Read the following statements and decide whether or not you agree with each one. To the left of each statement are the numbers 1 through 5.
If you STRONGLY DISAGREE with a statement, circle the 1;
if you GENERALLY DISAGREE, circle the 2;
if you GENERALLY AGREE, circle the 4;
if you STRONGLY AGREE, circle the 5; and
if you are UNSURE or AGREE SOMETIMES AND DISAGREE SOMETIMES, circle the 3.
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1. I must eat well to stay healthy during my pregnancy. |
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3 | 4 | 5 | 2. I need to regularly go to the doctor or a clinic while pregnant. |
| 1 | 2 | 3 | 4 | 5 | 3. Following the Food Guide Pyramid is a good way to eat a varied, balanced diet. |
| 1 | 2 | 3 | 4 | 5 | 4. I know which agencies to go to if I need help getting food, or money for food. |
| 1 | 2 | 3 | 4 | 5 | 5. Smoking while pregnant can seriously effect the growth and health of my baby. |
| 1 | 2 | 3 | 4 | 5 | 6. To have a healthy baby, I need to gain 25 to 35 pounds while pregnant. |
| 1 | 2 | 3 | 4 | 5 | 7. If I don't gain enough weight while pregnant, my baby is likely to be born small and weak. |
| 1 | 2 | 3 | 4 | 5 | 8. Babies that weight less than 5 pounds at birth are more likely to die during their first year of life |
| 1 | 2 | 3 | 4 | 5 | 9. It is normal to feel sick to your stomach, have heart burn, or be constipated while pregnant. |
| 1 | 2 | 3 | 4 | 5 | 10. I take the vitamin or mineral pill my doctor or clinic prescribes every day. |
| 1 | 2 | 3 | 4 | 5 | 11. I know which foods I can eat to help prevent anemia. |
| 1 | 2 | 3 | 4 | 5 | 12. While pregnant, I need to eat or drink at least 4 servings of dairy products every day. |
| 1 | 2 | 3 | 4 | 5 | 13. While pregnant, I try to eat at least one additional serving of all 5 food groups each day. |
| 1 | 2 | 3 | 4 | 5 | 14. If I don't have meat to eat, beans and eggs are just as nutritious. |
| 1 | 2 | 3 | 4 | 5 | 15. The fiber in fruits, vegetables and whole grain breads can help relieve constipation. |
| 1 | 2 | 3 | 4 | 5 | 16. Based on my usual schedule and what is available to eat, I can eat following the Food Guide Pyramid. |
| 1 | 2 | 3 | 4 | 5 | 17. Snacking is good for me. |
| 1 | 2 | 3 | 4 | 5 | 18. "Fast foods" can be part of a nutritious diet. |
| 1 | 2 | 3 | 4 | 5 | 19. I need to exercise regularly while pregnant. |
| 1 | 2 | 3 | 4 | 5 | 20. Breast-feeding is the recommended way to feed a baby. |
| 1 | 2 | 3 | 4 | 5 | 21. I often prepare food following a written recipe. |
| 1 | 2 | 3 | 4 | 5 | 22. I can prepare food cheaper at home than from buying them at a restaurant. |
| 1 | 2 | 3 | 4 | 5 | 23. I read the nutrition facts on food labels to help decide which foods to buy. |
| 1 | 2 | 3 | 4 | 5 | 24. I enjoy preparing my own meals and snacks. |
| 1 | 2 | 3 | 4 | 5 | 25. I have someone to talk to and help me with concerns about my baby and my future. |
What concerns you most about having a baby?
Evaluation Tools Page
ENTRY DATE:: January 1999