Age (years)
Sex
Ethinicity
Height (cm)
Weight (kg)
Highest level of education attained
Level of monthly household income
Family history of high blood pressure
Family history of diabetes
Family history of high cholesterol
Family history of kidney disease
Family history of heart disease
Family history of stroke
What does the term hypertension mean?
How dangerous is hypertension to your health?
Would lowering high blood pressure improve a person's health?
130/80mmHg is an example of a blood pressure reading What do the two numbers reported for blood pressure mean? Note: you can leave it blank if you do not know the answers - Bottom number
Top number:
Bottom number:
Which measure(s) is (are) more important?
Can people do things to lower their blood pressure?
Can lowering blood pressure even a little bit improve health?
In general, how important is it for you to do the following? - Take part in regular physical activity (eg. 30 minutes of walking 4-5 times per week
In general, how important is it for you to do the following? - Eat less processed foods (e.g., canned or frozen foods, half-cooked meat)
In general, how important is it for you to do the following? - Read nutrition facts label to check information on sodium content
In general, how important is it for you to do the following? - Read nutrition label to check info on saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
In general, how important is it for you to do the following? - Replace traditional high-salt foods (eg. Canned soup, instant noodles) with low salt products (eg. Homemade soups, fresh vegetables)
In general, how important is it for you to do the following? - Limit the use of high-salt condiments (eg ketchup)
In general, how important is it for you to do the following? - Eat less than 1 teaspoon of table salt per day 6g salt = 1 bowl Mee Soto or 1 bowl Mee Rebus or 2 plates of chicken rice
In general, how important is it for you to do the following? - Eat less foods that are high in saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
In general, how important is it for you to do the following? - Replace traditional high-fat foods (eg deep fried chicken) with low-fat products (eg baked chicken)
In general, how important is it for you to do the following? - Limit total calorie intake from fat (less than 65grams) daily. 65g fat = 3 plates of Char Kway Teow or 3 plates of Mee Rebus or 2 bowls of Laksa or 3 plates of fried noodles or 3 plates of chicken rice
In general, how important is it for you to do the following? - Use grill, bake or steam instead of frying when cooking
In general, how important is it for you to do the following? - Eat 5 or more servings of fruits and vegetables daily
In general, how important is it for you to do the following? - Practice moderation in drinking alcohol (2 glasses or less for men; 1 glass or less for women)
In general, how important is it for you to do the following? - Practice non-smoking
In general, how important is it for you to do the following? - Check your blood pressure at home or at a clinic (at least once a year)
In general, how difficult is it for you to do the following self-care habits regularly? - Take part in regular physical activity (eg. 30 minutes of walking 4-5 times per week
In general, how difficult is it for you to do the following self-care habits regularly? - Eat less processed foods (e.g., canned or frozen foods, half-cooked meat)
In general, how difficult is it for you to do the following self-care habits regularly? - Read nutrition facts label to check information on sodium content
In general, how difficult is it for you to do the following self-care habits regularly? - Read nutrition label to check info on saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
In general, how difficult is it for you to do the following self-care habits regularly? - Replace traditional high-salt foods (eg. Canned soup, instant noodles) with low salt products (eg. Homemade soups, fresh vegetables)
In general, how difficult is it for you to do the following self-care habits regularly? - Limit the use of high-salt condiments (eg ketchup)
In general, how difficult is it for you to do the following self-care habits regularly? - Eat less than 1 teaspoon of table salt per day 6g salt = 1 bowl Mee Soto or 1 bowl Mee Rebus or 2 plates of chicken rice
In general, how difficult is it for you to do the following self-care habits regularly? - Eat less foods that are high in saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
In general, how difficult is it for you to do the following self-care habits regularly? - Replace traditional high-fat foods (eg deep fried chicken) with low-fat products (eg baked chicken)
In general, how difficult is it for you to do the following self-care habits regularly? - Limit total calorie intake from fat (less than 65grams) daily. 65g fat = 3 plates of Char Kway Teow or 3 plates of Mee Rebus or 2 bowls of Laksa or 3 plates of fried noodles or 3 plates of chicken rice
In general, how difficult is it for you to do the following self-care habits regularly? - Use grill, bake or steam instead of frying when cooking
In general, how difficult is it for you to do the following self-care habits regularly? - Eat 5 or more servings of fruits and vegetables daily
In general, how difficult is it for you to do the following self-care habits regularly? - Practice moderation in drinking alcohol (2 glasses or less for men; 1 glass or less for women)
In general, how difficult is it for you to do the following self-care habits regularly? - Practice non-smoking
In general, how difficult is it for you to do the following self-care habits regularly? - Check your blood pressure at home or at a clinic (at least once a year)
How often do you do the following? - Take part in regular physical activity (eg. 30 minutes of walking 4-5 times per week
How often do you do the following? - Eat less processed foods (e.g., canned or frozen foods, half-cooked meat)
How often do you do the following? - Read nutrition facts label to check information on sodium content
How often do you do the following? - Read nutrition label to check info on saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
How often do you do the following? - Replace traditional high-salt foods (eg. Canned soup, instant noodles) with low salt products (eg. Homemade soups, fresh vegetables)
How often do you do the following? - Limit the use of high-salt condiments (eg ketchup)
How often do you do the following? - Eat less than 1 teaspoon of table salt per day 6g salt = 1 bowl Mee Soto or 1 bowl Mee Rebus or 2 plates of chicken rice
How often do you do the following? - Eat less foods that are high in saturated (eg red meat, butter) fat and transfat (eg shortening, lard)
How often do you do the following? - Replace traditional high-fat foods (eg deep fried chicken) with low-fat products (eg baked chicken)
How often do you do the following? - Limit total calorie intake from fat (less than 65grams) daily. 65g fat = 3 plates of Char Kway Teow or 3 plates of Mee Rebus or 2 bowls of Laksa or 3 plates of fried noodles or 3 plates of chicken rice
How often do you do the following? - Use grill, bake or steam instead of frying when cooking
How often do you do the following? - Eat 5 or more servings of fruits and vegetables daily
How often do you do the following? - Practice moderation in drinking alcohol (2 glasses or less for men; 1 glass or less for women)
How often do you do the following? - Practice non-smoking
How often do you do the following? - Check your blood pressure at home or at a clinic (at least once a year)
In the previous section, you have selected 'Always', 'Often', 'Sometimes', or 'Rarely/never' for the following self-care behaviour: Take part in regular physical activity (eg. 30 minutes of walking 4-5 times per week) If you often or always do so,
BMI
Can people do things to control their blood pressure?
Would lowering high blood pressure improve a person
Severity score
Self-efficacy score
Age Class
BMI Class