This free survey is powered by
  1. Surveys
  2. 2013
  3. October
  4. M
  5. Marital Stress
0%
Exit Survey
 
 
Dear Potential Participant,

I would like to ask you to consider participating in a questionnaire that is being conducted by a graduate student at The University of Southern Mississippi as part of a marriage education class. The purpose of this questionnaire is to gain a better understanding of marital stress as it relates to having a child ages 5-22 with a disability. Specifically, the goal is to see what parents would look for in a program developed to meet their needs relating to marital stress that stems from having a child with a disability. If you participate in this questionnaire, you will be given the opportunity to reflect on your own needs and wants pertaining to coping with marital stress relating to your child’s disability. Participation involves minimal anticipated risk.

If you choose to participate, you are agreeing to complete a questionnaire using an online survey method called Question Pro. The questionnaire will take about 10-15 minutes to complete. To ensure that all data remains anonymous, please do not put your name or any other identifying information on the questionnaire. Any information inadvertently gained during the course of this study will be kept completely confidential. Participation is completely voluntary. Please feel free to decline participation or remove yourself from participating at any time. Data will be collected and a summary of results will be used to help the graduate student develop a Family Life Education program for a marriage education class at the University of Southern Mississippi. Once data is compiled, all questionnaires will be destroyed.

If you have any questions, please feel free to contact Christina Cannon at [email protected] or by phone at (904) 382-2442. The link to this questionnaire is attached to the bottom of this letter.

By completing and submitting the questionnaire, you are agreeing to the submission of all confidential data obtained in the questionnaire to be used for the purposes as above.

Thank you for your consideration.

Sincerely,

Christina M. Cannon
 
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your marital status?
 
Single, never married
 
Married or domestic partner
 
Divorced
 
Separated
 
Widowed
 
Other
 
 
 
How old is your child?
   
 
 
 
What is your relationship to your child?
 
Biological Parent
 
Step Parent
 
Adopted Parent
 
Legal Guardian
 
Other
 
 
 
What techniques do you use to manage stress (Select all that apply)?
 
Prayer/Meditation
 
Journaling
 
Exercise
 
Smoking
 
Medication
 
Use of support groups
 
None
 
Other
 

 
 
 
What support groups do you use to manage stress?
 
Religious/Faith Based
 
Spouse/Significant Other
 
Relatives
 
Friends
 
Family Professionals (Ex: doctors, therapists, psychologists, child life specialists)
 
None
 
Other
 

 
 
 
Do you feel your marital relationship is affected by your child's disability? Please explain.
   
 
 
 
What specific needs do you have when it comes to coping with marital stress stemming from your child's disability?
   
 
 
 
What would you look for in a program designed to help manage marital stress that stems from having a child with a disability?
   
 
 
 
Would you be interested in a family life program designed to help you manage your marital stress?
 
Yes
 
Maybe
 
No
 
Not Sure