Cardiovascular Health Awareness Questionnaire

Section A: Demographics
1. Age: _____ years
2. Gender: □ Male □ Female □ Other □ Prefer not to say
3. Highest level of education: □ Secondary □ Bachelor's □ Master's □ Doctorate □ Other

Section B: Knowledge and Awareness

Please rate your agreement with the following statements:
1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree
ITEM 1 2 3 4 5
1. Smoking can increase the risk of heart
disease.
2. Regular exercise is good for heart health.
3. Eating too much fatty food can lead to heart
problems.
4. High blood pressure is bad for the heart.
5. Drinking too much alcohol can harm the
heart.
6. Diabetes increases the risk of heart disease.
7. Keeping a healthy weight is important for
the heart.
8. High cholesterol is a risk for heart disease.
9. Eating fruits and vegetables is good for the
heart.
10. Stress can contribute to heart problems.

Section C: Lifestyle and Habits

11. How often do you exercise?
□ Never □ 1-2 times a week □ 3-4 times a week □ 5 or more times a week
12. Do you smoke?
□ Yes □ No □ Former smoker
13. How many servings of fruits and vegetables do you eat daily? _____
14. Have you had your blood pressure checked in the last year?
 □ Yes □ No □ Not sure
15. Do you know your cholesterol levels?
□ Yes □ No
Section D: Personal Health Management
ITEMS 1 2 3 4 5
16. I get regular health check-ups.
17. I try to manage my stress levels.
18. I am aware of my family's history of
heart disease.
19. I know the signs of a heart attack.
20. I try to maintain good oral hygiene.

Section E: Information and Confidence

21. Where do you usually get information about heart health?
□ Doctor □ Internet □ Family/Friends □ TV/Radio □ Books/Magazines
22. How would you rate your knowledge about heart health? (1 = Very low, 10 = Very high)
____________
23. How confident are you in recognizing signs of a heart attack? (1 = Not at all, 5 = Very)
______________
24. In the past year, have you tried to improve your heart health?
□ Yes □ No
If yes, what did you do? ______________________________
25. What do you think is the biggest challenge in keeping a healthy heart?
_________________________________________________
Section F: Additional Factors
Please rate your agreement with the following statements:
1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree

ITEM SD D N A SA
26. Lack of sleep can affect heart health.
27. Secondhand smoke can increase heart
disease risk.
28. Eating less salt is good for the heart.
29. Sitting for long periods is bad for heart
health.
30. Age increases the risk of heart disease.