Mothers of Avalon Survey

Mothers of Avalon Survey

Please fill out this anonymous survey for research to support Newfoundland and Labrador’s Mothers and Caregivers.
Age

0 - 17 18 - 24 25 - 34 35 - 44 45 - 54 55+
What is your gender?

Female Male Non Binary
Which role describes you best?

Mother Father and Primary Caregiver Primary Caregiver / Guardian Other
Which ethnicity do you belong to?

Indigenous / Aborignal Innu Mi’kmaq Black Inuit Arab Chinese South Asian Filipino Other visible minority Caucasian Other
Are you from Newfoundland

Yes No
Current Location

St. John’s Logy Bay / Middle Cove / Outer Cove / Torbay CBS Mount Pearl St. Phillips/Portugal Cove Elsewhere on the Avalon Peninsula Elsewhere in Newfoundland Labrador Other
How many children (18 and under) do you have?

1 2 3 4 5 6+ My children are over 18
Education

Less than HS diploma High school Some college Bachelors degree College Diploma Higher education
Type of Employment

Student Unemployed (looking for a job) Unemployed (not looking for a job) Self-employed Full-time employment Part-time employment
Household Income

$0 - $24,999 $25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 or more
Marital Status

Single Married Divorced Widowed
Do you have a partner that lives with you?

Yes No
On a scale of 1 - 10 how supported do you feel by your partner? (1 being not at all supported, 10 being very supported)

1 2 3 4 5 6 7 8 9 10
Do you have any mental health issues or diagnoses?

Yes No Prefer not to say
Do you have any substance abuse or addiction issues?

Yes No Prefer not to say
Do you have any majorly debilitating health issues?

Yes No Prefer not to say
Do you have a disability?

Yes No Prefer not to say
Do any of your children have a disability?

Yes No Prefer not to say
Do any of your children have any mental health issues or diagnoses?

Yes No Prefer not to say
Do any of your children have any majorly debilitating health issues?

Yes No Prefer not to say
What are your biggest struggles in motherhood? Please tick all that apply.

Postpartum Depression Breastfeeding Sleep Lack of self care Financial Stress Personal health issues Child’s health issues Lack of family support Lack of support from other mothers Unsupportive partner or no partner Substance Abuse Other
What are you in need of the most? Please tick all that apply.

Counselling / Therapy Services Diapers Tampons, pads, or sanitary products Breastfeeding support Formula Food Clothing Toys Financial advice Transportation Friendship / supportive relationships Access to more Health Care Services Other
What are your interests?Please tick all that apply.

Art and craft Music Health / Wellness Fitness / Sport Cooking / Baking Nature / outdoor activities Mindfulness Gardening Foraging Beauty Self Care Other
Which of these activities would you be interested in doing?Please tick all that apply.

Mommy and Me Art Class Relaxation Art Class Self Care Sessions ( haircuts, manicures, massages etc.) Cooking Class / Meal Prep Excursions out of Town Foraging / Berry Picking Female Empowerment Talks Fitness classes Socializing event (bbqs, picnics, potlucks, holiday parties) Youth enrichment classes Other
If you wish, please give us any additional details on how you struggle in motherhood, or anything mentioned above, Let us know HOW we can HELP you.
Feel free to leave your contact information for us to chat with you further.
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