Survey on Body Image

Ref. No. ((((Interviewer No. _____ Survey on Body Image (Sample Questionnaire) PART I enchant put a tick ( in the box that best reflects your opinion. 1. Are you aged over 25? ( Yes (Please continue answering question 2 in this part) ( No (This is the decease of this survey. convey you very much for your helper ) 2. In general, are you satisfied with your body figure? (Interviewer please check the quota) ( Yes ( No PART II Please indicate how do you think about the following statements is true by circle the number. No. Questions Strongly discord Neutral Agree Strongly Disagree Agree 2 I think I am shorter than I should agree. 1 2 3 4 5 3 I choose to wear clothes that can hide my body baffle. 1 2 3 4 5 4 I need to do something to neuter my body figure. 1 2 3 4 5 5 I am very dissatisfied with my body figure. 1 2 3 4 5 6 I ceaselessly take records of my body weight. 1 2 3 4 5 7 I always read diet publications. 1 2 3 4 5 8 I always calculate the calorie intake. 1 2 3 4 5 9 I always pay attention on the issue of slimming. 1 2 3 4 5 10 Celebrities/models body image is my desired body image. 1 2 3 4 5 11 I feel unsatisfactory to my body shape when comparing with the 1 2 3 4 5 celebrities/models body image. 12 I am very envious of those celebrities/models body figures appear on those 1 2 3 4 5 slimming advertisements. 13 I want to look as good as a model/celebrity. 1 2 3 4 5 14 I think celebrities/models body image is a symbol of beauty. 1 2 3 4 5 No. Questions Strongly Disagree Neutral Agree Strongly Disagree Agree 16 I believe I would have more job opportunities if I have a good figure. 1 2 3 4 5 17 I believe I would have longer life if I have a good figure. 1 2 3 4 5 18 I believe I would have many admirers if I have a good figure. 1 2 3 4 5 19 I believe I would have more acceptances in social life if I hav e a good 1 2 3 4 5 figure. 20 People or so me are more likely to make friends with slim people. 1 2 3 4 5 21 People around me would use different ways to keep body shape. 1 2 3 4 5 22 People around me do not satisfied with their body figure. 1 2 3 4 5 23 People around me like discussing on their body shape. 1 2 3 4 5 24 I feel not in the group if I am fatter than people around me. 1 2 3 4 5 25 I do mind if people play a joke on my body figure. 1 2 3 4 5 26 Ido mind if I find that I have gained some weight. 1 2 3 4 5 27 I do mind people telling me I am fat. 1 2 3 4 5 28 I feel bad talking to another female with slim body. 1 2 3 4 5 29 I feel guilty when I eat too much. 1 2 3 4 5 30 All in all, I am inclined to feel that I am a failure 1 2 3 4 5 31 I take a positive attitude toward myself 1 2 3 4 5 32 I have confidence in myself. 1 2 3 4 5 33 At times I think I am no g ood at all 1 2 3 4 5 34 I feel that I have a number of good qualities 1 2 3 4 5 35. I most frequently obtain information about slimming from the following channel (tick ( one only) ( TV ( Radio ( Newspaper ( Magazine ( net ( Others (please specify)____________________ Part III We would like to end with a few demographic questions. Please write down the related information or put a tick ( in the appropriate option. 1 My age is ______ years 2 My weight is about ______________ pounds (or ______ kg) 3 My height is about ______feet ______inches (or ______ cm) 4 How often do you exercise? ______ times per month 5 My marital status is ( Single ( Married ( Widowed ( Divorced ( Separated 6 My monthly inocme is ( Below $5000 ( $5001-$9000 ( $9001-$15000 ( $15001-$25000 ( $25001 or above 7 The highest level of education I attained ( Primary school or below ( Lower secondary ( Upper secondary ( matric ( Certificate/Diploma/Higher Diploma/Associate/Bachelors Degree ( Master s Degree ( Ph. D. Thank you very much for your assistance Hello I am a student of XX University. I am now conducting a survey about body image among Chinese female adulthood. It is grateful if you could take 5 to 10 minutes to complete this questionnaire. There is no right or wrong answer. Your participation is voluntary. The information obtained in this study will be used to prepare a research report and no identifying information will be revealed in the dissemination of the results. Thank you.