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INTRO-SESSION WORKBOOK – ENGLISH VERSION
Intro Session Workbook (Click here!)
Step
1
of
5
20%
Full Name
*
Intro Date:
Day
Month
Year
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
No
Income Level
*
Low Income Range
Medium Income Range
High Income Range
Participant's GP Clinic
*
GP Name
*
Are you currently taking medication for high blood pressure?
*
Yes
No
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
Hidden
FAT TOTAL SCORE
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
Hidden
FIBRE TOTAL SCORE
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.)
Days per week (If zero, skip to question 3)
2.On average, How much time did you usually spend doing vigorous intensity physical activities on each of those days?
Minutes per day
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.)
Days per week (If zero, skip to question 5)
4. On average, how much time did you spend doing moderate intensity physical activity on each of those days?
Minutes per day
5. In the last seven days, how often did you walk for at least 10 minutes at a time.
Days per week (If zero, skip to question 7)
6. On average, how much time did you spend walking on each of those days?
Minutes per day
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.)
Hours per day
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
I feel tense or "wound up"
*
Most of the time
A lot of 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
Hidden
A-Score
Hidden
D-Score
Please fill out the required fields below
Height
Weight
*
Waist
*
Blood Pressure (mmHg)
Would you like a hard copy of the participant workbook?
*
If yes, where you would like it to send to? (enter your mailing address)
*
Email
*
Enter Email
Confirm Email
Intro Workbook
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