Qualitative interview procedures
United States Adolescent Physical Activity Survey Cover Sheet
1. Name:
2. Purpose statement:
The purpose of this quantitative study is to determine the relationship between physical activity levels and academic self-efficacy level among United States Private Middle School Adolescents.
Dependent Variable:
The dependent variable is the academic self-efficacy level depending on level of physical activity levels of United States Private Middle School Adolescents.
3. Target Population:
15 Private Middle School Adolescents- 8 boys, 7 girls (7th-8th grader)
4. Analysis Process:
Questions 1,2,&3 will be assessing the demographic background.
Likert Scale: answers will be assessed based on their reported value that is checked off
for each item
Questions 4, 5, & 6 will measure activity level starts from the lowest activity response and progress to the highest activity response. To analyze activity level (First box- Last box score 1- 5)
Questions 7, 8, 9, 10, 11, 12, 13, &14 will measure student’s academic
self-efficacy level (Likert Scale: answers will be assessed based on their numerical value)
Questions 15, &16 allow for qualitative responses to further allow subject to explain their thoughts toward physical activities and academic self-efficacy.
Physical Activity Level and Academic Self-Efficacy Survey
1. Gender
Male Female
2. Grade
7thth 8thth
3. What is your race? (Mark one or more boxes)
White Black, African American Asian, Asian American
Hispanic American Indian some other race __________
We are trying to find out about your level of physical activity from the last 7 days. This includes sports or dances that make you sweat or make your legs feel tired, or games that make you breathe hard, like playing soccer, running, playing basketball and others.
Please answer all the questions as honestly and accurately as you can.
4. In the last 7 days, during your physical education (PE) classes, how often were you very active?
I do not participate at all during PE class.
I Hardly ever participate during PE class.
I Sometimes participate during PE class.
I Quite often participate during PE class.
I Always actively participate during PE class.
5. In the last 7 days, what did you normally do at lunch? (check one only)
I was sitting down talking, reading, and doing homework.
I Stood around the cafeteria or walked around the school at lunch.
I Ran and played with classmates a little bit
I Ran around and played more than 3 days.
I Ran and played hard most of the time
6. Think about what activities outside of school over the last 7 days, how many times did you participate in sports, dance, or some other activity that required you to be active?
None 1 time in last week 2 or 3 times in last week
4 or 5 times in last week Everyday
Questions 7~14
Now we are trying to find out about your level of academic self-efficacy.
Self-efficacy means one's belief in one's ability to succeed in specific situations or accomplish a task.
One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges
Please answer all the questions as honestly and accurately as you can.
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Not at all 1 |
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Very well 5 |
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7. How well can you get teachers to help you when you get stuck on school work? |
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8. How well can you study when there are other interesting things to do? |
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9. How well can you study a chapter for a test? |
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10. How well do you succeed in finishing all your homework every day? |
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11. How well can you pay attention during every class? |
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12. How well do you succeed in understanding all subjects in school? |
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13. How well do you succeed in satisfying your parents with your school work? |
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14. How well do you succeed in passing a test? |
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For the next two questions, please do not hesitate to include your thoughts.
Your answers will not be shared.
15. What would you say to your friend to let him/her know the importance of regular physical activity?
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16. What factors help you feel like you will do well in school? (such as, parents compliment, friends, & health)
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Thank you for taking time to complete this survey. This survey is confidential.