Caregiver Survey
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Helping Caregivers
Please answer these 6 short questions. They are intended to help us create the best group possible for the people who nurture loved ones with a chronic illness. Your answers to this survey will help provide these caregivers with the time for themselves that they truly deserve and a place to bond with others going through something similar. Thank you in advance for your contribution!
1
. Are you caring for someone with a chronic illness?
Are you caring for someone with a chronic illness?
Yes
No
2
. Think of someone who is a caregiver for a loved one with a chronic illness. It can be you. Since they began caregiving, what topics might they benefit from bonding over, talking about, or learning new research about? Choose the 5 topics that you think would be most beneficial.
Think of someone who is a caregiver for a loved one with a chronic illness. It can be you. Since they began caregiving, what topics might they benefit from bonding over, talking about, or learning new research about? Choose the 5 topics that you think would be most beneficial.
Demands from loved one with chronic illness that are above what s/he needs
Finding time to do recreational activities
Learning stress relievers for tension in life
Making time for friends and other relatives
Nervousness and depression concerning relationship with loved one with chronic illness
Organizing time to do own daily chores
Personal Privacy
Stress in relationship with the loved one who has the chronic illness
What other topics might be on their mind?
3
. What services do you think would be helpful for a caregiver of someone with a chronic illness? Check all that apply.
What services do you think would be helpful for a caregiver of someone with a chronic illness? Check all that apply.
A place to exchange thoughts with people going through something similar
A place to find and exchange the most up to date research about caring for an individual with a chronic illness
A place to learn stress reducing techniques to improve the quality of life of the caregiver
Facilitated conversations about relevant stressors with a group of individuals who are going through something similar
Recreational activities created for a group of individuals who are going through something similar
What other resources might be useful?
4
. Have you ever been part of a support group?
Have you ever been part of a support group?
Yes
No
5
. What do you think would be the most valuable aspect of being part of a caregiver's support group? If you have experience, please share what was good or bad. Also, it would be very helpful for us to know what you think the best way to get people involved in a group like this would be.
What do you think would be the most valuable aspect of being part of a caregiver's support group? If you have experience, please share what was good or bad. Also, it would be very helpful for us to know what you think the best way to get people involved in a group like this would be.
6
. What do you think is the best time for a group like this? Check all that apply.
What do you think is the best time for a group like this? Check all that apply.
Morning
Afternoon
Evening
Weekday
Weekend
Not sure
If you are interested, what is the best time for you and best contact information to update you about when the group forms?
Please complete this survey by Monday, November 14, 2011.
Thank you so much for your participation in this survey!
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