8/13/2019 Hypertension Survey

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General QuestionsHi, we are a group of year 2 Pharmacy students surveying the awareness of issues pertaining to

hypertension. All data collected will be kept confidential.

This survey will take less than 5 minutes of your time.

Thank you for your participation, your response is greatly appreciated. :)

* Required

What is your age group? *

Mark only one oval.

30-39

40-49

50-59

60 and above

1.

Do you have hypertension(high blood pressure)? *

All data will be kept anonymous and confidential.

Mark only one oval.

Yes Skip to question 14.

No Skip to question 3.

I don't know Skip to question 3.

2.

Non-Hypertension

Stop filling out this form.

How often do you eat food that is high in salt content in a week? *

E.g. Ham, Cheese, MSG, Fast food, Canned food, Soya sauce, Dried ikan bilis, French fries

Mark only one oval.

1-2 times

3-4 times

5-6 times

Everyday

Never

3.

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How often do you do at least 30 minutes of physical activity? *

E.g. 30 minutes of brisk walking, jogging, tai chi, dancing, housework

Mark only one oval.

1-2 times

3-4 times

5-6 times

EverydayNever

4.

Do you smoke? *

If Yes, please proceed to the next question, if No, please skip the next question

Mark only one oval.

Yes

No

5.

If yes, how many sticks do you smoke a day?6.

Do you consume alcoholic drinks? *

E.g. Beer, Hard Liquor(Volka, Martini, XO, Tequila,Martel), Wine (Red wine, White Wine), Soju

Mark only one oval.

Yes

No

7.

If Yes, how many units of alcohol do you drink aweek?

E.g. 1 can of beer = 1 unit, 1 glass of wine = 1 unit,

1 shot of Tequila = 1 unit. If No, please skip this

question.

8.

How often do you go for a health checkup with a healthcare practitioner? *

Mark only one oval.

Twice a year

Once in two years

Once in five years

Never

9.

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Are you aware of what is pre-hypertension? *

Mark only one oval.

Yes

No

10.

What do you think are the chances of you getting hypertension? *

Mark only one oval.

1 2 3 4 5

Very Unlikely Very Likely

11.

Does your family have a history of High Blood Pressure (hypertension)? *

Mark only one oval.

Yes

No

I don't know

12.

What do you think the long term consequences of high blood pressure are? *

Tick all the options that apply

Check all that apply.

Heart Disease (e.g chest pain)

Diabetes

Kidney Failure

Blindness

Stroke

Heart Attack

13.

HypertensionStop filling out this form.

How often do you eat food that is high in salt content in a week? *

E.g. Ham, Cheese, MSG, Fast food, Canned food, Soya sauce, Dried ikan bilis, French fries

Mark only one oval.

1-2 Times

3-4 Times

5-6 Times

Everyday

Never

14.

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How often do you do at least 30 minutes of Physical Activity in a week? *

E.g. 30 minutes of brisk walking, jogging, tai chi, dancing, housework

Mark only one oval.

1-2 Times

3-4 Times

5-6 Times

EverydayNever

15.

Do you smoke? *

If yes please proceed to next question, if No, skip the next question

Mark only one oval.

Yes

No

16.

If yes, how many sticks do you smoke a day?17.

Do you consume alcoholic drinks? *

E.g. Beer, Hard Liquor (Volka, Martini, XO, Tequila,Martel), Wine (Red wine, White Wine), Soju

Mark only one oval.

Yes

No

18.

If Yes, how many units of alcohol do youconsume a week?

E.g. 1 can of beer = 1 unit, 1 glass of wine = 1 unit,

1 shot of Tequila = 1 unit. If No, please skip this

question.

19.

Have you ever missed taking your medicine for high blood pressure? *

If you answer no to this question or do not need to take medication, skip the next question

Mark only one oval.

Yes

No

I do not need to take medication

20.

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If you answered yes to the previous question, Why did you miss taking your medication?

Due to reasons such as: feeling better already/ too busy and forgot/ dislike side effects etc.

21.

What do you think the long term consequences of high blood pressure are? *

Tick all the options that apply

Check all that apply.

Heart Disease (e.g chest pain)

Diabetes

Kidney Failure

Blindness

Stroke

Heart Attack

22.

To what extent do you think that the measures taken to control hypertension(high blood

pressure) disrupt your lifestyle? *

Mark only one oval.

1 2 3 4 5

Minimal disruption Very disruptive

23.

Why do you think the measures to control hypertension are disruptive? *

Tick as many that applies.

Check all that apply.

Too inconvenient

Too busy to exercise

Family commitments (e.g taking care of family)

Work environment not conducive or supportive of measures

Side effects of hypertensive drugs

Healthy food is expensive

Unhealthy food taste better

You only live once, so why eat healthy?

Hypertension is not a severe problem and does not need too much intervention

I do not want to be the odd one out.

Other:

24.

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