Consent Form (15 Print)

Informed consent Form
Dear participant,
I Swagata Saha, pursuing Masters from Amity University Kolkata, conducting research under the
supervision of Dr. Debobani Bhattacharya, Professor of Amity University Kolkata. The data
collected will be kept confidential and will be used only for research purposes only. Participation
is voluntary, and the participant can retract from the research if faced with any
inconvenience. Individuals who are between 18- 25 years who use social media platforms are invited to
participate in this study.
We ask you to take a look at the instructions first and then decide if you wish to participate.
Please feel free to ask questions from the experimenter at any time. If you have any further
questions concerning this study, please feel free to ask me before start to fill up the
questionnaire. We take your further proceeding with the form and its submission as your consent
to participate in the study.
Thank You!
INFORMATION
SCHEDULE
Name
Educational
Qualification
Occupation
Age
Gender
Email Id
Kindly use the scale below to indicate how often you always use the social networking sites
like Facebook, Instagram, WhatsApp, Twitter, Myspace, Pinterest etc., during the past
week in the following situations and places:
1 = Not applicable to me during the past week.

2 = I never used it during the past week.
3 = I used it once during the past week but spend less than 10 min.
4 = I used it once during the past week but spend between 10 and 30 min.
5 = I used it once during the past week but spent more than 30 min.
6 = I used it between 2 and 3 times during the past week but spend less than 10 min each time.
7 = I used it between 2 and 3 times during the past week but spend between 10 and 30 min each
time.
8 = I used it between 2 and 3 times during the past week but spent more than 30 min each time.
9 = I used it more than 3 times during the past week but spend less than 10 min each time.
10 = I used it more than 3 times during the past week but spend between 10 and 30 min each
time.
11 = I used it more than 3 times during the past week but spent more than 30 min each time.
Tick ✔ on the option you feel is suitable with the statement.
Items 1 2 3 4 5 6 7 8 9 10 11
1 When you are at a seminar/workshop or
training program
2 When you are at home sitting idly

3 When you need to reduce your mental stress
4 When you go to the stadium to watch football,
basketball etc.
5 When you are doing school or job-related
assignment at home
6 When you are waiting for someone (e.g.,
friends) either in their house or at a pre-
arranged place
7 When you are listening to music, radio,

religious lectures etc
8 When you have gone through a lot of stress.
9 When you are in a meeting.
10 When you are in the class receiving lecture.
11 When you need to maintain contact with
existing friends.
12 When you are in bed about to sleep.
13 When you are reading in the library for
academic purpose e.g., recommended text for
class.
14. When you are at a place to repair your car,
house appliances, etc.
15. When you need to reduce your emotional
stress.
16. When you want to reduce the pressure of
your daily routines.
17. When you are at a social gathering like
wedding ceremony, birthday party, reception
etc.
18. When you need to communicate with your
families and friends.
19. When you are sitting in a religious place (e.g.,
church, mosque) and activities like sermon or
prayer is yet to start.
20. When you need to find out more about
people you met offline.
21. When you are in the company of
friends/family/colleagues having fun.
22. When you are watching TV, news, football,
films, sports, etc.
23. When you go to the cinema house to watch
movie(s)
24. When you are a passenger in a car/bus/train
for at least 2 min.
25 When you need to find people you haven’t
seen for a while.
26 When you are waiting for your boss in her
office for at least 2 min when she is not
attending to you.
27 When you are trying to forget your financial
challenges.
28 When you are online doing school or job-
related works e.g., project, homework.
29 Watching academic-related video lectures or
those related to your job.
Below is a list of statements dealing with your general feelings about yourself.
Tick ✔ on the option you feel is suitable with the statement.
Items Strongly Agree Agree Disagree Strongly

Disagree
1. On the whole, I
am satisfied with
myself
2. At times I think I
am no good at all.
3. I feel that I have

a number of good
qualities.
4. I am able to do
things as well as
most other
people.
5. I feel I do not
have much to be
proud of.
6. I certainly feel
useless at times.
7. I feel that I'm a
person of worth,
at least on an
equal plane with
others.
8. I wish I could
have more respect
for myself.
9. All in all, I am
inclined to feel
that I am a failure.
10. I take a
positive attitude
toward myself.

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Informed consent Form

1 = Not applicable to me during the past week.

Tick ✔ on the option you feel is suitable with the statement.

2 When you are at home sitting idly

7 When you are listening to music, radio,

Items Strongly Agree Agree Disagree Strongly

3. I feel that I have

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