MDI - Questionnaire

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Field Name

 Note

 q1

I feel sorry for other kids who don't have the things that I have

 q2

When I see someone being treated mean it bothers me

 q3

I am a person who cares about the feelings of others

 q4

I have more good times than bad times

 q5

I believe more good things than bad things will happen to me

 q6

I start most days thinking I will have a good day

 q7

In general, I like being the way I am

 q8

Overall, I have a lot to be proud of

 q9

A lot of things about me are good

 q10

In most ways my life is close to the way I would want it to be

 q11

The things in my life are excellent

 q12

I am happy with my life 

 q13

So far I have gotten the important things I want in life

 q14

If I could live my life over, I would have it the same way

 q15

I feel unhappy a lot of the time

 q16

I feel upset about things

 q17

I feel that I do things wrong a lot

 q18

I worry about what other kids might be saying about me

 q19

I worry a lot that other people might not like me

 q20

I worry about being teased

 q21

I cheered someone up who was feeling sad

 q22

I helped someone who was being picked on

 q23

I helped someone who was hurt

 q24

Are there adults who are important to you at your school

 q24no

Number of adults listed

 q25

At school, a teacher or another adult who really cares about me

 q26

At school, a teacher or another adult who believes that I will be a success

 q27

At school, a teacher or another adult who listens to me when I have something to say

 q28

In neighbourhood/community, an adult who really cares about me

 q29

In neighbourhood/community, an adult who believes that I will be a success

 q30

In neighbourhood/community, an adult who listens to me when I have something to say

 q31

Places in neighbourhood/community provides programs for kids your age

 q32

Safe places in your neighbourhood/community where you feel comfortable to hang out with friends

 q33

In home, a parent or another adult who believes that I will be a success

 q34

In home, a parent or another adult who listens to me when I have something to say

 q35

In home, a parent or another adult who I can talk to about my problems

 q36

I care about what my parents (or guardians) think of me

 q37

I feel part of a group of friends that do things together

 q38

I feel that I usually fit in with other kids around me

 q39

When I am with other kids my age, I feel I belong

 q40

I have at least one really good friend I can talk to when something is bothering me

 q41

I have a friend I can tell everything to

 q42

There is somebody my age who really understands me

 q43

I am certain I can learn the skills taught in school this year

 q44

If I have enough time, I can do a good job on all my school work

 q45

Even if the work in school is hard, I can learn it

 q46

Teachers and students treat each other with respect in this school

 q47

People care about each other in this school

 q48

Students in this school help each other, even if they are not friends

 q49

I feel like I belong in this school

 q50

I feel like I am important to this school

 q51

When I grow up, I have goals and plans for the future

 q52a

Make friends

 q52b

Get good grades

 q52c

Learn new things

 q53

Physical bullying

 q54

Verbal bullying

 q55

Social bullying

 q56

Cyberbullying

 q57

In general, how would you describe your health

 q58_1

No physical or health condition that keeps you from doing things other kids your age do

 q58_2

Yes, physical disability

 q58_3

Yes, long term illness

 q58_4

Yes, overweight

 q58_5

Yes, something else

 q58_5tx

Yes, something else (text)

 q59

How do you rate your body weight

 q60

How often do you like the way you look

 q61

How often do you eat breakfast

 q62

How often do your parents or other adult family members eat meals with you

 q63

How often do you eat food like pop, candy, potato chips, or something else

 q64

How often do you get a good night's sleep

 q65

What time do you usually go to bed during the weekdays

 q66_1

By myself - On school days, who are you usually with for most of the afternoon

 q66_2

Friend(s) about my age

 q66_3

Mother (or step mother, foster mother)

 q66_4

Father (or step father, foster father)

 q66_5

Younger brothers/sisters

 q66_6

Older brothers/sisters

 q66_7

Other adult(s)

 q_66_8

Other describe

 q_66_8tx

Other describe (text)

 q67a

After school until 6pm, go home

 q67b

After school until 6pm, stay at school to participate in after school activities

 q67c

After school until 6pm, go to an after school program/daycare

 q67d

After school until 6pm, go to a friend's house

 q67e

After school until 6pm, go to a park, playground, or community centre

 q67f

After school until 6pm, hang out at the mall or stores

 q67g

After school until 6pm, go someplace else, e.g., family member's home, or other places

 q68a

Educational lessons or activities

 q68a_Day

Days spent - educational lessons or activities

 q68b

Art or music lessons

 q68b_Day

Days spent - art or music lessons

 q68c

Youth organizations

 q68c_Day

Days spent - youth organizations

 q68d

Individual sports with a coach or instructor

 q68d_Day

Days spent - individual sports with a coach or instructor

 q68e

Team sports with a coach or instructor

 q68e_Day

Days spent - team sports with a coach or instructor

 q69a

Sports and/or exercise for fun

 q69a_Day

Days spent - sports and/or exercise for fun

 q69a_Time

Time spent - sports and/or exercise for fun

 q69b

Homework

 q69b_Day

Days spent - homework

 q69b_Time

Time spent - homework

 q69c

Watch TV

 q69c_Day

Days spent - watch TV

 q69c_Time

Time spent - watch TV

 q69d

Play video or computer games

 q69d_Day

Days spent - play video or computer games

 q69d_Time

Time spent - play video or computer games

 q69e

Instant Message

 q69e_Day

Days spent - Instant Message

 q69e_Time

Time spent - Instant Message

 q69f

Read for fun

 q69f_Day

Days Spent- Read for fun

 q69f_Time

Time Spent - Read for fun

 q69g

Household chores

 q69g_Day

Days spent - household chores

 q69g_Time

Time spent - household chores

 q69h

Practice a musical instrument

 q69h_Day

Days spent - practice a musical instrument

 q69h_Time

Time spent - practice a musical instrument

 q69i

Arts & Crafts

 q69i_Day

Days spent - Arts & Crafts

 q69i_Time

Time spent - Arts & Crafts

 q69j

Hang out with friends

 q69j_Day

Days spent - hang out with friends

 q69j_Time

Time spent - hang out with friends

 q70

Are you already doing the activity you wish you could be doing from 3-6pm

 q70notx

If No - list one activity wish to do (text)

 q70yestx

If Yes - activity already doing that you wished for (text)

 q71_1

Where would you like this activity to be: School

 q71_2

Where activity: Community Centre

 q71_3

Where activity: Home

 q71_4

Where activity: Park or Playground

 q71_5

Where activity: Other

 q71_5tx

Where activity: Other describe (text)

 q72_1

Stops you from participating in the activities that you want to participate in after school - Have to go straight home after school

 q72_2

It is too difficult to get there

 q72_3

The activity that I want is not offered

 q72_4

The schedule does not fit the times that I can attend

 q74_5

It's not safe for me to go

 q74_6

I have too much homework to do

 q72_7

My parents do not approve

 q72_8

It costs too much

 q72_9

I need to take care of brothers or sisters or do other things at home

 q72_10

I am afraid I will not be good enough in that activity

 q72_11

I'm too busy

 q72_12

I don't know what is available

 q72_13

None of my friends are interested or want to go

 q72_14

Other

 q72_14tx

Other, please describe (text)

 

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Page last revised: November 13, 2013