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Baseline Interview: Financial Distress/Financial
Well-Being Scale
Record ID.
__________________________________
Baseline Interview: Financial Distress & Wellbeing
(Please repeat the reminder below if it has not been provided during this interview session.)
Reminder about resources to help you cope with distress.
When you enrolled in this study, you were provided with a list of resources to help you cope
with negative feelings and reactions to these interviews. These resources can also help you
with other problems in your life not related to the study.
If you do not remember receiving this information, we will provide it to you immediately
following this interview.
Interview prompt:
"Now I'll ask you a few more questions about your financial history."
What do you feel is the level of your financial
distress today?
1-2 Overwhelming Stress
4-5 High Stress
6-7 Low Stress
9-10 No Stress at All
Overwhelming
Stress
Medium Stress
No Stress at All
(Place a mark on the scale above)
On the stair steps below, indicate how satisfied you
are with your present financial situation. The "1"
at the bottom of the steps represents complete
dissatisfaction. The "10" at the top of the stair
represents complete satisfaction. The more
dissatisfied you are, the lower the number you should
choose. The more satisfied you are, the higher the
number you should circle.
Dissatisfied
Satisfied
(Place a mark on the scale above)
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How do you feel about your current financial
situation?
1-2 Feel Overwhelmed
4-5 Sometimes Feel Worried
6-7 Not Worried
9-10 Feel Comfortable
Feel Overwhelmed
Ambivalent
Feel Comfortable
(Place a mark on the scale above)
How often do you worry about being able to meet normal
monthly living expenses?
1-2 Worry All the Time
4-5 Sometimes Worry
7-8 Rarely Worry
9-10 Never Worry
Worry All the
Time
Worry as Much as
Not
Never Worry
(Place a mark on the scale above)
How confident are you that you could find the money to
pay for a financial emergency that costs about $1,000?
1-2 No Confidence
4-5 LIttle Confidence
7-8 Some Confidence
9-10 High Confidence
No Confidence
Medium Confidence
High Confidence
(Place a mark on the scale above)
How often does this happen to you? You want to go out
to eat, go to a movie or do something else and don't
because you can't afford to?
1-2 All the Time
4-5 Sometimes
7-8 Rarely
9-10 Never
All the Time
As Often as Not
(Place a mark on the scale above)
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Never
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How frequently do you find yourself just getting by
financially and living paycheck to paycheck?
1-2 All the Time
4-5 Sometimes
7-8 Rarely
9-10 Never
All the Time
As Often as Not
Never
(Place a mark on the scale above)
How stressed do you feel about your personal finances
in general?
1-2 Overwhelming Stress
4-5 High Stress
7-8 Low Stress
9-10 No Stress at All
Overwhelming
Stress
Medium Stress
No Stress at All
(Place a mark on the scale above)
Do you have any debt?
How much debt, in dollars?
What is your approximate monthly income?
Yes
No
Unsure
__________________________________
__________________________________
We will now ask you about your sources of income and the approximate monthly amount you
receive from each source.
What is your most important source of monthly income?
How much income do you receive each month from this
source?
Do you receive monthly income from a second source?
What is your second source of monthly income?
How much income do you receive each month from this
second source?
Do you receive monthly income from a third source?
05/01/2024 12:09pm
__________________________________
__________________________________
Yes
No
__________________________________
__________________________________
Yes
No
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What is your third source of monthly income?
How much income do you receive each month from this
third source?
Do you receive monthly income from a fourth source?
What is your fourth source of monthly income?
How much income do you receive each month from this
fourth source?
Do you receive monthly income from a fifth source?
What is your fifth source of monthly income?
How much income do you receive each month from this
fifth source?
Do you receive monthly income from a sixth source?
What is your sixth source of monthly income?
How much income do you receive each month from this
sixth source?
Do you receive monthly income from a seventh source?
What is your seventh source of monthly income?
How much income do you receive each month from this
seventh source?
Do you receive monthly income from an eighth source?
What is your eighth source of monthly income?
How much income do you receive each month from this
eighth source?
05/01/2024 12:09pm
__________________________________
__________________________________
Yes
No
__________________________________
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Yes
No
__________________________________
__________________________________
Yes
No
__________________________________
__________________________________
Yes
No
__________________________________
__________________________________
Yes
No
__________________________________
__________________________________
projectredcap.org
| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2024-05-01 |