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Questionnaire template

Community Mental Health Self-Perception

Explores community members' self-rated wellbeing, stress and anxiety, their triggers, and healthy routine habits.

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Healthcare · Mental health assessment. All Healthcare templates

Questions in this template

Your General Wellbeing

  1. Thank you for taking part. This survey explores how people in our community see their own mental health, and your honest answers will shape local support.

  2. Overall, how would you rate your wellbeing at the moment?

    Choose one from a list:

    • Excellent
    • Very good
    • Good
    • Fair
    • Poor

  3. How much do you agree or disagree with each statement?

    • Most of the time I feel at ease.
    • I frequently feel I have more to deal with than I can manage.
    • I typically feel full of energy.

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

Stress and Anxiety

  1. How often do you feel stressed or anxious?

    Choose one:

    • Daily
    • Weekly
    • Monthly
    • Rarely
    • Never

  2. Could you tell us a little more about when these feelings tend to come up?

    Asked only when q_stress_frequency.outcome is not None and q_stress_frequency.outcome <= 4

    Open answer

  3. Do the following tend to leave you feeling stressed or anxious?

    • Your job or studies
    • News and current events
    • Things happening in your family

    For each row: choose one:

    • Yes
    • Not sure
    • No

Lifestyle

  1. Which of these habits are a regular part of your routine?

    Choose any that apply:

    • Regular exercise
    • A balanced diet
    • Meditation or mindfulness
    • Time outdoors
    • Eight or more hours of sleep a night
    • None of these

  2. What else do you do to look after your mental health?

    Open answer