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1. How
much fun are you having in this intervention?
none ————— little —————— a bit —————— lots
2. Is
this intervention to do something or for something to do?
convenient job —————— so-so —————— really important
3. How
much approval, recognition and satisfaction are you getting from this
intervention?
little —————— some —————— fair bit —————— a lot
4. What
is the norm for social support given by the steering committee (or the
group where you spend most time)?
little —————— some —————— fair bit —————— a lot
5. How
many stakeholders in the intervention do you talk to about your personal
intervention concerns?
none ———— 1 or 2 ———— 2 or 3 ———— 4 or more
6. How
many people outside this intervention do you talk to about concerns with
this intervention?
none ———— 1 or 2 ———— 2 or 3 ———— 4 or more
7.
While working on the intervention how often do you participate in a
social, educational, recreational, church or community group?
rarely ——— once a month ——— once a week ——— 2 or more times a week
8. Do
you have a partner or spouse?
no ————— sometimes ————— a steady ————— married or live-in
List
your personal support system people in this intervention
1.
__________________
4. ___________________
2.
__________________
5. ___________________
3.
___________________
6. ___________________
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