Women's Breast Health Fund

Survivor Survey

The Women’s Breast Health Fund is dedicated to supporting people who have been diagnosed with breast cancer. We’re asking you to share your experience with finding and using support during your journey.

Support can include things like caregiving help, information that helped you understand your diagnosis, or stores that offered useful products. It can also mean services that supported your mental, physical, or everyday needs.

We want to know what has worked well and what has been harder to find. If the goal is to make life easier after a diagnosis, what kinds of support and services truly help?

Please read each question carefully, especially the instructions about how to score your answers.

Question Title

* 1. How satisfied are you with support services for those with breast cancer in your community?

1. Very Dissatisfied, 2. Dissatisfied, 3. Neither Dissatisfied or Satisfied, 4. Satisfied, 5 Very Satisfied

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. How difficult is it to locate services supporting those with breast cancer ?

1. Very Easy, 2. Somewhat or Fairly Easy, 3. Neither Easy or Difficult, 4. Somewhat or Fairly Difficult, 5. Very Difficult

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 3. Top 3 most valuable services available to support a someone with breast cancer?

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* 4. Did you receive services in the county you live in?

Yes

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* 5. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 6. What is your ethnic background?

Hispanic or Latino

Not Hispanic or Latino

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* 7. What is your race? (Select all that apply)

American Indian or Alaska Native

Asian or Asian American

Black or African American

Native Hawaiian or other Pacific Islander

White/Caucasian

Other (please specify)

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* 8. What is your annual household income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Between $150,000 and $200,000

Between $200,000 and $250,000

Greater than $250,000

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* 9. Do you have children in the home?

Yes

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* 10. If you have children in the home, how many?

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* 11. How many years has it been since your breast cancer diagnosis?

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* 12. What is your county of residence?

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* 13. Have you heard of Forge Breast Cancer Survivor Center?

Yes

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* 14. Were you referred to Forge Breast Cancer Survivor Center?

Yes

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* 15. Would you consider participating in a focus group?
A focus group is a small group conversation where participants can talk more in depth about their experiences and ideas. It helps us learn more than what we can capture through the survey alone.

Yes

Women's Breast Health Fund

Survivor Survey

Question Title

* 1. How satisfied are you with support services for those with breast cancer in your community?

Question Title

* 2. How difficult is it to locate services supporting those with breast cancer ?

Question Title

* 3. Top 3 most valuable services available to support a someone with breast cancer?

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* 4. Did you receive services in the county you live in?

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* 5. How old are you?

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* 6. What is your ethnic background?

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* 7. What is your race? (Select all that apply)

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* 8. What is your annual household income?

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* 9. Do you have children in the home?

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* 10. If you have children in the home, how many?

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* 11. How many years has it been since your breast cancer diagnosis?

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* 12. What is your county of residence?

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* 13. Have you heard of Forge Breast Cancer Survivor Center?

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* 14. Were you referred to Forge Breast Cancer Survivor Center?

Question Title

* 15. Would you consider participating in a focus group?A focus group is a small group conversation where participants can talk more in depth about their experiences and ideas. It helps us learn more than what we can capture through the survey alone.

* 15. Would you consider participating in a focus group?
A focus group is a small group conversation where participants can talk more in depth about their experiences and ideas. It helps us learn more than what we can capture through the survey alone.