Hawaii Health Survey

Thank you for choosing to participate in Building a Healthy Hawaii. You are not required to identify yourself in the survey, but every individual's honest response is very important.

This is a privately funded survey and a summary of responses will be provided to our many partners who contribute to our effort in Building a Healthy Hawaii. This survey consists of only 15 questions and is estimated to take about 2-3 minutes to complete. And please be sure to click Submit at the end of the survey. Thank you in advance for your contribution to the health and wellness of Hawaii's people.

Aloha from the Life FitNet Team

FOR REFERENCE ONLY: Who referred you to this Hawaii Health Survey?

1. What challenges do you face in maintaining an exercise program? (select all that apply)

No convenient/accessible facility/equipment
Not motivated, no goals
Don't know what to do and how to train
No time, other priorities & commitments
Intimidated, uncomfortable
Health reasons
No challenges, bored
Lazy, tired
Cost
None
Other:

2. Why do you want/need to exercise? (select all that apply)

Health reasons
Lose weight
Gain weight
Tone
Outdoors
Enhanced performance
Strength
Look better
Feel better
Social reasons
Anti-aging
Other:

3. Which of the following would be of value to you? (select all that apply)

Access to workout facility/equipment
Specific goals
Training advice/instruction
Fitness assessment
Support/training partner
Exercise tracking tool
Nutritional advice
Diet tracking tool
Other:

4. How often do you exercise?

Not at all
1-2 days per week
3-4 days per week
5-7 days per week

5. Where do you exercise? (select all that apply)

Large gym
Small gym
Home
Outdoors
Work
Other:

6. Hours of sleep per day?

7. Age:

8. Gender: Female Male

9. Height:

10. Weight:

11. Select up to 5 of your preferred activities:

12. Check if you suffer from any of the following conditions. (select all that apply)

High blood pressure
High cholesterol
Heart disease
Diabetes
Vertigo
Migraine
Osteoporosis
Asthma or other respiratory condition
Arthritis
Back or neck pain
Sport, motor vehicle, or other injuries
Gout
Weight-related issues
Other:

13. How often do you skip meals?

Not at all
1-2 days a week
3-4 days a week
5-7 days a week

14. What are your greatest barriers to healthy eating?

On the go, convenience
No time to prepare
Someone else prepares food
Used to eating large portions
Cost
Don't know what healthy choices are
Social eating (parties, meetings, hanging out)
Love fatty foods (fried, gravy, butter, cream, etc.)
Love salty snacks
Have a sweet tooth
Other:

15. What will it take for you to adhere to a healthy diet, exercise & lifestyle regimen? (select all that apply)

When clothes don't fit
When you don't like what you see in the mirror
When someone insults you
When you suffer physically
When the kids are gone
When your job changes
When everyone else does
When healthier options are easier and cheaper
When someone you know passes on prematurely
When your doctor gives you a warning
A near death experience
When pigs fly
Other:

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