Healthy People Survey


Welcome to the Healthy People Survey.

This survey will ask you about your:

−Health behaviours (e.g. if you smoke and how much physical activity you do).

−General health and wellbeing (e.g. how well you manage your work-life balance).

−Background and work situation (e.g. how old you are and if you work full or part-time).

The survey will take approximately 20 minutes, so try to find a space in the day where you will not be interrupted.

When completing the survey:

−Read the instructions above each question carefully before answering, as different questions may ask you to recall your behaviour for different time frames (for example, what you did yesterday, last week, or what you would usually do).

−Tick one answer unless otherwise specified..

−Answer all questions as accurately as you can.

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−For questions that ask you to select one answer from a range of options, choose the option that best describes your situation.

Note: An online version of the survey can be found on

How many serves of vegetables (including fresh, dried, frozen and tinned vegetables) do you usually eat each day?
(1 serve of vegetables is a cup of salad, half a cup of cooked vegetables or a medium-sized potato excluding chips)
(Mark one only)
 None
 Less than 1 serve
 1 serve
 2 serves
 3 serves
 4 serves
 5 serves
 6+ serves
How many serves of fruit (including fresh, dried, frozen and tinned fruit) do you usually eat each day?
(1 serve of fruit is 1 medium-sized piece (or 2 smaller-sized pieces) of fresh fruit, 1 cup of canned or chopped fruit, half a cup of fruit juice, or 1½ tablespoons of dried fruit)
(Mark one only)
 None
 Less than 1 serve
 1 serve
 2 serves
 3 serves
 4 serves
 5 serves
 6+ serves

Nutrition

Alcohol

Have you had an alcoholic drink of any kind in the last twelve months? Yes/No

On a day that you have an alcoholic drink, how many standard drinks do you usually have?

1-2

3-4

 5 or more

In the last 12 months, how often do you have more than 4 drinks on one occasion?

Never

Less than monthly

Monthly

Weekly

Daily or almost daily

Smoking

Which of the following is applicable to you:

 You have never smoked cigarettes, cigars, pipes or other tobacco products(Go to Physical Activity Section)

 You are an ex-smoker

 You currently smoke cigarettes, cigars, pipes or other tobacco products

Do you smoke regularly, that is, at least once a day?

 Yes

No

If you smoke daily, on average how many cigarettes do you smoke each day?

_____

If you smoke, but not daily, on average, how many cigarettes do you smoke per week?

_____

In the last 12 months, have you successfully given up smoking for more than a month?

 Yes

 No

In the last 12 months, have you tried to give up smoking but been unsuccessful?

 Yes

 No

Physical Activity

In the last week, how many times have you walked continuously, for at least 10 minutes, for recreation/exercise or to get to or from places? Number

What do you estimate was the TOTAL TIME that you spent walking in this way IN THE LAST WEEK? Hours/Minutes

How many of these walks that lasted at least 10 minutes were specifically to get to or from places rather than for recreation or exercise? Number/week

What do you estimate was the TOTAL TIME you spent walking this way IN THE LAST WEEK? Hours/Minutes

In the last week, how many times did you do any vigorous gardening or heavy work around the yard, which made you breathe harder or puff and pant? Number

What do you estimate was the TOTAL TIME that you spent doing vigorous gardening or heavy work around the yard IN THE LAST WEEK? Hours/Minutes

The next question excludes household chores or gardening or yard work.

IN THE LAST WEEK, how many times did you do any vigorous physical activity which made you breathe harder or puff and pant? (E.g. jogging, cycling, aerobics, competitive tennis)? Number

What do you estimate was the TOTAL TIME that you spent doing this vigorous physical activity IN THE LAST WEEK? Hours/Minutes

IN THE LAST WEEK, how many times did you do any other more moderate physical activity that you haven't already mentioned? (E.g. gentle swimming, social tennis, golf, lawn bowls) Number

What do you estimate was the TOTAL TIME that you spent doing these activities IN THE LAST WEEK?

Hours/Minutes

Including any activities already mentioned, in the last week did you do any strength or toning activities? Yes/No

On how many days did you do any strength or toning activities in the last week? Number

Sitting

What is the total time you spend sitting at work on a typical day? Hours/Minutes

What is the total time you spend sitting on a non-work day? Hours/Minutes

Change

Which one of the following behaviours would you most like to change in the next 6-months? (Please tick one box)

I would like to:

 Eat more fruits and vegetables

Reduce my alcohol intake

Quit smoking

Increase my physical activity

Reduce the amount of time I spend sitting

Wellbeing

This section asks some general questions about how you feel about your health and your level of satisfaction with your life and your work. Most answers are rated on a scale of 1 to 10 and choosing from a set of descriptions by ticking a box.

In general, would you say your health is:

Excellent

Very good

Good

Fair

Poor

If you are pregnant or have a pre-existing medical condition (e.g. heart disease or diabetes), please tick this box. 

How satisfied are you with your life as a whole? (Please tick one box)

0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
Completely dissatisfied / Neutral / Completely satisfied

How satisfied are you with your work life as a whole? (Please tick one box)

0 / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
Completely dissatisfied / Neutral / Completely satisfied

How would you describe the level of stress in your job during the past six months? (Please tick one box)

1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10
Very low stress / Very high stress

Overall, how would you describe your relationship with your supervisor?

 Excellent

 Very Good,

 Good,

 Fair

 Poor

Overall, how would you describe your relationship with your immediate co-workers?

 Excellent

 Very Good

 Good

 Fair

 Poor

Managing time is often difficult. How often do you feel: (Please tick one)

Every day
(5) / A few times a week
(4) / About once a week
(3) / About once a month
(2) / Never (1)
That you are rushed, pressured, too busy?
That you have time on your hands that you don't know what to do with?

Please indicate how often you have felt each of the following in the past six months (where 1 is not at all, 4 is sometimes and 7 is all the time): (Please tick one box)

1 / 2 / 3 / 4 / 5 / 6 / 7
My personal life suffers because of work
My job makes my personal life difficult
I neglect personal needs because of work
I put my personal life on hold for work
I miss personal activities because of work
I struggle to juggle work and non-work
I am happy with the amount of time for non-work activities
My personal life drains me of energy for work
I am too tired to be effective at work
My work suffers because of my personal life
I find it hard to work because of personal matters

In the last 6 months, how often has your work been affected by your (Please tick one box):

A lot of the time
(3) / Some of the time
(2) / A little of the time (1) / None of the time
(0)
Physical health?
Emotional or psychological wellbeing?

About you

Are you….

male

 female

What is your current age? ______

How much do you weigh (wearing light clothing and no shoes)? _____kilograms

How tall are you (wearing no shoes)? ______centimetres

In which country were you born?

Australia

Other English-speaking country (e.g. UK, New Zealand, USA, Canada, South Africa)

Non-English speaking country in Europe

Non-English speaking country in Africa

Non-English speaking country in Asia

Non-English speaking country in South America

Other

Which language do you mainly speak at home?

English

Other

Are you of Aboriginal or Torres Strait Islander origin?

No

Aboriginal

Torres Strait Islander

Both

What is the postcode where you live?

____

Which of the following best describes your household type?

Person living alone

Married or defacto couple only

Married or defacto couple living with children

One person living with children

Shared household

All other households

What is the highest qualification you have ever COMPLETED?

No formal education

Primary school only

Year 10 or equivalent

Year 12 or equivalent

Technical or trade certificate

Diploma or advanced diploma

Bachelor degree

Graduate diploma or graduate certificate

Postgraduate degree

How do you manage on the income you have available?

It is difficult all of the time

It is difficult some of the time

It is not too bad

It is easy

How would you describe your work?

Manager (e.g., chief executive, general manager, legislator, farm manager, sales manager, service manager)

Professional (e.g., journalist, accountant, engineer, scientist, teacher, nurse or allied health professional, IT worker, solicitor, social worker)

Technician or trades worker (e.g., electrician, mechanic, carpenter, butcher, chef, horticulturalist, hairdresser)

Community or personal service worker (e.g., health support worker, child care worker, teacher aide, waiter, security officer, personal trainer)

Clerical or administrative worker (e.g., secretary, receptionist, book keeper, administrative assistant)

Sales worker (e.g., real estate agent, retail sales assistant, checkout operator)

Machinery operator or driver (e.g., plant operator, delivery driver, bus driver, store person, truck or fork lift operators)

Labourer (e.g., cleaner, laundry worker, construction worker, gardener, food preparation assistant)

Do you work...

Full time

Part time

Casual

In a usual week, how much time in total do you spend at work in paid employment?

____ hours and ____ minutes

Do you normally do any of the following kinds of paid work?

(Tick all that apply)

Paid shift work

Paid work with irregular hours

Paid work on short-term contract (less than one year)

Paid work in more than one job

Paid work at night

Paid work from home

None of the above

Thank you for your time.

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