Community Activity Initiative

Community-based activity for Spinal Cord Injury (SCI).

The survey is confidential, and will remain anonymous. No personally identifying demographic data is collected, and you won't contacted by anyone regarding your responses.

When completing the survey data, please tick the applicable questions and respond with written text where prompted.

Question Title

1. Are you a self-propelled wheelchair user?

Yes

Question Title

2. Which one of the following conditions best describes the reason for your wheelchair use?

Incomplete Spinal Cord Injury

Complete Spinal Cord Injury

Other (please specify)

Question Title

3. What age group do you belong to?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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4. What is your gender?

Male

Female

Transgender

Non-binary / non-conforming

Prefer not to answer

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5. What is your ethnic group

Asian or Asian British

Indian

Pakistani

Bangladeshi

Chinese

Black British

Black Caribbean

African

Any other Black, Black British or Caribbean background

White and Black Caribbean

White and Black African

White Asian

Any other Mixed or multiple ethnic background

English

Irish

Roma

Arab

Any other white background

Prefer not to say

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6. Which borough/district do you live in?

Birmingham

Dudley

Solihull

Walsall

Coventry

Sandwell

Stourbridge

Wolverhampton

Halesowen

Aldridge/Brownhills

Other (please specify)

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7. Do you currently engage in community activities?

Yes, roughly once per week

Yes, roughly twice per week

Yes, roughly three times per week

Yes, More than five times per week

If no, please state the reason.

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8. Are you interested in gaining a new hobby or skill?

Yes

If you answered no, please state the reason

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9. Would you be interested in the following community activities if they were available?

Drawing and painting

Embroidery and sewing

Carpentry and Joinery

Pottery and ceramics

Other (please specify)

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10. What is the maximum distance will you travel to engage in a community activity?

0-4 Miles

5-9 Miles

10-14 Miles

15-19 Miles

20-25 Miles

30-40 Miles

Over 50 miles

None of the above (please specify)