Body

Questionnaire

Relationship Violence

Research questionnaire into the Information Needs of Couples in

Relationships with Physical and Non-Physical Violence

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Please fill in the spaces, tick boxes, where appropriate.

Age :

a) under 25

b) 26 - 35

c) 36 - 45

d) over 45

Sex :

a) female

b) male

Occupation :

a) employed

b) self employed

c) unemployed

d) homeworker

Racial/Cultural background:

a) African b) Asian c) European d)

other (please specify)

1) Have you ever been involved in a personal relationship with anyone (of either the opposite sex or the same sex)?

a) yes (go to next question)

b) no (go to question 22)

1.1) How many times have you been involved in a personal relationship?

a) once

b) 2 - 3 times

c) 4 - 6 times

d) 7 times and over

2) Are you currently involved in a personal relationship with anyone (of either the opposite sex or the same sex) ? a) yes (go to next question 2.1) b) no (go to question 3.)

2.1) Is your current relationship your first?

a) yes (continue)

b) no (go to question 3)

2.2) How long have you been involved in your current relationship?

a) less than 6 months

b) 6 months to 1 year

c) 1 - 2 years

d) 3 - 4 years

e) 5 - 6 years

f) 7 - 10 years

g) 11 - 15 years

h) over 15 years

2.3) Has this involvement been:

a) continuous without breaks?

b) on and off with breaks?

2.4) Has there ever been any violence in your relationship from either side?

a) yes (go to question 3.1)

b) no (go to question 4)

3) Have you ever been involved in a relationship where there was violence from either side?

a) yes (go to question 3.1)

b) no (go to question 4)

3.1) How many of the relationships you have been involved in included violence?

a) all of them

b) most of them

c) a few of them

d) two of them

e) one of them

3.2) Are you currently in a relationship where there has been violence?

a) yes (go to question 3.3)

b) no (go to question 3.4)

3.3) How long have you been involved in this relationship?

(go to table 1 and tick one box in column 3.3)

3.4) How long did the last relationship you had which included violence go on for?

(go to table 1 and tick one box in column 3.4)

	3.3			3.4
a		less than 6 months	a
b		6 months to 1 year	b
c		1 - 2 years	c
d		3 - 4 years	d
e		5 - 6 years	e
f		7 - 10 years	f
g		11 - 15 years	g
h		over 15 years	h

Table 1

3.5) Has this relationship been:

a) continuous without breaks?

b) on and off with breaks during the entire period?

4) Have you ever said anything designed to or intended to cause your partner/ex-partner injury, pain, discomfort or disadvantage?

a) yes (go to question 4.1)

b) no (go to question 5)

4.1) How often have you said any of these things?

a) all of the time

b) most of the time

c) sometimes but not very often

d) rarely

e) only once

4.2) How did your partner/ex-partner react?

a) showed no reaction

b) laughed it off

c) was obviously upset but did and said nothing

d) retaliated verbally

e) retaliated physically

f) other reaction (please explain briefly) ...................................................................................................

5) Have you ever done anything (apart from hitting your partner/ex-partner) which was designed to or intended to cause your partner/ex-partner injury, pain, discomfort or disadvantage?

a) yes (go to question 5.1)

b) no (go to question 6)

5.1) How often have you done any of these things?

a) all of the time

b) most of the time

c) sometimes but not very often

d) rarely

e) only once

5.2) How did your partner/ex-partner react?

a) showed no reaction

b) laughed it off

c) was obviously upset but did and said nothing

d) retaliated verbally

e) retaliated physically f) other reaction (please explain briefly) ..................................................................................................................................

6) Has your partner/ex-partner ever said anything which you felt was designed to or intended to cause you injury, pain, discomfort or disadvantage?

a) yes (go to question 6.1)

b) no (go to question 7)

6.1) How often did your partner/ex-partner say such things?

a) all of the time

b) most of the time

c) sometimes but not very often

d) rarely

e) only once

6.2) How did you react?

a) showed no reaction

b) laughed it off

c) you were upset but did and said nothing

d) you retaliated verbally

e) you retaliated physically

f) other reaction (please explain briefly) ................................................................................................................................................

7) Has your partner/ex-partner ever done anything (apart from hitting you) which you felt was designed to or intended to cause you injury, pain, discomfort or disadvantage?

a) yes (go to question 7.1)

b) no (go to question 8)

7.1) How often did your partner/ex do any of these things?

a) all of the time

b) most of the time

c) sometimes but not very often

d) rarely

e) only once

7.2) How did you react?

a) showed no reaction

b) laughed it off

c) you were upset but did and said nothing

d) retaliated verbally

e) retaliated physically

f) other reaction (please explain briefly)

......................................................................

........................................................................

8) Did you or your partner/ex-partner ever impose any rules, regulations, conditions, or ultimatums on each other which were designed to, intended to or actually did restrict or dictate each other's movement or suppress their expression in any way?

(please tick one or more)

a) your partner/ex-partner always did

b) your partner/ex-partner most of the time

c) your partner/ex-partner sometimes but not often

d) you and your partner/ex-partner equally sometimes

e) you sometimes but not often

f) you most of the time

g) you always did

h) neither of you ever did

8.1) If you ticked any of a) to g), give 3 examples of the kinds of rules which were imposed.

1) ......................................................................................

..................................................................................

2) ......................................................................................

.................................................................................

3) .............................................................................

...................................................................................

9) How would you define violence in your own words?

..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................

10) Do you believe there are any other forms of violence apart from physical violence?

a) yes (go to question 10.1)

b) no (go to question 11)

10.1) How many forms of violence can you identify?

please list:.................................................................

..........................................................................................

.........................................................................................

..................................................................................

11) Whenever there was any violence in your relationship, who would you say committed it? a) your partner/ex-partner

b) you

c) both of you

11.1) What form did this violence take?

a) physical

b) emotional

c) psychological

d) social

e) spiritual

11.2) How often did violence occur?

a) all of the time

b) quite often

c) not often

d) once

12) How did you react to violence against you?

a) apologised for what you had done to cause it

b) pretended it did not happen

c) you said you deserved it anyway

d) you said he/she was wrong to treat you that way

e) you reported it to a third party (e.g. took legal action)

f) you retaliated verbally and/or physically

g) you terminated the relationship

h) other reaction (explain briefly)

................................................................................

.................................................................................

13) How did your partner/ex-partner react to violence by you against her/him?

a) apologised for what they had done to cause it

b) pretended it did not happen (did nothing)

c) he/she said they deserved it anyway

d) he/she said you were wrong to treat them that way

e) he/she reported it to a third party (e.g. took legal action)

f) he/she retaliated verbally and/or physically

g) he/she terminated the relationship

h) other reaction (explain briefly)

...................................................................................

....................................................................................

14) How much of what has happened in the relationship can you say was good?

a) everything

b) most things

c) some things

d) very few things

e) nothing at all

14.1) Who would you say was responsible for the good things (if any)?

a) you entirely

b) you mostly

c) you and your partner/ex-partner equally

d) your partner/ex-partner mostly

e) your partner/ex-partner entirely

15) How much of what has happened in the relationship can you say was bad?

a) everything

b) most things

c) some things

d) very few things

e) nothing at all

15.1) Who would you say was responsible for the bad things (if any)?

a) you entirely

b) you mostly

c) you and your partner/ex-partner equally

d) your partner/ex-partner mostly

e) your partner/ex-partner entirely

16) Whenever there was any "problems" between you which may or may not have resulted in violence, were they resolved by: (tick one or more as appropriate):

a) calm discussion between you

b) heated argument

c) physical violence

d) arbitration/intervention from a third party (e.g. friend, relative, counsellor, legal, police)

e) doing nothing and hoping things will "blow over" with the passage of time

f) the "kiss-and-make-up" method

g) other means (please specify)

....................................................................................

..................................................................................

h) never resolved at all

17) Do you feel that you and your partner/ex-partner communicate(d) readily ?

a) always (go to question 17.1)

b) sometimes (go to questions 17.1 and 17.2)

c) not at all (go to question 17.2)

17.1) What do/did you talk about? (please tick one or more items)

a) sex

b) other people

c) her/his job

d) your job

e) current affairs and politics

f) T.V. programmes

g) money

h) your relationship

i) anything and everything

j) other (please specify)

17.2) Was the difficulty in communication due to:

a) your partner/ex's inability to communicate

b) your own inability to communicate

c) both of you equally

d) lack of information on the subjects at hand

e) other (please specify)

18) Do you feel that there is adequate information available to couples about preventing violence or resolving problems in their relationships?

a) yes (go to question 18.1)

b) no (go to question 18.2)

18.1) Can you give examples of some sources of such information?

18.2) What kind of information do you think would have been helpful to you in preventing violence in your relationship?

18.3) What kind of information would you like to see available to couples in future?

19) Have you or your partner/ex-partner ever tried to get information from outside agencies or individuals in your attempts to resolve any problems between you?

a) yes (go to question 19.1)

b) no (go to question 19.2)

19.1) What was the result?

a) the information received helped to resolve the

problem

b) the information received helped but did not

resolve the problem

c) the information received did not help at all

d) no information was available or obtained

e) other (please specify)

19.2) Why not?

20) Do you feel generally, that your information needs with regards relationship violence have been satisfied ? (please tick one or more items)

a) by your efforts

b) by your partner/ex-partner's efforts

c) by the level of communication between you

d) by information received from third parties

e) not resolved at all

21) How much has this relationship been typical of your other involvements in terms of the amount, type or lack of violence between you?

a) very typical

b) sort of typical

c) sort of untypical

d) very untypical

22) Is your answer to question 1.(b) because:

a) you are too young

b) you do not understand the question

c) you have a particular definition of the term "personal relationship" that falls outside the scope of this questionnaire, if so please give a brief explanation:

23) Finally, is there anything you wish to add which you feel have been overlooked and may be of use to the research? (Please use a separate sheet of paper if necessary).