Self-Completion Questionnaire (Paper)

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Self-Completion Questionnaire (Paper) for ELSA 2018

Label Type Description
1 Question Which of these statements apply to you?
2 Question Are you a member of any of these organisations, clubs or societies?
3 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? If none, please enter ‘0’.
4A 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
4B Question Now some questions about your social activities. How often, if at all, do you do any of the following activities?: Eat out of the house
4C Question Now some questions about your social activities. How often, if at all, do you do any of the following activities?: Go to an art gallery or museum
4D Question Now some questions about your social activities. How often, if at all, do you do any of the following activities?: Go to the theatre, a concert or the opera
5 Question We would now like to ask you some questions about your use of the Internet and email. On average, how often do you use the Internet or email?
6 Question On which of the following devices do you access the Internet?
7 Question For which of the following activities did you use the Internet in the last 3 months?
8A Question Please say how much you agree or disagree with the following statements. In most ways my life is close to my ideal
8B Question Please say how much you agree or disagree with the following statements. The conditions of my life are excellent.
8C Question Please say how much you agree or disagree with the following statements. I am satisfied with my life
8D 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
8E Question Please say how much you agree or disagree with the following statements. If I could live my life again, I would change almost nothing
9A 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?
9B 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 left out?
9C 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 isolated from others?
9D 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 in tune with the people around you?
9E 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 lonely?
10A Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? My age prevents me from doing the things I would like to
10B Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel that what happens to me is out of my control
10C Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel free to plan for the future
10D Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel left out of things
10E Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I can do the things that I want to do
10F Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? Family responsibilities prevent me from doing what I want to do
10G Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel that I can please myself what I do
10H Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? My health stops me from doing things I want to do
10I Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? Shortage of money stops me from doing the things I want to do
10J Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I look forward to each day
10K Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel that my life has meaning
10L Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I enjoy the things that I do
10M Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I enjoy being in the company of others
10N Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? On balance, I look back on my life with a sense of happiness
10O Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel full of energy these days
10P Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I choose to do things that I have never done before
10Q Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel satisfied with the way my life has turned out
10R Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel that life is full of opportunities
10S Question Here is a list of statements that people have used to describe their lives or how they feel. How often, do you feel like this? I feel that the future looks good for me
11 Question Do you have a husband, wife or partner with whom you live?
12A Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much do they really understand the way you feel about things?
12B Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much can you rely on them if you have a serious problem?
12C Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much can you open up to them if you need to talk about your worries?
12D Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much do they criticise you?
12E Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much do they let you down when you are counting on them?
12F Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How much do they get on your nerves?
12G Question We would now like to ask you some questions about your spouse or partner. Please tick the box which best shows how you feel about each statement. How often do they make too many demands on you?
13 Question How close is your relationship with your spouse or partner?
14 Question Do you have any children?
15A Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How much do they really understand the way you feel about things?
15B Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How much can you rely on them if you have a serious problem?
15C Question
15D Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How much do they criticise you?
15E Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How much do they let you down when you are counting on them?
15F Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How much do they get on your nerves?
15G Question We would now like to ask you some questions about your children. Please tick the box which best shows how you feel about each statement. How often do they make too many demands on you?
16A 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)
16B 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
16C 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
16D Question On average, how often do you do each of the following with any of your children, not counting any who live with you? Send or receive text messages
17 Question How many of your children would you say you have a close relationship with? Please write the number in this box.
18 Question Do you have any other immediate family, for example, any brothers or sisters, parents, cousins or grandchildren?
19A Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much do they really understand the way you feel about things?
19B Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much can you rely on them if you have a serious problem?
19C Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much can you open up to them if you need to talk about your worries?
19D Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much do they criticise you?
19E Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much do they let you down when you are counting on them?
19F Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How much do they get on your nerves?
19G Question We would now like to ask you some questions about these family members. Please tick the box which best shows how you feel about each statement. How often do they make too many demands on you?
20A 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)
20B 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
20C 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
20D 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? Send or receive text messages
21 Question How many of these family members would you say you have a close relationship with?
22 Question Do you have any friends?
23A Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much do they really understand the way you feel about things?
23B Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much can you rely on them if you have a serious problem?
23C Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much can you open up to them if you need to talk about your worries?
23D Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much do they criticise you?
23E Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much do they let you down when you are counting on them?
23F Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How much do they get on your nerves?
23G Question We would now like to ask you some questions about your friends. Please tick the box which best shows how you feel about each statement. How often do they make too many demands on you?
24A Question On average, how often do you do each of the following with any of your friends, not counting any who live with you? Meet up (include both arranged and chance meetings)
24B Question On average, how often do you do each of the following with any of your friends, not counting any who live with you? Speak on the phone
24C Question On average, how often do you do each of the following with any of your friends, not counting any who live with you? Write or email
24D Question On average, how often do you do each of the following with any of your friends, not counting any who live with you? Send or receive text messages
25 Question How many of your friends would you say you have a close relationship with?
26 Question What is your religion?
27 Question About how often have you attended religious services during the past year?
28A Question These questions are about your religious or spiritual beliefs. Please tick the box which best shows how you feel about each statement. Religious faith is extremely important to me
28B Question These questions are about your religious or spiritual beliefs. Please tick the box which best shows how you feel about each statement. I pray or meditate daily
28C Question These questions are about your religious or spiritual beliefs. Please tick the box which best shows how you feel about each statement. I look to religion to provide meaning and purpose in my life
28D Question These questions are about your religious or spiritual beliefs. 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.)
29 Question The next questions are about paid employment. Were you in paid employment last month?
30A Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. All things considered I am satisfied with my job
30B Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. My job is physically demanding
30C Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. I receive the recognition I deserve for my work
30D Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. My salary is adequate
30E Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. My job promotion prospects are poor
30F Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. My job security is poor
30G Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. I am under constant time pressure due to a heavy workload
30H Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. I have very little freedom to decide how I do my work
30I Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. I have the opportunity to develop new skills
30J Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. I receive adequate support in difficult situations
30K Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. At work, I feel I have control over what happens in most situations
30L Question Here are some statements people might use to describe their work. We would like to know how strongly you think these apply to the paid employment you did in the last month. Considering the things I have to do at work, I have to work very fast
31A Question Now thinking about the food eaten in your household and whether you were able to afford it, to what extent were these statements true for your household in the last twelve months? The food that we bought just didn’t last and we didn’t have enough money to
31B Question Now thinking about the food eaten in your household and whether you were able to afford it, to what extent were these statements true for your household in the last twelve months? We couldn’t afford to eat balanced meals
32 Question Please mark a cross on the rung on the ladder where you would place yourself.
33 Question Overall, how happy did you feel yesterday?
34 Question Overall, how anxious did you feel yesterday?
35 Question Overall, how satisfied are you with your life nowadays?
36 Question Overall, to what extent do you feel the things you do in your life are worthwhile?
37 Question Now, please pause briefly to think about yesterday, from the morning until the end of the day. Think about where you were, what you were doing, who you were with, and how you felt. What day of the week was it yesterday?
38 Question What time did you wake up yesterday?
39 Question What time did you go to sleep at the end of the day yesterday?
40 Question Yesterday, did you feel any pain?
41 Question Did you feel well-rested yesterday morning (that is you slept well the night before)?
42 Question Was yesterday a normal day for you or did something unusual happen?
43 Question Please think about the things you did yesterday and how you spent your time. Yesterday did you watch TV?
44 Question How much time did you spend watching TV yesterday?
45 Question Yesterday did you work or volunteer?
46 Question How much time did you spend working or volunteering yesterday? For example, if you spent nine and a half hours, write 9 in the hours box and 30 in the minutes box.
47 Question Yesterday did you go for a walk or exercise?
48 Question How much time did you spend walking or exercising yesterday?
49 Question Yesterday did you do any health-related activities other than walking or exercise? For example, visiting a doctor, taking medications or doing treatments.
50 Question How much time did you spend doing health-related activities yesterday?
51 Question Yesterday did you travel or commute? E.g. by car, train, bus etc.
52 Question How much time did you spend travelling or commuting yesterday?
53 Question Yesterday did you spend time with friends or family?
54 Question How much time did you spend with friends or family yesterday?
55 Question Yesterday did you spend time at home by yourself? Without a spouse, partner, or anyone else present.
56 Question How much time did you spend at home by yourself yesterday?
57 Question Yesterday, did you spend time shopping or running errands?
58 Question How much time did you spend shopping or running errands yesterday?
59 Question Yesterday, did you spend time looking after someone? For example, a sick or disabled relative, a grandchild, or someone else.
60 Question How much time did you spend looking after someone yesterday?
61 Question Yesterday, did you spend time doing housework or preparing food?
62 Question How much time did you spend doing housework or preparing food yesterday?
63 Question Yesterday, how much time did you spend sitting?
64 Question Thinking now about all kinds of drinks, how often have you had an alcoholic drink of any kind during the last 12 months?
65 Question Did you have an alcoholic drink in the seven days ending yesterday?
66 Question On how many days out of the last seven did you have an alcoholic drink?
67 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’.
68 Question During the last seven days, how many glasses of wine did you have? Include sherry, port, vermouth. If none, please enter ‘0’.
69 Question During the last seven days, how many pints of beer, lager or cider did you have? If none, please enter ‘0’.
70 Question We would like to ask you about incontinence. During the last 12 months, have you lost any amount of urine beyond your control?
71 Question When you had this problem, did it last for more than one month?
72 Question During the last 12 months, have you had any problems controlling your bowels?
73 Question When you had this problem, did it last for more than one month?
74 Question If there is anything else you would like to tell us, please write in the space below. We shall be very interested to read what you have to say.