden?
Yes
No
22. What does eating a healthy diet mean to you?
23.) Overall how difficult is it for you to eat a healthy diet?
Not at all difficult
Somewhat difficult
Very difficult
(If answered Not at all difficult, skip to question 25)
24.) If you said that it is very or somewhat difficult to eat a healthy diet, what are some of the reasons you find it difficult? Please check all that apply
Healthy food is too expensive
Takes too much time to prepare healthy food at home
Don’t like the taste
I don't have adequate cooking space
Other family members don’t want to eat healthy food
Hard to find healthy options in my neighborhood food stores
Hard to find healthy options in my neighborhood restaurant
Don’t know how to prepare healthy options to make them taste good
Don’t know how to cook in general
Not sure what is healthy and unhealthy
25.) If high quality fruits and vegetables were more available and affordable in your community how likely would you be to buy them?
Very likely
Somewhat likely
Not likely
26.) Are you interested in participating in any of the following? Please check all that apply
Free cultural cooking classes
Free urban gardening workshops
Meetings to improve our local food system
Community gardening
Free nutrition education classes
Community/shared kitchen
Community Supported Agriculture –(where community members purchase a share of a local farm at a fixed price and receive a weekly supply of freshly harvested fruits and vegetables)
27.) Do you think other members of your household would be interested in such opportunities?
Yes
No
I don’t know
28.) What is your gender?
Female
Male
Other
29.) What language do you speak at home?
30.) How old are you?
Under 18
18-25
26-40
41-65
65+
31.) Would you like to share your contact information with us so that we can keep you informed of…
The results of this report
Future upcoming opportunities in the neighborhood
Both