Sample of Questionnaires: Sample of Survey Questions in Research

Sample of Questionnaires

The sample of questionnaires has been collected from University Putra Malaysia. New researchers will get a concept on how to create a survey questionnaire. This sample of questionnaires represents an example of questionnaires.

The author has uploaded some different samples of questionnaires and set download links here so that readers download the pdf form. This sample of questionnaires might provide a better level of understanding for the new researchers.

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  1. Sample of Questionnaire 
  2. Sample of Questionnaire
  3. Sample of questionnaire
Sample of Questionnaires

Dear respondent,

We are KOM3431 Communication Research Students from the Department of Communication, Faculty of Modern Languages, and Communication. We are currently doing our individual assignment on data analysis. We wish to collect some information about your awareness of obesity.

You are invited to participate in this survey in which your insight and information are valuable for us to strategize the health communication campaign to be more effective. We greatly appreciate your help in providing us your honest answers to the questions below. I reassure you that the information gathered in this survey will only be used for event purposes and will be kept confidential.

Thank you.

SECTION A: DEMOGRAPHIC
1 Ethnic : □ Malay □ Indian
2 Gender : □ Chinese □ Other: ______________
□ Male □ Female
3 Age : Below 15 31–35
15–19 36–40
20–25 41–45
26–30 Above 45

 

  1. Which written language(s) do you understand? (Choose whichever relevant)
Malay English
Chinese Tamil

 

  1. Which spoken language do you prefer? (Choose one (1) ONLY)
Malay English
Mandarin Tamil
Cantonese Hakka
Hokkien Other: ___________
SECTION B: MEDIA CONSUMPTION
  1. What are the main sources you use the most to obtain health information? (Choose minimum one (1) answer and maximum three (3) answers)
Newspaper Internet
Magazine Facebook
Television Instagram
Radio Twitter
WeChat Other: ______________

 

  1. If you have selected a newspaper as one of the sources for obtaining information pertaining to health, which newspaper vehicle do you read the most? (Choose one (1) ONLY)
Sin Chew Daily Guang Hwa Daily
China Press Oriental Daily
Nanyang Siang Pau The Star
Utusan Malaysia Berita Harian
Kosma! News StraitTime
Guang Ming Daily Other: ______________
SECTION C: MEDIA PREFERENCE
  1. Do you watch local television (TV) station(s)?
  • Yes (Proceed to Q2)
  • No (Proceed to Q4)
  1. How many hours of TV do you watch in a day? (Choose one (1) ONLY)
  • Less than 1 hour per day
  • 4-6 hours per day
  • 1-3 hours per day
  • More than 6 hours per day
  1. Which TV channel you watch the most? (Choose one (1) ONLY)
Astro NTV 7
RTM 1 8TV
RTM 2 TV 9
TV 3 Other: ______________

 

  1. Do you listen to the local radio?
  • Yes (Proceed to Q5)
  • No (Proceed to Q7)
  1. How many hours of local radio station do you listen in a day? (Choose one (1) ONLY)
  • Less than 1 hour per day
  • 1-3 hours per day
  • 4-6 hours per day
  • More than 6 hours per day
  1. Which local radio station you listen to the most? (Choose one (1) ONLY)
One FM Hitz.FM
988 FM Fly FM
Melody FM Lite FM
MY FM Mix FM
Ai FM Era FM
Red FM Hot FM
Sinar FM Other: ______________

 

  1. Which social media do you use the most? (Choose one (1) ONLY)
Facebook Twitter
Instagram WeChat
WhatsApp Other: ______________

SECTION DAwareness about Obesity

Tick (✓) the spaces provided to indicate your level of agreement with the statements below.

I. Problem Recognition
No Statements Strongly

Disagree/

1

2 3 4 Strongly

Agree/

5

1 Obesity is becoming an increasingly large problem in my community.
2 There is an urgent need to solve the obesity problem in my community.
3 There is much room for local authorities and the government to improve the policies in controlling obesity in Malaysia.
4 I believe the prevention of obesity is very important.
II. Constraint Recognition
No Statements Strongly

Disagree/

1

2 3 4 Strongly

Agree/5

1 I am not able to do anything to solve the obesity problem in my community.
2 My efforts to combat the obesity problem in my community is pointless.
3 I do not see any points in trying to encourage my community members to control their weights.
4 I think I could not affect my community members to control their weight and to prevent obesity.
III. Involvement Recognition
No Statements Strongly

Disagree/

1

2 3 4 Strongly

Agree/

5

1 I am concerned that overweight is affecting my life.
2 I believe obesity could affect my health.
3 I have a strong opinion about obesity.
4 I feel that obesity affects me personally.

– – End of Survey Questionnaire – –

Thank you for answering.