6 items
Self-reported health history: general health, chronic conditions, medication, anthropometrics and smoking. Health data is special-category under GDPR Art. 9 — every item here is flagged accordingly and needs an explicit lawful basis, not consent-by-default.
Special-category data
Some items here collect special-category data under GDPR Art. 9 (such as racial or ethnic origin, or health data). Collecting them requires an explicit lawful basis and consent text that covers them — check your ethics approval before use.
Source
The general-health item is the standard single-item self-rated health question used in SF-36, the EU-SILC Minimum European Health Module and most national health surveys, which makes results directly comparable to population norms.
License: Free to use and adapt.
In general, would you say your health is:
Excellent · Very good · Good · Fair · Poor · Prefer not to say
Have you been diagnosed with any of the following? Select all that apply.
None · Cardiovascular condition (e.g. hypertension, heart disease) · Diabetes · Respiratory condition (e.g. asthma, COPD) · Chronic pain condition · Neurological condition (e.g. epilepsy, migraine) · Mental health condition · Autoimmune or inflammatory condition · Cancer (current or previous) · Other long-term condition · Prefer not to say
Are you currently taking any prescribed medication?
No · Yes — one medication · Yes — two or more medications · Prefer not to say
What is your height (in cm)?
50–250
What is your weight (in kg)?
20–400
Which best describes your smoking status?
Never smoked · Former smoker · Occasional smoker · Daily smoker · Prefer not to say
Use this module in your own ESM/EMA study — drop it into a survey within SMAAT.