Diabetes Impact Quiz

Welcome to your Diabetes Impact Quiz

Name

Email address

Phone number

Age

Check this box to confirm that you have diabetes

How upsetting is having diabetes for you?

Not at all

Slightly upsetting

Moderately upsetting

Very upsetting

Extremely upsetting

How much control over your diabetes do you have?

None at all

Slight amount

Moderate amount

Large amount

Total amount

How much uncertainty do you currently experience in your life as a result of being diabetic?

None at all

Slight amount

Moderate amount

Large amount

Extremely large amount

How likely is your diabetes to worsen over the next several years? (Try to give an estimate based on your personal feeling rather than based on a rational judgement.)

Not likely at all

Slightly likely

Moderately likely

Very likely

Extremely likely

Do you believe that achieving good diabetic control is due to your efforts as compared to factors which are beyond your control?

Totally because of me

Mostly because of me

Partly because of me & partly because of other factors

Mostly because of other factors

Totally because of other factors

How effective are you in coping with your diabetes?

Not at all

Slightly effective

Moderately effective

Very effective

Extremely effective

To what degree does your diabetes get in the way of your developing life goals?

Not at all

Slight amount

Moderate amount

Large amount

Extremely large amount

Happiness Test Questionnaire

Diabetes Impact Quiz