Q01
Message
All templates
Self-Improvement Habits and Progress Check-In
Captures how people are actually pursuing personal growth — which areas they're working on, how consistently they show up, and what's really stopping them — with an AI follow-up interview that digs into the real story behind their biggest obstacle. Built for coaches, app makers, and researchers studying habit formation and motivation.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
14 questions · ~7 min
Q02
Multiple ChoiceRequired
In the last 3 months, which of these areas have you actively worked on improving?
- Physical health or fitness
- Mental health or mindfulness
- Career or professional skills
- Financial literacy or habits
- Relationships or social skills
- Productivity or time management
- Learning a new skill or hobby
Q03
Opinion ScaleRequired
Overall, how much progress have you made toward your personal goals in the last 3 months?
Scale: 1 – 7
Min:No progress at allMax:Major progress
Q04
Rating ScaleRequired
How satisfied are you with the resources you've used for self-improvement (books, courses, apps, coaches, communities)?
Range: 1 – 5
Min:Not satisfiedMax:Extremely satisfied
Q05
Best–Worst Trade-off (MaxDiff)Required
Thinking about the next 3 months, which of these is most important for you to make progress on, and which matters least right now?
- Physical health
- Mental wellbeing
- Career growth
- Financial stability
- Relationships
- Productivity
- Learning new skills
Pick best & worst per setBest:Most important to improve nextWorst:Least important right now
Q06
Multiple ChoiceRequired
In the last 30 days, how often have you set aside dedicated time for self-improvement activities?
- Daily
- A few times a week
- About once a week
- Rarely
- Never
Q07
MatrixRequired
How much do you agree with each statement about how you approach your own growth?
5 rows × 5 columns
- I set specific, measurable goals for myself
- I track my progress regularly
- I seek feedback from others on how I'm doing
- I adjust my approach when something isn't working
- I celebrate small wins along the way
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q08
AI Interview
Reconstruct the respondent's most significant recent attempt at self-improvement: what specific goal they set, what they actually did day to day, and where it broke down or succeeded. Anchor on their stated biggest obstacle and probe for a concrete recent example rather than a general opinion — ask what happened the last time that obstacle got in their way. If they report strong progress, probe what specific system or habit made the difference so it can be identified as a best practice.
Q09
Multiple ChoiceRequired
What is the single biggest obstacle keeping you from making more progress on your goals?
- Not enough time
- Lack of motivation or consistency
- No clear plan or roadmap
- No accountability or support
- Financial constraints
- Health or energy limitations
Q10
Long Text
Describe one specific change you made recently that had the biggest positive impact on your growth (or one that clearly didn't work).
Q11
Multiple Choice
Which age range do you fall into?
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65 or older
- Prefer not to say
Q12
Multiple Choice
How do you describe your gender?
- Woman
- Man
- Non-binary
- Prefer to self-describe
- Prefer not to say
Q13
Dropdown
What is the highest level of education you've completed?
- High school or less
- Some college
- Bachelor's degree
- Graduate degree
- Prefer not to say
Q14
Message
That's everything — thank you for the honest reflection! Your responses feed into research on what actually helps people build sustainable growth habits.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Goes beyond static rating questions with an AI follow-up interview that reconstructs the respondent's most significant recent self-improvement attempt and probes the real story behind their biggest obstacle
- Combines quantitative structure (multiple choice, opinion scale, rating, max-diff, matrix) with open-ended depth (long text and adaptive AI probing) so researchers get both breadth and narrative context in one flow
- Automated per-response quality scoring and auto-generated reports mean coaches, app makers, and researchers can act on results without manually coding open-ended answers
- Transparent prompts let teams see exactly how the AI follow-up was worded and why, supporting methodological scrutiny that closed-ended competitor templates can't offer
QuestionPro
Self Improvement Survey | Sample Survey, Examples, Questions & QuestionnairesThis is a sample question set/template page on QuestionPro's site rather than a fully built, ready-to-field interview flow with adaptive logic. It covers similar territory (self-improvement habits, satisfaction, obstacles) but presents standard static question types typical of QuestionPro's library. Useful as a starting question bank, but researchers would need to build out logic, scoring, and reporting themselves within the QuestionPro platform.
What it does well
- Established survey platform with broad question-type library and distribution tools
- Template offers example questions specifically framed around self-improvement, giving a quick starting point
- Backed by a large ecosystem of templates across many survey categories
Where it falls short
- No adaptive AI follow-up interview — respondents answer fixed questions with no dynamic probing into their specific obstacles or stories
- No indication of automated per-response quality scoring or AI-generated narrative reports
- No transparent prompt methodology since there is no AI interviewing component to document
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.