Hello,

The Congress of Black Women of Ontario (CBWO) creates opportunities for Black Women to build connections and community as we address our shared challenges.  CBWO will be hosting an online Black Women Wellness event in March 2021.  If you are a Black woman living in Ontario we would love to hear from you. We invite you to complete this Wellness Survey.

Our upcoming online event will provide an opportunity for Black Women across Ontario to come together, nurture our wellbeing and tackle our wellness challenges, including the restrictions caused by the COVID-19 pandemic. In order to prepare a meaningful wellness series, we need your input. We invite you to share your thoughts, opinions and experiences so that we can create an engaging and relevant experience.

The following survey has 23 questions that will take approximately 15 minutes to complete.

Thank you, in advance, for contributing your input and helping us to support the wellbeing of Black women. Learn more about the CBWO at our website: https://cbwc-ontario.com/

NOTE: Your survey responses will be anonymous. We will maintain your privacy. You will have the option to share an e-mail address at the end of the survey if you’d like us to keep you up-to-date as the event takes shape. Anyone who chooses to share contact information will be entered into the draw for one of five $50 gift cards. Your contact information will not be shared.
Demographics: We would appreciate it if you would tell us a bit about yourself.

Question Title

* 1. What is your race or ethnicity?

Question Title

* 2. Into which category below does your age fit?

Question Title

* 3. Which of the following categories best describes your employment status?

Question Title

* 4. Do you live alone or with other people in your household? What best describes your current living situation?

Question Title

* 5. Are you a parent or legal guardian of a child 18 years of age or younger?

COVID-19 Impact: Please share with us how you have been affected by the COVID-19 pandemic.

Question Title

* 7. Has your household income changed since March 1, 2020? (Select one)

Question Title

* 8. Has your day to day access to extended family and trusted friends changed since March 1, 2020?

Question Title

* 9. In the past week, how often did you use the following approaches to stay in touch with family and friends?

  Never Rarely  Sometimes Often
Texting
Talking by phone
Talking by video (e.g. Skype, FaceTime, Zoom)
Meeting in person at home
Meeting in person in public

Question Title

* 10. Have you experienced stress as a result of the pandemic?  

Health & Wellness: Tell us about your health and wellbeing both prior to and since the start of the pandemic.

Question Title

* 11. Have you experienced any changes in your physical health since the outbreak of the COVID-19 pandemic (March 2020)?

Question Title

* 12. Has your psychological or emotional well-being changed since the outbreak of the COVID-19 pandemic (March 2020)?

Question Title

* 13. Over the past 12 months have you experienced stress as a result of any of the following? (select all that apply)

Question Title

* 14. Have you tried to reduce or manage stress in your life over the last 12 months by doing any of the following? (select all that apply)

Question Title

* 15. Do you experience discrimination or have you been treated unfairly based on your racial identity?

Question Title

* 16. What has been your day-to-day experience as a result of your race? (Select all that apply)

Wellness Interests and Goals: Please share your wellness interests and goals by responding to the questions below.

Question Title

* 17. Reflect on the health and wellness areas listed below and rate them in order of importance to you

  Very important Somewhat important Neutral Not very important Not important
Maintaining a healthy body
Mental and emotional wellbeing
Financial stability and security
Healthy family relationships
Healthy intimate relationships
Satisfying career and work life
Satisfying social and community connections

Question Title

* 18. If you could connect with a professional practitioner to get advice and strategies on your current wellness challenges, which three (3) would you choose? (Please select three)

Question Title

* 19. If you could speak with a small group of women about a feeling or experience you’ve had in the last twelve months, which feelings or experiences would it be? (Select up to three)

Question Title

* 20. Would you participate in or take advantage of the following initiatives if they were offered online (0 being not likely and 10 being definitely)

  0 1 2 3 4 5 6 7 8 9 10
Professional wellbeing coaching/workshops
Walking club/group
Regular group stretch sessions
A physical activity challenge/competition (i.e. step counting challenge)
Online virtual fitness session (i.e. Zumba, Yoga, Pilates, Tai-chi)
Weight management program
Mindfulness Stress Management Program

Question Title

* 21. What time of the day would be ideal for you to participate in a live online summit/ workshops? Choose one (1)

Question Title

* 22. Is there something we did not ask on the topic of Black Women and Wellness that you would like to share? (Optional)

Question Title

* 23. If you would like to be on our mailing list and be entered in a draw for 1 of 5 $50.00 gift cards, please share your email address below. (Optional)

Thank you for participating in the Congress of Black Women of Ontario Black Women Wellness Survey. Please forward this survey link to other Black women who may be interested in supporting this initiative.

To complete the survey, please click the “Submit” button below.

T