1.Have you experienced domestic or family violence?

Yes

No

2.If yes, how likely are you to attend a support group for women where domestic violence and mental health are topics of discussion?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

3.How likely are you to attend an informal, discussion-based and group-led support group?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

4.What needs would cause you to reach out to a support group? E.g. loneliness, mental health, friendship

5.Would you prefer an informal chat-based support group (1) or a structured program-style meeting? (2)

1

2

6.Please select and type the top three activities you'd be most interested in (Please format as follows: 1, 4, 6, for example)

(1) Quotes and topic specific discussion

(2) Mental health prompts such as therapeutic techniques or mindfulness

(3) Storytelling and informal group discussion

(4) Writing activities such as goal setting or vision boards

(5) Art

(6) Cooking as a group

7.What topics of discussion are most important to you? (E.g. life experiences, Domestic Violence, self care habits)

8.What might prevent you from joining? E.g. transport, stigma, dependents

9.Would you like to be notified of future group meetings or related events?

If yes, please leave:

Name, Phone, Email