Behavioral

Are you concern for your health?

Yes

No

Sometimes

Do you Smoke?

Yes, but I want to quite

No, I was never a smoker

I quite smoking

I smoke sometimes

How often do you eat out?

Often

sometimes

Rarely

Never

Is healthy practices important for you?

Yes

No

Somewhat

Do you have a blood pressure monitor or machine at home?

Yes

No

Where do you measure your blood pressure?

Are you on blood pressure medication?

Yes, only 1 medication

yes, more than 1 medication

No, I have never taken medication

No, because I choose not to take the medication but the doctor prescribe some to me.

Are there any other healthy concerns you have have?

When you measure your blood pressure, how often is it higher than 120/80?

Rarely

All the time

Sometimes

I have never measured my blood pressure

What obstacles prevent you from maintaining a safe range for your blood pressure ?

Medical conditions

medications

Lifestyle: smoking, drinking, fatty foods, salts, or exercise

I do not have a way to measure or monitor my blood pressure

lack of time

other