Texas A&M AgriLife Extension Service
Better Living for Texans
Needs Assessment Survey
Texas A&M AgriLife Extension Services Better Living for Texans Program seeks to provide information to help Texans prepare and eat healthier meals, stretch their food dollars, practice food safety, and increase their physical activity. Please take a few moments to complete this form. You do not have to answer any question that makes you uncomfortable. The sole purpose of this survey is to hear from our participants so we can better serve you.
Part 1: Tell us which topic below you’re interested in learning more about by circling Yes, No, or Not Sure:
1. how to cook meals with less fat, sugar, or salt Yes Not Sure No
2. how to plan meals that don’t cost a lot of money Yes Not Sure No
3. how to make my food stamps last longer Yes Not Sure No
4. how to cook meals safely so my family doesn’t get sick Yes Not Sure No
5. how to keep food from spoiling Yes Not Sure No
6. how to make quick and easy meals Yes Not Sure No
7. how to make healthy snacks Yes Not Sure No
8. about the Food Guide Pyramid Yes Not Sure No
9. about nutrients and what they do Yes Not Sure No
If there are other things you would like to learn about, write them here: ______
______
Part 2: In the last 12 months before today, did you (or other adults in your household) ever cut the size of your meals or skip meals because there wasn’t enough money for food? ❑Yes ❑No
If so, how often did this happen?
❑Almost every month ❑Some months but not every month ❑In only one or two months
In the last 12 months, have you ever eaten less than you felt you should because there wasn’t enough money to buy food? ❑Yes ❑No
In the last 12 months, were you ever hungry but didn’t eat because you couldn’t afford enough food? ❑Yes ❑No
How would you answer the following statements?
During the last 12 months, the food that I bought just didn’t last, and I didn’t have money to get more.
❑often true ❑sometimes true ❑never true
During the last 12 months, I couldn’t afford to eat balanced meals.
❑often true ❑sometimes true ❑never true
Within the past 3 months, have you or members of your household received food from a food pantry? ❑Yes ❑No
Part 3: When shopping for food, how often do you:
a. plan meals and snacks before shopping? ❑Always ❑Most of the time ❑Sometimes ❑Seldom ❑Never
b. make a shopping list before going to the store? ❑Always ❑Most of the time ❑Sometimes ❑Seldom ❑Never
c. use coupons? ❑Always ❑Most of the time ❑Sometimes ❑Seldom ❑Never
d. buy store-brand or generic foods? ❑Always ❑Most of the time ❑Sometimes ❑Seldom ❑Never