this questionnaire will help so many people.......

1. COMPARATIVE STUDY OF URBAN AND RURAL HOUSEHOLDS WITH
SPECIAL REFERENCE TO QUALITY OF LIFE
QUESTIONNAIRE
Note:
Strongly Dissatisfied-
1
Dissatisfied-
2
Neutral-
3
Satisfied-
4
Strongly Satisfied-
5
A. PERSONAL INFORMATION
General information (this information will be kept confidential)
Name……………………………………………………………… Age ……………
Sex Male  Female  Residential Address ………………………………
………………………………………………………………… Pin Code……………….
Marital Status Married  Unmarried 
Number of members in the family ………………..
Average monthly income (in rupees.)..…………………………………………..………
Job Profile...……………………………………………………………………………….
Area you live in Rural  Urban 
What is your education?
 Cannot read
 Without any degree
 Less than primary school
 Primary school/ similar
 Secondary education/ middle school/ high school
 University/ similar
 Other, please specify……………………………………………….
Have you often worried about the daily expenses?
 Never
 Quite often
 Often
 Always
B. PHYSICAL WELL-BEING
How satisfied or dissatisfied you are with
1 2 3 4 5
Life overall
Food
Housing
Income
Health
Work
Local Security Level
Friends

2. Family
Education
Free Choice & control over life
Dignity
Locality to yard
C. FAMILY LIFE
1 2 3 4 5
I get proper time to spend with my family & friends
I get proper time for households chores such as
cleaning, cooking etc
My family members are satisfied with my routine
D. ECONOMIC LIFE
1 2 3 4 5
I am satisfied with my economic stand
I spend on fruits
I go for outing with my family
I go usually for dinner with my family & friends
I affected by sales of departmental stores
I have a car/ expensive vehicle
I buy new cloths on every festival
I often buy branded cloths
E. PERSONAL LIFE
1 2 3 4 5
I am satisfied with my personal health & well-being
I am psychologically healthy & stress free
I manage meals properly that is in proper amount
and at a proper time
I am getting ample amount of time for leisure
activities
I am perfectly satisfied with my lifestyle
Have you felt that you do everything badly?
Have you felt sad?
Have you felt so bad that you didn’t want to do
anything?
Have you felt that everything in your life goes
wrong?
Have you felt fed up?
Have you felt lonely?
Have you felt under pressure?

3. F. SELF - PERCEPTION
1 2 3 4 5
I am happy with the way I am
I am happy with my clothes
I am worried about the way I look
I felt jealous of the way other girls and boys look
I would like to change something about my body
G. SELF-RULE
1 2 3 4 5
Have I had enough time for myself
I have been able to do the things that I want to do in
my free time?
I have had enough opportunity to be outside
I had enough time to meet friends
I have been able to choose what to do in my free
time
H. PSYCHOLOGICAL WELL-BEING
1 2 3 4 5
My life has been enjoyable
I had felt pleased that I am alive
I had felt satisfied with my life
I have been in a good mood
I felt cheerful?
I had fun in my life
I. MOODS AND EMOTIONS
1 2 3 4 5
I felt that I can do everything badly
I felt sad
I felt so bad that I didn’t want to do anything
I felt that everything in your life goes wrong
I felt fed up
I felt lonely
I felt under pressure
J. SOCIAL LIFE AND SUPPORT
1 2 3 4 5
I possess proper well- being in terms of social
interaction
I am able to manage social circles and parties
I often get indulge in welfare services
I have good social status and esteem

4. I participated in religious functions
I spent time with my friends
I had fun with my friends
I often do help of my friends
I have been able to talk about everything with my
friends
K. FINANCIAL RESOURCES
1 2 3 4 5
I had enough money to do the same things as my
friends do
I have enough money for my expenses
I have enough money to do things with my friends?