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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?
2. How prepared were you for his passing?
3. Who assisted you with burial arrangements?
4. Who did you turn to for support during your bereavement?
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?
4. Did you take a job after your husband passed?
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.
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):
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?
2. What obstacles did you encounter in trying to regain your balance?
3. What satisfactions have you experienced since regaining your
balance?
4. What is the experience with which you can identify when you realized
that you had regained your balance?
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.
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