Self-Help Group Impact Interview
Help us understand the impact of self-help group participation by sharing your experiences and feedback.
Participant Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name of Self-Help Group
*
How long have you been participating in this group?
*
Please Select
Less than 3 months
3-6 months
6-12 months
More than 1 year
How often do you attend group meetings?
*
Weekly
Bi-weekly
Monthly
Occasionally
Please rate the following aspects of your experience with the self-help group.
*
Rows
Not at all
A little
Somewhat
Very much
Extremely
Feeling supported
1
2
3
4
5
Gaining new skills
6
7
8
9
10
Sense of belonging
11
12
13
14
15
Improvement in well-being
16
17
18
19
20
Ability to cope with challenges
21
22
23
24
25
What benefits have you experienced as a result of participating in the group? (Select all that apply)
*
Improved mental health
Better coping skills
Expanded social network
Increased confidence
Access to resources
Other
Please share a specific example of how the group has positively impacted your life.
What challenges, if any, have you faced while participating in the group?
Please provide any suggestions for improving the self-help group experience.
Submit Interview
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