This survey is designed to explore what free strength & balance activities carers want

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* 1. Do you currently have have caring responsibilities? (i.e. do you provide regular, unpaid care and support to a family member, friend, or neighbour who is unable to cope without your help due to illness, disability, mental health problems, or addiction? This care is not part of a paid job or formal volunteering)

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* 2. Do you currently have a physical health condition or illness that has lasted or is expected to last 12 months or more?

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* 3. How has your physical health changed since you started having caring responsibilities? (please tick one option)

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* 4. How much do you feel any changes in your physical health are due to your caring responsibilities? (please tick one option)

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* 5. Do you currently have a mental health condition or illness lasting or expected to last 12 months or more?

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* 6. How has your mental health changed since you started having caring responsibilities? (please tick one option)

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* 7. How much do you feel any changes in your mental health are due to your caring responsibilities? (please tick one option)

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* 8. Your understanding of strengthening activities - What do you think counts as muscle strengthening activities? (Please describe any activities you think might help to build or maintain muscle strength, ps, its ok if you don't know any)

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* 9. Do you currently do any muscle strengthening activities each week? (This could include things like lifting weights, yoga, resistance band exercises, or bodyweight movements like squats or push-ups, please tick one option)

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* 10. Your understanding of balance activities - What do you think counts as balance activities? (Please describe any activities you think might help to improve or maintain your balance, ps its ok if you don't know any)

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* 11. Do you currently do any balance activities each week? (This could include things like Tai Chi, yoga, dancing, or exercises that improve stability like standing on one leg, please tick one option)

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* 12. Barriers to you doing strengthening exercises or movements - What makes it difficult, or might make it difficult, for you to do strength or balance activities each week? (Please tick any that apply to you)

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* 13. Things that could help - What helps, or might help to enable you to do strength and balance activities each week? (Please tick any that apply to you)

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* 14. When would be the most likely time during the week that you would do strength and/or balances activities?

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
9am - 12 noon
12 noon - 1pm
1pm - 5pm
5pm - 7pm
After 7pm
None of these

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* 15. What strength and balance activities would you be most likely to be interested in doing? (Please tick any that apply to you)

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* 16. Where/Venue - Which of the options you feel would work for you? (Please tick any that would work for you)

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* 17. What is your full name?

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* 18. What is your age?

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* 19. What is your gender?

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* 20. Is the gender that you identify with the same as your sex registered at birth?

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* 21. What is your ethnic group? If you have mixed ethnicity, please select which combination of ethnicities describes you best

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* 22. What is your home address?

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* 23. What is your home post code?

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* 24. What is your mobile phone number?

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* 25. What is your email address?

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* 26. What is your current employment status?

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* 27. Do you live in the same household as the person who you care for?

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* 28. How many hours per week do you spend on your caring responsibilities?

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* 29. Is there anything else you’d like to tell us? (optional)

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* 30. Your data - In order for WIRED and Active Wirral to be able to use your data to inform the development of free strength and balance activities for people with caring responsibilities in Wirral we need you to confirm that you give the following consent by ticking all of the consents - if you do not tick all of the consents we will not be able to use your data/feedback on this occasion

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