Demographic Questionnaire

Full Name *

Intro Session Date *

Marital Status *

Never Married

Separated

Widowed

Divorced

De facto/married

I don't want to provide this information

Highest Educational Level *

Pre Primary Education

Primary Education

Junior Secondary Education

Senior Secondary Education

Certificate Level

Advance Diploma and Diploma Level

Bachelor Degree Level

I don't want to provide this information

Employment Status *

Employed

Unemployed

Child at home

Student

Home Duties

Retired

Other

Healthcare Card Holder? *

Yes

Income Level

Low Income Range

Medium Income Range

High Income Range

GP Name *

GP Clinic *

Are you currently taking medication for high blood pressure? *

Yes

FAT & FIBRE BAROMETER

How many days a week do you eat take-away foods (e.g. burgers, pizza, fish and chips, Chinese, pizza, etc?) *

6 or more days

3 - 5 days

1 - 2 days

Less than 1 day

Never

When eating bread (as toasts, sandwiches, or a snack,) how often do you spread butter or margarine on it? *

Always

Usually

Occasionally

Rarely

Never

I don't eat bread

How many days a week do you eat fried food with a batter or crumb coating? *

4 or more days

2 or 3 days

Once a week

Less than once a week

Never

How many days a week do you eat fried potato (e.g. hot chips or potato crisps?) *

6 or more days

3 - 5 days

1 - 2 days

Less than 1 day

Never

How often do you eat fried or roasted vegetables? *

Always

Usually

Occasionally

Rarely

Never

How often do you (or the person who cooks for you) use fat when cooking (e.g. butter, margarine, oil, lard, etc?) *

Always

Usually

Occasionally

Rarely

Never

How many days a week do you eat processed meats (e.g. ham, sausages, bacon, salami, cured or smoked meat, chicken nuggets, deli, or lunch meats, etc?) *

4 or more days

2 or 3 days

Once a week

Less than once a week

Never

How many days a week do you eat high fat cheeses (e.g. cheddar, or cream cheese) *

6 or more days

3 - 5 days

1 -2 days

Less than 1 day

Never

How many times a week do you eat meat pies, pasties or sausage rolls, (including vegetarian)? *

3 or more times a week

Once or twice a week

Once a fortnight

Less than once a fortnight

Never

How often do you choose low-fat milk in preference to whole milk? *

Never

Rarely

Occasionally

Usually

Always

I don't drink milk

When eating cheese, how often do you choose reduced fat cheese in preference to regular cheese? *

Never

Rarely

Occasionally

Usually

Always

I don't eat cheese

How often do you or (the person who cooks for you) removed the skin from the chicken before it cooked? *

Never

Rarely

Occasionally

Usually

Always

I don't eat chicken

How often do you trim all the visible fat off the meat you eat? *

Never

Rarely

Occasionally

Usually

Always

I don't eat meat

Am I eating enough fibre?

How many days a week do you eat 2 or more pieces of fruit? *

Never

Less than 1 day

1 -2 days

3 - 5 days

6 or more days

How often do you choose wholemeal or wholegrain in bread preference to white bread? *

Never

Rarely

Occasionally

Usually

Always

I don't eat bread

How many different types of vegetables do you eat in a typical day? *

None

1 or 2 types

3 types

4 types

5 or more types

How many servings of vegetables do you eat in a typical day? (1 serve is equal to 1/2 cup of cooked vegetables or 1 cup of salad)? *

None

1 or 2 serves

3 serves

4 serves

5 or more serves

How many days a week do you eat Legumes? (e.g. three bean mix, lentils, split peas, dried beans, etc.)? *

Never

Less than once a week

Once a week

2 or 3 days

4 or more days

How many days a week do you eat high-fibre breakfast cereal (e.g. Weetbix, All-Bran, untoasted muesli, porridge)? *

Never

Less than 1 day

1 - 2 days

3 - 5 days

6 or more days

How often do you choose wholemeal pasta instead of regular pasta? *

Never

Rarely

Occasionally

Usually

Always

I don't eat pasta

Physical Activity Questionnaire

1. In the seven days, on how many days did you go vigorous intensity physical activities? (Vigorous intensity physical activity, such as running or fast cycling, means you are working hard and you can't say more than a few words without gasping for breath.) *

2. On average, How much time did you usually spend doing vigorous intensity physical activities on each of those days? *

3. In the last seven days, how often did you do moderate intensity physical activity? (Moderate physical activity, such as brisk walking and steady cycling, requires some effort. You can talk but you cannot sing while doing them.)

4. On average, how much time did you spend doing moderate intensity physical activity on each of those days? *

5. In the last seven days, how often did you walk for at least 10 minutes at a time. *

6. On average, how much time did you spend walking on each of those days? *

7. In the last week, on a typical weekday, how much time on average did you spend being sedentary? (This includes time spent sitting at a desk, table or on couch and time travelling in a car, bus, train or aeroplane. Do not count your sleeping time.) *

Self-Efficacy Questionnaire

1. I can stick to a healthy diet even if I have to make a detailed plan *

Not at all

Slightly True

Moderately True

Mostly True

Completely True

2. I can stick to a healthy diet even if I have to rethink my entire way of eating *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

3. I can stick to a healthy diet even if I have to try several times until it works *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

4. I can stick to a healthy diet even if it takes a long time to develop the right routines. *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

5. I can stick to a healthy diet even if I don't get a lot of support from family or friends when making my first attempts *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

6. I can participate in physical activity even if I am tired *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

7. I can participate in physical activity even if I am in a bad mood *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

8. I can participate in physical activity even if I feel like I don't have the time *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

9. I can participate in physical activity even if I am on holiday *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

10. I can participate in physical activity even if it is raining *

Not at all

Slightly true

Moderately true

Mostly true

Completely true

HADS Questionnaire

H1. I feel tense or "wound up"

Most of the time

A lot of the time

From time to time, occasionally

Not at all

I still enjoy the things I used to enjoy *

Definitely as much

Not quite so much

Only a little

Hardly at all

I get a sort of frightened feeling as if something awful is going to happen *

Yes definitely and quite badly

Yes, but not too badly

A little, but it doesn't worry me

Not at all

I can laugh and see the funny side of things *

As much as I always could

Not quite so much now

Definitely not so much

Not at all

Worrying thoughts go through my mind *

A great deal of time

A lot of time

Not too often

Very little

I feel cheerful *

Never

Not often

Sometimes

Most of the time

I can sit at ease and feel relaxed *

Definitely

Usually

Not often

Not at all

I feel as if I am slowed down *

Nearly all the time

Very often

Sometimes

Not at all

I get a sort of frightened feeling like 'butterflies' in the stomach *

Not at all

Occasionally

Quite often

Very often

I have lost interest in my appearance *

Definitely

I don't take as much care as I should

I may not take quite as much care

I take just as much care as ever

I feel restless as if I have been on the move *

Very much indeed

Quite a lot

Not very much

Not at all

I look forward with enjoyment to things *

As much as I ever did

Rather less than I used to

Definitely less than I used to

Hardly at all

I get sudden feelings of panic *

Very often indeed

Quite often

Not very often

Not at all

I can enjoy a good book or radio or television programme *

Often

Sometimes

Not often

Very seldom

Please fill out the required fields below

Height *

Weight *

Waist *

Blood Pressure *

Would you like a hard copy of the participant workbook? *

Yes