Self Perception and Relationship Tool (S-PRT)

Personal and Interpersonal Dimensions of Experience

When illness and disability strike, we have many different feelings and thoughts.  There are parts of our coping with illness that may receive less attention over the course of care.  This survey will allow you to describe how you and your relationships have been affected by illness and disability.  With this information, and your permission, your caregivers will be able to better understand your needs and support you in your personal journey of healing.

Instructions for Completing the Questionnaire

Please read each group of double-ended word pairs below.  There is a 7-point rating scale between each word pair.  Please take time to think about each of the pairs of words and your own experiences over the last few days.  Then rate where you feel your experiences lie by filling in one bubble per line which best represents your choice.  There are no right or wrong answers.  

 
SPRT_1 Within My Illness Experience, I Feel I Am:  (Intrapersonal Well-being)
    Nearly Always Much More Often More Often Equally More Often Much More Often Nearly Always  
a Relaxed Tense
b Comfortable Uncomfortable
c At Ease In Agony
d Composed Distraught
e Optimistic Discouraged
f Confident Unsure
g Capable Helpless
g Certain Uncertain

SPRT_2 My Relationships Help Me Feel I Am:  (Interpersonal Receptiveness)
    Nearly Always Much More Often More Often Equally More Often Much More Often Nearly Always  
a Valued Worthless
b Comforted Distressed
c Close Distant
c Connected Isolated
d Included Excluded
e Supported Blamed
f Accepted Criticized

SPRT_3 Towards Those Who Are Emotionally Close to Me, I Feel I Am:  (Interpersonal Contribution)
    Nearly Always Much More Often More Often Equally More Often Much More Often Nearly Always  
a Forgiving Resentful
b Welcoming Unreceptive
c Accepting Rejecting
d Encouraging Discouraging
e Trusting Distrusting
f Understanding Misunderstanding
g Respectful Disrespectful

SPRT_4 Universal Beliefs & Principles or a Divine Presence Help Me Feel I Am:  (Spiritual Well-being - Receptiveness)
    Nearly Always Much More Often More Often Equally More Often Much More Often Nearly Always  
a Inspired Uninspired
b Comforted Troubled
c Accepted Judged
d Guided Aimless
e Embraced Rejected
f In Harmony Out-of-Step
g Sustained Adrift

SPRT_5 Towards Universal Beliefs & Principles or a Divine Presence I Feel I Am:  (Spiritual Well-being - Orientation)
    Nearly Always Much More Often More Often Equally More Often Much More Often Nearly Always  
a Listening Ignoring
b Receptive Closed
c Thankful Demanding
d Accepting Critical
e Approaching Receding
f Willing Resisting
g Connecting Separating

 

For an electronic version please visit our website at http://www.s-prt.com/. We would appreciate hearing from you, by contacting us below with your feedback on the S-PRT; what you find useful or limiting about this instrument.

Mark Atkinson, MEd, PhD
Voluntary Associate Clinical Professor
Dept of Family & Preventive Medicine
University of California, San Diego

UCSD Health Services Research Center
5440 Morehouse Dr. Suite 3500
San Diego CA 92121

Phone: (619) 559-9005
VoIP: (619) 618-0243
Fax: (858) 622-1790
Email: mjatkinson@ucsd.edu

Paul M. Wishart, PhD, MA, 
Adjunct Assistant Professor, Department of Surgery
Faculty of Medicine, University of Calgary
Calgary, Alberta, Canada

President, Spirituality Research Institute (Sri) Inc.
24 Edgebrook Rd, NW
Calgary, AB
Canada T3A 4M1

Phone: (403) 208-3431
Email: pmwishart@shaw.ca