Attitudes towards health questionnaire
I am carrying out an evaluation of individual’s attitudes and understanding towards health, for AS Health and Social Care coursework. Thank you for taking the time to fill in this questionnaire; it should only take 10 minutes, and your participation is greatly valued. Please feel free to leave out any questions you do not wish to answer. Please return your completed questionnaire to the allocated box by the year office on completion. Your answers will be treated with complete confidentiality and will be entirely anonymous.
Attitudes towards health questionnaire
I am carrying out an evaluation of individual’s attitudes and understanding towards health, for AS Health and Social Care coursework. Thank you for taking the time to fill in this questionnaire; it should only take 10 minutes, and your participation is greatly valued. Please feel free to leave out any questions you do not wish to answer. Please return your completed questionnaire to the allocated box by the year office on completion. Your answers will be treated with complete confidentiality and will be entirely anonymous.
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What gender are you? (Please tick one box)
Male □
Female □
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How old are you? (Please tick one box)
16-25 □ 26-35 □ 36-45 □ 46-55 □ 56-65 □ 65+ □
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Have you ever had a serious health problem or disability? (Please tick one box and comment)
Yes □
No □
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Can you match the terms to the health problems? (Draw a line between the ones that match)
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What is your definition of health? (Please comment)
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Which factors are most important for your health? (Please rank factors in order of importance, 1 being the highest, 6 being the lowest)
Eating sensibly
Regular exercise
Visiting your GP
Monitoring your weight
Not smoking
Limiting alcohol consumption
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Which statement best describes your view of ill health? (Please tick one box)
I’m ill if I feel unwell □
I’m ill if I’m not actively looking after my body □
I’m ill if my social, physical, intellectual and emotional well being isn’t like normal □
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In the last six months, how often have you visited the GP? (Please comment)
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How much do you agree with the following statement: ‘If I’m ill, I’ll self treat first before visiting the GP’ (Please tick one box)
Strongly Agree □
Agree □
Unsure □
Disagree □
Strongly Disagree □
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Does your culture impact your health, and if so how? (Please circle one score)
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If you felt sick, which statement best describes how you would act? (Please tick one box)
I would visit the GP as soon as I could □
I would wait a few days to see if I felt better, if I didn’t I would go to my GP □
I would wait until the symptoms got worse before I would go to my GP □
I would only seek treatment if it impaired my daily activities □
I wouldn’t do anything, unless I felt I was at serious risk □
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What a balanced diet? (Please comment)
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On a scale of 1-10, 10 being the highest, how well do you maintain a balanced diet? (Please circle one score)
1 2 3 4 5 6 7 8 9 10
- How could you improve your diet, and why haven’t you?
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How often do you monitor your weight? (Please comment)
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Why do you monitor your weight as often as stated in question 15? (Please comment)
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Do you consider your lifestyle to considerably affect your weight? (Please tick one box)
Yes □
No □
Unsure □
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What is a unit of alcohol? (Please comment)
- For your gender, what is the recommended amount of units of alcohol per week?
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What affects does alcohol have on your health? (Please comment)
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In an average week, how many units of alcohol do you consume? (Please comment)
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Which statement best describes you’re drinking style? (Please tick one box)
I spread out my alcohol consumption equally over the week □
I drink 50% on the weekend □
I drink mostly on the weekend □
I drink mostly in one night □
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Do you smoke? (Please tick one box. If no, go to item 28)
Yes □
No □
Used to □
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Have you tried to quit smoking, and if so how many times? (Please tick one box)
Never □ 1 □ 2-3 □ 4-10 □ 11-15 □ 16+
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How often do you smoke in one day? (Please tick one box)
1-5 □ 6-10 □ 11-20 □ 4-10 □ 11-15 □ 16+
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How much do you agree with the following statement: ‘I smoke more after drinking’(Please tick one box)
Strongly Agree □
Agree □
Unsure □
Disagree □
Strongly Disagree □
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How did the smoking ban affect your life? (Please comment)
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How many hours per week do you exercise? (Please comment)
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What exercise activities do you do? (Please comment)
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What are the risks of exercising less than 3 ½ hours a week on your health? (Please tick all boxes that apply)
High blood pressure □
Obesity □
Depression □
Dementia □
Breathing problems □