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Exercise Referral Questionnaire
This questionnaire is part of a consultancy project between Sheffield Hallam University and Sheffield City Trust. It should take just 2-3 minutes to complete and all data collected will be analysed and later presented in the form of graphs, visuals and an overriding report. All questions have been ethically approved by both parties and all answers will remain completely anonymous and confidential throughout the whole process.
Once completed all data will be disposed of in an appropriate and safe manner.
Thank you in advance for taking the time to complete this survey!
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* Indicates required question
Age
*
15-20
21-29
30-39
40-49
50-59
60+
Gender
*
Female
Male
Trans Female
Trans Male
Non-Binary
Prefer not to say
Ethnicity
*
Other may include any other ethic group, for example, Arab
Asian or Asian British (Includes any Asian background, for example, Bangladeshi, Chinese, Indian, Pakistani)
Black, African, Black British or Caribbean (Includes any Black background)
Mixed or multiple ethnic groups (Includes any Mixed background)
White (Includes British, English, Northern Irish, Scottish, or Welsh, or any other white background)
Prefer not to say
Other:
Have you been previously diagnosed or do you believe yourself to have any of the following conditions?
*
(If none of your conditions are listed or you would like to specify which condition please answer in the 'other' section)
Stroke / TIA
Breathing difficulties (Asthma / COPD )
Mental Health (e.g. Anxiety, Depression, Eating Disorders, Stress)
Heart Conditions (e.g. Coronary Heart Disease / Cardiac Rehabilitation / Hypertension (medicated) )
Diabetes
Musculoskeletal and Connective Tissue Disorders (e.g. Osteoarthritis and Arthritis / Osteoporosis)
None of the above
Other:
Required
Would you be happy to hear about programmes or initiatives that would help you manage your health?
*
Yes
No
Have you heard of an Exercise Referral (ER) scheme before?
*
No
Yes - if so please give a brief explanation of your understanding in the 'other' box below
Other:
Required
Would you ever consider taking part in an ER scheme for health benefits?
*
Yes
No - if so please specify why not in the 'other' box below
Other:
Required
Which of the following marketing platforms would you take the most notice of? (You may tick more than one)
*
Radio
Television
Newspaper
Billboards / Posters
Social Media
Email Campaigns
Word of mouth from friends / family
Word of mouth from authority figures
Other:
Required
Which of the following would appeal to you the most (You may tick more than one)
*
Pictures
Videos
Headlines / straight to the point messaging
Longer messaging i.e. paraphraphs or sentences
Bright / bold colours (i.e. red, yellow, blue, pink)
Dull colours (i.e. black, white, grey)
Other:
Required
Which of the following messaging strategies would appeal to you the most? (You may tick more than one)
*
Emotional messaging (e.g. People like you have signed up and changed their lives for the better)
Unique Selling Proposition (e.g. Highly qualified staff will tailor something specific to you)
Generic messaging (Standard information)
Call to action (e.g. Click here to refer now)
Offers (e.g. Free first session or discounted block sessions if you sign up now)
Functions (e.g. You can achieve your health goal through an ER Scheme)
Other:
Required
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