MATERNAL BEHAVIOR SURVEY QUESTIONNAIRE
This survey is being conducted as a part of a study designed to develop programs the goal of which will be to prevent or reduce the incidence of child abuse. There are no right or wrong, correct or incorrect answers to the questions included in this survey. Please mark the response for each question which best describes your behavior. Please be honest in responding to the survey questions. Accurate responses are essential, if the goals of the study are to be attained. The confidentiality of your responses will be protected. No information will be collected or developed that will permit any connection to be made between individual responses to the survey questions and specific individuals participating in the survey.
Please indicate your age at the time of the birth of your first child.
( ) 16 20 years old ( ) 21 25 years old
Please indicate how many children you have had.
Please indicate how many of your children live with you now.
Is a husband, boyfriend, or significant other a part of your household now?
1. How often do you ever feel that your child (or children) is a burden that prevents you from enjoying life as you would like?
2. How often do you ever feel that your child (or children) is a burden that prevents you from getting ahead in life?
3. How often do you feel that your child (or children) is the cause of problems between you and your husband, boyfriend, or significant other?
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