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Part I. Death of Spouse
Directions: Rank the items below in order of importance, using 1 as highest and 5 as lowest.

1. What was your understanding about your husband's death?
Passing was imminent
Illness was progressive and incurable
Sudden death from health issue
Accidental death
Refused to accept

2. How prepared were you for his passing?
Emotionally prepared
Financially prepared
Spiritually prepared
Other. Please specify:

3. Who assisted you with burial arrangements?
Funeral staff
Family members
Friends
Church members
Sorority or club members
Other. Please specify:

4. Who did you turn to for support during your bereavement?
Sister
Brother
Friend
Church members
Parent
Sorority or club members
Other. Please specify:

Part II. Your Marriage
1. How many years were you married?

2. How many years has it been since your husband passed?

3. How would you describe your marriage?
50-50 Partnership
40-60 Partnership with husband as lead
30-70 Partnership with husband as lead
40-60 Partnership with me as lead
Other. Please specify:
Decline to answer

4. Did you take a job after your husband passed?
No. I was already working
No. I am not working at this time.
No. I am retired.
Yes. I took a full time job.
Yes. I took a part time job.
Reason for taking a job:

Part III. New Roles
Directions: Please rank from 1 - 12, using 1 to show highest importance.

1. New tasks that you were required to perform as a widow but were not required to perform while your husband was alive.
Buying Insurance.
         Select type(s): homeowners automobile long term care life
Organizing affairs
Obtaining credit
Managing bank accounts
Caring for automobiles
Clearing debts
Processing medical claims
Changing beneficiaries
Managing investments
Changing titles: deeds, autos, policies
Making a new will
Other. Please specify:

2. What strategies did you use to address the challenges in carrying out the responsibilities for any of the above?


3. Please rank in order of importance additional household tasks which you
must perform since becoming a widow (using 1 through 5):
Paying Bills
Balancing the checkbook
Lawn Care
Household maintenance
Other. Please specify:


Part IV. Survival Strategies
Directions: Rank in order from 1 to 5 the items that provided the biggest challenge for you as you tried to regain your balance.

1. What strategies did you use to help regain your balance after your husband's death?
Joined a mutual support network
Accepted widow(oneness)
Redefined interests
Established a new identity
Other. Please specify:

2. What obstacles did you encounter in trying to regain your balance?
Stereotypes toward widows
Loss of identity
Releasing your past
Establishing a new personal identity
Developing new friends
Other. Please specify:

3. What satisfactions have you experienced since regaining your balance?
Overcame feelings of being a widow
Managing my affairs
Handling bank accounts
At peace as a single person
Other. Please specify:

4. What is the experience with which you can identify when you realized that you had regained your balance?
Stopped crying; laughing more
Began socializing
Making plans for my future
Disposing of his possessions
Making my own decisions
Accepted widowhood/oneness
Comfortable in new roles
Other. Please specify:

5. Indicate any mutual support network which you joined as a widow and your reasons for joining:


6. Indicate support networks which you elected not to join and your reasons for not joining:


7. What new strengths have you discovered about yourself?


8. What new talents have you developed since your husband's death?



Part V. Mentoring Others
1. What advice would you give other women who are in long time marriages?


2. What advice would you give other widows who are going through bereavement?


3. What advice would you give to younger married women?


4. What programs or services would you like to see in place to benefit new widows?


5. Please use this opportunity to write any comments that you feel are pertinent to this type of study:



Part VI. Your Story
Please tell us your story or any part of it that you feel moved to write about. You should be guided by what you want to talk about and the fact the information that you provide may be useful to other widows. A list of themes has been included only to give you some ideas: family and other relationships (new and old), burial issues, financial issues, responsibilities before and after, spirituality, faith and hope, support networks, counseling or psychotherapy, great challenges, organizing affairs, relocating, negotiating insurance policies and wills, self-concept, self reliance, accepting that life is different, developing a plan for getting your life in order, moving on. If you have thoughts about related issues that have not been included, feel free to include them in your story.

Part VII. Demographics
1. What is your age?

2. Number of children?

3. Number of dependent children?

4. What is your religion?

5. What is your highest educational level? Select one:
High School Bachelors Masters Doctorate Professional
Other. Please specify:

6. In which section of the U.S. do you live?
South North East West Northeast Mid-Atlantic

Please give us information so that we may contact you should we wish to use specific quotes in the final report.
Name:
Address:
City: State: Zip Code:
Telephone number:
Best time to call:
Email address:

Please send me a copy of the final report.
I would like to be contacted to participate in an oral interview.
I would like to be contacted to join a support network.
I would like to be notified and given an opportunity to contribute to a newsletter.