Transformational Teaching Questionnaire

[Survey - Student Version]

Adolescent Health Promotion – The Role of Parents

We are researchers from the University of British Columbia (UBC). We are interested in what you think about bike helmet use. The information you provide will help us to better understand health compromising behaviours.

We want your opinion on these issues. There are no right or wrong answers. There are no good or bad answers. This is NOT a test. It will take about 25 minutes to complete this questionnaire package. You are asked to do this on your own. Your answers are very important to us so please make sure you complete all answers honestly.

If you have any questions please ask the researcher. If for ANY reason, you do not want to take part in this study that’s fine, you don’t have to. It is up to you if you want to take part or not. You are also free to withdraw at any time without having to give any reason. If you drop out you will not experience ANY negative consequences.

Your answers will be kept confidential. Your responses will be combined with those of other students, so no-one else will know how you answered the questions. All completed surveys will be kept in a locked cabinet in the office of the principal investigator at UBC. Your questionnaire will not be made available to anyone other than the researchers involved in this research.

There are no known risks associated with participation in this study. If you have any questions about what is involved please contact Dr. Mark Beauchamp, his contact details are below. Alternatively, if you have any concerns about your rights or treatment as a research subject please contact the ‘Research Subject Information Line’ in the UBC Office of Research Services at (604) 822-8598 or if long distance, an email to .

By completing this questionnaire you are agreeing to participate in this study. Please read the instructions carefully. Once you have finished, please check to see that all questions have been answered. When you have finished return the questionnaire to the researcher.

Thank you for your help,

Page 1 of 7

Version: November 3, 2010

Research Coordinators:

Lindsey Kermer -

Ayli Berson –

Alex Wilson -

School of Human Kinetics

University of British Columbia

Principal Investigator:

Mark R. Beauchamp, Ph.D.

School of Human Kinetics

University of British Columbia

Phone Number: 604-822 4864

Page 1 of 7

Version: November 3, 2010

Questionnaire

PART A: Background Information

A1. Date of Birth: ______(Month) 19______(Year)

A2. Place of Birth: ______(City) ______(Country)

A3. What is your age (years):______

A4. Gender (check one):MaleFemale

A5.School Name:______

A6. Class Name:______

A7. How do you describe yourself in terms of your ethnic origin? Please mark the one or two groups that you feel most closely describe(s) your ethnic origin.

  

Canadian / East Indian / American (USA)
Native/Aboriginal / Dutch / Norwegian
Chinese / Persian / Italian
British / Polish / Korean
Irish / Ukrainian / Filipino
German / Russian / African
French / Vietnamese / Jewish

Other______

A8.What are the first three digits on your postal code (e.g. V6T...): ______

A9. What is your mother/female guardian’s job? ______

A10. What is your father/male guardian’s job? ______

A11. Today’s date: ______(Day) ______(Month) 20______(Year)

PART B

In this section, we would like you to describe the parenting strategies used by your parent(s)/guardian(s). If you have one parent/guardian, please complete section B1 only. If you have two parents/guardians please complete section B1 and B2 (separately for each parent/guardian).

Please state clearly which parent/guardian you are thinking about when completing each questionnaire. Please complete the questionnaire(s) about the parents/guardians you spend MOST of your time with (Maximum of TWO).

To answer each question, please circle the number that best describes what you think. If a question is irrelevant, or if you are unsure or do not know the answer, leave the answer blank.Please read each sentence carefully and answer honestly. Thank you.

Use the following rating scale:

Strongly Disagree / Disagree / Slightly Disagree / Slightly Agree / Agree / Strongly Agree
0 / 1 / 2 / 3 / 4 / 5

B1. The parent/guardian I am thinking about when completing this questionnaire is:

______(e.g., Mother/Father/Step-Mother/Foster-Mother/Grandfather etc.)

MY PARENT/GUARDIAN…………

1. Acts as a person that I look up to………..………………………………………..……. / 0 / 1 / 2 / 3 / 4 / 5
2. Is optimistic about what I can accomplish……………………………………..………. / 0 / 1 / 2 / 3 / 4 / 5
3. Gets me to think for myself…...…………………………………………....………...…. / 0 / 1 / 2 / 3 / 4 / 5
4. Displays a genuine interest in my life……….….……………………………………… / 0 / 1 / 2 / 3 / 4 / 5
5. Behaves as someone that I can depend on……….………....……………….………. / 0 / 1 / 2 / 3 / 4 / 5
6. Demonstrates that s/he believes in me………………………………………………... / 0 / 1 / 2 / 3 / 4 / 5
7. Encourages me to look at issues from different sides……………..………………… / 0 / 1 / 2 / 3 / 4 / 5
8. Helps me when I am struggling ……………………………………..…………………. / 0 / 1 / 2 / 3 / 4 / 5
9. Behaves as someone that I can trust ………………..……………...……….………... / 0 / 1 / 2 / 3 / 4 / 5
10. Is enthusiastic about what I am capable of achieving………….…………………… / 0 / 1 / 2 / 3 / 4 / 5
11. Encourages me to freely express my own ideas and opinions………………….… / 0 / 1 / 2 / 3 / 4 / 5
12. Shows comfort and understanding when I am upset/frustrated…………………… / 0 / 1 / 2 / 3 / 4 / 5
13. Treats me in ways that build my respect for him/her ……..…………………..……. / 0 / 1 / 2 / 3 / 4 / 5
14. Encourages me to achieve my goals ……………………………………….……….. / 0 / 1 / 2 / 3 / 4 / 5
15. Shows respect for my ideas and opinions …………………………………..………. / 0 / 1 / 2 / 3 / 4 / 5
16. Displays genuine care and concern for me ………………………………….……… / 0 / 1 / 2 / 3 / 4 / 5

If you only have ONE parent/guardian, please do not fill in the next section, please go straight to PART C.

Strongly Disagree / Disagree / Slightly Disagree / Slightly Agree / Agree / Strongly Agree
0 / 1 / 2 / 3 / 4 / 5

B2. The parent/guardian I am thinking about when completing this questionnaire is:

______(e.g., Mother/Father/Step-Mother/Foster-Mother/Grandfather etc.)

MY PARENT/GUARDIAN…………

PART C

1. Do you own a bicycle helmet? (please circle one) YESNO

2.Do you own a bike? (please circle one) YESNO

3. If you answered yes, how many times in the last two weeks have you ridden a bike?

______

4. If you do ride your bike, how many times in the last two weeks have you worn a helmet?

______

6. How likely is it that you will wear a helmet in the next two weeks?(circle number that best describes what you think)

Extremely Unlikely Extremely Likely

1 / 2 / 3 / 4 / 5

PART D

These questions ask about your attitudes towards wearing a helmet when riding a bike. Use the scale below to answer questions 1 through 6. To answer each question, please circle the number that best describes what you think.

Wearing a bike helmet is…

1. / Extremely Unpleasant / 1 / 2 / 3 / 4 / 5 / 6 / 7 / ExtremelyPleasant
2. / Extremely Beneficial / 1 / 2 / 3 / 4 / 5 / 6 / 7 / Extremely Harmful
3. / Extremely Fun / 1 / 2 / 3 / 4 / 5 / 6 / 7 / ExtremelyBoring
4. / Extremely Bad / 1 / 2 / 3 / 4 / 5 / 6 / 7 / ExtremelyGood
5. / Extremely Enjoyable / 1 / 2 / 3 / 4 / 5 / 6 / 7 / Extremely Unenjoyable
6. / Extremely Unuseful / 1 / 2 / 3 / 4 / 5 / 6 / 7 / ExtremelyUseful

Next we would like to know what you think other people want you to do when riding a bike. To answer each question, please circle the number that best describes what you think.

Strongly Disagree / Disagree / Neutral / Agree / Strongly Agree
7. People who are important to me would approve of me wearing a bike helmet……… / 1 / 2 / 3 / 4 / 5
8. People who are important to me would want me to wear a bike helmet…………….. / 1 / 2 / 3 / 4 / 5
9. People who are important to me wear bike helmets…………………………………… / 1 / 2 / 3 / 4 / 5

These questions ask you about some factors that might make it easier or more difficult to wear a helmet when riding a bike. To answer each question, please circle the number that best describes what you think.

10.For me to wear a bike helmet in the next two weeks is Difficult Easy

1 / 2 / 3 / 4 / 5 / 6 / 7

11.I am confident that if I wear a bike helmet I could keep to it