Experience Journal

	Experience Journal

This 14-item questionnaire is our attempt to find out if visiting this website is helpful for families. It is valuable for us to know in what ways the Experience Journal is helpful or unhelpful and in what ways it could be improved.

We are interested in both positive and negative impressions. There are no right or wrong answers to these questions; we are interested in your reactions and ideas about the Experience Journal. All answers are confidential. This questionnaire will be assigned a project number - your name/e-mail address will not appear on any material or report. You do not have to answer questions if they make you feel uncomfortable.

1. Overall, how satisfied are you with the Experience Journal?
1- Not at All	2	3	4-Moderately	5	6	7-Extremely

2. How satisfied are you with the way "people's stories regarding childhood illness" are presented in the Experience Journal?
1-Not at All	2	3	4-Moderately	5	6	7-Extremely

3. Did you feel the Experience Journal was hurtful?
1-Not at All	2	3	4-Moderately	5	6	7-Extremely

4. Did the Experience Journal give you any sense that there are others who are also facing the same issues of raising a child with your child's llness?
1-Not at All	2	3	4-Moderately	5	6	7-A Great Deal

5. Did you find it helpful to read about other families' experiences or stories about living with their child's illness?
1-Not at All	2	3	4-Moderately	5	6	7 -A Great Deal

6. Did the Experience Journal increase your sense of hope?
1-Not at All	2	3	4-Moderately	5	6	7-A Great Deal

7. Which Experience Journal are you evaluating?
ADHD	Asthma	Cardiac	Depression	IBD	Overweight	Transplant


It is important to know something about your family, so we request some demographic information. Only grouped data will be used, and you will never be identified. However, if you prefer not to answer any or all of these questions, you may freely do so.
Your age:
Under 20 21-25 26-35 36-45 46-55 55+
Your gender:
Male Female
Your relationship to child:
Mother Father Other
If "Other", please specify:
Your race:
African American/Black American Indian/Alaska Native Asian Caucasian/White Native Hawaiian/Pacific Islander Prefer not to answer Other
If "Other", please specify:
Your ethnic background:
Caucasian/White African American/Black Hispanic/Latino Prefer not to answer Other
If "Other", please specify:
Your education level:
Grade 8 or less Some high school High school grad Some college College grad Some post grad Masters, PhD, MD, etc...
Age of child:
Less than 1 Year 1-5 6-12 13-18 Over 18

Gender of child: Male Female

Children's Hospital Boston