SURVEY FOR HEALTH WEBSITE

1. DemographicsInterviewer’s

name

Age 0-15 16-20 21-30 31-40 41-50 51-60 61+Gender Male Female

First letters of Postcode

Profession Professional Manager Skilled Semi-skilled Student Pensioner Unemployed

Salary

Religion Christian/Catholic

Atheist Muslim Jewish Hindu Other

……………

Personal HealthSmoker Yes NoAlcohol units consumed per week*

0-10 11-15 16-20 21+

Please specifiy. . . . . units

Hours of exercise per week

0-5 6-10 11-15 16+

Please specify. . . . . hours

Calorie intake per day Under 1000 1500 2000 2000+

Height: Weight:

*One alcohol unit is measured as 10ml or 8g of pure alcohol. This equals one 25ml single measure of whisky, or a third of a pint of beer or half a standard (175ml) glass of red wine.

2. Psychographics

Rate these topics in order of value(please circle and use each number only once) 1 = least important, 10 = most important

Sexual Health Education

1 2 3 4 5 6 7 8 9 10

STI’s 1 2 3 4 5 6 7 8 9 10

Anti-Smoking 1 2 3 4 5 6 7 8 9 10

Drug Awareness 1 2 3 4 5 6 7 8 9 10

Drink-Driving 1 2 3 4 5 6 7 8 9 10

Healthy Eating 1 2 3 4 5 6 7 8 9 10

Fitness 1 2 3 4 5 6 7 8 9 10

Women Well-being 1 2 3 4 5 6 7 8 9 10

NHS Direct 1 2 3 4 5 6 7 8 9 10

First Aid 1 2 3 4 5 6 7 8 9 10

3. “The public smoking ban is appropriate”Please tick

strongly disagree disagree don’t know agree strongly agree

4. “Fad diets are overrated”Please tick

strongly disagree disagree don’t know agree strongly agree

5. What sports do you play?Please tick

Often Occasionally NeverFootball

Rugby

Golf

Cricket

Hockey

Cycling

Tennis

Badminton

Swimming

Netball

Dancing

Gymnastics

Other (please specify)

. . . . . . . . . . . . . . .

. . . . . . . . . . . . . . .

6. “I would cook more meals if the recipes are…”Please circle

Not Time-Consuming

Strongly disagree

Disagree Don’t’ know

Agree Strongly agree

Child-FriendlyStrongly disagree

Disagree Don’t’ know

Agree Strongly agree

7. What would you like to see on a Health website? Please circle the three most important boxes

Bright Colours Large, clear fonts

Organised information

A forum to ask and read previous questions/answers

Healthy recipes

Information on how to lose weight

Audio/visual information

Useful links What to wear for your body shape

Useful diets

8. What type of websites do you use most regularly? Rate these from 1 – 5.You can use the same number more than once1 = lowest, 5 = highest

Social networking

News Entertainment Health Games General Information

1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

9. Is Britain becoming overweight?Please briefly explain your views on this

10. Do too many people rely on fast food?Please briefly explain your views on this

Yes / No / Don’t know

Yes / No / Don’t know