Appendix A: Survey Instrument

Project title: A Randomised Trial of Economic Incentives to Promote Physical Activity Among Full Time Employees

Principal Investigator with the contact number and organisation:Dr. Eric Finkelstein, Associate Professor, Duke-NUS Graduate Medical SchoolTel: (65) 6516 2338

Interviewer Name: Duration of Interview (min): Date (dd/mm/yy): Language Used:

Respondent's Name: Respondent's Contact No. Questionnaire No. Version No.

Good morning/afternoon/evening, my name is ____________. I am an interviewer from Research Plus Pte Ltd. We are carrying out a major survey on behalf of Duke-NUS Graduate Medical School, which is funded by the Ministry of Health. This survey looks at how the use of economic incentives may promote physical activity among full-time employees and explores potential interest in a Smartphone-based programme. This survey takes around 30 minutes to complete and a $10 NTUC voucher will be presented at the end as a token of our appreciation. This interview is for research purposes only and your identity will be kept confidential.

SCREENERS

S1 Are you currently able to do at least 10 minutes continuously of moderate to vigorous physical activity? [SA] Definition of moderate to vigorous physical activity: Activity that makes you breathe harder and your heart beat faster, examples include brisk walking, dancing, cycling, jogging, or swimming.Yes No

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A1S2

S2 Do you think you will be able to do at least 10 minutes continuously of moderate to vigorous physical activity in six months’ time? [SA]Yes No

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A1Closed

SECTION A: HEALTH

A1 Would you say that in general your health is:

Poor FairGoodVery Good Excellent

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A2 What is your weight? Please give us your best estimation.

Don't know

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777

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A3 What is your height? Please give us your best estimation.

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kg

cm

Don't know 777

A4 How would you describe your weight?

Very underweightSlightly underweightAbout the right weightSlightly overweightVery overweightPrefer not to say

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A5 Throughout your adult life, which of the following best describes your approach to managing your health? I maintain a healthy lifestyle all the timeI maintain a healthy lifestyle most of the timeI maintain a healthy lifestyle sometimesI have never maintained a healthy lifestylePrefer not to say

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Please select the option that best represents your health today for each of the following groups of statements.

A6 MobilityI have no problems in walking aboutI have slight problems in walking aboutI have moderate problems in walking aboutI have severe problems in walking aboutI am unable to walk about

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A7 Self-careI have no problems washing or dressing myselfI have slight problems washing or dressing myselfI have moderate problems washing or dressing myselfI have severe problems washing or dressing myselfI am unable to wash or dress myself

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A8 Usual Activities (e.g. work, study, housework, family or leisure activities)I have no problems doing my usual activities I have slight problems doing my usual activitiesI have moderate problems doing my usual activitiesI have severe problems doing my usual activitiesI am unable to do my usual activities

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A9 Pain/DiscomfortI have no pain or discomfortI have slight pain or discomfortI have moderate pain or discomfortI have severe pain or discomfortI have extreme pain or discomfort

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A10 Anxiety/DepressionI am not anxious or depressedI am slightly anxious or depressedI am moderately anxious or depressedI am severely anxious or depressedI am extremely anxious or depressed

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A11 To help people say how good or bad a health state is, we have drawn a scale (rather like a thermometer) on which the best state you can imagine is marked 100 and the worst state you can imagine is marked 0. We would like you to indicate on this scale how good or bad your own health is today, in your opinion.Please do this by circling whichever point on the scale indicates how good or bad your health state is today.

RECORD exact number:

_____________

SECTION B: PRODUCTIVITYThe following questions ask about the effect of your health problems on your ability to work and perform regular activities. By health problems we mean any physical or emotional problem or symptom. The next questions are about the past seven days, not including today.

B1 During the past seven days, a. how many hours did you miss from work because of your health problems? (Include hours you missed on sick days, times you went in late, left early, etc., because of your health problems. Do not include time you missed to participate in this study.)

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hrs

b. how many hours did you miss from work because of any other reason?(such as vacation, holidays, time off to participate in this study) hrs

c. how many hours did you actually work? hrs

B2 During the past seven days, how much did health problems affect your productivity while you were working?Think about days you were limited in the amount or kind of work you could do, days you accomplished less than you would like, or days you could not do your work as carefully as usual. If health problems affected your work only a little, choose a low number. Choose a high number if health problems affected your work a great deal.

Consider only how much health problems affected productivity while you were working

0 1 2 3 4 5 6 7 8 9 10

Health problems had no effect on my work

Health problems completely prevented me from working

B3 During the past seven days, how much did health problems affect your ability to do your regular daily activities, other than work at a job?By regular activities, we mean the usual activities you do, such as work around the house, shopping, childcare, exercising, studying, etc. Think about times you were limited in the amount or kind of activities you could do and times you accomplished less than you would like. If health problems affected your activities only a little, choose a low number. Choose a high number if health problems affected your activities a great deal.

Consider only how much health problems affected your ability to do your regular daily activities, other than work at a job

0 1 2 3 4 5 6 7 8 9 10

Health problems had no effect on my daily activities

Health problems completely prevented me from doing my daily activities

SECTION C: PHYSICAL ACTIVITY

Next I am going to ask you about the time you spend doing different types of activity in a typical week. Please answer these questions even if you do not consider yourself to be a physically active person.

ACTIVITY AT WORKThink first about the time you spend doing work. Think of work as the things that you have to do such as paid or unpaid work, study/training, household chores or seeking employment. In answering the following questions, 'vigorous-intensity activities' are activities that require hard physical effort and cause large increases in breathing or heart rate, 'moderate-intensity activities' are activities that require moderate physical effort and cause small increases in breathing or heart rateC1a Does your work involve vigorous-intensity activity that causes large increases in

breathing or heart rate like carrying or lifting heavy loads for at least 10 minutes continuously? YesNo

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C2C1b In a typical week, on how many days do you do vigorous-intensity activity as part of your work?

C1c On a typical day in that week, how much time do you spend doing vigorous-intensity activities at work? [CHECK IF >2 HOURS]

C2a Does your work involve moderate-intensity activity that causes small increases in breathing or heart rate such as carrying light loads for at least 10 minutes continuously? YesNo

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C3C2b In a typical week, on how many days do you do moderate-intensity activity as part of your work?

C2c On a typical day in that week, how much time do you spend doing moderate-intensity activities at work? [CHECK IF >2 HOURS]

TRAVEL TO AND FROM PLACESThe next questions exclude the physical activities at work that you have already mentioned.C3a Do you walk or use a bicycle (pedal cycle) for at least 10 minutes continuously

to get to and from places? YesNo

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C4C3b In a typical week, on how many days do you walk or bicycle for at least 10 minutes

continuously to get to and from places?

C3c On a typical day in that week, how much time do you spend on average walking or bicycling to get to and from places? [CHECK IF >2 HOURS]

days

____ hrs ____ mins

days

____ hrs ____ mins

days

____ hrs ____ mins

RECREATIONAL ACTIVITIES

The next questions exclude the work and transport activities that you have already mentioned. Now I would like to ask you about sports, fitness and recreational activities.

C4a Do you do any vigorous-intensity sports, fitness or recreational activities that cause large increases in breathing or heart rate like running, football or kick-boxing for at least 10 minutes continuously? YesNo

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C5C4b In a typical week, on how many days do you do vigorous-intensity sports, fitness or recreational

activities?

C4c On a typical day in that week, how much time on average do you spend doing vigorous-intensity sports, fitness or recreational activities? [CHECK IF >2 HOURS]

C5a Do you do any moderate-intensity sports, fitness or recreational activities that causes small increase in breathing or heart rate such as brisk walking, cycling, swimming, volleyball for at least 10 minutes continuously? YesNo

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C6C5b In a typical week, on how many days do you do moderate-intensity sports, fitness or recreational activities?

C5c On a typical day in that week, how much time on average do you spend doing moderate-intensity sports, fitness or recreational activities? [CHECK IF >2 HOURS]

SEDENTARY BEHAVIOURThe following question is about sitting or reclining at work, at home, getting to and from places, or with friends including time spent sitting with friends, travelling in car, bus train, reading or watching television.

Please do not include time spent sleeping.C6 On a typical day, how much time do you usually spend sitting or reclining? [CHECK IF <5 HOURS]

SECTION D: PERCEPTIONS OF PHYSICAL ACTIVITY

Now we would like to ask you some questions about your perceptions of physical activity.

D1 When you think about physical activity as a means to improve health and fitness, do you see a positive or negative picture in your mind?

Completely negativeSomewhat negativeNeutralSomewhat positiveCompletely positive

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days

days

____ hrs ____ mins

____ hrs ____ mins

____ hrs ____ mins

D2 How would you describe the environment for walking and running in your neighbourhood?

0 1 2 3 4 5 6 7

Very unpleasant Very

pleasant

SECTION E: ORGANISED PHYSICAL ACTIVITIES

E1 Have you paid to participate in physical activities in the last 12 months? This includes paying for gym membership, classes or races. YesNo

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SECTION F: HYPOTHETICAL SMARTPHONE-BASED INCENTIVISED PHYSICAL ACTIVITY PROGRAMMES

Later, we will ask you to think about a hypothetical Smartphone-based physical activity programme designed to promote physical activity through the use of rewards.As part of this exercise, you will need to choose between two programmes with different features 10 times. Before that, I’ll go through with you what those features are.

Weekly Activity Goals Specify the minimum number of moderate to vigorous physical activity (MVPA) minutes required to obtain the rewards. Activities will be tracked by the built-in GPS and step counter function in your smartphone. Goals may vary between:

60 minutes (1 hour) 100 minutes (1.7 hours) 150 minutes (2.5 hours) 210 minutes (3.5 hours)

F1 What do you think is the maximum number of minutes of moderate to vigorous physical activity you could consistently do per week if you were really motivated?

Less than 2 hours2 hours to less than 3 hours 3 hours to less than 4 hours 4 hours to less than 5 hours More than 5 hours

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Types of RewardsRewards are not always paid in cash. Other options include vouchers or even to have the money designated to a charity. You will be asked to consider the following options:

Cash payments Vouchers (e.g NTUC, Capita Malls) Medisave Donations to a charity of your choice

F2 Please rank your preference for the above types of rewards. Please fill in your rank order in the spaces provided using the numbers 1 through 4, with one being the best option and 4 the worst option.

Rankorder(1 to 4)

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a. Cash paymentsb. Vouchers (e.g NTUC, Capita Malls)c. Medisaved. Donations to a charity of your choice

Values of RewardsIf you meet your weekly physical activity goals, you will receive rewards that vary between the following amounts for that week.

SGD$15 weekly (Max. payout: $390) SGD$30 weekly (Max. payout: $780) SGD$40 weekly (Max. payout: $1,040) SGD$60 weekly (Max. payout: $1,560)

F3a Would you consider committing to a six-month Smartphone based physical activity programme if there is no incentive for meeting physical activity goals? Very likelySomewhat likelySomewhat unlikelyDefinitely would not join

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F4

F3bF3b Would you consider committing to a six-month Smartphone based physical

activity programme with rewards for meeting goals if there is a potential to earn rewards worth up to $390? Very likelySomewhat likelySomewhat unlikelyDefinitely would not join

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F4

F3cF3c Would you consider committing to a six-month Smartphone based physical

activity programme with rewards for meeting goals if there is a potential to earn rewards worth up to $1,560 ? Very likelySomewhat likelySomewhat unlikelyDefinitely would not join

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Enrolment FeesTo join the programme, participants may need to pay an enrolment fee to cover administrative/operational expenses incurred and/or to fund rewards. Consider the following enrolment fees:

No enrolment fee collected $50 enrolment fee $150 enrolment fee $300 enrolment fee

Preferences for Smartphone-based Incentivised Physical Activity ProgrammeNow we will ask you a set of 10 questions. In each question, you will be asked to choose between two Smartphone-based incentive programmes that vary along the features just described and whether you would join your preferred programme if it were offered to you.

F4A Which programme do you prefer?Programme A Programme B

Weekly activity goal 150 mins (2.5 hrs) per week 60 mins (1 hr) per weekType of rewards Vouchers MedisaveValue of rewards $16 per week

(Max. payout: $1,560)$15 per week

(Max. payout: $1,040)Enrollment fee $150 $300

F4B Would you join your preferred programme if it was offered to you? Yes No

F5A Which programme do you prefer?Programme A Programme B

Weekly activity goal 210 mins (3.5 hrs) per week 100 mins (1.7 hrs) per weekType of rewards Cash payments Donation to a charity of your choiceValue of rewards $30 per week

(Max. payout: $780)$40 per week

(Max. payout: $1,040)Enrollment fee $150 $300

F5B Would you join your preferred programme if it was offered to you? Yes No

F6A Which programme do you prefer?Programme A Programme B

Weekly activity goal 60 mins (1 hr) per week 100 mins (1.7 hrs) per weekType of rewards Medisave Donation to a charity of your choiceValue of rewards $60 per week

(Max. payout: $1,560)$15 per week

(Max. payout: $390)Enrollment fee $300 $50

F6B Would you join your preferred programme if it was offered to you? Yes No

F7A Which programme do you prefer?Programme A Programme B

Weekly activity goal 210 mins (3.5 hrs) per week 100 mins (1.7 hrs) per weekType of rewards Vouchers Cash paymentsValue of rewards $30 per week

(Max. payout: $780)$40 per week

(Max. payout: $1,040)Enrollment fee No enrolment fee $150

F7B Would you join your preferred programme if it was offered to you? Yes No

F8A Which programme do you prefer?

Programme A Programme BWeekly activity goal 60 mins (1 hr) per week 150 mins (2.5 hrs) per week

Type of rewards Cash payments MedisaveValue of rewards $60 per week

(Max. payout: $1560)$30 per week

(Max. payout: $780)Enrollment fee No enrolment fee $150

F8B Would you join your preferred programme if it was offered to you? Yes No

F9A Which programme do you prefer?Programme A Programme B

Weekly activity goal 150 mins (2.5 hrs) per week 60 mins (1 hr) per weekType of rewards Medisave Cash paymentsValue of rewards $30 per week

(Max. payout: $780)$15 per week

(Max. payout: $390)Enrollment fee $300 $150

F9B Would you join your preferred programme if it was offered to you? Yes No

F10A Which programme do you prefer?Programme A Programme B

Weekly activity goal 210 mins (3.5 hrs) per week 100 mins (1.7 hrs) per weekType of rewards Donations to a charity of your

choiceVouchers

Value of rewards $60 per week(Max. payout: $1,560)

$40 per week(Max. payout: $1,040)

Enrollment fee $50 No enrolment fee

F10B Would you join your preferred programme if it was offered to you? Yes No

F11A Which programme do you prefer?Programme A Programme B

Weekly activity goal 60 mins (1 hr) per week 100 mins (1.7 hrs) per weekType of rewards Vouchers Donations to a charity of your choiceValue of rewards $30 per week

(Max. payout: $780)$60 per week

(Max. payout: $1,560)Enrollment fee $50 $150

F11B Would you join your preferred programme if it was offered to you? Yes No

F12A Which programme do you prefer?

Programme A Programme BWeekly activity goal 150 mins (2.5 hrs) per week 100 mins (1.7 hrs) per week

Type of rewards Cash payments MedisaveValue of rewards $40 per week

(Max. payout: $1,040)$15 per week

(Max. payout: $390)Enrollment fee $300 No enrolment fee

F12B Would you join your preferred programme if it was offered to you? Yes No

F13A Which programme do you prefer?Programme A Programme B

Weekly activity goal 100 mins (1.7 hrs) per week 150 mins (2.5 hrs) per weekType of rewards Vouchers Cash paymentsValue of rewards $30 per week

(Max. payout: $780)$40 per week

(Max. payout: $1,040)Enrollment fee $50 $150

F13B Would you join your preferred programme if it was offered to you? Yes No

SECTION G: SMARTPHONE OWNERSHIP AND USAGE

G1 Do you own a mobile phone? Yes No

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G2 Is your phone a Smartphone? Definition of Smartphone: A Smartphone has more sophisticated functions than an ordinary cell phone. Examples of such functions are: i) able to access the internet, ii) able to open and read documents (e.g. pdf, office document) and ii) able to add / install applications on phone.Yes NoDon't know

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G3aH1G3a

G3a Have you ever used a sport and fitness app to track your physical activities?

Yes – using the app nowYes – used the app before but no longer using No

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H1

G3b

G3b Would you consider using a sport and fitness app in the future?Definition of sports and fitness app: A Smartphone app that helps you improve your fitness level. Possible functions include tracking and analysing physical activities, providing guidance and feedback on your performance and enabling you to compete with your peers.YesNoMaybe

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SECTION H: PHILANTHROPIC BEHAVIOUR

H1 In the last year, have you donated any money to a non-profit organisation? This could be a charity, a church, etc.? YesNo

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H2I1

H2 Which organisation have you donated the most to? __________________________________________________________________________________________________________________________________

SECTION I: WORK

I1 How many employees are there in your organisation?

0-45-910-1920-4950-99100-199200-299300-399400-499 More than 500

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I2 In your main job, are you: INTERVIEWER NOTE: If the respondent has more than one job, they should answer about the one which occupies them for the most hours per week. If they have two jobs that are exactly equal, they should answer about the more highly paid of the two.An employeeSelf-employedWorking for your own family's business

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I3 Which of the following descriptions best describes the sort of work you do?

Professional and technical occupations (eg. doctor, teacher, engineer, artist, accountant) Higher administrator occupations (eg. banker, executive in big business, high government official, union official) Clerical occupations (eg. secretary, clerk, office manager, book keeper) Sales occupations (eg. sales manager, shop owner, shop assistant, insurance agent) Service occupations (eg. police officer, waiter, caretaker, barber, armed forces) Skilled worker (eg. foreman, motor mechanic, printer, tool and die maker, electrician) Semi-skilled worker (eg. bricklayer, bus driver, cannery worker, carpenter, sheet metal worker, baker) Unskilled worker (eg. laborer, security personnel, unskilled factory worker) Farm worker (eg. farmer, farm laborer, fisherman) Don’t know

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34

56

7

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SECTION J: WORKSITE HEALTH PROMOTION

J1 Have you taken part in any health promotion activities organised or facilitated by your employer? These activities can include health screenings, physical activity programmes or wellness classes? YesNo

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SECTION K: SOCIO-DEMORAPHICS

K1 RECORD Gender Male Female

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K2 RECORD Exact Age as of last birthday

K3 Which ethnic group do you belong to? Chinese MalayIndianOthers (Please specify: ____________________________)Prefer not to say

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K4 What is your current marital status?

MarriedWidowed Separated from SpouseDivorcedNever MarriedPrefer not to say

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K5 What type of housing are you living in?

HDB/ JTC flat (1-2 room)HDB/ JTC flat (3 room)HDB/ JTC flat (4 room)HDB/ JTC flat (5 room and above/ HUDC/ Executive)Condominium/ Private flatBungalow/ semi-detached/ terrace houseShop houseOther

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K6 [SHOWCARD K6] What is the highest level of education you have completed?

No formal educationLower primaryPrimaryLower secondarySecondaryUpper secondary: GeneralUpper secondary: Vocational

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years old

Polytechnic DiplomaProfessional qualification and other diploma University first degreeUniversity postgraduate diploma/ degreeOther

89101112

K7a Do you have any children?

YesNo

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K7bK8

K7b Do you live with any of them?

YesNo

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K8 Please tell me which letter best describes your monthly personal income from all sources, after tax and compulsory deductions?

Below $1,000$1,000-$1,999$2,000-$2,999$3,000-$3,999$4,000-$4,999$5,000-$5,999$6,000-$6,999$7,000-$9,999$10,000 and aboveDon’t knowPrefer not to say

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K9 Please tell me which letter best describes your household's total yearly income from all sources, after tax and compulsory deductions?

Below $12,000$12,000-$23,999$24,000-$35,999$36,000-$47,999$48,000-$59,999$60,000-$71,999$72,000-$83,999$84,000-$119,999$120,000 and aboveDon’t knowPrefer not to say

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K10 Have you ever been told by a doctor or other health professional that you had any of the following medical conditions? Yes No

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If all 0, then Q14=1(Please circle all)

1. Diabetes 1 02. High blood cholesterol 1 03. High blood pressure (hypertension) 1 04. Heart disease 1 05. Chronic obstructive pulmonary disease (COPD) 1 06. Cancer 1 07. Depression 1 08. Osteoporosis 1 09. Arthritis or osteoarthritis 1 010. Asthma 1 011. Stroke 1 012. Kidney ailments (Weak or failing kidneys) 1 013. Another condition 1 014. I have never been told by a doctor that I have any of

these conditions1 0

15. Don’t know 1 016. Prefer not to say 1 0

K11 How much time do you spend commuting on a typical day? Please include the time you spend on travelling to work AND travelling from work.

K12 Which modes of travel do you use most often to travel to and from work on a typical day?If you use multiple modes of travel in a single trip, e.g. transferring from bus to MRT, please choose both answers? Yes No

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If all 0, then Q9=1(Please circle all)

1. Car 1 02. Motorbike 1 03. MRT/LRT 1 04. Bus 1 05. Taxi 1 06. Walk (for at least 10 minutes in a row) 1 07. Cycle (for at least 10 minutes in a row) 1 08. Other (Please specify: ___________________) 1 09. None of these 1 0

SECTION L: RECONTACT QUESTIONS

L1 Should the opportunity arise, would you like Duke-NUS to contact you about participating in actual physical activity programmes? YesNo

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L2 Should the opportunity arise, would you like Duke-NUS to contact you about participating in future research studies? YesNo

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mins

If Yes at L1 and/or L2, please collect their particulars:Title

First Name

Surname

Mobile Telephone Number

Email Address