Child Brain Health Survey
Dear Participant, Thank you and appreciate your time for participating in filling out this questionnaire to work together to improve the child's brain health. Please answer the following:
Age ?
20-29
30-39
40-49
50 and above
Gender?
Male
Female
Level of education?
Illiterate
Primary School
Secondary
University
Post Graduate
Marital status?
Single
Married
Do you know about child brain health?
Yes
No
How did you know about the child brain health? ( you can choose more than one response )
School
Public
Books
Social media
State media
Scientific/voluntary societies
In your opinion, what stages in life are important to look after child’s brain? ( you can choose more than one response )
Before birth
Neonate (less than one month)
Infant (1 m -1Y)
Toddler (1-4) Y
School age (4-12) Y
Adolescence (13-18) Y
In your opinion, which of the following has influence on child brain health? ( you can choose more than one response.)
Diet
Physical health
Sleeping habits
Social factors
Genetics
How do you rate your awareness on child’s brain health?
Excellent
Very good
Good
Fair
Poor
Do you have a child of your own or close relative? ( If yes , please answer the following )
Yes
No
Physical growth:
Satisfied
Average
Dissatisfied
Very dissatisfied
Mental development:
Satisfied
Average
Dissatisfied
Very dissatisfied
Social development:
Satisfied
Average
Dissatisfied
Very dissatisfied
Language development:
Satisfied
Average
Dissatisfied
Very Dissatisfied
Learning abilities:
Satisfied
Average
Dissatisfied
Very Dissatisfied
How often was your related child hard to manage?
Frequently
Often
Rarely
Never
Do you think social media/internet has helped to acknowledge the importance of child’s brain health?
Yes
No
In your opinion which of the following points to brain illness
The child has difficulty staying seated during meals (√ / x)
The child has trouble expressing emotions (√ / x)
The child is uncooperative and argumentative (√ / x)
The child tends to say “no” very often (√ / x)
The child has difficulty getting dressed independently (√ / x)
In school and during homework, the child lacks motivation but not for things they enjoy (√ / x)
The child has low self-esteem (√ / x)
The child is shy and withdrawn around people (√ / x)
The child needs to see or hear concepts many times in order to learn them (√ / x)
The child does not like doing homework (√ / x)
The child has difficulty socializing in school (√ / x)
The child has difficulty in learning a new subject/activity in school (√ / x)
The child gets anxious around new people (√ / x)
The child cries/throws tantrums when they don’t get what they want (√ / x)
Thank you
Submit
