General Questions

https://docs.google.com/forms/d/1idKBdNnPMIgGn4j7GbzmegCQgevq...

General Questions
Hi, 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

1. What is your age group? * Mark only one oval. 30-39 40-49 50-59 60 and above 2. Do you have hypertension(high blood pressure)? * All data will be kept anonymous and confidential. Mark only one oval. Yes No Skip to question 14. Skip to question 3. Skip to question 3.

I don't know

Non-Hypertension
Stop filling out this form. 3. 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

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General Questions

https://docs.google.com/forms/d/1idKBdNnPMIgGn4j7GbzmegCQgevq...

4. 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 Everyday Never 5. Do you smoke? * If Yes, please proceed to the next question, if No, please skip the next question Mark only one oval. Yes No 6. If yes, how many sticks do you smoke a day?

7. 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 8. If Yes, how many units of alcohol do you drink 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.

9. 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

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General Questions

https://docs.google.com/forms/d/1idKBdNnPMIgGn4j7GbzmegCQgevq...

10. Are you aware of what is pre-hypertension? * Mark only one oval. Yes No 11. What do you think are the chances of you getting hypertension? * Mark only one oval. 1 Very Unlikely 2 3 4 5 Very Likely

12. Does your family have a history of High Blood Pressure (hypertension)? * Mark only one oval. Yes No I don't know 13. 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

Hypertension
Stop filling out this form. 14. 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

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General Questions

https://docs.google.com/forms/d/1idKBdNnPMIgGn4j7GbzmegCQgevq...

15. 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 Everyday Never 16. Do you smoke? * If yes please proceed to next question, if No, skip the next question Mark only one oval. Yes No 17. If yes, how many sticks do you smoke a day?

18. 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 19. If Yes, how many units of alcohol do you consume 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.

20. 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

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General Questions

https://docs.google.com/forms/d/1idKBdNnPMIgGn4j7GbzmegCQgevq...

21. 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.

22. 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 23. To what extent do you think that the measures taken to control hypertension(high blood pressure) disrupt your lifestyle? * Mark only one oval. 1 Minimal disruption 2 3 4 5 Very disruptive

24. 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:

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General Questions

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