(PARTICIPANT INFORMATION)

Age: ___________

Gender: Male ( ) Female ( )

Marital Status: Married ( ) Single ( ) Divorced ( ) Separated ( ) Widow/Widower ( )

Number of children if any: _____________

Religious affiliation: Christian ( ) Muslim ( ) Traditional ( )

Ethnic Group: Igbo ( ) Hausa ( ) Yoruba ( ) others specify: ____________

Instruction: Please indicate the extent to which you agree with each statement. Choose the

response that best describes your experience. (1) Almost always (2) Some of the time (3) Hardly
ever

Note; There are no right or wrong answers. All information is anonymous and will be kept

confidential at all times.

S/N ITEMS Almost Some of the Hardly

always time ever
1. When something is troubling me, I am satisfied that I
can turn to my family for help by means of money,
advice/moral support, and spiritual guidance.

2. I am satisfied with the way my family talks on things

with me

3. I am satisfied with the way my family talks to me about

problems and their possible solutions.

4. I am satisfied that my family accepts my wishes to take

on new

5. I am satisfied that my family supports my wishes to

take on new activities or directions

6. I am satisfied with the way my family accepts and

values to my emotions such as love, joy, anger, sorrow,
others.
7. I am satisfied with the way my family expresses love
and affection for each other.
8. I am satisfied with my relationship with my spouse and
children.