Hhq-Gp-1 Healthy Heart Questionnaire - Urban Indian Heart Health Program
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15Healthy Heart Questionnaire (HHQ-GP-1)
1
Healthy Heart Questionnaire
Thank you for participating in the Urban Indian Heart Health Program. The purpose of this
survey is to learn about the heart health of patients at this clinic. The following pages ask
questions about heart attack and stroke, and about your blood pressure, cholesterol, physical
activity, diet, and tobacco use.
The survey should take about 20-30 minutes to complete. Answering these questions is
voluntary and your answers will be kept private. This is not a test. Just mark the answers that
best reflect what you think. If you have questions, please feel free to ask a project staff member
for help. Thank you for completing this survey!
For each item, please check the box for the answer that is closest to how you feel, think, act,
or what you know about your blood pressure, cholesterol, physical activity, diet, and
tobacco use. Unless otherwise directed, choose only one answer for each item.
First, we’d like to ask you some questions about your blood pressure.
1. When was the last time you had your blood pressure checked?
Within the past year (anytime less than 12 months ago)
Within the past 2 years (more than 1 year ago but less than 2 years ago)
Within the past 5 years (more than 2 years ago but less than 5 years ago)
Five or more years ago
Don’t Know
Never had it checked you may go to question #10
2. The LAST time you had your blood pressure checked, was it normal or high?
Normal
High
Don’t Know/Not Sure
3. Have you EVER been told by a doctor, nurse, or other health professional that you have
high blood pressure?
Yes
No you may go to question #10
Don’t Know/Not Sure you may go to question #10
4. If yes, and if you are female, was this only when you were pregnant?
Yes you may go to question #10
No
Don’t Know/Not Sure you may go to question #10
5. Are you currently taking medicine for your high blood pressure?
Yes
No
Don’t Know/Not Sure
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Parent category: Life