Questionnaire GGD Health Monitor 2024

A1.    What is your year of birth?

A2.    Are you … ?

• Male
• Female
• Non-binary
• Other than the above mentioned

A3.    Who do you live with?
You may give more than one answer.

• My partner / husband or wife
• A child/children below the age of 4
• A child/children between the ages of 4 and 11
• A child/children between the ages of 12 and 17
• A child/children aged 18 or over
• My parent(s) / caregiver(s)
• Another adult / other adults
• I do not live with a partner, but I do have a long-term relationship
• I live alone

A4.    What is your highest completed education (with a diploma or a certificate of proficiency)?

• No education (not finished primary school)
• Primary education (primary school, special primary education)
• Lower or preparatory vocational education (such as lts, leao, lhno, vmbo-b/k, special or pre-vocational education)
• Junior general secondary education (such as (m)ulo, mavo, vmbo-g/t, mbo-kort, mbo-1)
• Upper secondary vocational education and apprenticeship training (such as training to become a baker or hairdresser, mts, meao, bol, bbl, mbo-2, mbo-3, mbo-4)
• Upper general secondary education and pre-university education (such as hbs, mms, havo, vwo, atheneum, gymnasium)
• Higher professional education (such as teacher training college, hbo, hts, heao, hbo-v, kandidaats or bachelor)
• University (doctoral or master, postdoctoral, hbo-master)

B1. How is your health in general?

• Very good
• Good
• Reasonable
• Poor
• Very poor

B2. Do you suffer from one or more chronic illnesses or disorders?
Chronic implies (expectedly) 6 months or longer.

• Yes
• No

B3. Are you restricted by your health problems in your daily life?

• Yes, seriously restricted
• Yes, restricted but not seriously
• No, not restricted at all (GO TO QUESTION B5)

B4. Have you been restricted by your health problems for 6 months or longer?

• Yes
• No

B5. Do you currently have health complaints that are due or possibly due to the coronavirus?

• Yes
• No (GO TO QUESTION B9)

B6. How long have you had these complaints due to the coronavirus for?

• Less than 3 months (GO TO QUESTION B9)
• 3 to 12 months
• 1 to 3 years
• 3 years or more

B7. Are you restricted by these health complaints due to the coronavirus in your daily life?

• Yes, seriously restricted 
• Yes, restricted but not seriously
• No, not restricted at all

B8. Has a doctor determined that you have long COVID / post-COVID condition?

• Yes
• No

B9. The following questions concern what you are normally able to do. This is not about temporary problems. 
Provide one answer for each row.

Can you follow a conversation in a group consisting of three or more persons (with a hearing aid if required)?
Can you have a conversation with one other person (with a hearing aid if required)?
Can you read small print in the newspaper (with glasses or contact lenses if required)?
Can you recognize someone’s face from a distance of 4 metres (with glasses or contact lenses if required)?
Can you carry an object weighing 5 kilos (such as a full shopping bag) for a distance of 10 metres?
Can you bend over from a standing position and pick something up from the ground?
Can you walk 400 metres without pausing (with a walking stick or walker if necessary)?

• Yes, without any difficulty
• Yes, with some difficulty
• Yes, with great difficulty
• No, I am not able to do so

B10. Did you or anyone in your household require medical or dental treatment in the last 12 months but not receive it?

• Yes
• No

B11. Have you used a prescription sleeping pill or sedative in the past two weeks?
E.g. oxozepam (Seresta), temazepam (Normison), diazepam (Stesolid), lorazepam (Temesta), zopicolon (Imovane) or zolpidem (Stilnoct)

• Yes
• No

B12. On a scale from very easy to very difficult, how easy would you say it is to...
Check one box in each row.

Judge when you may need to get a second opinion from another doctor?
Use information the doctor gives you to make decisions about your illness?
Find information on how to manage mental health problems like stress or  
depression?
Judge if the information on health risks in the media is reliable?
Find out about activities that are good for your mental well-being?
Understand information in the media on how to get healthier?

• Very easy
• Easy
• Difficult
• Very difficult

C1. Are you worried about falling?

• Yes
• No

C2. Have you fallen in the past 12 months?

• Yes, once
• Yes, twice or more
• No (GO TO QUESTION D1)

C3. Have you suffered an injury because of a fall in the past 12 months? 
By an injury we mean an open wound, a bruise, a sprain, or a broken bone, for example.

• Yes
• No

C4. Where were you the last time that you fell?

• In the house
• Outside but near the house
• Somewhere else
• I can’t remember

D1. The questions below are about how you felt in the last 4 weeks.
Provide one answer for each row.

About how often did you feel tired out for no good reason?
About how often did you feel nervous?
About how often did you feel so nervous that nothing could calm you down?
About how often did you feel hopeless?
About how often did you feel restless or fidgety?
About how often did you feel so restless that you could not sit still?
About how often did you feel depressed?
About how often did you feel that everything was an effort?
About how often did you feel so sad that nothing could cheer you up?
About how often did you feel worthless?

• All the time
• Most of the time
• Some of the time
• A little of the time
• None of the time

D2. In the last 4 weeks, have you been suffering from stress? For example because of work, education, child-raising, health, informal care, money matters, social media?

• No or barely (GO TO QUESTION D4)
• Yes, a little bit of stress
• Yes, much stress
• Yes, a lot of stress

D3. In which domains did you experience this stress?
You may give more than one answer.

• Work
• Education
• Relationship with partner
• Family or friends
• Child-raising / children
• Housing
• Health
• Informal care
• Money matters
• Social media
• Other

D4. The following statements concern how you have felt in the last 4 weeks. 
Are you not sure which answer applies to you? Give the answer that most closely corresponds to how you have felt.
Provide one answer for each row.

I am very capable of dealing with setbacks.
I am very good at coming up with solutions in difficult situations.
I recover quickly after a difficult period.
Previous experiences mean that I feel stronger in difficult times.
Every experience that I have makes me stronger.

• Almost never
• Sometimes
• Now and then
• Regularly
• Usually
• Almost always
• Always

D5. Please indicate how strongly you agree or disagree with  each statement below.
Provide one answer for each row.

I have little control over the things that happen to me.
There is really no way I can solve some of the problems I have.
There is little I can do to change many of the important things in my life.
I often feel helpless in dealing with the problems of life.
Sometimes I feel that I’m being pushed around in life.
What happens to me in the future mostly depends on me.
I can do just about anything I really set my mind to.

• Completely agree
• Agree
• Neither agree nor disagree
• Disagree
• Completely disagree

E1. How would you find…
Check your answer in each line.

two men kissing in public?
two women kissing in public?
a man and a woman kissing in public?

• Totally unacceptable
• Unacceptable
• Neutral
• Acceptable
• Perfectly acceptable

E2. Please indicate how strongly you agree or disagree with each statement below.
Check your answer in each line.

Gay couples should have the same rights to adopt children as straight couples.
Information about LGBTIQA+ provided by govermental organisations or at schools should be prohibited.
Something is wrong with people who do not feel like a man or a woman.
Surgery is a good idea if someone has thought carefully about changing their gender.

• Completely disagree
• Disagree
• Neither agree nor disagree
• Agree
• Completely agree

E3. Have you ever felt discriminated against, for example because of your beliefs or skin colour, sexual preference or age?

• No, never
• Yes, sometimes
• Yes, frequently

F1. Please indicate for each of the following statements, the extent to which they apply to your situation, the way you have been lately.
Provide one answer for each row.

There is always someone I can talk to about my day-to-day problems.
I miss having a really close friend.
I experience a general sense of emptiness.
There are plenty of people I can lean on when I have problems.
I miss the pleasure of the company of others.
I find my circle of friends and acquaintances too limited.
There are many people I trust completely.
There are enough people I feel close to.
I miss having people around me.
I often feel rejected.
I can call on my friends whenever I need them.

• Yes
• More or less
• No

The following questions are about social contact. By this we mean contact with family members, friends, acquaintances or neighbours, but not care professionals.
F2. Please indicate the extent to which the following statements apply to you, thinking about the last couple of months.
Provide one answer for each row.

I have people around me who want to help me and do odd jobs for me.
I have someone who I can talk to about personal problems.
I visit family, friends, acquaintances or neighbours for a chat, or they visit me at home.

• Yes
• More or less
• No

F3. How often do you have contact with your neighbours or people who live in your street?

• At least once a week
• Three times a month
• Twice a month
• Once a month
• Less than once a month
• Seldom or never

F4. Several statements are given below. Please indicate how strongly you agree or disagree with each statement below?
Check your answer in each line.

The people in my neighbourhood generally don’t get along well with each other.
Work is just a way to earn money.

• Completely agree
• Agree to some extent
• Neither agree nor disagree
• Dis-agree to some extent
• Completely disagree

G1. This question concerns a number of chronic conditions and other illnesses . Please indicate whether you have or had in past 12 months any of these illnesses or disorders. 
Check one box on each line.

Diabetes mellitus        
Cardiovascular diseases
COPD (chronic obstructive pulmonary disease)    
Osteoarthritis
Cancer

• Yes
• No

H1. How tall are you (without shoes)?

H2. How many kilos do you weigh without clothes? (round up or down to whole kilos)
If you are pregnant, please fill in your weight prior to the pregnancy.

I1. Do you sometimes smoke? 
We are referring to all sorts of tobacco products. Electronic cigarettes do not count. Heating tobacco or heatsticks also do not count.

• Yes (GO TO QUESTION I3)
• No

I2. Have you ever smoked?

• Yes
• No

I3. Do you sometimes use a vape or e-cigarette?

• Yes
• No

I4. In the last 12 months, have you ever consumed alcoholic beverages, such as beer, wine, liquor, mixed drinks or cocktails?
This includes low-alcohol beverages, but no non-alcoholic beverages.

• Yes (GO TO QUESTION I6)
• No

I5. Have you ever consumed alcoholic beverages?

• Yes (GO TO QUESTION I12)
• No (GO TO QUESTION I12)

I6. On average, on how many of the 4 weekdays (Monday through Thursday) do you drink alcoholic beverages?

• 4 days
• 3 days
• 2 days
• 1 day
• Less than 1 day
• I never drink on weekdays (GO TO QUESTION I8)

I7. When drinking alcoholic beverages on a weekday, how many glasses do you drink on average?

• 16 or more glasses
• 11 – 15 glasses
• 7 – 10 glasses
• 6 glasses
• 5 glasses
• 4 glasses
• 3 glasses
• 2 glasses
• 1 glass

I8. On average, on how many of the 3 weekend days (Friday through Sunday) do you drink alcoholic beverages?

• 3 days
• 2 days
• 1 day
• Less than 1 day
• I never drink in the weekend (GO TO QUESTION I10)

I9. When drinking alcoholic beverages on a weekend day, how many glasses do you drink on average?

• 16 or more glasses
• 11 – 15 glasses
• 7 – 10 glasses
• 6 glasses
• 5 glasses
• 4 glasses
• 3 glasses
• 2 glasses
• 1 glass

I10. How often have you drunk 4 or more glasses of alcoholic beverages in one day in the last 6 months?

• More than once a week
• Once a week
• 1-3 times a month
• Less than once a month
• Never (GO TO QUESTION I12)

I11. How often have you drunk 6 or more glasses of alcoholic beverages on one day in the last 6 months?

• More than once a week
• Once a week
• 1-3 times a month
• Less than once a month
• Never

I12. Have you ever taken the following substances?
Check your answer in each line

Cannabis (hash, weed or marijuana)
XTC (ecstasy, MDMA)
Amphetamine (pep of speed)
Designer drugs (such as 3-MMC or 4-MMC/Mephedrone/Meow Meow)
Cocaine (or crack, cooked base or freebase)

• No, never
• Yes, in the last 4 weeks
• Yes, in the last 12 months, but not in the last 4 weeks
• Yes, longer than 12 months ago

J1. How many days a week do you usually eat:

Vegetables    
Fruit
Fish
Meat
Pulses (e.g. lentils, chickpeas, dried beans)
Wholemeal products (e.g. wholemeal bread, wholemeal pasta, brown rice)
Snacks (e.g. biscuits, crisps, deep-fried snacks)
Dairy products (e.g. milk, yoghurt, cheese)
Sweetened drinks (e.g. tea/coffee with sugar, soft drinks)
A homemade warm meal
A ready-made (frozen) meal
A takeaway or meal that was delivered to your home

• Never
• Less than 1 day per week
• 1–3 days per week
• 4–6 days per week
• 7 days per week

The following questions are about exercise. Each question concerns a different activity. Think about an average week in the past months.

K1. Commuting activities

How many days per week do you walk to/from work or school?
How many days per week do you bicycle to/from work or school?

K2. Physical activity at work or school

How many hours on average per week do you do light or moderately strenuous physical activity at work or school?
This could be seated/standing work, like work at an office, with occasional walking, such as desk work or work that requires walking with light loads.
How many hours on average per week do you do intense strenuous physical activity at work or school? 
This could be work for which you have to walk a lot or regularly lifting heavy objects at work.

K3. Household activities

How many days per week do you do light or moderately strenuous household activities? This could be cooking, ironing, vacuuming or tidying up.
How many days per week do you do intense strenuous household activities? This could be carrying heavy shopping bags up the stairs, moving furniture or cleaning the floor on your knees.

K4. Leisure time activities

How many days per week do you go walking? This does not include walking to work or school.
How many days per week do you go bicycling? This does not include cycling to work or school.
How many days per week do you go gardening?
How many days per week do you do odd jobs in your spare time?

K5. Sports
Which sports do you practice? Fill in a maximum of 4 sports e.g. fitness/endurance training, tennis, running, football. If you do not take part in any sport, you may skip this question.

K6. Are you member of a sports club?

• Yes
• No

L1. The following questions concern how you have felt in the last 4 weeks. Please give the answer that best reflects how you have felt.
Provide one answer for each row.

How much of the time have you been a very nervous person?
How much of the time have you felt so down in the dumps that nothing could cheer you up?
How much of the time have you felt calm and peaceful?
How much of the time have you felt downhearted and blue?
How much of the time have you been a happy person?

• All of the time
• Most of the time
• A good bit of the time
• Some of the time
• A little of the time
• None of the time

Informal care is the care you provide to acquaintances who are ill, in need of help or disabled for an extended period of time. Think of your partner, parents, child, neighbors or friends. This care may consist of household tasks, washing and dressing, keeping them company, providing transport, taking care of financial matters, etc. Informal care is unpaid. A volunteer from a volunteer center is not an informal carer.

M1. Do you provide informal care?

• Yes
• No (GO TO QUESTION M5)

M2. How many hours a week on average do you currently provide informal care, including travel time? Round to whole hours.

Average ... hours per week

M3. How long have you been providing informal care?

• Less than three months
• Three months or longer

M4. Some people feel heavily burdened by providing care for another person. They find the care hard and difficult to maintain. For other people this applies to a lesser extent. How burdened do you feel by providing informal care?

• Not or hardly burdened
• Somewhat burdened
• Burdened considerably
• Heavily burdened
• Overburdened

M5. Do you do any volunteer work? 
We mean work that is carried out unpaid at a (sports)club, church, school or other organisation.

• Yes
• No

N1. A number of social activities are listed below. Please indicate how often you take part in these activities.
Check one box on each line.

Visiting other people/have people to visit.
Keeping in touch with people by telephone or internet (e.g. email, Skype/Facetime, WhatsApp, Facebook/Instagram).
Taking part in club activities.
Attending courses together or sharing a hobby with other people.
Visiting and/or actively participating in the church, mosque, etc.
Doing odd jobs for other people.
Taking part in local activities in the neighbourhood.
Visiting the library.
Doing recreational or cultural activities (e.g. going to the zoo, park, museum or cinema).

• Daily/almost daily
• Weekly
• A few times a month
• Once a month or less
• Never/almost never

N2. Which of the following applies to you?

I donate money to charity

• Yes
• No

I sometimes help a neighbour

• Yes
• No

I dispose of glass in the glass recycling container

• Yes, always
• Yes, sometimes
• No, never

N3. Are you able to use the internet for the following activities
Check one box in each row.

Look up information.
Make an application or an appointment (e.g. with the municipality or the GP).
Internet banking.
Buy products online (food shopping, theatre tickets, clothing, book a holiday).
Email, chat, send messages (e.g. WhatsApp).
Video calling (e.g. Teams, Skype or FaceTime).
Social media (e.g. Facebook, LinkedIn, X or Instagram).

• Yes
• With some difficulties
• With a lot of difficulties
• I can’t
• Not applicable

N4. Are you able to do your financial administration without support from others (for example insurances, pay your bills)?

• Yes, without any difficulties
• Yes, but with some difficulties
• Yes, but with a lot of difficulties
• No, only with help of others

N5. Are you able to use your own or public transportation unassisted?

• Yes, without any difficulties
• Yes, but with some difficulties
• Yes, but with a lot of difficulties
• No, only with help of others

O1. In the last 12 months, have you ever seriously considered ending your life?

• Never
• Rarely
• Occasionally
• Often
• Very often

Do you need help? If so, you can call 0800-0113 or chat on 113.nl/english (free of charge and anonymous), 24/7.

P1. Thinking of the last 12 months, which number from 0 to 10 indicates best the extent to which you were bothered, disturbed or annoyed by noise from the sources mentioned below when you were at home?
If the noise cannot be heard in your home, note this in the last column.

Traffic on roads where the speed limit is higher than 50 km/hour
Traffic on roads where the speed limit is 50 km/hour or less
Trains
Air traffic
Mopeds / scooters
Neighbours
Business premises / factories
Wind turbines / windmills
Heat pump / air conditioning

• 0 (Not bothered at all)
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 (Extremely bothered)
• Inaudible

Q1. Thinking of the last 12 months, which number from 0 to 10 indicates best the extent to which your sleep was disturbed by noise from the sources mentioned below when you were at home? 
If the noise cannot be heard in your home, note this in the last column.
Provide one answer for each row.

Traffic on roads where the speed limit is higher than 50 km/hour
Traffic on roads where the speed limit is 50 km/hour or less
Trains
Air traffic
Mopeds / scooters
Neighbours
Business premises / factories
Wind turbines / windmills
Heat pump / air conditioning

• 0 (Not bothered at all)
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 (Extremely bothered)
• Inaudible

R1. Thinking of the last 12 months, which number from 0 to 10 indicates best the extent to which you were bothered, disturbed or annoyed by an unpleasant smell from the sources mentioned below when you were at home? 
If the smell cannot be detected in your home, note this in the last column.
Provide one answer for each row.

Fireplace / multi fuel stove / other wood-burning stove 
Firepit / barbecue / garden stove 
Sewerage / water purification
Livestock or arable farm activities
Other business / factories
Traffic

• 0 (Not bothered at all)
• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 (Extremely bothered)
• Not detectable

S1. How satisfied are you with your house and local neighbourhood? 
Express this as a number from 1 to 10: 1 = very dissatisfied, 10 = very satisfied.
Provide one answer for each row.

House
Local neighbourhood
Green spaces in your local neighbourhood
Opportunities for cycling and walking in the neighbourhood
Quiet areas in the neighbourhood
Places in the neighbourhood where I can meet other people outside

• 1 (Very dissatisfied)
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 (Very satisfied)

S2. Are you able to find somewhere cool in or outside your house during a prolonged hot spell?
Express this as a number from 1 to 10: 1 = almost never, 10 = very easily.
Provide one answer for each row.

Inside your house
Outside (balcony / garden / local neighbourhood)

• 1 (Almost never)
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 (Very easily)

S3. How do you keep your home cool in hot weather?  
Check your answer in each line.

Air conditioning or other cooling system 
Outdoor sun blinds
I open the windows at night

• Yes
• No

S4. The following questions are about your home in the last 12 months. 
Please answer yes or no depending on whether the statement applies to your home or not.
Check your answer in each line.

Someone smokes in my house every day.
There are damp patches or mould in my living room or bedroom.
I think I can ventilate my house sufficiently.

• Yes
• No

S5. Do you own or rent your home?

• Own
• Rent

S6. How often do you or someone in your household use any of the following? 
For this question think about the past 12 months.  
Check your answer in each line.

In winter:
   -Pellet stove
   -Fireplace
   -Wood burning stove/log burner/multi-fuel burner
In summer:
   -BBQ (on coals or wood)
   -Fire pit/outdoor fireplace

• (Almost) daily
• A few times a week
• A few times a month
• (Almost) never/ I don’t have this

T1. Which situation applies to you? 
You may give more than one answer.

• I have a paid job, 1-19 hours per week 
• I have a paid job, 20 hours or more per week
• I have retired (AOW, prepensioen)
• I am unemployed / looking for employment (registered at UWV )
• I am unfit for work, receiving invalidity benefit (WAO, WAZ, WIA, Wajong)
• I receive social assistance benefits (in Dutch: bijstand)
• I am a housewife / houseman
• I attend school / I am a student

T2. Have you had difficulties in the last 12 months to make ends meet with your household’s income?

• No, no difficulties at all
• No, no difficulties , but I do have to pay attention to my expenditures
• Yes, some difficulties
• Yes, big difficulties

T3. Does your household usually have enough money to do the following things? 
Check your answer in each line.

Heat your home properly.
Pay for membership of a sports club or association.
Visit friends or members of your family.

• Yes
• No

T4. Do you have financial problems?

• Yes
• No

T5. Are you able to cover an unexpected expenditure of 1,000 euros without going into debt or having to take out a loan?

• Always
• Most of the time
• Sometimes
• Usually not
• Never

T6. The following questions are about debts and arrears.
Check one answer for each question.

Do you have more than three different payment arrears (e.g. rent, store card/credit card, loan repayment, energy bill, water bill)?
Do you have payment arrears of 12 months or more?
Do you have payment arrears of €1,000 or more?
Do you have at least one payment arrear that you are unable to pay off on your own within the next 12 months?
Do you have a payment arrear for which you have requested assistance from a professional organisation to pay off?

• Yes
• No