Einstein-Mount Sinai Diabetes Research Center

Survey Instruments

Lifestyle Assessment Tools

  1. WAVE (Weight, Activity, Variety, Excess) Card (Download Word) (Download PDF
    The WAVE Card is a quick reference card for health professionals, containing questions relating to the physical activity and eating habits of their patients. It includes scoring instructions and recommendations based on the patient’s score. It also includes specific suggestions on how to increase physical activity and improve eating habits.
    Related article: Barner et al, WAVE card  
  2. Kid WAVE (Weight, Activity, Variety, Excess) – The Get Healthy Game (Download Word)
    The Kid WAVE card is similar to the WAVE Card, but adapted for children and adolescents, with scoring instructions and suggestions for improvement in physical activity and eating habits that take into account the typical lifestyle issues facing children.
  3. WAVE (Weight, Activity, Variety, Excess) Questionnaire (Download PDF)
    The WAVE questionnaire is a tool designed to for use in primary care settings and schools to quickly assess weight, activity, variety, and excess in patients. Using this assessment, healthcare providers can initiate a tailored dialogue with students about the desire to lose weight and helping them identify goals for increasing activity, improving dietary intake, and decreasing sources of excess calories. A similar version, tailored for adults, is also available. 
    Related article: Isasi et al, Youth WAVE screener addressing weight-related behaviors with school age children  
  4. Healthy Mom Card (Download PDF)
    The Healthy Mom Card is a short questionnaire similar to the WAVE Card for adults that is tailored to moms and addresses their specific lifestyle issues such as eating junk foods from their children’s plates and includes suggestions on how to improve physical activity and eating habits that involve spending time with the children and modeling healthy behaviors for them.
  5. REAP (Rapid Eating Assessment for Participants) (Download PDF)
    The REAP is a short questionnaire designed to quickly assess the dietary and eating habits of prediabetes patients, particularly in a low-literacy population. It can be used to identify which patients would benefit most from further dietary/nutritional counseling.
    Related article: Segal-Isaacson et al, REAP-S 

Risk Perception Surveys

  1. Risk Perception Survey-Diabetes Mellitus (RPS-DM) and Scoring Guide 
    (Phone Survey - English) (Phone Survey - Spanish)
    (Print Survey - English) (Print Survey - Spanish
    (Scoring Guide)
    The RPS-DM is a 31-item survey for people with diagnosed diabetes (type 1 or 2) to assess comparative risk perceptions related to diabetes and its complications, including an environmental risk subscale. There are 6 subscales. The risk knowledge subscale is not scored with the rest of the composite items, but is an appropriate descriptive score for measuring change in risk knowledge. There are versions available for data collection by telephone interview or print versions for in-person completion or mailing to the respondent. Both are available in English and Spanish.
    Related citations can be found here 
  2. Risk Perception Survey for Developing Diabetes (RPS-DD) and Scoring Guide and Psychometrics
    (Download English Survey) (Download Spanish Survey) (Scoring Guide)
    The RPS-DD (Developing Diabetes) is a 43-item survey (in English) appropriate for people who are at risk for type 2 diabetes, and it assesses their comparative risk perceptions for developing diabetes and/or its complications, as well as their environmental perceived risks. It has recently been shortened from a previous version, although the composite risk scale includes the same items as before. This version is appropriate for print administration. 
    For information regarding the subscales that are now deleted please contact the author (elizabeth.walker@einstein.yu.edu).
    Related citations can be found here 
Click here to log in