Physical Activity in Burslem Community Conversation
We want to help people locally be more active to help with their physical and mental health.
We want to know more about what might stop you from being active, and what we can do to help you be more active.
OK
1.
Do you want to be more physically active or feel you need to be?
Yes
No
2.
Is there anything that gets in the way and means you can’t be physically active or look after yourself?
3.
What helps you move more? What works well?
4.
What needs to change locally to help you move more?
5.
How could a community centre/lounge/hub (with lots of local people and services all in one place and near you) help you to be more physically active?
6.
Does where you live help you to be physically active?
Yes
No
7.
Do your family and friends support you in being physically active?
Yes
No
8.
Are your family and friends physically active?
Yes
No
9.
Do you make plans to help you move more?
10.
Would you choose being active over other activities?
Yes
No
11.
Do you have any other comments?
12.
What gender do you identify as?
Male
Female
Non binary
Transgender
Prefer not to answer
Other (please specify)
13.
What is your age?
Under 18
18-24
25-34
35-44
45-54
55-64
65+
14.
What is your ethnic group?
White British / Welsh / Scottish / Northern Irish / English
Irish
Gypsy or Irish Traveller
White and Black Caribbean
White and Black African
White and Asian
Indian
Pakistani
Bangladeshi
Chinese
Arab
Prefer not to say
Any other ethnic group, please specify.
15.
Do you consider yourself to have a physical disability?
Yes
No
Prefer not to say
16.
Do you consider yourself to have a mental illness?
Yes
No
Prefer not to say
17.
Please provide your email address or a phone number to enter the prize draw to win a £50 Amazon voucher
Thank you for taking the time to complete this survey.
Your answers will help us to improve services local to you and support the needs of your community.
Current Progress,
0 of 17 answered
