Hhq-Gp-1 Healthy Heart Questionnaire - Urban Indian Heart Health Program Page 3
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15Healthy Heart Questionnaire (HHQ-GP-1)
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11. About how long has it been since you last had your blood cholesterol 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/Not Sure
12. The last time you had your blood cholesterol checked, was it normal or high?
Normal
High
Don’t Know/Not Sure
13. Have you EVER been told by a doctor, nurse or other health professional that your blood
cholesterol is high?
Yes
No you may skip question #14
Don’t Know/Not Sure you may skip question #14
14. If so, when were you told that your blood cholesterol was high?
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/Not Sure
Next, we are interested in learning about your physical activity, diet, and tobacco use.
The following questions are about your physical activities – those activities where you move and
your heart beats faster than when you are just resting. You may do these activities for pleasure,
work, or to get from one place to another. These questions ask about how much physical activity
you usually do. They also ask about intensity, which is related to the amount of energy you use
to do these activities. Below are some examples of different physical activity intensity levels:
Light activity level: Your heart beats slightly faster than normal; you can talk and sing.
Examples include walking slowly, stretching, vacuuming, or light yard work.
Moderate activity level: Your heart beats faster than normal; you can talk but not sing.
Examples include fast walking, aerobics class, doing weights, or swimming gently.
Vigorous activity level: Your heart beat increases a lot; you can’t talk or your talk is
broken up by large breaths.
Examples include jogging, running, basketball, or hiking up a steep hill.
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