Radiance Roundtable 2020
The Institute for Successful Leadership (ISL) thanks you for your interest in participating in the Radiance Roundtable. Since 1996, ISL has been committed to addressing disparities and inequities in health. Black women worldwide have endured higher levels of illness and poor health outcomes for decades. The Radiance Roundtable is purposed to identify social, cultural, and gender-based factors contributing to health status and decision-making among Black women. All responses will be kept confidential, anonymous, and remain the sole property of the Institute for Successful Leadership.

With your approval, your submission will enter you for random selection to attend the Radiance Roundtable Luncheon in " The City Beautiful" Orlando, Florida. The Radiance Roundtable Luncheon will be a complimentary affair to discuss survey outcomes, and enjoy a festive, scrumptious lunch in the company of Black women from various cultures and backgrounds on a new date to be determined pending federal, statewide, and local guidance on preventing the spread of COVID-19.

Please allot about 20 minutes to complete this survey and provide us your best and honest responses--there are no wrong answers!! For more information on ISL, visit www.THEISL4Uonline.com. Thank you very much, and STAY WELL!!!

ISL Team
In what city, state, and country do you currently live?
Please enter your complete email address:
Do you define your gender as female/woman?
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Do you identify yourself Black even if bi-racial?
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Age Range:
Current Relationship Status:
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Were you born in the United States?
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If you were born in the United States, in what region were you born?
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If you were not born in the United States, in which region were you born?
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Were both your parents/guardians born in the United States? If so, in which region? (Choose all that apply)
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If your parents/guardians were not born in the United States, in which region were they born? (Choose all that apply)
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If you do not currently live in the United States, in which region do you live?
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If you have children, how many children do you have?
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What language(s) do you speak fluently? (Choose all that apply)
Describe the religious teachings you currently follow most closely. (Choose all that apply)
How much do you allow religious teachings to guide your life decisions?
Clear selection
How important is your religion in developing your beliefs?
Not at all Important
Extremely Important
Clear selection
How consistent is your life experience with most of the women you know?
Not at all Consistent
Extremely Consistent
Clear selection
You consider yourself:
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How responsible do you feel for your health outcomes and health status?
Not At All Responsible
Fully Responsible
Clear selection
How willing are you to change your current lifestyles and habits to improve your health?
Not at all Willing to Change
Extremely Willing to Change
Clear selection
How well do you know your own health status including blood pressure, weight, height, disease diagnoses, reproductive health, eye/vision health, dental/oral health?
Not at all Knowledgeable
Extremely Knowledgeable
Clear selection
When was the last time you went to the doctor?
How much do you trust doctors' recommendations on your health?
How willing are you to change the following factors to improve your overall health?
Not at All Willing
Slightly Willing
Moderately Willing
Extremely Willing
Increase adequate sleep
Increase physical activity
Reduce salt intake
Eat more fresh vegetables and fruit
Increase order in personal spaces
Increase order in work spaces
Eliminate stress
Reduce use of electronic technology (ie. cell phones, computers)
Increase religious/spiritual growth
Increase knowledge of personal health status
Increase knowledge of health status of sexual partners
Increase positive social relationships
Clear selection
How important are the following issues on your decision-making?
Not at All Important
Slightly Important
Moderately Important
Extremely Important
Availability of money
Personal comfort
Comfort of peers/family
Individual satisfaction
Pride/happiness of peers or family
Consistency with traditional roles of women
Reflections of personal lessons learned
Reflections of lessons learned from others
Consistency with religious teachings/spirituality
Potential contribution to individual knowledge
Potential contribution to knowledge of others
Clear selection
What percentage of your total stress comes from the following sources:
0%
10%
25%
50%
More than 50%
Availability of money
Personal living conditions
Current status of peers or family members
Current job
Status of world affairs
Incorrect perceptions of Black women by white populations
Incorrect perceptions of Black women by Black women
Incorrect perceptions of Black women by Black men
Visions of personal future
Vision of futures for your children
Discrimination based on race
Discrimination based on gender
Clear selection
What inspires you to be well (that is, to maintain good physical, mental, and spiritual health)?
What can other Black women learn from you?
If selected, will you attend the Radiance Roundtable luncheon pending the new date in Orlando, Florida?
Clear selection
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