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* 1. Participation Information Sheet

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* 2. Online Consent Form

This study is funded by a Brandon University Research Committee. No commercialization of research findings will occur within this study.

Title: Where are We Now? Rural 2SLGBTQIA+ Individual’s Perspectives on Access to Health Services and Family Supports

I agree to take part in this research project.

I have read the Information Sheet provided and have been given information on the purpose of this study, the procedures involved, and of what is expected of me.

I understand that I will be asked to: Participate in an online survey. The survey has demographic questions and four validated scales to examine the self-rated physical and mental health and supportive service use/healthcare service use and needs, and experiences of discrimination of 2SLGBTQIA+ persons and families living in rural communities in Manitoba. There is a possibility that participants may feel a range of different emotions when participating in this research project.

I understand that I may withdraw from completing the survey at any time.

I understand that it is impossible to withdraw from the survey once it has been submitted.

I understand that all information provided by me is treated as confidential and will not be released by the researcher to a third party unless required to do so by law.

I agree that any research data gathered for the study may be published. Identifying information is not disclosed.

By consenting, I understand that I have not waived any right to legal recourse in the event of research related harms.

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* 3. I consent to participate in this study

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* 4. Please specify your age group

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* 5. Sex assigned at birth

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* 6. Education level

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* 7. Current Occupation

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* 8. Marital Status

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* 9. Do you have children/live with children?

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* 10. Gender identity

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* 11. Gender expression

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* 12. Sexual orientation

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* 13. Your primary Health Region where you access services

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* 14. Have you been diagnosed with a mental illness/challenges. (e.g. PTSD, depression, anxiety)

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* 15. Do you identify as someone with a disability.

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* 16. Self report of your quality of life?

  Very Poor Poor Neither poor nor good Good Very good
How would you rate your quality of life?
How well are you able to get around?

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* 17. How satisfied are you with your quality of life

  Vey dissatisfied Dissatified Neither satisfier nor dissatisfied Satisfied Very satisfied
How satisfied are you with your health?
How satisfied are you with your sleep?
How satisfied are you with your ability to perform your daily living activities?
How satisfied are you with your capacity for work/study?
How satisfied are you with yourself?
How satisfied are you with your personal relationship?
How satisfied are you with your sex life?
How satisfied are you with support you get from your friends?
How satisfied are you with support you get from your family?
How satisfied are you with the conditions of your living place?
How satisfied are you with your access to health services?
How satisfied are you with your transport?

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* 18. The following questions ask you about how much you have experienced certain things in the last four weeks.

  An extreme amount Very much A moderate amount A little Not at all
To what extent do you feel that physical pain prevents you from doing what you need to do?
How much do you need any medical treatment to function in your daily life?

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* 19. The following questions ask about how much you have experienced certain things in the last four weeks

  Not at all A little A moderate amount Very much Extremely
How much do you enjoy life?
To what extent do you feel your life to be meaningful?
How well are you able to concentrate?
How safe do you feel in your daily life?
How healthy is your physical environment

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* 20. The following questions ask you about how much you were able/complete to do certain things in the last four weeks.

  Not at all A little A moderate amount Mostly Completely
Do you have enough energy for everyday life?
Are you able to accept your body appearance?
Do you have enough money to meet your needs?
How available to you is the information that you need in your day to day life?
To what extent do you have the opportunity for leisure activities?

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* 21. This question ask you how often you have felt or experienced certain things in the last for weeks

  Never Seldom Quite often Very often Always
How often do you have negative feelings such as blue mood, despair, anxiety, depression

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* 22. Self report of your emotional states of depression, anxiety and stress over the past week.

  Did not apply to me at all Applied to me to some degree or some of the time Applied to me to a considerable degree or a good part of the time Applied to me very much or most of the time
I found hard to wind down
I was aware of dryness of my mouth
I could not seem to experience any positive feeling at all
I experienced breathing difficulty (e.g. excessively rapid breathing, breathlessness in the absence of physical exertion)
I found it difficult to work up the initiative to do things
I tended to over react to situations
I experienced trembling (e.g. in the hands)
I felt that I was using a lot of nervous energy
I was worried about situations in which I might panic and make a fool of myself
I felt that I had nothing to look forward to
I found myself getting agitated
I found it difficult to relax
I felt down hearted and blue
I was intolerant of anything that kept me from getting on with what I was doing
I felt I was close to panic
I was unable to become enthusiastic about anything
I felt I wasn't worth much as a person
I felt that I was rather touchy
I was aware of the action of my heart in the absence of physical exertion (e.g. sense of heart rate increase, heart missing a beat)
I felt scared without any good reason
I felt that life was meanigless

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* 23. Please think carefully about your life as you answer the questions below. Indicate how much the described events in the past year apply to you.

  If the event has NEVER happened to you If the event happened ONCE IN A While) If the event happened SOMETIMES If the event happened A LOT If the event happened MOST OF THE TIME If the event happened ALMOST ALL OF THE TIME
How many times have you been been rejected by friends because you are 2LGBTQIA+?
How many times have you been verbally insulted because you are 2LGBTQIA+?
How many times have you been made fun of, picked on, pushed, shoved, hit or threatened with harm because you are 2LGBTQIA+?
How many times have you heard Anti-2LGBTQIA+ remarks from family members?
How many times have you been rejected by family members because you are 2LGBTQIA+?
How many times have you been called a heterosexist/cissexist name like dyke, lezzie or other names?
How many times have you been treated unfairly by your peers/employer/manager/supervisor because you are 2LGBTQIA+?
How many times have you been treated unfairly by your family because you are 2LGBTQIA+?
How many times were you denied a raise, a promotion, tenure, a good assignment, a job or other such things at work/school that you deserved because you are 2LGBTQIA+?
How many times have you been treated unfairly by your teachers or professors because you are 2LGBTQIA+?
How many times you have been treated unfairly by your co-worker, fellow students or colleagues because you are 2LGBTQIA+?
How many times you have been treated unfairly by people in service jobs (by store clerks, waiters, bartender, bank tellers, mechanics) and others because you are 2LGBTQIA+?
How many times you have been treated unfairly by health practitioners (by nurses, physician, psychiatrists, dentists, counselors, and others) because you are 2LGBTQIA+?
How many times have you been treated unfairly by strangers because you are 2LBGTQIA+?

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* 24. Please indicate how helpful each source is to you

  Not helpful at all Sometimes helpful Generally helpful Very helpful Extremely helpful
My parents
My spouse's parents
My relatives
My spouse
My friends
My spouse's friends
My own children/stepchildren
Other parents
Church or religious place of worship
Social groups/clubs
My family physician/physician
Professional helpers, social workers, therapies, teacher, specialist
School/Day care center
Professional agencies (public health, social services, mental health etc)
My siblings

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* 25. Your contribution to this research is valuable and we appreciate your participation.

THANK YOU

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