Health Related Behaviors Survey Template

A health behaviors survey is a set of questions that health practitioners ask patients to better understand their lifestyle choices and the impacts of those choices on health outcomes. In addition to compiling data on an individual’s health and habits, the survey also gauges the extent to which patients might be willing to make lifestyle changes to improve their health.

This list is not comprehensive but provides a general summary of the areas covered in a health behavior survey:

• Diet
• Exercise
• Smoking
• Alcohol consumption
• Sleep
• Weight
• Healthcare check-ups
• General health & wellbeing

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The easiest way to find out patients' typical behavior or attitude is through closed questions that ask how important patients think a particular behavior is or how often they engage in it. Gathering quantitative data from these questions makes tracking and measuring patient data quick and efficient. If the same survey is completed regularly, it is easy to spot changes and intervene by offering treatment or advice if needed. Repeating the survey after any intervention will also collect data to analyze the success of the intervention.

• Demographic questions can be sensitive, so consider carefully if including questions such as age and gender is necessary for your survey. They may be essential if you want to monitor certain age groups more carefully. In this case, add an age question with bracket options (under 18, 18-24, etc.), rather than asking for the exact date of birth, as some patients may be reluctant to provide their exact age.
• Consider how you will implement this survey. Asking about behaviors that may not be socially desirable can lead to patients not answering truthfully. Allowing patients to complete the survey on their own rather than having it administered by a healthcare professional may help alleviate the problem of providing socially desirable but inaccurate answers.

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The simplest way to create a health behaviors survey is to sign up for Checkbox and use the provided template. Start your free trial on Checkbox now – no credit card required.