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Parent Questionnaire

For children under 7, parents/carers need to complete both the parent and the child version of this questionnaire.
Wellbeing in Diabetics Questionnaire - Parent/Carer Version
Relationship to child/young person
1. In the last month, has your child had any difficulties with the following areas:
a. Worrying about eating patterns or appetite
b. Feeling sad / low in mood
c. Worrying or feeling nervous
d. Home life or family relationships have been difficult
e. Struggling at pre-school, school, college or work
f. Having difficulty getting on with friends
g. Having difficulty doing what is needed to look after the diabetes e.g. testing, injections, pump, carb count etc.
2. How well do YOU feel you are you managing your child's diabetes? (1 being "not very well at all" - 10 being "excellent"
3. In the last month, as a result of your child's diabetes, have you had any difficulties with:
a. Feeling tired
b. Feeling sad / low in mood
c. Worrying or feeling nervous
d. Home life or family relationships have been difficult
5. Would you like to:
a. Talk about the above with the diabetes team in clinic today?
b. Would you like the psychologist to make an appointment to see you on a separate occasion?
The below should be completed on behalf of your child.
7. Please tick to show how much you agree with each statement. These statements are about you/the person with diabetes have been getting on in the last month:
a. Worrying about eating patterns or appetite
b. Feeling sad / low in mood
c. Worrying or feeling nervous
d. Home life or family relationships have been difficult
e. Struggling at pre-school, school, college or work
f. Having difficulty getting on with friends
g. Having difficulty doing what is needed to look after my diabetes e.g. testing, injections, pump, carb count etc.
9. To complete in clinic:
Alder Hey Children's Charity

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Alder Hey Children's NHS Foundation Trust

Eaton Road Liverpool, L12 2AP

(Use L14 5AB on sat-navs for main East Prescot Road car park)

Tel: 0151 228 4811

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