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Questionnaire template

Motherhood Experience

Explores mothers' family situation, day-to-day wellbeing, support networks and work-family balance.

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Questions in this template

About You and Your Family

  1. Thank you for sharing your experience of motherhood. Your answers are confidential and will help shape support for mothers and families.

  2. How old are you?

    Choose one:

    • Under 20
    • 20-24
    • 25-29
    • 30-34
    • 35-39
    • 40-44
    • 45 or older
    • Prefer not to say

  3. How many children do you have?

    A number from 1 to 15

  4. How old is your youngest child?

    Choose one:

    • Under 1 year
    • 1-2 years
    • 3-5 years
    • 6-12 years
    • 13-17 years
    • 18 years or older

Day-to-Day Wellbeing

  1. Thinking about the past month, how much do you agree with each statement?

    • I feel confident in my role as a parent
    • I get enough rest
    • I have some time for myself
    • I feel connected to other parents

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

  2. In the past month, how often have you felt overwhelmed by everyday demands?

    Choose one:

    • Never
    • Rarely
    • Sometimes
    • Often
    • Very often

Support

  1. Who do you regularly turn to for practical or emotional support? Select all that apply.

    Choose any that apply:

    • Partner
    • Family
    • Friends
    • Other parents
    • Health professionals
    • Online communities
    • Paid childcare
    • No regular support

  2. How satisfied are you with the support you receive?

    Condition: Shown when at least one source of support was selected

    Choose one:

    • Very dissatisfied
    • Dissatisfied
    • Neither satisfied nor dissatisfied
    • Satisfied
    • Very satisfied

  3. What kind of support would make the biggest difference to you?

    Open answer

Work and Family Life

  1. Which best describes your current work situation?

    Choose one:

    • Employed full time
    • Employed part time
    • Self-employed
    • On parental leave
    • Not in paid work
    • Other

  2. How much do you agree with each statement about combining work and family?

    Condition: Shown to respondents in paid work

    • I can balance my work and family responsibilities
    • My working hours are flexible enough for my family's needs
    • I can take time off when my child needs me

    For each row: choose one:

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree

Final Thoughts

  1. Is there anything else you would like to share about your experience as a mother?

    Open answer