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Demographic Data Entry

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Stigma Scale for Receiving Psychological Help (SSRPH)

For this 5-item scale, respondents rate the degree in which they agree or disagree with each item using a likert-type format from 1 (very strongly disagree) to 5 (very strongly agree).


1. Receiving treatment for emotional or mental problems carries social stigma.
 


2. It is a sign of personal weakness or inadequacy to receive treatment for emotional or mental problems.
 


3. People will see a person in a less favourable way if they come to know that he or she has received treatment for emotional or mental problems.
 


4. It is advisable for a person to hide from people that he or she has been treated for emotional or mental problems.
 




Self-efficacy in Seeking Mental Health Care (SE-SMHC)

Below are several statements about your confidence in your ability to seek mental health care if you ever needed it. For each statement, rate how confident you are from a score of 1 = no confidence to a score of 10 = complete confidence in your ability to do each behavior. There are no right or wrong answers. We are interested in how you see yourself and your own abilities.


1. Find a place to get mental health treatment.
 

2. Get transportation to a mental health care service.
 

3. Clearly tell the staff what is troubling me.
 

4. Understand the information given to me by the staff.
 

5. Be able to follow the treatment recommendations made by staff.
 

6. Cope well with the consequences of seeking care (for example, treatments, tests, hospitalizations).
 

7. Cope well with my family and friends reactions to me seeking mental health treatment.
 

8. Cope well with the attitudes that the staff may have towards me.
 

9. Overcome any embarrassment I may have about seeking mental health treatment.
 

The Multidimensional Health Locus of Control Questionnaire

For each question, select your answer from the drop down menu provided here using a likert-type format from 1 (very strongly disagree) to 6 (very strongly agree)



1. If I get sick, it is my own behaviour which determines how soon I will get well.
 


2. No matter what I do, if I am going to get sick, I will get sick.
 


3. Having regular contact with my physician is the best way for me to avoid illness.
 


4. Most things that affect my health happen to me by accident.
 


5. Whenever I don't feel well, I should consult a medically trained professional.
 


6. I am in control of my health.
 


7. My family has a lot to do with my becoming sick or staying healthy.
 


8. When I get sick I am to blame.
 


9. Luck plays a big part in determining how soon I will recover from an illness.
 


10. Health professionals control my health.
 


11. My good health is largely a matter of good fortune.
 


12. The main thing that affects my health is what I myself do.
 


13. If I take care of myself, I can avoid illness.
 


14. When I recover from an illness, it's usually because of other people (for example, doctors, nurses, family, friends) have been taking good care of me.
 


15. No matter what I do, I'm likely to get sick.
 


16. If it's meant to be, I will stay healthy.
 


17. If I take the right actions, I can stay healthy.
 


18. Regarding my health, I can only do what my doctor tells me to do.
 

RAND 36-Item Health Survey 1.0 Questionnaire Items

For each question in this section, select your response from the list provided with each question.

1. In general, would you say your health is:  
 

2. Compared to one year ago, how would your rate your health in general now?  
 

3. The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?  

3a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports:
 

3b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf:
 

3c. Lifting or carrying groceries:
 

3d. Climbing several flights of stairs:
 

3e. Climbing one flight of stairs:
 

3f. Bending, kneeling, or stooping:
 

3g. Walking more than a mile:
 

3h. Walking several blocks:
 

3i. Walking one block:
 

3j. Bathing or dressing myself:
 

4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?  

4a. Cut down the amount of time you spent on work or other activities:
 

4b. Accomplished less than you would like:
 

4c. Were limited in the kind of work or other activities:
 

4d. Had difficulty performing the work or other activities (for example, it took extra effort):
 

5. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?  

5a. Cut down the amount of time you spent on work or other activities:
 

5b. Accomplished less than you would like:
 

5c. Didn’t do work or other activities as carefully as usual:
 

6. During the past 4 weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours, or groups?  
 

7. How much bodily pain have you had during the past 4 weeks?  
 

8. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?  
 

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks . . .  

9a. Did you feel full of pep?
 

9b. Have you been a very nervous person?
 

9c. Have you felt so down in the dumps that nothing could cheer you up?
 

9d. Have you felt calm and peaceful?
 

9e. Did you have a lot of energy?
 

9f. Have you felt downhearted and blue?
 

9g. Did you feel worn out?
 

9h. Have you been a happy person?
 

9i. Did you feel tired?
 

10. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?  
 

11. How TRUE or FALSE is each of the following statements for you.  

11a. I seem to get sick a little easier than other people
 

11b. I am as healthy as anybody I know
 

11c. I expect my health to get worse
 

11d. My health is excellent
 


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