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Maternal Journal Participant info sheet
Maternal Journal
1.
Which Maternal Journal group did you take part in - name and dates
2.
What is your gender identity?
Woman
Genderqueer or non-binary
Prefer not to answer
I prefer to self-identify as:
3.
Do you identify as transgender (or another non-cisgender identity)?
Yes
No
I prefer to self-identify as:
4.
What is your sexual orientation?
Asexual
Bisexual
Gay
Heterosexual or straight
Lesbian
Pansexual
Queer
Prefer not to answer
I prefer to self-identify as:
5.
What is your ethnic identity? (Select all that apply.)
Black African
Black Caribbean
Mixed African
Mixed Caribbean
Indian
Pakistani
Bangladeshi
Mixed Asian
Arab
Chinese
White British - England, Scotland, Wales, Northern Island
Irish
Traveller community
Other white
Other mixed
Other Ethnic group
Prefer not to say
None of the above, please specify...
6.
Do you identify as disabled/consider yourself to have a disability
Yes
No
Prefer not to say
7.
Is english your first language?
Yes
No
8.
What language(s) do you speak at home?
9.
Do you identify with any of the following religions? (Please select all that apply.)
Protestantism
Catholicism
Christianity
Judaism
Islam
Buddhism
Hinduism
Inter/Non-denominational
No religion
prefer not to say
Other (please specify)
10.
Are you a parent or caretaker of children?
Yes
No
Prefer not to say
11.
Are you a caretaker of adults?
Yes
No
Prefer not to say
12.
What age are you?
Under 18
18 - 24
25-34
35 - 44
over 45
Over 60
Prefer not to say
