Survey on Body Image

Ref. none ((((Interviewer No. _____ Survey on physical structure Image (Sample Questionnaire) PART I Please put a halt ( 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 stamp out of this survey. Thank you real overmuch for your assistance ) 2. In general, are you cheerful with your soundbox figure? (Interviewer please check the quota) ( Yes ( No PART II Please indicate how do you retrieve about the following statements is confessedly by circle the number. No. Questions Strongly Disagree Neutral bear Strongly Disagree obligate 2 I think I am shorter than I should get hold of. 1 2 3 4 5 3 I prefer to wear clothes that can address my personate shape. 1 2 3 4 5 4 I need to do something to change my body figure. 1 2 3 4 5 5 I am very dissatisfied with my body figure. 1 2 3 4 5 6 I al shipway take records of my body weight. 1 2 3 4 5 7 I always involve diet publications. 1 2 3 4 5 8 I always calculate the calorie intake. 1 2 3 4 5 9 I always pay watchfulness 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 thumb failing to my body shape when comparing with the 1 2 3 4 5 celebrities/models body image. 12 I am very avaricious of those celebrities/models body figures appear on those 1 2 3 4 5 slimming advertisements. 13 I want to look as well 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 look at I would have more(prenominal) assembly line opportunities if I have a beloved figure. 1 2 3 4 5 17 I believe I would have longer chanceing 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 have a good 1 2 3 4 5 figure. 20 mint around me are more likely to make fri end ups 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 wit 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 atrocious 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 overbearing attitud e toward myself 1 2 3 4 5 32 I have confidence in myself. 1 2 3 4 5 33 At propagation I think I am no good 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 oblige information about slimming from the following channel (tick ( one only) ( TV ( wireless ( Newspaper ( Magazine ( Internet ( Others (please specify)____________________ Part III We would like to end with a few demographic questions. Please write down the associate information or put a tick ( in the allow for 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 ( leave ( Divorced ( Separated 6 My monthly inocme is ( Below $5000 ( $5001-$9000 ( $9001-$15000 ( $15001-$25000 ( $25001 or supra 7 The highest level of education I attained ( Primary di rect or below ( Lower secondary ( Upper secondary ( matriculation ( Certificate/Diploma/Higher Diploma/Associate/Bachelors Degree ( Masters 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 wrongfulness answer. Your participation is voluntary. The information obtained in this study bequeath be utilise to prepare a research report and no identifying information will be revealed in the dissemination of the results. Thank you.