CRISO project. University of Malta.

This questionnaire will take you about 10 minutes to complete.


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* 1. What is your identity number and your phone number?

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* 2. How did you get to know about the project?

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* 3. When did your brother or sister or parent had their heart attack?

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* 4. What is your gender

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* 5. What is your age?

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* 6. What is your educational level

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* 7. Do you live by yourself?

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* 8. Are you employed?

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* 9. Do you smoke?

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* 10. If a smoker, how soon after you wake up do you smoke your first cigarette? 

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* 11. If a smoker, do you find it difficult to refrain from smoking in the places where it is forbidden (e.g., in church, at the library, in cinema)? 

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* 12. If a smoker, which cigarette would you hate most to give up?

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* 13. If a smoker, how many cigarettes/day do you smoke?

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* 14. If a smoker, do you smoke more frequently during the first hours after waking than during the rest of the day? 

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* 15. If a smoker, do you smoke if you are so ill that you are in bed most of the day?

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* 16. Your physical activity status. Please check ONE answer that accurately describes you.

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* 17. I do activities to increase muscle strength (eg. lifting weights) once a week or more.

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* 18. I do activities to improve flexibility, such as stretching or yoga, once a week or more.

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* 19. The next questions are about your diet. 
Do you use olive oil as main culinary fat?

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* 20. How much olive oil do you consume in a given day? (Including oil used for frying, salads, out-of-house meals, etc.)?

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* 21. How many vegetable servings do you consume per day? (1 serving: 200g -consider side dishes as half a serving)

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* 22. How many fruit units (including natural fruit juices) do you consume per day?

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* 23. How many servings of red meat, hamburger, or meat products (ham, sausage, etc.) do you consume per day? (1 serving: 100-150g)

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* 24. How many servings of butter, margarine, or cream do you consume per day? (1 serving: 12g)

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* 25. How many sweet or carbonated beverages do you drink per day?

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* 26. How much wine do you drink per week?

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* 27. How many servings of legumes (eg. soy beans, kidney beans, fava beans) do you consume per week? (1 serving: 150g)

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* 28. How many servings of fish or shellfish do you consume per week? (1 serving 100-150g of fish or 4-5 units or 200g of shellfish)

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* 29. How many times per week do you consume commercial sweets or pastries (not homemade), such as cakes, cookies, biscuits, or custard?

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* 30. How many servings of nuts (including peanuts) do you consume per week? (1 serving 30g)

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* 31. Do you preferentially consume chicken, turkey, or rabbit meat instead of veal, pork, hamburger, or sausage?

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* 32. How many times per week do you consume vegetables, pasta, rice, or other dishes seasoned with tomato sauce, onion or garlic and simmered with olive oil?

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* 33. The next questions are about your health literacy. How strongly you disagree or agree with the following statements: 

I have at least one healthcare provider who knows me well.

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* 34. I have at least one healthcare provider I can discuss my health problems with

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* 35. I have the healthcare providers I need to help me work out what I need to do

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* 36. I can rely on at least one healthcare provider

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* 37. I feel I have good information about my 'heart' health  

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* 38. I have enough information to help me deal with my health problems

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* 39. I am sure I have all the information I need to manage my 'heart' health effectively

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* 40. I have all the information I need to look after my 'heart' health

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* 41. I spend quite a lot of time actively managing my 'heart' health

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* 42. I make plans for what I need to do to be healthy

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* 43. Despite other things in my life, I make time to be healthy

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* 44. I set my own goals about health and fitness

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* 45. There are things that I do regularly to make myself healthier

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* 46. I am on the following drug treatment:

Drug to control blood pressure

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* 47. Drug to control cholesterol

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* 48. Drug to control blood glucose

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* 49. You wish to be contacted by the researcher to schedule an appointment.

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