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Métis Nation British Columbia Comprehensive Survey
By completing and submitting this survey to MNBC you consent to the use of the
information that you share. Your personal information (Name, address, phone number and
personal health number) is for tracking and data linking purposes only and will not be
disclosed or associated to the survey questions or your responses. Your anonymity is
assured and is of the greatest of importance to us. Once you complete this survey and
return it to the Chronic Disease Surveillance Program Manager your personal information,
name address, phone number, and personal health number, will be removed from the
remainder of the survey so that no one will now that it was you who shared any specific
information.

Please answer all the questions to the best of your ability, if you find a question or the format of the survey to be confusing please put a question mark by the question and provide a comment. Some questions may Not apply to you and you may be asked to skip questions. Please provide a "Decline" or "Decline" response if you feel the question is too intrusive a "Not applicable" response if you believe that the question does Not apply to you or your circumstances and a "don't know" response if you can Not think of the answer. Some questions in this survey may provoke an emotional response, for instance there are questions on attending residential schools. If you feel uncomfortable answering any questions please do Not proceed or proceed to questions you feel comfortable answering. Thank you! Health information collected when you visit the doctor, share with Census Canada,
Worksafe, BC, provincial insurance providers, pharmacare and vital statistics is also
crucial for the very same reasons that self-administered surveys are. This information
also informs program development, evaluation and funding distribution. For this reason
we would like the opportunity to access this information of yours to better inform program
and policy developers and evaluators. Combined with the information that you provide in
this survey we will have a better chance of demonstrating need, success, and strengths of
the Métis Nation.

If you will permit us to access this information please mark the box below and sign your
name.

I permit MNBC to access my publicly held administrative data.
________________________________________________signature.
What is your personal health number? This is the number on your British
Columbia health care card.

WRITE IN ANSWER WITHIN THE RANGE 0 - 10
First name
Ques WRITE IN ANSWER.
tion

Last name
Ques WRITE IN ANSWER.
tion1


maili Please provide your mailing address for administrative and data matching
ngad purposes.

dress WRITE IN ANSWER.
Please enter the date (Year-Month-Day) and time (for example,
Time 09:30 am) of when you started the survey.
Ques
tion

Date of birth (Year-Month-Day)
WRITE IN ANSWER.
In which MNBC Region do you live?
SELECT ONE ANSWER ONLY.
What is your sex?
SELECT ONE ANSWER ONLY.
What is your age?
SELECT ONE ANSWER ONLY.
What is your current marital status?
SELECT ONE ANSWER ONLY.
Do you currently have children 18 or younger living in your household?
SELECT ONE ANSWER ONLY.
What type of dwelling do you live in? Is it a:
SELECT ONE ANSWER ONLY.
… Low-rise apartment of fewer than 5 stories or a flat? … High-rise apartment of 6 stories or more? Please select the age and gender of each child 18 or younger living in your
household.

SELECT ONE ANSWER IN EACH COLUMN DOWN.
How many children under the age of 18 live in your household?
WRITE IN ANSWER.
Including yourself, how many people live in your household?
WRITE IN ANSWER.
What is your annual household income? (the combined income of all people over
the age of 15 years living in your house)

SELECT ONE ANSWER ONLY.
Do you consider yourself to be:
SELECT ONE ANSWER ONLY.
… heterosexual? (sexual relations with people of the … homosexual, that is lesbian or gay? (sexual relations … bisexual? (sexual relations with people of both sexes) Do any of your ancestors belong to any of the following groups (check all that
apply)

SELECT ONE ANSWER ONLY.
Are you an Aboriginal that is
SELECT ONE ANSWER ONLY.
Are you a member of a Chartered Métis Community (a chartered community has an
affiliation with the MNBC)

SELECT ONE ANSWER ONLY.
What Chartered community do you belong to?
WRITE IN ANSWER.
Are you a citizen of the Métis Nation British Columbia
SELECT ONE ANSWER ONLY.
Are you a member of a Métis community that is Not chartered (does Not have an
affiliation to the MNBC or you are affiliated with a Métis community from outside of
BC)

SELECT ONE ANSWER ONLY.
What Métis Community are you a member of?
WRITE IN ANSWER.
Have you ever applied to the Department of Indian Affairs and Northern
Development to be registered as a status Indian under Bill C-31?

SELECT ONE ANSWER ONLY.
In a typical week in the past 3 months, how much time did you usually spend on a
computer, including playing computer games, working and/or using the Internet?

SELECT ONE ANSWER ONLY.
Over the last 3 months what types of physical activity did you participate in, how
long each time on average, how many times a month on average and how many
months during the year?

SELECT ONE ANSWER ON EACH LINE ACROSS.
Yes 1-15 Yes 16-30 Yes 31-45 Yes 46-60
How satisfied are you with your leisure activities?
SELECT ONE ANSWER ONLY.
What is your height with out shoes (feet and inches)
WRITE IN ANSWER.
What is your weight (pounds)
WRITE IN ANSWER.
Not counting juice, how often do you usually eat fruit or vegetables?
SELECT ONE ANSWER ONLY.
The following questions have to do with the food that you like, able to afford, and have
access too.

In the past 12 months, were you (personally) ever hungry but didn't eat because
you couldn't afford enough food?

SELECT ONE ANSWER ONLY.
In the past 12 months, did you lose weight because you didn't have enough money
for food?

SELECT ONE ANSWER ONLY.
In the last 12 months did you or anyone in your household have problems
shopping for food because .

SELECT ALL ANSWERS THAT APPLY.
have any other problems shopping for food? Which of the following statements best describes the food eaten in your household
in the last year?

SELECT ONE ANSWER ONLY.
You And Others in your household always had enough You And Others in your household had enough to eat, but not always the kinds of food you wanted. Sometimes You And Others in your household did not Often You And Others in your household didn’t have The next few questions are about country foods only. Country foods are food that is not
purchased at a store; rather they are harvested from the land. Country foods include
deer, moose, elk, bear, or other big game, upland game birds (grouse, ptarmigan) or
migratory birds (duck, geese), fresh or salt water fish, berries, roots, mushrooms or other
plants, medicinal plants or fruits and vegetables grown in private gardens.

In the last 12 months have you consumed traditional/country food?
SELECT ONE ANSWER ONLY.
In the past 6 months have you eaten any country food?
SELECT ONE ANSWER ONLY.
In the past 6 months have you processed any country food (canned, pickled, dried,
or smoked any country food)?

SELECT ONE ANSWER ONLY.
How would you describe your usual ability to remember things?
SELECT ONE ANSWER ONLY.
How would you describe your usual ability to think and solve day-to-day problems?
SELECT ONE ANSWER ONLY.
Able to think clearly and solve problems To what extent do your spiritual values help you to find meaning in your life?
SELECT ONE ANSWER ONLY.
Do spiritual values play an important role in your life?
SELECT ONE ANSWER ONLY.
To what extent do spiritual values play an important role in your life?
SELECT ONE ANSWER ONLY.
Thinking about stress in your day-to-day life, what would you say is the most
important thing contributing to feelings of stress you may have?

SELECT ALL ANSWERS THAT APPLY.
Own physical health problem or condition Own emotional or mental health problem or condition Financial situation (e.g., Not enough money, debt) Own work situation (e.g., hours of work, working Other personal or family responsibilities During the last month have you felt
SELECT ONE ANSWER ON EACH LINE ACROSS.
Frequentl
Have you ever seriously considered committing suicide or taking your own life?
SELECT ONE ANSWER ONLY.
During the past month how often did you feel tired out for No good reason?
SELECT ONE ANSWER ONLY.
During the past 12 months, was there ever a time when you felt sad, blue, or
depressed for 2 weeks or more in a row?

SELECT ONE ANSWER ONLY.
Thinking about the amount of stress in your life, would you say that most days are:
SELECT ONE ANSWER ONLY.
How satisfied are you with your life in general?
SELECT ONE ANSWER ONLY.
In general, would you say your mental health is:
SELECT ONE ANSWER ONLY.
Would you describe yourself as being usually:
SELECT ONE ANSWER ONLY.
… unhappy with little interest in life? … so unhappy that life is Not worthwhile? In general would you say your health is:
SELECT ONE ANSWER ONLY.
Compared to 3 months ago how would you say your health is Now?
SELECT ONE ANSWER ONLY.
Compared to one year ago how would you say your health is now?
SELECT ONE ANSWER ONLY.
Does a physical or mental condition or health problem reduce the amount or the
kind of activity you can do…

SELECT ALL ANSWERS THAT APPLY.
in other activities, for example, transportation or leisure? I am Not limited by a mental condition or health problem. Have you been told by a doctor, nurse or other health professional that you have
diabetes?

SELECT ONE ANSWER ONLY.
At what age were you first told?
WRITE IN ANSWER.
Which type(s) of diabetes have you been diagnosed with?
SELECT ONE ANSWER ONLY.
Have you been told by a doctor, nurse or other health professional that you have
SELECT ONE ANSWER ON EACH LINE ACROSS.
If Yes do you
currently take any
medication or
receive any
treatment for this
health issue?
Not counting repetitive strain injuries, in the past 12 months were you injured?
SELECT ONE ANSWER ONLY.
What type of activity were you doing when you were injured?
SELECT ONE ANSWER ONLY.
Sports or physical exercise (include school activities) Working at a job or business (exclude travel to or from Household chores, other unpaid work or education What type of injury did you have? For example, a broken bone or burn.
SELECT ALL ANSWERS THAT APPLY.
Cut, puncture, animal or human bite (open wound) Have you ever been diagnosed with a sexually transmitted disease?
SELECT ONE ANSWER ONLY.
Do you have any difficulty hearing, seeing, communicating, walking, climbing
stairs, bending, learning or doing any similar activities?

SELECT ONE ANSWER ONLY.
Is there a history of cancer in your family?
SELECT ONE ANSWER ONLY.
What type or types of cancer has there been in your family?
SELECT ALL ANSWERS THAT APPLY.
In general, would you say the health of your teeth and mouth is:
SELECT ONE ANSWER ONLY.
In the past month, how often have you had any pain or discomfort in your teeth or
gums?

SELECT ONE ANSWER ONLY.
It is important to know when analyzing health whether or Not the person is
pregnant. Are

you pregnant?
SELECT ONE ANSWER ONLY.
During the past twelve months, Have you had pain or stiffness in your joints?
SELECT ONE ANSWER ONLY.
Do you consider yourself:
SELECT ONE ANSWER ONLY.
Are you usually able to see well enough to read ordinary newsprint without glasses
or contact lenses?

SELECT ONE ANSWER ONLY.
Are you usually able to hear what is said in a group conversation with at least 3
other people without a hearing aid?

SELECT ONE ANSWER ONLY.
Are you usually able to walk around the neighbourhood without difficulty and
without mechanical support such as braces, a cane or crutches?

SELECT ONE ANSWER ONLY.
Does a long-term physical condition or mental condition or health problem, reduce
the amount or the kind of activity you can do:…

SELECT ONE ANSWER ON EACH LINE ACROSS.
Sometimes
activities, for example, transportation or Which one of the following is the best description of the cause of this condition?
SELECT ONE ANSWER ONLY.
Emotional or mental health problem or condition In the past 12 months, have you seen or talked on the telephone with the following
health professionals about your physical, emotional or mental health (please mark
all that apply)?

SELECT ALL ANSWERS THAT APPLY.
Eye doctor, such as an ophthalmologist or optometrist Other medical doctor, such as surgeon, allergist or First Nation, Métis or Inuit Traditional healer Physiotherapist or occupational therapist Social worker, counselor or psychologist Do you have a regular medical doctor or family doctor?
SELECT ONE ANSWER ONLY.
In the past 12 months, did you require one of these tests?
MRIs, CAT Scans and/or angiographies provided in a Non emergency situation.
SELECT ONE ANSWER ONLY.
When was the last time that you went to an optometrist or had your eyes checked?
SELECT ONE ANSWER ONLY.
If you have never visited a dentist, or feel that you need to but have Not, why Not?
SELECT ALL ANSWERS THAT APPLY.
What are the reasons that you have Not had a flu shot in the past year?
SELECT ALL ANSWERS THAT APPLY.
Respondent - did Not think it was necessary Fear (e.g., painful, embarrassing, find something wrong) Unable to leave the house because of a health problem Is there a place that you usually go to when you are sick or need advice about your
health?

SELECT ALL ANSWERS THAT APPLY.
In the past 12 months, have you received any health care services?
SELECT ONE ANSWER ONLY.
Overall, how satisfied were you with the way health care services were provided?
Were you:
SELECT ONE ANSWER ONLY.
In the past 12 months, have you received any health care services at a hospital, for
any diagnostic or day surgery service, overnight stay, or as an emergency room
patient? Thinking of your most recent hospital visit, were you:

SELECT ONE ANSWER ONLY.
… admitted overnight or longer (an inpatient)? … a patient at a diagnostic or day surgery clinic (an Have you ever had a flu shot?
SELECT ONE ANSWER ONLY.
When did you have your last flu shot?
SELECT ONE ANSWER ONLY.
How often do you usually have your blood checked for glucose or sugar by
yourself or by a family member or friend?

SELECT ONE ANSWER ONLY.
In the past 12 months, has a health care professional tested you for haemoglobin
“A- one-C”? (An “A-one-C” haemoglobin test measures the average level of blood
sugar over a 3-month period.)

SELECT ONE ANSWER ONLY.
In the past 12 months, has a health care professional checked YOUR feet for any
sores or irritations?

SELECT ONE ANSWER ONLY.
Due to your physical or mental health do you require the help of another person
with:

SELECT ONE ANSWER ONLY.
Have you received any home care services in the past 12 months, with the cost
being entirely or partially covered by government?

SELECT ONE ANSWER ONLY.
What type of services have you received?
SELECT ONE ANSWER ONLY.
Nursing care (e.g., dressing changes, preparing Other health care services (e.g., physiotherapy, occupational or speech therapy, nutrition counselling) Personal care (e.g., bathing, foot care) During the past 12 months, was there ever a time when you felt that you needed
home care services but you didn’t receive them? Thinking of the most recent time,
why didn’t you get these services?

SELECT ALL ANSWERS THAT APPLY.
Not available - at time required (e.g., inconvenient Didn’t get around to it / didn’t bother Did Not qualify / Not eligible for homecare Have you ever had a PAP smear test?
SELECT ONE ANSWER ONLY.
If No, why Not
SELECT ALL ANSWERS THAT APPLY.
do Not have a family physician that would remind me Have you ever had a mammogram, that is, a breast x-ray?
SELECT ONE ANSWER ONLY.
Other than a mammogram, have you ever had your breasts examined for lumps,
tumors or cysts, by a medical doctor or other health professional?

SELECT ONE ANSWER ONLY.
Have you ever had a prostate specific antigen test for prostate cancer, that is, a
PSA blood test?

SELECT ONE ANSWER ONLY.
If you never had a PSA, why Not
SELECT ALL ANSWERS THAT APPLY.
do Not have a family physician that would remind me
Q100 Are Métis traditional medicines, healing or wellness practices available in the city,
town or community where you currently live?
SELECT ONE ANSWER ONLY.

Q101 Have you ever seen an Aboriginal Healer?
Q102 If No, why Not
do Not have a family physician that would remind me
Q103 Have you ever smoked cigarettes

Q104 At what age did you begin to smoke cigarettes daily (please leave blank if you have
never smoked)?
WRITE IN ANSWER.

Q105 At what age did you stop smoking cigarettes daily (please leave blank if you have
never smoked)?
WRITE IN ANSWER.

Q106 In the past month, have you used snuff?

Q107 In the past month, have you used chewing tobacco?

Q108 Including both household members and regular visitors, does anyone smoke inside
your home, every day or almost every day?
SELECT ONE ANSWER ONLY.
Q109 In the past 4 weeks, did you take any vitamin or mineral supplements?

Q110 How satisfied are you with your job or main activity?

Q111 How often in the past 12 months have you had 5 or more drinks on one occasion?
WRITE IN ANSWER WITHIN THE RANGE 0 - 10
Q112 During the past 12 months, how often did you drink alcoholic beverages?

Q113 How long do you usually spend sleeping each night?
Q114 How often do you have trouble going to sleep or staying asleep?

Q115 How often do you find your sleep refreshing?

Q116 How often do you find it difficult to stay awake when you want to?

Q117 In the past 12 months, did you do anything to improve your health? (For example,
lost weight, quit smoking, increased exercise)
WRITE IN ANSWER.

Q118 What is the single most important change you have made to improve your health in
the last 12 months?
SELECT ALL ANSWERS THAT APPLY.
Increased exercise, sports / physical activity Q119 In the past month, did you take prescription medications such as Lipitor or Zocor
to control your blood cholesterol levels?
SELECT ONE ANSWER ONLY.

Q120 How old were you when you last took elementary or high school courses? Do Not
include courses taken later as part of a High School Equivalency Program.
WRITE IN ANSWER WITHIN THE RANGE 06 - 18

Q121 What kind of difference did education make in your life (please mark all that apply)

Q122 Was there anything or anyone that really made a difference in helping you get your
post secondary education?
WRITE IN ANSWER.

Q123 What were the main reasons why you decided to get a post-secondary education?
Q124 How important is it that you keep, learn or re-learn your Aboriginal language? Is
it…
SELECT ONE ANSWER ONLY.

Q125 What languages are you fluent in (can carry on a conversation in, check all that
apply)
SELECT ONE ANSWER ON EACH LINE ACROSS.
Yes, Speak
Well (can
Yes, Speak
Yes, Speak talk slowly
No, do Not
Declined
Fluently
and do not
speak at all

Q126 Would you say that you have learned
Not Applicable
Q127 How many of your teachers during your primary, elementary and secondary
education were Métis
SELECT ONE ANSWER ON EACH LINE ACROSS.
1 or 2 3 or 4 4 or more Don't know Decline
Q128 Excluding kindergarten, how many grades of elementary and high school have you
successfully completed? (Including High School Equivalency program.)
SELECT ONE ANSWER ONLY.

Q129 Did you graduate from high school? Please do Not include graduation through a
High School Equivalency program (GED).
SELECT ONE ANSWER ONLY.

Q130 Have you successfully completed a High School Equivalency program (GED)?

Q131 Are you a full-time student or a part-time student?
Q132 Why did you Not continue elementary or high school?

Q133 Now, think about any education or training ABOVE the high school level. Have you
ever taken some education towards a DIPLOMA, CERTIFICATE or DEGREE above
the high school level?

SELECT ONE ANSWER ONLY.

Q134 At what type of educational institution did you take this education?
A publicly-funded technical institute, or a A private business school or private training institute
Q135 Have you completed the requirements for ANY diploma, certificate or degree for
your education or training above the high school level?
SELECT ONE ANSWER ONLY.

Q136 In what year did you last take post-secondary education?
Q137 Why did you Not finish your post-secondary education?

Q138 What certificate(s), diploma(s) or degree(s) have you completed?
Other Non-university certificate or diploma (obtained at community college, CEGEP, Technical institute, etc.) University certificate or diploma below bachelor level Bachelor’s degree(s) (e.g., B.A., B.Sc., LL.B.) University certificate or diploma ABOVE Bachelor’s, Master’s Degree(s) (e.g., M.A., M.Sc., M.Ed.) Degree in medicine, dentistry, veterinary medicine or optometry (M.D., D.D.S., D.M.D., D.V.M., O.D.) Earned doctorate (e.g., Ph.D., D.Sc., D.Ed.)
Q139 In what year did you obtain your most recent certificate, diploma or degree?

Q140 About how many hours a week do you usually work at your job or business? If you
usually work extra hours, paid or unpaid, please include these hours.
WRITE IN ANSWER.
Q141 What kind of business, industry or service is this? (For example: cardboard box
manufacturing, road maintenance, retail shoe store, secondary school, dairy farm,
municipal government)

WRITE IN ANSWER.

Q142 Were you:
On temporary lay-off from a job to which you expect to On vacation, ill, on strike or locked out, or absent for
Q143 Last week, did you work for pay or in self-employment?

Q144 Last week, were you on temporary lay-off or absent from your job or business?

Q145 Thinking about the total income for all household members, from which of the
following sources did your household receive any income in the past 12 months?
SELECT ALL ANSWERS THAT APPLY.
Dividends and interest (e.g., on bonds, savings) Benefits from Canada or Quebec Pension Plan Retirement pensions, superannuation and annuities Old Age Security and Guaranteed Income Supplement Provincial or municipal social assistance or welfare Other (e.g., rental income, scholarships) Q146 Did you harvest any wild game or naturally growing plants, berries, roots,
mushrooms, or medicinal plants, or did you grow your own fruits, vegetables or
medicinal plants in the previous year?

SELECT ONE ANSWER ONLY.

Q147 When harvesting how often and what type of trip did you go on? (Day trips are
when you leave from home and return home on the same day, where camps are
when you go to a harvesting location and stay overnight on site or near to a
harvest location in the outdoors).

SELECT ONE ANSWER ON EACH LINE ACROSS.
less than 1
more than 4
not at all
1-3 weeks

Q148 What and how many days did you dedicate to harvesting the following animals or
plants?
SELECT ONE ANSWER ON EACH LINE ACROSS.
1-5 days 6-10 days
Q151 Are you a member of any voluntary organizations or associations such as school
groups, church social groups, community centres, ethnic associations or social,
civic or fraternal clubs (other than a Métis specific organization)?

WRITE IN ANSWER.

Q154 How often did you participate in meetings or activities of these groups in the past
12 months? If you belong to many, just think of the ones in which you are most
active (average hours/month).

WRITE IN ANSWER.

Q155 How would you describe your sense of belonging to your provincial Métis
organization? Would you say it is:
SELECT ONE ANSWER ONLY.

Q154 How often did you participate in meetings or activities of these groups in the past
12 months? If you belong to many, just think of the ones in which you are most
active.

WRITE IN ANSWER.

Q155 How would you describe your sense of belonging to your provincial Métis
organization? Would you say it is:
SELECT ONE ANSWER ONLY.

Q156 How would you describe your sense of belonging to your Federal Métis
organization? Would you say it is:
SELECT ONE ANSWER ONLY.
Q157 How would you describe your sense of belonging to your provincial government?
Would you say it is:
SELECT ONE ANSWER ONLY.

Q158 How would you describe your sense of belonging to your municipal or regional
British Columbia representation?
Would you say it is:
SELECT ONE ANSWER ONLY.

Q159 How would you describe your sense of belonging to your Federal Canadian
governance? Would you say it is:
SELECT ONE ANSWER ONLY.

Q149 Were any of the following members of your family ever a student at a federal
residential school, a federal industrial school or a day school (mark all that apply)?
SELECT ALL ANSWERS THAT APPLY.

Q150 Were you ever a student at a federal residential school, or a federal industrial
school, or a federally run day school?
SELECT ONE ANSWER ONLY.
Please enter the date (day/month/year) and time (for example, 9:30
Time am) of when you completed the survey.
Ques
tion1

Source: http://www.mnbc.ca/pdfs/mnbc%20comprehensive%20survey.pdf

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