Coventry City Council, NHS Coventry and Warwick Medical School have commissioned M·E·L Research to undertake an online Household Survey. We are interested in your views on the quality of life you experience living here, what you think could be done to improve things in the future and issues around physical and mental wellbeing.

Your response will be completely confidential and will not be used for any purpose other than this survey.  Information from the survey will be used by the Partnership to develop services and help create a better quality of life for residents here.

	Can you confirm you are a resident of Coventry City?
	Yes

	Can you confirm that you are over 16?
	Yes

	Can you confirm that you have not already taken the survey? (Other members of your household and friends can complete the survey)
	Yes

Section 1 - Equalities and Communities

The first questions are about the local neighbourhood (this means the streets and houses within a few minutes walk from your home)

	How long you have lived in this neighbourhood?
	Less than 1 year		11-15 years
	1-2 years		16-20 years
	3-5 years		More than 20 years
	6-10 years

	And what do you like MOST about the neighbourhood where you live?

	And generally, how satisfied are you with THIS NEIGHBOURHOOD as a place to live?
	Very satisfied		Slightly dissatisfied
	Fairly satisfied		Very dissatisfied
	Neither satisfied nor dissatisfied		Don’t know

	What is your overall perception of how quality of life in this neighbourhood has changed over the last 2 years?
	Improved
	Stayed the same
	Got worse
	Don't know

	In which of these places, if any, do you currently get information about public services in Coventry? Select all that apply.
	Local Newspaper		Posters
	Local radio station		Leaflets
	Citivision or other magazine		Libraries
	Website		Other, please specify
	By telephone		None of the above
	By visiting services in person

	Other please specify

	In which of these places, if any, would you like to be able to get information about public services in Coventry from in the future? Select all that apply.
	Local Newspaper		Posters
	Local radio station		Leaflets
	Citivision or other magazine		Libraries
	Website		Other, please specify
	By telephone		None of the above
	By visiting services in person

	Other, please specify

	Do you agree or disagree that you can influence decisions affecting your local area?
	Definitely agree		Definitely disagree
	Tend to agree		Don’t know
	Tend to disagree

	Below are a list of things people have said would make it easier for them to influence decisions. Which if any of these might make it easier for you to influence decisions in your local area? Select all that apply.
	If I had more time		If I knew who the local councillor was
	If the council got in touch with me and asked me		If I could get involved in a group making decisions about issues affecting my local area/neighbourhood
	If I could give my opinion online/by email		Other, please specify
	If I knew what issues were being considered		Nothing
	If it was easy to contact my local councillor		Don’t know

	Other, please specify

	Are you actively involved in working towards improving your neighbourhood? e.g. through Neighbourhood Watch, Residents or Tenants Association, Helping with Parent Teacher Association, volunteering at community building, etc.
	Yes
	No
	Don’t know

	And generally, how hopeful do you feel about the future both for yourself and your household?
	Very hopeful		Worried
	Hopeful		Very worried
	Neither hopeful nor worried		Don’t know

	To what extent do you agree or disagree that this neighbourhood is a place where people from different backgrounds (i.e. different ethnic groups, faith groups, social backgrounds or countries of origin) get on well together?
	Definitely agree
	Tend to agree
	Tend to disagree
	Definitely disagree
	Don’t know
	Too few people live in the local area to judge

Section 2 - Housing and Environment

We would now like to ask you some questions about housing and the environment.

	First of all, is your property….
	Owner Occupied		Rented from Private Landlord
	Rented from Whitefriars		Shared Ownership
	Rented from another Housing Association e.g. Midland Heart		Other, please specify

	Other, please specify

	And how satisfied are you with the quality of your home?
	Very satisfied		Slightly dissatisfied
	Fairly satisfied		Very dissatisfied
	Neither satisfied nor dissatisfied		Don’t know

	How likely is it that you will want to move house in the next 4 or 5 years?
	Very likely		Not at all likely
	Fairly likely		Don’t know
	Not very likely

	What are the main reasons for you possibly wanting to move? Select all that apply.
	To move to a larger property		To be nearer to shops and local facilities
	To move to a smaller property		To be nearer family or friends
	To move to a more modern property		To move away from an unsatisfactory situation
	To move to a property more suited to my needs		To move to a more desirable location
	To change the type of tenure (renting, owning etc)		Other, please specify
	To be nearer place of work or job opportunities		No particular reason
	To be nearer to my preference for schools

	Other, please specify

	And whereabouts would you most like to move to?
	Somewhere in this neighbourhood
	Elsewhere in Coventry
	Somewhere outside Coventry
	Don’t know

	Whereabouts?

	Whereabouts?

And now thinking about the environment….

	Do you recycle any of the following? (Include charitable donations and household charity collections)
	Paper and cardboard
	Cans
	Glass
	Garden Waste
	Textiles/Clothing/Shoes
	None of the above

	Please tell us if you have taken any of these environmental actions at home in the last 12 months?
		Yes	No
	a) Reduced water use for instance by actions such as using a water saving device or dual flush in your toilet, not using a hose or garden sprinkler etc.?
	b) Reduced energy use by actions such as not leaving your TV etc. on standby, turning off lights when leaving a room etc.?
	c) Reduced the amount of waste you throw away by making compost out of kitchen and garden waste?
	d) Encouraged wildlife in your garden by actions such as feeding birds, not using chemicals, planting wild flowers?
	e) Grown your own fruit and vegetables Includes home garden, window boxes and allotments?

Section 3 - Community Safety

We would now like to ask you some questions about crime and community safety

	How safe do you feel IN YOUR NEIGHBOURHOOD?
		Very safe		Safe		Not very safe		Very unsafe		Don’t know
	a) Around your neighbourhood during the day
	b) Around your neighbourhood at night

	To what extent do you agree with the following statement - ‘Crime in my neighbourhood has increased over the last 12 months’?
	Agree strongly		Disagree strongly
	Agree slightly		No opinion
	Neither agree nor disagree		Have not lived in the area for 12 months
	Diasagree slightly

	How much of a problem, if at all, are the following in your NEIGHBOURHOOD?
		Major problem		Minor problem		Not a problem at all		Don’t know
	Theft from vehicles
	Theft of vehicles
	Traffic Offences (e.g. speeding)
	Problem/Noisy Neighbours
	People hanging around
	Rubbish or litter lying around
	Vandalism to bus shelters or public telephones
	Vandalism to other types of public property
	Graffiti
	Burglaries

	How much of a problem, if at all, are the following in your NEIGHBOURHOOD?
		Major problem		Minor problem		Not a problem at all		Don’t know
	Mugging
	People using or dealing drugs
	People being drunk or rowdy in public places
	Hate Crime (incident motivated by prejudice or hate. Reasons include age, faith, race, sexuality, disability)
	Prostitution/Kerb Crawling
	Mini Mopeds
	Vandalism to private property
	Dog fouling/barking
	Other, specify

	Other, please specify

Section 4 - Health and Well-being

We would now like to ask you some questions about health and well being.

	First of all, would you say in general your health is…?
	Very good
	Good
	Fair
	Bad
	Very bad

	Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?  (include problems related to old age and mental health)
	Yes limited a lot
	Yes limited a little
	No

	How would you rate the quality of your sleep in the last month?
	Poor
	Average
	Good
	Not sure

	And approximately, how long have you typically slept for per night during the last month (including naps during the day). ENTER NUMBER OF HOURS PER DAY (ROUNDED NEAREST HOUR)
	Number of hours

	How many portions of fruit or vegetables would you say you eat in a typical day?                                                                                                                                                                                                                                                                 A portion can be: ·Vegetables (fresh, raw, tinned, or frozen) 1 portion = 3 tablespoons ·Pulses, 1 portion = 3 tablespoons or more ·Salad, 1 portion = 1 bowl ·Fresh fruit, 1 portion = 1 medium apple ·Dried fruit (excluding cereal, cakes) 1 portion = 1 tablespoon or more ·Frozen or tinned fruit, 1 portion = 3 tablespoons ·Fruit juice (excluding cordials, fruit drinks, squashes), 1 portion = 1 small glass or more Potatoes, rice or pasta are not included.
	At least 5 portions		Less than one portion
	At least 3 portions, but less than 5 portions		Don’t know
	At least one portion, but less than 3 portions		Prefer not to say
	About one portion

	Do you, or have you ever, smoked?
	Yes, I currently smoke
	Yes, but I no longer smoke
	No

	On average, how many cigarettes (including roll ups, cigars etc) do you smoke per day?
	Number smoked per day

	Are you currently exposed to passive smoking (second hand smoke) either at work or at home?
	Yes
	No
	Don't know

	How many days in a typical week do you usually drink alcoholic beverages? (also think about special occasions)
	7 days		Once per week
	5-6 days		Less than once per week
	2 - 4 days		Don't drink

	How many days in an average week, do you drink more than [WOMEN 2-3 units] [MEN 3-4 units] of alcohol? ·Normal strength beer, lager, cider (less than 6% ABV) = 1 pint equals 2 units; cans or bottles (size unknown) equals 1.5 units ·Strong beer, lager, cider (6% ABV or more) = 1 pint equals 4 units; cans or bottles (size unknown) equals 2.5 units ·Spirits and liqueurs glass (single measure) = 1 unit ·Sherry, martini, vermouth or other fortified wines (glass) = 1 unit ·Wine = small glass (125ml) equals 1.5 units; standard glass (175ml) equals 2 units; large glass (250ml) equals 3 units ·Alcopops/alcoholic soft drinks = small can or bottle equals 1.5 units
	0 days		5 days
	1 day		6 days
	2 days		7 days
	3 days		Prefer not to say
	4 days		Don’t know

	Can you tell us how frequently, if at all, you do the following?                                                                                                                                                                                                                                                       PHYSICAL ACTIVITY SHOULD BE OF MODERATE INTENSITY* - PROMPT - *FOR AT LEAST 30 MINUTES AT A TIME WHERE THE PARTICIPANT IS SLIGHTLY OUT OF BREATH BUT ABLE TO TALK
		At least 5 times a week		3-4 times a week		Less than 3 times a week		Never		Don't know
	Take part in ANY physical activity* (e.g. brisk walking, cycling, housework, gardening, DIY, swimming, or sport)
	Participate in any sport (e.g. playing football, netball, attending an aerobics class, visiting the gym, visit a sports/leisure centre, running, cycling, swimming etc

	Below are a number of statements about feelings and thoughts. Please select the box that best describes your experience of each over the last two weeks.
		None of the time		Rarely		Some of the time		Often		All of the time
	I’ve been feeling optimistic about the future
	I’ve been feeling useful
	I’ve been feeling relaxed
	I’ve been feeling interested in other people
	I’ve had energy to spare
	I’ve been dealing with problems well
	I’ve been thinking clearly
	I’ve been feeling good about myself
	I’ve been feeling close to other people
	I’ve been feeling confident
	I’ve been able to make up my own mind about things
	I’ve been feeling loved
	I’ve been interested in new things
	I’ve been feeling cheerful

Section 5 - Work and Training

	Which of the following best describes your current economic status?
	In full time paid work		Long-term sick or disabled
	In part time paid work		Retired
	Self employed		In full-time education
	Taking part in a government training programme (e.g. trade and modern apprenticeships, work based learning for adults)		Doing unpaid/voluntary work
	Registered unemployed/signing on for Job Seekers Allowance		Carer
	Not registered unemployed but actively seeking work (i.e. have actively looked for work in the last 4 weeks)		Other, please specify
	At home/not seeking work - (looking after the home or family)

	Other, please specify

	And what type of work do you do, or did you do most recently? Please give as much detail as you can.

	And how many adults living permanently in your household are in paid employment?
	None		3 people
	1 person		4 or more people
	2 people

	Which of these is your highest qualification? If the qualification is not listed, select the nearest equivalent.
	Level 1: 1+ 'O' levels/CSE/GCSE (any grade), NVQ level 1, Foundation GNVQ
	Level 2: 5+ 'O' levels, 5+ CSEs (grade 1), 5+ GCSEs (grade A - C), School Certificate, 1+ 'A' levels/'AS' levels, NVQ level 2, Intermediate GNVQ or equivalents.
	Level 3: 2+ 'A' levels, 4+ 'AS' levels, Higher School Certificate, NVQ level 3, Advanced GNVQ or equivalents.
	Level 4/5: First degree, Higher Degree, NVQ levels 4 - 5, HNC, HND, Qualified Teacher Status, Qualified Medical Doctor, Qualified Dentist, Qualified Nurse, Midwife, Health Visitor or equivalents.
	Other qualifications/level unknown: Other qualifications (e.g. City and Guilds, RSA/OCR, BTEC/Edexcel), Other Professional Qualifications.
	No qualifications: No academic, vocational or professional qualifications.

Section 6 - Transport and Accessibility

	For each of the following types of journey, what is the main form of transport that you currently use?
		Car as Driver		Car as Passenger		Train		Bus		Motorbike		Bicycle		Taxi		Walking		Park & Ride		Not applicable
	Travel to work
	Education
	Escorting children to school

Section 7 - General Profile Questions

Finally we’ve got a few questions about you, these are just to make sure we have covered a representative cross section of Coventry people.

	Gender
	Male		Female

	What was your age at your last birthday?

	16-24	55-59
	25-34	60-64
	35-44	65-79
	45-54	80+

	What is your marital status? Select option that best fits.
	Single (Never married and never registered a same-sex civil partnership	Widowed
	Co-habiting	In a registered same-sex civil partnership
	Married	Separated but still legally in a same-sex civil partnership
	Separated but still legally married	Formerly in a same-sex civil partnership that is now legally dissolved
	Divorced	Surviving partner from a same-sex civil partnership

	How many people living permanently in your household (including yourself) are in each of the following categories? (Enter the number in each category, enter 0 if the answer to any category is nil).
	1)  Pre-school age (0-4 years)
	2)  Primary school age (5-11 years)
	3)  Secondary school age (12-16 years)
	4)  Post school education (16/17 years)
	5)  Adult (18-59 or 64)
	6)  Retired (60 or 65+)

	Which of the options below best describes you?
	Heterosexual		Bisexual
	Gay man		Other
	Gay woman/lesbian		Prefer not to say

	Which of the options below best describes your religion?
	No religion		Jewish
	Christian (including Church of England, Catholic, Protestant, and all other Christian denominations		Muslim
	Buddhist		Sikh
	Hindu		Any other religion, please specify

	Any other religion, please specify

	Which of the following groups do you consider you belong to?
	White - White British		Asian or Asian  - British Pakistani
	White  - White Irish		Asian or Asian British - Bangladeshi
	White - Any Other White Background		Asian or Asian British - Any Other Asian Background
	Mixed - White and Black Caribbean		Black or Black British - Caribbean
	Mixed - White and Black African		Black or Black British - African
	Mixed - White and Asian		Black or Black British - Any Other Black Background
	Mixed - Any Other Mixed Background		Chinese
	Asiian or Asian - British Indian		Any Other Ethnic Group

	Any Other, please specify

	Coventry Partnership may want to involve people more in the future, looking at ways of improving services and the quality of life for residents. Would you be interested in taking part in further consultation such as workshops, focus groups and other surveys like this? By answering yes you are giving your permission for M·E·L Research to use your details to contact you about further work, and if necessary to pass your details on to the Coventry Partnership.
	Yes
	No

In order to validate our online questionnaires it would be very helpful if you could fill in the following information:

	Title
	Mr		Ms
	Mrs		Dr
	Miss		Other, please specify

	Other, please specify

	Name
	Address
	Postcode
	Telephone Number
	Email Address

And finally...

	What three words summarise Coventry as a place?
	1
	2
	3

That’s all the questions, thank you very much for completing this survey!