Lifestyle Living Questionnaire

1 About You

Help us understand who is responding. All fields are optional but appreciated.

Your Name

Email Address (optional)

Age Group

Gender

Floor / Block in Tsavo Estate

2 Mental Health & Wellbeing

Rate each statement on a scale of 1 to 5.

Q1. How would you rate your current mental state?

1 = Very Poor · 2 = Poor · 3 = Fair · 4 = Good · 5 = Excellent

1 2 3 4 5

Very PoorPoorFairGoodExcellent

Q2. To what extent does living in the Tsavo environment affect you mentally?

1 = Not at all · 2 = Slightly · 3 = Moderately · 4 = Considerably · 5 = Very much

1 2 3 4 5

Not at allSlightlyModeratelyConsiderablyVery much

3 Social Life in Tsavo

Select how often each applies to you.

Q3. How often do you interact with people you live with on your floor?

Rarely

Occasionally

Frequently

Q4. How often do you meet up with friends you consider close within Tsavo?

Rarely

Occasionally

Frequently

4 Your Thoughts — In Your Own Words

These are open questions. Write as much or as little as you feel comfortable sharing. There are no right or wrong answers.

Q5. What do you usually do in your free time while within Tsavo Estate?

0 characters

Q6. What do you do to deal with mental stress?

0 characters

Any other comments or suggestions? (optional)

I consent to Ustawi Initiative using my anonymous responses for community health research and program improvement. I understand my personal details (if provided) will be kept confidential.

Tsavo Community Wellbeing Study

1 About You

2 Mental Health & Wellbeing

3 Social Life in Tsavo

4 Your Thoughts — In Your Own Words