SC. Self-Completion Questionnaire

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Self-Completion Questionnaire module of ELSA 2010

Label Type Description
SCPTP Question Which of these statements apply to you? TICK ALL THAT APPLY
SCORG Question Are you a member of any of these organisations, clubs or societies? TICK ALL THAT APPLY
SCORGN Question Thinking about all the organisations, clubs or societies that you are a member of, how many committee meetings if any, do you attend in a year?
SCEDCP Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Bank or cash point
SCEDPO Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Post Office
SCEDCS Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Corner Shop
SCEDSU Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Medium or large supermarket
SCEDSC Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Shopping centre
SCEDGP Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? General Practitioner (GP)
SCEDCH Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport?) Chiropodist
SCEDDE Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Dentist
SCEDOP Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Optician
SCEDHO Question How easy or difficult would it be for you to get to each of the following places, using your usual form of transport? Hospital
SCACTA Question Now some questions about your social activities. How often, if at all, do you do any of the following activities? Go to the cinema
SCACTB Question How often, if at all, do you do any of the following activities? Eat out of the house
SCACTC Question How often, if at all, do you do any of the following activities? Go to an art gallery or museum
SCACTD Question How often, if at all, do you do any of the following activities? Go to the theatre, a concert or the opera
SCMOREA Question Would you like to do any of the following activities more often but feel that, for whatever reason, you cannot? Go to the cinema
SCMOREB Question Would you like to do any of the following activities more often but feel that, for whatever reason, you cannot? Eat out of the house
SCMOREC Question Would you like to do any of the following activities more often but feel that, for whatever reason, you cannot? Go to an art gallery or museum
SCMORED Question Would you like to do any of the following activities more often but feel that, for whatever reason, you cannot? Go to the theatre, a concert or the opera
SCTVWKD Question The next two questions are about watching television. How many hours of television do you watch on an ordinary day or evening during the week, that is, Monday to Friday?
SCTVWKE Question And thinking now about an ordinary weekend. How many hours of television do you normally watch in total over the weekend, that is, Saturday and Sunday?
SCLIFEA Question Please say how much you agree or disagree with the following statements. In most ways my life is close to ideal
SCLIFEB Question Please say how much you agree or disagree with the following statements. The conditions of my life are excellent
SCLIFEC Question Please say how much you agree or disagree with the following statements. I am satisfied with my life
SCLIFED Question Please say how much you agree or disagree with the following statements. So far I have got the important things I want in life
SCLIFEE Question Please say how much you agree or disagree with the following statements. If I could live life again, I would change almost nothing
SCDCA Question Here are some questions about how you feel about your life in general. Please say how much you agree or disagree with the following statements. At home, I feel I have control over what happens in most situations
SCDCC Question Please say how much you agree or disagree with the following statements. I feel what happens in life is often determined by factors beyond my control
SCDCD Question Please say how much you agree or disagree with the following statements. In general, I have different demands that I think are hard to combine
SCDCE Question Please say how much you agree or disagree with the following statements. In general, I have enough time to do everything
SCDCG Question Please say how much you agree or disagree with the following statements. Considering the things I have to do at home, I have to work very fast
SCFEELA Question The next questions are about how you feel about different aspects of your life. For each one, please say how often you feel that way. How often do you feel you lack companionship?
SCFEELB Question How often do you feel left out?
SCFEELC Question How often do you feel isolated from others?
SCFEELD Question How often do you feel in tune with the people around you?
SCFEELE Question How often do you feel lonely?
SCQOLA Question My age prevents me from doing the things I would like to
SCQOLB Question I feel that what happens to me is out of my control
SCQOLC Question I feel free to plan for the future
SCQOLD Question I feel left out of things
SCQOLE Question I can do the things that I want to do
SCQOLF Question Family responsibilities prevent me from doing what I want to do
SCQOLG Question I feel that I can please myself what I do
SCQOLH Question My health stops me from doing things I want to do
SCQOLI Question Shortage of money stops me from doing things I want to do
SCQOLJ Question I look forward to each day
SCQOLK Question I feel that my life has meaning
SCQOLL Question I enjoy the things that I do
SCQOLM Question I enjoy being in the company of others
SCQOLN Question On balance, I look back on my life with a sense of happiness
SCQOLO Question I feel full of energy these days
SCQOLP Question I choose to do things that I have never done before
SCQOLQ Question I feel satisfied with the way my life has turned out
SCQOLR Question I feel that life is full of opportunities
SCQOLS Question I feel that the future looks good for me
SCFEDE Question During the past 30 days, to what degree did you feel Determined?
SCFEEN Question During the past 30 days, to what degree did you feel Enthusiastic?
SCFEAC Question During the past 30 days, to what degree did you feel Active?
SCFEPR Question During the past 30 days, to what degree did you feel Proud?
SCFEINT Question During the past 30 days, to what degree did you feel Interested?
SCFEHA Question During the past 30 days, to what degree did you feel Happy?
SCFEAT Question During the past 30 days, to what degree did you feel Attentive?
SCFECO Question During the past 30 days, to what degree did you feel Content?
SCFEINS Question During the past 30 days, to what degree did you feel Inspired?
SCFEHO Question During the past 30 days, to what degree did you feel Hopeful?
SCFEAL Question During the past 30 days, to what degree did you feel Alert?
SCFECA Question During the past 30 days, to what degree did you feel Calm?
SCFEEX Question During the past 30 days, to what degree did you feel Excited?
SCDEOU Question During the past 30 days, to what degree did you feel Please indicate how well each of the following describes you : Outgoing
SCDEHE Question Please indicate how well each of the following describes you : Helpful
SCDEMO Question Please indicate how well each of the following describes you : Moody
SCDEOR Question Please indicate how well each of the following describes you : Organised
SCDEFR Question Please indicate how well each of the following describes you : Friendly
SCDEWA Question Please indicate how well each of the following describes you : Warm
SCDEWO Question Please indicate how well each of the following describes you : Worrying
SCDERE Question Please indicate how well each of the following describes you : Responsible
SCDELI Question Please indicate how well each of the following describes you : Lively
SCDECA Question Please indicate how well each of the following describes you : Caring
SCDENE Question Please indicate how well each of the following describes you : Nervous
SCDECR Question Please indicate how well each of the following describes you : Creative
SCDEHA Question indicate how well each of the following describes you : Hardworking
SCDEIM Question Please indicate how well each of the following describes you : Imaginative
SCDESOF Question Please indicate how well each of the following describes you : Softhearted
SCDECAL Question indicate how well each of the following describes you : Calm
SCDEIN Question Please indicate how well each of the following describes you : Intelligent
SCDECU Question Please indicate how well each of the following describes you : Curious
SCDEAC Question Please indicate how well each of the following describes you : Active
SCDECAR Question Please indicate how well each of the following describes you : Careless
SCDEBR Question Please indicate how well each of the following describes you : Broad-minded
SCDESY Question Please indicate how well each of the following describes you : Sympathetic
SCDETA Question Please indicate how well each of the following describes you : Talkative
SCDESO Question Please indicate how well each of the following describes you : Sophisticated
SCDEAD Question Please indicate how well each of the following describes you : Adventurous
SCDETH Question Please indicate how well each of the following describes you : Thorough
SCPTR Question Do you have a husband, wife or partner with whom you live?
SCPTRA Question How much do they really understand the way you feel about things?
SCPTRB Question How much can you rely on them if you have a serious problem?
SCPTRC Question How much can you open up to them if you need to talk about your worries?
SCPTRD Question How much do they criticise you?
SCPTRE Question How much do they let you down when you are counting on them?
SCPTRF Question How much do they get on your nerves?
SCPTRX Question How often do they demands on you?
SCPTRG Question How close is your relationship with your spouse or partner?
SCCHD Question Do you have any children?
SCCHDA Question How much do they really understand the way you feel about things?
SCCHDB Question How much can you rely on them if you have a serious problem?
SCCHDC Question How much can you open up to them if you need to talk about your worries?
SCCHDD Question How much do they criticise you?
SCCHDE Question How much do they let you down when you are counting on them?
SCCHDF Question How much do they get on your nerves?
SCCHDX Question How often do they make demands on you?
SCCHDG Question On average, how often do you do each of the following with any of your children, not counting any who live with you? Meet up (include both arranged and chance meetings)?
SCCHDH Question On average, how often do you do each of the following with any of your children, not counting any who live with you? Speak on the phone?
SCCHDI Question On average, how often do you do each of the following with any of your children, not counting any who live with you? Write or email?
SCCHDM Question How many of your children would you say you have a close relationship with?
SCFAM Question Do you have any other immediate family, for example, any brothers or sisters, parents, cousins or grandchildren?
SCFAMA Question How much do they really understand the way you feel about things?
SCFAMB Question How much can you rely on them if you have a serious problem?
SCFAMC Question How much can you open up to them if you need to talk about your worries?
SCFAMD Question How much do they criticise you?
SCFAME Question How much do they let you down when you are counting on them?
SCFAMF Question How much do they get on your nerves?
SCFAMX Question How often do they make too many demands on you?
SCFAMG Question On average, how often do you do each of the following with any of these family members, not counting any who live with you? Meet up (include both arranged and chance meetings)?
SCFAMH Question On average, how often do you do each of the following with any of these family members, not counting any who live with you?) Speak on the phone?
SCFAMI Question On average, how often do you do each of the following with any of these family members, not counting any who live with you?) Write or email?
SCFAMM Question How many of these family members would you say you have a close relationship with?
SCFRD Question Do you have any friends?
SCFRDA Question How much do they really understand the way you feel about things?
SCFRDB Question How much can you rely on them if you have a serious problem?
SCFRDC Question How much can you open up to them if you need to talk about your worries?
SCFRDD Question How much do they criticise you?
SCFRDE Question How much do they let you down when you are counting on them?
SCFRDF Question How much do they get on your nerves?
SCFRDX Question How much do they make too many demands on you?
SCFRDG Question On average, how often do you do each of the following with any of these friends, not counting any who live with you? Meet up (include both arranged and chance meetings)?
SCFRDH Question On average, how often do you do each of the following with any of these friends, not counting any who live with you?)
SCFRDI Question On average, how often do you do each of the following with any of these friends, not counting any who live with you?) Write or email?
SCFRDM Question How many of your friends would you say you have a close relationship with?
SCDTDRE Question In your day-to-day life, how often have any of the following things happened to you? You are treated with less courtesy or respect than other people
SCDTDST Question In your day-to-day life, how often have any of the following things happened to you? You receive poorer service than other people at restaurants or stores
SCDTDCL Question In your day-to-day life, how often have any of the following things happened to you? People act as if they think you are not clever
SCDTDHA Question In your day-to-day life, how often have any of the following things happened to you? You are threatened or harassed
SCDTDDR Question In your day-to-day life, how often have any of the following things happened to you? You receive poorer service or treatment than other people from doctors or hospitals
SCDTD Question If any of the above things mentioned in the previous question have happened to you, what do you think were the reasons WHY these experiences happened to you? Tick all that apply
SCREWH Question What is your religion?
SCRELOF Question About how often have you attended religious services during the past year?
SCRELFA Question Please tick the box which best shows how you feel about each statement. Religious faith is extremely important to me
SCRELPR Question Please tick the box which best shows how you feel about each statement. I pray or meditate daily
SCRELME Question Please tick the box which best shows how you feel about each statement. I look to my religion to provide meaning and purpose in my life
SCRELAC Question Please tick the box which best shows how you feel about each statement. I consider myself active in organised religion (going to church, temple, mosque, etc.)
SCRELIM Question How important is religion in your daily life?
SCEMPL Question The next questions are about paid employment. Were you in paid employment last month?
SCWORKA Question All things considered I am satisfied with my job
SCWORKB Question My job is physically demanding
SCWORKC Question I receive the recognition I deserve in my work
SCWORKD Question My salary is adequate
SCWORKE Question My job promotion prospects are poor
SCWORKF Question My job security is poor
SCWORKG Question I am under constant pressure due to a heavy workload
SCWORKH Question I have very little freedom to decide how I do my work
SCWORKI Question I have the opportunity to develop new skills
SCWORKJ Question I receive adequate support in difficult situations
SCWORKK Question At work I feel I have control over what happens in most situations
SCWORKL Question Considering the things I have to do at work I have to work very fast
SCRTAGE Question At what age would you like to retire?
SCRAGB Question I have already retired?
SCLDDR Question Think of this ladder as representing where people stand in our society. At the top of the ladder are the people who are the best off - those who have the most money, most education and best jobs. At the bottom are the people who are the worst off - who ha
SCVEG Question How many portions of vegetables - excluding potatoes - do you eat on a typical day? If none, please enter '0'. A serving or portion of vegetables means three heaped tablespoons of green or root vegetables such as carrots, parsnips, spinach, small vegetables like peas, baked beans or sweet corn, or a medium bowl of salad (lettuce, tomatoes, etc).Please write in portion
SCFRU Question How many portions of fruit - of any kind - do you eat on a typical day? If none, please enter '0'. A portion of fruit is an apple or banana, a small bowl of grapes, or three tablespoons of tinned or stewed fruit. If you drink fruit juice, you can count one glass per day, but additional glasses of fruit juice do not count as additional portions. Please write in portion
SCAKO Question Thinking now about all kinds of drink, how often have you had an alcoholic drink of any kind in the last 12 months?
SCAL7A Question Did you have an alcoholic drink in the seven days ending yesterday?
SCAL7B Question On how many days out of the last seven did you have an alcoholic drink?
SCDRSPI Question During the last seven days, how many measures of spirits did you have? Drinks poured at home may be larger than a pub single measure please estimate number of singles. If none, please enter '0'.
SCDRWIN Question During the last seven days, how many pints of beer, lager or cider did you have? If none, please enter '0'.
SCDRPIN Question During the last seven days, how many glasses of wine did you have? Include sherry, port, vermouth. If none, please enter '0'.
SCEND Question If there is anything else you would like to tell us please write in this space below. We shall be very interested to read what you have to say. Text: up to 100 characters