BreakThrough Wrap Up - SmartLoving

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We would like to ask you to now take the time to take impact quiz again to compare your results, nd complete a feedback survey so that we can improve the course.

Impact Quiz

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Step 1 of 11

Phone

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Part I

Thinking about your relationship in the past week (if it wasn't a typical week, answer in terms of a typical week in the past month)...

1. How would you rate your personal contentment in your relationship?*

Very Discontented	Discontented	Neutral	Contented	Very Contented

2. How often did you think that things were going well between you?*

Never or rarely	Sometimes	Mostly	Always

3. How safe and at ease did you feel in your relationship?*

Never or rarely	Sometimes	Mostly	Always

4. How often did you feel hurt or disappointed in your relationship?*

Never	Once or twice	Almost daily	Lost Count

5. How often did you connect on a significant level?*

Never	Once or twice	Almost daily	Lost Count

6. How often did you laugh or have fun together?*

Never	Once or twice	Almost Daily	Lost Count

7. How often did you have time together (of 10+ mins) for just the two of you?*

Never	Once or twice	Almost daily	Lost Count

8. How equitable do you think your relationship is (ie both are contributing)?*

None	A Little	Acceptable	Good

9. How often did you argue or disagree?*

None	Once or twice	3-4 Times	Every day	Lost Count

10. How many positive to negative interactions did you have?*

Only Negative	Mostly Negative	About Even	Mostly Positive	Only Positive

11. How often were you physically intimate (sex, kissing, caressing, other non-genital touch etc)?*

Never	Once	Twice	Three times	Four times	Lost Count

Part 2

Thinking about yourself in the past week…

12. How often did you make a gesture of kindness or service towards the other?*

None	Once	Twice	3-4 Times	Every day	More than Daily

13. How often did you express affection towards the other?*

None	Once	Twice	3-4 Times	Every day	More than Daily

14. How often did you express gratitude and appreciation to the other?*

None	Once	Twice	3-4 Times	Every day	More than Daily

15. How often did you speak or act in anger towards the other?*

None	Once	Twice	3-4 Times	Every day	More than daily

16. How often did you criticise or negatively judge the other?*

None	Once	Twice	3-4 Times	Every day	More than daily

17. How often were you dishonest with the other (withheld information, kept a secret, misled or lied)?*

None	Once	Twice	3-4 Times	Every day	More than Daily

18. How much did you grow or develop as a person?*

Went Backwards	No Growth	Grew a Little	Grew a Lot

19. How committed are you to becoming a better husband/wife?*

Not at all	Somewhat	A little	Totally

20. How hopeful are you with regards to the future of your relationshiip?*

Total Despair	Despair	Cautiously Hopeful	Extremely Hopeful

Your Sex*

Male

Female

Relationship Status*

Dating

Cohabitating/Defacto

Engaged

Married

Remarried

Separated

Divorced

Other

Sexual Status*

Please select the one that best describes your relationship.

Pre-sexual - some physical intimacy but no intercourse

Sexual - includes genital intercourse

Post-sexual - were previously sexual but are not currently so.

Other

What SmartLoving course did you do?

Discern

Engaged

Fertility

Sponsor

Newlywed

Marriage Kit

Breakthrough

Theology

Other

Name*

First

Email*

We need this so that our system can send you a reminder in 6 months time to do the quiz again.

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Feedback

"*" indicates required fields

1Impact

2Rate

3Comment

4Promotion

5Demographics

Impact

How did you engage with the BreakThrough material?*

Enrolled in the Online course

Did the course on my own

Did the course with my spouse

I did the course with a friend

I had a BreakThrough Companion

I had a SL Coach

I attended an in-person event

I attended an Online group event

Other

How did you use the Participant notes?

I had a print copy and pen

I used the interactive PDF

I used a notebook to answer the questions

What participant notes? I didn't know it existed

Do you plan to do the 40-day Gratitude Challenge?

Do you plan to use the TaNGo tool?

Time out | Needs | Gratitude

Do you plan to use the Daily Prayer for My Marriage?

How would you describe your emotions about your marriage before BreakThrough?

How would you describe your emotions about your marriage after BreakThrough?

How has BreakThrough benefited you and your marriage

Are you interested in... (check all that apply)

Having a SL Coaching session?

Doing other SL online courses?

Attending a SL Marriage Weekend Seminar?

Attending a live Workshop?

Hosting a SL event or course in your community?

Training to be a BreakThrough companion?

Rate BreakThrough on the following:

1. Information presented about relationships and arguments

2. Video presentation style

3. Reflection points and activities

4. Practical Strategies

5. Prayer

6. Being able to complete the course without your spouse

Comments/Suggestions

Do you have any suggestions to improve BreakThrough and/or suggestions for topics?

Promotion

1. How did you hear about BreakThrough? Tick all that apply and give details below.

Spouse

Recommendation by SmartLoving participant

Other person

Parish bulletin/website

Internet Search

Social Media (which one)

SmartLoving eNews

Brochure/Flyer/Poster (where did you get it)

Other (give details below)

Extra details

2. What factors were most influential in your decision to participate? (tick all that apply)

Encouragement from priest/deacon/minister

Recommendation of past attendee

Recommendation of counsellor

Endorsement of the workshop by the diocese/Bishop

Our marriage needed the support

Looked like something I/we would benefit from

Have already tried counselling

On-demand - available immediately

Live event in my local area

Privacy from the community

Privacy from my spouse

Minimal cost

Gift certificate/subsidised access

Other/extra details

Demographic Information

Your Name

First Last

Sex*

Age*

State of Life/Marital Status*

Years Married

Number of Children

Religion

How often do you attend Church?

We would like to ask you to now take the time to take impact quiz again to compare your results, nd complete a feedback survey so that we can improve the course.

Impact Quiz

Part I

Part 2

Feedback

Impact

Rate BreakThrough on the following:

Comments/Suggestions

Promotion

Demographic Information

SmartLoving

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