Full Name *

Facilitator's Name *

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 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

Life! Program Evaluation - Session 6

Please tick the box that matches what you think

1. I understood the information that was discussed *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

2. The information was relevant for people from my cultural background *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

3. Our group facilitator was supportive and encouraging *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

4. Our group facilitator communicated well *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

5. There was sufficient opportunity for me to join in group discussions *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

6. There was sufficient opportunity for me to ask questions *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

7. I found the Life! program workbook useful *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

8. The content of the workbook was relevant for people from my cultural background *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

9. I now have a better understanding of my risk for type 2 diabetes, heart disease and stroke *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

10. Life! has increased my skills to allow me to eat a healthy diet *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

11. Life! has increased my skills to allow me to become more physically active *

Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

12. I have made healthy changes to my eating habits as a result of the program *

Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

13. I have made changes to increase my physical activity as a result of the program *

Strongly disagree

Disagree

Neutral

Agree

Strongly Agree

14. What were the most useful things about the course for you? *

15. What were the least useful things about the course for you? *

16. What, if anything, would you recommend we do differently in the sessions? *

17. The overall rating I would give to Life! program is..... *

Very bad

Bad

Average

Very good

Excellent

18. Would you recommend this program to others? *

Yes

Undecided

Please explain why?

19. Any other comments?

Please fill out the required fields below

Height *

Weight *

Waist *

Blood Pressure *

Are you currently taking medication for high blood pressure? *

Yes