December 16, 2013

Health and Hygiene Survey Questionnaire for Adolescents


  The following Health and Hygiene Survey Questionnaire for Adolescents is for reference purpose only.

Please fill the following information about yourself

Age: ………  Class: ………  Gender: ………………   Religion: ................  Caste: ...............

Qualification of Parent: below S.S.L.C./Pre degree/Degree/Post graduate/Professional

Occupation of Parent:   Mother.................................   Father..............................................


Instructions

Read the following statements carefully and tick in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.


A

1. How many glasses of water should one drink a day?      5             8         whenever thirsty 

2. A proper hand wash should last…    3min   -       8min             unsure                 1 min

3. We should dry our undergarments in the sun.     true   very true    unsure    not necessary

4. One should not delay urination for more than…     3hrs    4hrs   8hrs  whenever necessary

5. Exercise can make you  …     physically fit –  mentally fit       beautiful      all the above

6. Walking in the sun can make you…      dark         healthy         thirsty             all the above

7. An ideal breakfast for a student in Kerala is…idly/sambar   bread/jam   porotta  cornflakes

8. It is more important to brush teeth in the night than morning.   True    false      unsure 

9. No one has told  me about how to keep  my body (especially private parts) clean.                             True                false                unsure
                                                                                          

        B

Read the following statements carefully and write the option in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.

Strongly  agree     Agree   Unsure     Disagree       Strongly disagree
                                                                                                     

10. *No one appreciates my achievements    
                   
11. People like spending  time with me    
                        
12. I behave politely with others 
                                   
13. *I have no special talents  
                                                 
14. I am a good looking person                                             
                                                                                              
15. When someone criticizes me I would..  (can mark more than one item)
a) Be angry                  
b) Ignore it   
c) Find fault with the person                               
d) Try and think if he/she is correct
e) Change my behaviour if it is correct


  C



Read the following statements carefully and write the option in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.

never   once many a time regularly more than 
once a day
   

16.A.
    
  a.  I have tasted alcohol                     
                         
  b. I smoke cigarette/chew pan  

   c. I have tried Hans        

                                              
   d. I have used other additive                substances         


17.B.  I use mobile phone only on emergency situations              yes             no   




17.C. Never once many a time regularly more than once a day
(can mark more than one item)

a. Listen to music
                        
b. Play games      
                          
c. To call only   
                                
d. Chat/messaging    
                    
e. To watch videos                        

                                                        
                                                                                              

D


Read the following statements carefully and write the option in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.

never   once many a time regularly more than 
once a day
     
18      I like being alone than spend time with others                           
                          
19 *  I like to meet and interact with new people                                

20      I often wish to share my problems with someone                                       


21   There are problems that I have not shared with anyone.            

  
22X   I am in love with someone                                                              
                                                                 
23   This relationship interferes with my other activities                                    

24 X  I have friends, whom I have not seen in person         true        unsure       false


25.  I have shared my personal problems with anonymous friends.   true    unsure     false                                                    

E

Read the following statements carefully and write the option in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.

never   once many a time regularly more than 
once a day

26.   The circumstances at home affect my studies.  
                 
27.    I think my parents feel that I am a burden to them

28.   I feel that parents have no role in my achievements.   

29.   My parents fight with each other.           

30.   My parent use alcohol                                       




F


31.   I like my school because of  (rate the following)

          A   teaching                                                                 B   Extracurricular activities

          B   friends                                                                    B   other reasons          
        (please specify)……………………………………………………………………………………………………..
                   
Read the following statements carefully and write the option in the box next to the option you think is correct or close to your opinion. All your answers will be kept confidential.

  Never               Sometimes            Always

32.A   I share my academic problems with my teachers    

33.A   I find it is easy to discuss my personal problems 
with teachers          
          
34.A   I seek the help of teachers to solve issues with my friends    
                                      
35.A* I feel that teachers lack depth in the subject or they come to class without much preparation                                                                                                                                                                                                          
                                                                                                        
36B* I am satisfied with my grades                                  

37B     I have exam anxiety           

                                       
38B    I often fall sick during the exam period                     


39B *I have a clear ambition about my future                         true                         false                                                                                                                                                                           
 (please specify)…………………………………………………………………………………………………………



    SCORING                                             



 *-negative items


A. AWARENESS OF BASIC HEALTH AND HYGIENE PRACTICES



ITEMS 1—8: 1 point each for correct answer

                                                                                                                                       
& 6  2 POINTS FOR  “ALL THE ABOVE”   maximum 10

I
nterpretation


  • Up to score  of  4 =  “low”
  •  Between 5&8     =average
  • Above  8              =high

Item 9 treat separately


B   SELF ESTEEM



Items  10 to 14 
POINT                           

  1                                   2                         3                          4                        5
strongly agree                    agree              unsure            disagree            strongly disagree
                                                                                                   
Items 10 ,13  *negative  statements

Item 
15                a=5   b-4   c=3   d=2   e=2

interpretation


  • score of       30—25           = high self esteem
  • score of        24-13            = moderate
  •  score  below       12          = low self esteem

C    A=SUBSTANCE ADDICTION  &   B= MISUSE OF TECHNOLOGY



Items 16,     a to d             17,    a to e 


Response            never    once    many a time    regularly    more than once a day

Score                       1           2                   3                 4                             5

interpretation


  • score   20—16    =  indicates  addiction
  • score    15—13   =  at risk of addiction/suspected recreational use
  • score    below 12= low /have not used addictive substances

D       INTERPERSONAL PROBLEMS



18--25 
Items 22 24 X not to be considered for scoring

       Response                       True                      unsure                         false

         Score                                1                              2                                 3


Interpretation


  • Score    below 10       =    low interpersonal skills/lonely/ need counselling
  • Score   11—15           =    lonely by choice/low interpersonal issues
  • Score    above 15        =     high interpersonal  skills/ low interpersonal issues




E          FAMILY ENVIRONMENT


Items 26--30

            Response            never      once      many a time      rarely      more than once a day
            score                       1             2                   3                 4                             5

Interpretation


  • Below 10   =    low /no family problems
  • 10-20            =  problems in at least one area alcoholism/domestic violence/interpersonal
  • 20 above       =  multiple problems within the family

 


F   SATISFACTION WITH ACADEMIC ENVIRONMENT


Items  31  --39

32---38
Response                                        never                    sometimes             always
Score                                                    1                           2                              3      

Item 31               score of 1 for each response

Item 39                 yes=1,                          no=2 

A  ==teacher ’s involvement  with the student    items   31---35

Interpretation
  • Below 5     =low involvement
  • 5—10         =restricted to academics
  • Above 10   =high involvement


B==satisfaction with academic achievement  items  31, 36---39

Interpretation

  • Below 10    = satisfied with performance
  • 10—12          =  moderate
  • Above 12      = poor academic adjustment


Interpretation


Total score   =-overall satisfaction with academic environment 



  • above  15   =    highly satisfied
  • 10—15        =   moderately  satisfied
  • below 10     =  poor academic adjustment
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