Survey on grocery shopping patterns

Answers marked with a * are required.

1. Survey on grocery shopping patterns

1. Age *

2. Gender *

Male

Female

3. Highest Education Level *

4. How often do you visit the supermarket? *

5. How many household members do you take into consideration when doing your grocery shopping? *

6. How often do you cook for family members?

Do you or any of your family members have existing medical conditions?

Yes

8. What is/are the medical condition(s)? Kindly skip this question if answer to Q9 is "No".

Do you or any of your family members have special dietary habits / requirements? (e.g.vegetarian, high-protein)

If so, (please specify):
If no, kindly state no:

10.

Do you look at nutritional facts on food products when making food selections? Rate how often you would look at these facts.
1 = Never ; 10=All the time

	1	2	3	4	5	6	7	8	9	10
How often you would look at nutrition facts?

11.

How well do you understand all of the nutritional information displayed on the food product?
1 = Do not understand at all ; 10=Understand completely

	1	2	3	4	5	6	7	8	9	10
How well do you understand all of the nutritional information displayed on the food product?

12.

What are the nutritional facts you look out for?Kindly state either yes or no for each option

	Yes	No
a) Calories
b) Fat
c) Sugar
d) Protein
e) Sodium
f) Vitamins and minerals

13.

What are the top 3 criteria influencing your food selections? Check the top 3 critera that influence your decision making.

	1	2	3
Price
Promotions
Packaging
Nutritional content ( Calories, Fat, Sugar, Protein, etc)
Brand
Freshness
Recommendation (of friends / family / reviews etc.)

14.

Would you appreciate additional help in making your food choices?

Yes

15.

Would you like to be alerted to which foods patients with certain medical conditions / dietary needs must avoid

Yes

16. Would you like to be alerted to which foods are healthy/unhealthy?

Yes


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