Supervisor
School of Psychology University of KwaZulu - Natal (Westville Campus)
APPENDIXD
DEMOGRAPIDC INFORMATION I (Caregivers in a support group)
The information provided by you will be used solely for the purpose of the research, the latter being a prerequisite for the partial completion of the degree of Masters of Arts in Clinical Psychology. This information will be treated with high confidentiality.
1. Age (incomplete years) _ _
2. Are you Male or Female?- - - - -
3. Relationship to the patient (mother, spouse, sister etc)- - - -
4. Duration of the patient's illness _
5. Age of patient _
6. Gender of the patient _ 7. Specify patient's illness _
8. Highest educational level: make an X at the one that describes you Primary education _ _
High school education- - - Post matric qualification- - - - Other (specify) _
9. Are you living in a rural or urban area?
- - - -
10. How many people in the household?
- - - - - 11. MontWy income per household
R 500 - R 1000
R 1000 - R2000 R 2000 - 3000 _ _ Higher than R 3000 _
12. Are you in a group that helps you?
Yes
13. How often do you meet? _
14. Where do you get your support? _
15. What exactly do they do? _
16. Who is allowed to attend? _
17. What exactly does the support group do for you? _
18. Does the support group (the helps you) meet the needs it promised to offer?
Yes- - -
No (Ifno answer 19)
19. What activities would you like to see happening in the support group?
APPENDIXE
DEMOGRAPHIC INFORMATION II (Caregivers not affiliated to a support group)
The information provided by you will be used solely for the purpose of the research, the latter being a prerequisite for the partial completion of the degree of Masters of Arts in Clinical Psychology. This information will be treated with high confidentiality.
1. Age (in complete years) _ _
2. Are you Male or Female? _
3. Relationship to the patient (mother, spouse, sister etc)- - - -
4. Duration of the patient's illness _
5. Age ofpatient _
6. Gender of the patient- - - -
7. Specify patient's illness- - - -
8. Highest educational level: make an X at the one that describes you Primary education _ _
High school education- - - Post matric qualification- - - - Other (specify) _
9. Are you living in a rural or urban area?
- - - - 10. How many people in the household?
- - - - - 11. Monthly income per household
R 500 - R 1000
R 1000 - R2000 R2000 - 3000 _ _ Higher than R 3000 _ _
12. Are you in a group that helps you?
No
13. Where do you get your support? _
14. What exactly do they do? _
APPENDIXF
GENERAL WELLBEING SCHEDULE(Dupuy, 1977)
This part contains questions about how you have been feeling and how things have been going since you have been caring for your relative. Answer each question by circling the number of the description which best applies to you.
1. How have you been feeling in general?
1. Inexcellent spirits.
2.Invery good spirits.
3.Ingood spirits mostly.
4. I have been up and down in spirits a lot.
5. Inlow spirit.
6.Invery low spirits.
2 Have been bothered by nervousness or your nerves?
1. Extremely so, to the point where I could not work or take care of things.
2. Very much.
3. Quite a bit
4. Sometimes, enough to bother me.
5. A little 6. Not at all.
3. Have you been in firm control of you behaviour, thoughts, emotions, or feelings?
1.Yes, definitely so.
2. Yes, for most part.
3. Generally so.
4. Not too, well so.
5. A little 6. Not at all
4. Have you felt so sad, discouraged, and hopeless or had many problems that you wondered if anything was worthwhile?
1. Extremely so, to the point that I have just about given up.
2. Very much so.
3. Quite a bit.
4. Sometimes enough to bother me.
5. A little, bit.
6. Not at all.
5. Have you been under or felt you were under strain, stress, or pressure?
1. Yes almost more than I could bear it or stand it.
2. Yes quite a bit of pressure.
3. Yes, some more than usual.
4. Yes, some but usual.
5. Yes, a little bit.
6. Not at all
6. How happy, satisfied or pleased have you been with your personal life?
1. Extremely happy - could not have been more satisfied or pleased.
2. Very happy.
3. Fairly happy.
4. Satisfied - pleased.
5. Somewhat dissatisfied.
6. Very dissatisfied.
7. Have you had any reason to wonder if you were losing your mind or losing control over the way you act, think, feel or of your memory?
1. Not at all.
2. Only a little
3. Some, but not enough to be worried about.
4. Some, and have been a little concerned.
5. Some and I am quite concerned.
6. Yes, very much so and I am very concerned.
8. Have you been always anxious, worried or upset?
1 Extremely so, to the point of being sick, almost sick 2. Very much so
3. Quite a bit.
4. Sometimes enough to bother me.
5. A little bit.
6. Not at all.
9. Have you been waking up fresh and rested?
1. Every day.
2. Most of days.
3. Fairly often
4. Less than half the time.
5. Rarely
6. None of the time.
10. Have you been troubled by illness, bodily disorder, pains or fears about your health?
1. All the time.
2. Most of the time.
3. A good bit of the time.
4. Some of the time.
5. A little of the time.
6. None of the time.
11. Has your daily life been full of things that were interesting to you?
1. All the time.
2. Most of the time.
3. A good bit of the time.
4. Some of the time.
5. A little bit of the time.
6. None of the time.
12. Have you felt down - hearted or blue?
1. All the time.
2. Most of the time.
3. A good bit of the time.
4. Some of the time.
5. A little bit of the time.
6. None of the time.
13. Have you been feeling emotionally stable and sure of your self?
1. All the time.
2. Most of the time.
3. A good bit of the time.
4. Some of the time.
5. A little bit of the time.
6. None of the time.
14. Have you felt tired, worn out, used up or exhausted?
1. All the time.
2. Most of the time.
3. A good bit of the time.
4. Some of the time.
5. A little bit of the time.
6. None of the time.
For each of the four scales below, note that the words at each end of the 0 to 10 scale describe opposite feelings. Circle any number along the bar, which seems closest to how you began are feeling at present.
15. How concerned or worried about your life have you been?
o
1 2 3 4 5 6 7 8 9 10very concerned Not
all concerned
16. How relaxed or tense have you been?
o
1 2 3 4 5 6 7 8 9 10Very relaxed very tense
17. How much energy, pep, and vitality have you felt?
o
2 3 4 5 6 7 8 9 10No energy at all very energetic
18. How depressed or cheerful have you been?
o
1 2 3 4 5 6 7 8 9 10Very depressed very cheerful
APPENDIXG
THESOCIAL SUPPORT APPRAISALSCALE(Vaux et ai, 1986)
Below is a list of statements about your relationship with family, friends and other people. Please
Indicate how much you agree or disagree with each statement. Circle the appropriate response.
1. My friends 1 2 3 4
respect me. Strongly agree Agree Disagree Strongly disagree
2. My family 1 2 3 4
cares for me Strongly agree Agree Disagree Strongly
very much. disagree
3. I am not 1 2 3 4
important to Strongly agree Agree Disagree Strongly
others. disagree
4. My family 1 2 3 4
holds me In Strongly agree Agree Disagree Strongly
high esteem. disagree
5. I am well 1 2 3 4
liked. Strongly agree Agree Disagree Strongly
disagree
6. I can rely on 1 2 3 4
my friends. Strongly agree Agree Disagree Strongly
disagree
7. I am really 1 2 3 4 admired by my Strongly agree Agree Disagree Strongly
family. disagree
8. I am 1 2 3 4
respected by Strongly agree Agree Disagree Strongly
other people. disagree
9. I am loved 1 2 3 4
dearly by my Strongly agree Agree Disagree Strongly
family. disagree
10. My friends 1 2 3 4
don't care Strongly agree Agree Disagree Strongly
about my disagree
welfare.
11. Members 1 2 3 4
of my family Strongly agree Agree Disagree Strongly
rely on me disagree
12. I am held 1 2 3 4
in high esteem. Strongly agree Agree Disagree Strongly disagree
13. I can rely 1 2 3 4
on my family Strongly agree Agree Disagree Strongly
for support. disagree
l4.People 1 2 3 4
admire me. Strongly agree Agree Disagree Strongly
disagree
15. I feel a 1 2 3 4 strong bond Strongly agree Agree Disagree Strongly
with my disagree
family.
16. My friends 1 2 3 4
look out for Strongly agree Agree Disagree Strongly
me. disagree
17. I feel 1 2 3 4
valued by Strongly agree Agree Disagree Strongly
other people. disagree
.
18. My family 1 2 3 4
really respects Strongly agree Agree Disagree Strongly
me. disagree
19. My friends 1 2 3 4
and I are really Strongly agree Agree Disagree Strongly
important to disagree
each other.
20. I feel like I 1 2 3 4
belong. Strongly agree Agree Disagree Strongly
disagree
21. If I die 1 2 3 4
tomorrow, Strongly agree Agree Disagree Strongly
very few disagree
people will mISS me.
22. I don't feel 1 2 3 4
close to Strongly agree Agree Disagree Strongly
members of disagree
my family.
23. My friends 1 2 3 4
and I have Strongly agree Agree Disagree Strongly
done a lot for disagree
one another.