Hi, my name is Jamey and I am trying to get some volunteers to fill out a VERY short survey for my school project. In particular I am hoping to get fellow parents an that's why I am posting here. If you are interested, simply fill the form out below and email to "[email protected]
" or "[email protected]
Consent to Participate in Research (email version)
My name is Jamey F. Maine. I am a student at Saint Leo University conducting a study on perceived social support and overall life satisfaction. You have been selected to participate in this study. If you do agree to participate in this study, you will be asked to complete two surveys. Your participation is completely voluntary and you can change your mind at any time and withdraw from the research.
Participation involves completion of a questionnaire, and takes about ten minutes.
You are absolutely free to choose not to participate; participation is completely voluntary.
If you choose to participate, you are free to stop your participation in the questionnaire at any time.
This study will include only adults over the age of 18. Results will be averaged. No individual scores or feedback will be given. No names will be used in the report on this project.
The information gathered from this study will be strictly confidential and your privacy will be carefully protected. Your name will not be used. Should the results of this study be published or presented in any form, your name or other identifying information will not be revealed.
If you have any questions please contact:
Principle Investigator: Jamey F. Maine (757) 846-1458
Faculty Investigator (if student project): Dr. Stephen Madonna
Telephone: (813) 654-7649
Research-related injury: In the event that you suffer injury St. Leo University is not responsible. However, should you suffer any adverse consequences resulting from your participation, please contact Stephen Madonna at (813) 654-7649 or at email@example.com
for a referral to the appropriate source of assistance.
Research-related injury: In the event that you suffer injury St. Leo University is not responsible.
I am 18 years of age or older. (Type YES or NO in the following bracket) [ ]
I understand that participation is voluntary and I can change my mind at any time for any reason.
(Type YES or NO in the following bracket [ ]
I agree to participate. Type YES or NO in the following bracket) [ ]
Ethnic Background: ______________
Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet & Farley, 1988)
Instructions: We are interested in how you feel about the following statements. Read each statement carefully. Indicate how you feel about each statement.
Circle the 1 if you Very Strongly Disagree
Circle the 2 if you Strongly Disagree
Circle the 3 if you Mildly Disagree
Circle the 4 if you are Neutral
Circle the 5 if you Mildly Agree
Circle the 6 if you Strongly Agree
Circle the 7 if you Very Strongly Agree
1. There is a special person who is around when I am in need. 1 2 3 4 5 6 7
2. There is a special person with whom I can share my joys and sorrows. 1 2 3 4 5 6 7
3. My family really tries to help me. 1 2 3 4 5 6 7
4. I get the emotional help and support I need from my family. 1 2 3 4 5 6 7
5. I have a special person who is a real source of comfort to me. 1 2 3 4 5 6 7
6. My friends really try to help me. 1 2 3 4 5 6 7
7. I can count on my friends when things go wrong. 1 2 3 4 5 6 7
8. I can talk about my problems with my family. 1 2 3 4 5 6 7
9. I have friends with whom I can share my joys and sorrows. 1 2 3 4 5 6 7
10. There is a special person in my life who cares about my feelings. 1 2 3 4 5 6 7
11. My family is willing to help me make decisions. 1 2 3 4 5 6 7
12. I can talk about my problems with my friends. 1 2 3 4 5 6 7
The items tended to divide into factor groups relating to the source of the social support, namely family (Fam), friends (Fri) or significant other (SO).
Canty-Mitchell, J. & Zimet, G.D. (2000). Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. American Journal of Community Psychology, 28, 391-400.
Zimet, G.D., Dahlem, N.W., Zimet, S.G. & Farley, G.K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52, 30-41.
Zimet, G.D., Powell, S.S., Farley, G.K., Werkman, S. & Berkoff, K.A. (1990). Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 55, 610-17.
Satisfaction with Life Scale (Diener, Emmons, Larsen & Griffin, 1985)
Instructions: Below are five statements that you may agree or disagree with. Using the 1-7 scale below, indicate your agreement with each item by placing the appropriate number in the box to the right of the statement. Please be open and honest in your responding.
7 Strongly agree
5 Slightly agree
4 Neither agree nor disagree (Neutral)
3 Slightly disagree
2 - Disagree
1 Strongly disagree
1. In most ways, my life is close to ideal. ____
2. The conditions of my life are excellent. ____
3. I am satisfied with my life. ____
4. So far, I have gotten the important things I want in life. ____
5. If I could live my life over, I would change almost nothing. ____
31-35 Extremely satisfied
21-25 Slightly satisfied
15-19 Slightly dissatisfied
5 - 9 Extremely dissatisfied
Diener, E., Emmons, R.A., Larsen, R.J., & Griffin, S. (1985). The Satisfaction with Life Scale. Journal of Personality Assessment, 49, 1-5.
Pavrot, W., & Diener, E. (1993). Review of the Satisfaction with Life Scale. Psychological Assessment, 5, 164-172.