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Question 1

Age Group

Under 18

18–35

36–55

Over 55

Question 2

Gender (Optional)

Male

Female

Other / Prefer not to say

Question 3

Health Concerns or Goals (Select all that apply)

I want to manage my weight

I have high blood pressure

I have diabetes

I often feel stressed or anxious

I am pregnant or planning a baby

I want to quit smoking

I have a long-term condition

I am generally healthy, just checking

Question 4

Physical Activity Level

Very active (e.g., farming, walking daily)

Somewhat active (e.g., occasional walking or chores)

Not active (e.g., sit or lie down most of the day)

Question 5

How would you describe your diet?

Mostly healthy (fruits, veggies, home-cooked)

Mixed (some healthy, some snacks or fast food)

Not healthy (mostly processed, sugary, or salty food)

Question 6

Do you currently smoke or use tobacco products?

Yes

No

I quit recently

Question 7

Do you have any diagnosed health conditions? (Select all that apply)

High blood pressure

Diabetes

Asthma or lung condition

Kidney problems

Mental health concern

None / Not diagnosed

Question 8

Do you have access to a health facility nearby?

Yes

No

Sometimes

Question 9

How often do you feel stressed or anxious?

Rarely

Sometimes

Often

All the time

Question 10

Do you use a mobile phone regularly?

Yes

No