Feedback Survey

Thank you for participating in the Let's Talk Cafe.  Your perspective and thoughts will help to shape our intervention.  This survey may take 10 minutes to complete.

For more information about our initiative, check out our website at: Kujenga Wellness Project. Please feel free to email your questions or thoughts to us.

Thank you, the Kujenga Team!!

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* 1. Describe (in your own words) characteristics of “wellness” being well in your physical body, your mental health, your relationships, and more?

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* 2. Rate the following potential stressors that may impact you from difficult to easy.

  Very Difficult Somewhat Difficult Neutral Somewhat Easy Very Easy
Education & learning
Spirituality & faith
Finances
Social Relationships
Health
Social Media
Friends & extended family
Intimate partner relationships
Career
Mental Health
My identity (i.e. gender, race, culture) & self-worth
Mentorship & coaching

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* 3. Describe how these stressors impact your life?

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* 4. Explain the importance of these values for you?

  Very Important Important Somewhat Important Important
Unity
Self-Determination
Collective work & work ethic
Building wealth & financial literacy
Purpose: Being able to accomplish your dreams and goals
Creativity
Faith
Spirituality
Physical Health
Mental wellness
Belongingness

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* 5. What factors make it difficult for you to upload these values?

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* 6. Describe your gaps or areas to develop within yourself?

  Yes, I need to work on this No, I feel competent in this area
Financial Literacy
Building Wealth
Obtaining further education
Managing a household
Parenting my children (if applicable)
Maintaining my physical health
Attending to my mental health
Accessing support in my community
Planning for retirement
Being and feeling "part" of a community
Maintaining healthy relationships
Healthy dating or marriage relationships
Establishing goals for myself
Finding or changing my career
Accessing mentors who can support me

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* 7. What barriers do you experience in trying to address these gaps for yourself?

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* 8. Kujenga Wellness Project hopes to facilitate support groups and educational workshops to support families. What topics would you like to see from the project?

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* 9. In your experiences, how does anti-Black Racism or other forms of discrimination (i.e. anti-Indigenous racism, homophobia, sexism, anti-Islamophobia) impact the following areas of your life?

  A great deal Somewhat A little Not at all
My identity & personality
My family, i.e. my children or other family members
My relationships with my partner
My career or work aspirations
Travelling

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* 10. What resources will help you address the impact of anti-Black racism or other forms of discrimination that you experience?

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