QUESTIONNAIRE
Research Study: Studying the impact of traditional food for health
Please give Tick mark as response
1. Name:
2. Specify your gender
Male Female
3. State your age group
Below 25 25-35 36-45 46-55 56 and above
4. What is your Occupation?
Student Housewife Govt Job Private job Own business
5. State your family income (per month)
Below Rs. 20,000 Rs.20, 001 - 30,000 Rs.30,001- 40,000
Rs.40,000 – 50, 000 Above 50, 000
6. Which area you reside?
Urban Semi urban Rural
7. How frequent are you doing exercises?
Daily Weekly Monthly Occasionally Not at all
8. If yes, specify the exercises you are doing.
Walking Jogging Yoga Warm up Exercises
9. Specify your body weight (Kgs)
Below 50 kgs 51-60kgs 61-70kgs 71-80kgs Above 80kgs
10. Specify your height in feet (Approximately.)
Below 5 inches 5-5.5 inches 5.6 – 6 inches Above 6 Inches
11. Do you have any health problem
Yes No
12. Specify the traditional food you consume
Palaya sadam Neeragaram Porridge Millets foods Rice varieties
Snacks (Sesame, Groundnut etc)
13. How frequent do you consume traditional food?
Daily Weekly 15 days once Monthly once
Occasionally
14. What about your opinion about taste of traditional food compare to other foods.
Very Good Good Neutral Bad Very bad
15. Do you feel that traditional food grains are expensive relative to normal food grains?
Yes No
16. Specify your source of awareness about the traditional food importance for healthy life.
Ancient beliefs Family custom Relatives & friends
Through media (TV, internet, newspapers etc)
17. Do you face health related issues after consuming traditional food?
Always Often Rarely Sometimes Not at all
18. Are you feel satisfied with your fitness after consuming traditional food
Highly satisfied Satisfied Neutral Dissatisfied Highly dissatisfied
19. How frequently are you consuming junk food items?
Daily Weekly 15 days once Monthly once Occasionally
20. Specify the junk food items you consume
Pizza Noodles Burger Chat Items Snacks Others
21. Do you have any health related issue after consuming junk food
Always Often Rarely Sometimes Not at all