Please indicate the extent to which you agree that the following items describe you. Use the following 1-5 scale for your responses.
1 2 3 4 5
Don’t agree at all
Agree a little Agree somewhat Agree Strongly agree
1. I find myself thinking about food even when I’m not physically hungry. ___ 2. I get more pleasure from eating than I do from almost anything else. ___ 3. If I see or smell a food I like, I get a powerful urge to have some. ___
4. When I’m around a fattening food I love, it’s hard to stop myself from at least tasting it. ___ 5. It is scary to think of the power that food has over me. ___
6. When I know a delicious food is available, I can’t help myself from thinking about having some. ___
7. I love the taste of certain foods so much that I can’t avoid eating them even if they’re bad for me. ___
8. Just before I taste a favourite food, I feel intense anticipation. ___ 9. When I eat delicious food I focus a lot on how good it tastes. ___
10. Sometimes, when I’m doing everyday activities, I get an urge to eat “out of the blue” (for no apparent reason). ___
11. I think I enjoy eating a lot more than most other people. ___
12. Hearing someone describe a great meal makes me really want to have something to eat. ___ 13. It seems like I have food on my mind a lot. ___
14. It is very important to me that the foods I eat are as delicious as possible. ___ 15. Before I eat a favourite food my mouth tends to flood with saliva. ___
Scoring instructions:
Factor 1 (Food Available) = Average of items 1, 2, 5, 10, 11 and 13 Factor 2 (Food Present) = Average of items 3, 4, 6, and 7
Factor 3 (Food Tasted) = Average of items 8, 9, 12, 14, and 15 Reference 178.
Appendix J. Self-efficacy questionnaire
Please indicate on the below scale how confident you are in your ability to be able to control your own weight. 1 Not at all confident 2 Slightly confident 3 Reasonably confident 4 Very confident 5 Extremely confident
Please indicate on the below scale how confident you are in yourself generally. 1 Not at all confident 2 Slightly confident 3 Reasonably confident 4 Very confident 5 Extremely confident
Appendix K. Pittsburgh sleep quality index
Instructions: the following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. Please answer all questions.
1. During the past month, when have you usually gone to bed at night? Usual bed time: ……….
2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night?
Number of minutes: ……….
3. During the past month, when have you usually gotten up in the morning? Usual getting up time: ……….
4. During the past month, how many hours of actual sleep did you get at night? Hours of sleep per night: ……….
For the remaining questions, circle the one best response. Please answer ALL questions. 5. During the past month, how often have you had trouble sleeping because you…..
(a) Cannot get to sleep within 15 minutes Not during the
past month
Less than once a week
Once or twice a week
Three or more times a week (b) Wake up in the middle of the night or early morning
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (c) Have to get up to use the bathroom
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (d) Cannot breathe properly
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (e) Cough or snore loudly
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (f) Feel too cold
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (g) Feel too hot
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (h) Had bad dreams
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week
(i) Have pain Not during the past month
Less than once a week
Once or twice a week
Three or more times a week (j) Other reason(s), please describe
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week
How often during the past month have you had trouble sleeping because of this? Not during the
past month
Less than once a week
Once or twice a week
Three or more times a week
6. During the past month how would you rate your sleep quality overall
Very good Fairly good Fairly bad Very bad
7. During the past month, how often have you taken medicine to help you sleep? Not during the
past month
Less than once a week
Once or twice a week
Three or more times a week
8. During the past month, how often have you had trouble staying awake while driving, eating meals or engaging in social activity?
Not during the past month
Less than once a week
Once or twice a week
Three or more times a week
9. During the past month, how much of a problem has it been for you to sleep up enough enthusiasm to get things done?
Not a problem at all Only a very slight problem Somewhat of a problem A very big problem Scoring instructions:
Component 1: Subjective sleep quality
Examine question 6 and assign a score as follows
Very good – 0 Fairly good – 1 Fairly bad – 2 Very bad – 3
Component 2: Sleep latency
Examine question 2 and assign a score as follows
≤ 15 minutes – 0 16 – 30 minutes – 1 31 – 60 minutes – 2 > 60 minutes – 3
Examine question 5a and assign a score as follows
Not during the past month – 0 Less than once a week – 1 Once or twice a week – 2 Three or more times a week – 3
Add question 2 and 5a scores together Assign component 2 score as follows
0 – 0 1-2 – 1 3-4 – 2 5-6 – 3
Component 3: Sleep duration
Examine question 4 and assign a score as follows
>7 hours – 0 6-7 hours – 1 5-6 hours – 2 <5 hours – 3
Component 4: Habitual sleep efficiency (HSE)
HSE = number of hours slept / number of hours spent in bed x 100
Examine question 4 and assign a score as follows
HSE (%) = >85% – 0 75 – 84% – 1 65 – 74% – 2 <64% – 3
Component 5: Sleep disturbances
Examine questions 5b to j and assign scores for each question as follows
Not during the past month – 0 Less than once a week – 1 Once or twice a week – 2 Three or more times a week – 3
Add scores for questions 5b-j together Assign component 5 score as follows
0 – 0 1 – 9 – 1 10 – 18 – 2 19 – 27 – 3
Component 6: Sleep medications
Examine question 7 and assign a score as follows
Not during the past month – 0 Less than once a week – 1 Once or twice a week – 2 Three or more times a week – 3 Component 7: Daytime dysfunction
Examine question 8 and assign a score as follows
Not during the past month – 0 Once or twice – 1
Once or twice a week – 2 Three or more times a week – 3
Examine question 9 and assign a score as follows
No problem at all – 0
Only a very slight problem – 1 Somewhat of a problem – 2
A very big problem – 3
Add the scores for questions 8 and 9 together Assign component 7 score as follows
0 – 0 1 – 2 – 1 3 – 4 – 2 5 – 6 – 3
Global PSQI score:
Add seven score components together to obtain global score. Reference 179.
Appendix L. Epworth sleepiness scale
How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you haven't done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Situation Score
Sitting and reading Watching TV
Sitting inactive in a public place (e.g. a theatre or meeting As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopped for a few minutes in traffic Total
Scoring instructions
The ESS is made up of 8 questions which the subject is required to answer by rating each item on a scale of 0 to 3. When scoring the test, the sum of all the responses to each article gives the overall ESS score. A score of 0-7 is considered to be within the normal range. A score of 8-14 is suggestive of mild to moderate symptoms of daytime tiredness, and a score of 15-24 is suggestive of significant (severe) symptoms of daytime tiredness.