Norbeck Social Support Questionnaire


The Norbeck social support questionnaire was created by Dr. Jane S Norbeck, a professor in UCSF School of nursing. The questionnaire also known as NSSQ, is an important social support questionnaire that measures several components related to the functional properties of social support. These properties include emotional and tangible support, loss of supportive relationships, support from other sources etc.

Norbeck Social Support Questionnaire Sample

Name of the individual: _______________________________________

Sex: _______  Age: _________  Marital Status: ____________________

Address: ___________________________________________________

City: ________________ State: ______________  Zip: ______________

Telephone: ____________________  Fax: ________________________

Q1. Please list the name of significant people in your life and the relationship you share with them?

Note: Relationship includes: friend, brother, sister, mother, neighbor, father, colleague, classmate, healthcare provider, counselor, therapist, priest, others

First name                                  Relationship

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Rate Q2- Q7 according to this scale: “0” – Not at all; “1” – a little; “2” – moderately; “3” – quite a bit; “4” – a great deal

Q2. How much has each of these people made you feel loved or liked?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q3. How much has each of these people made you feel admired or respected?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q4. How much can you confide in each of them?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q5. How much each of these people agree with or support your thought?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q6. How much would each of these people help if you needed to borrow money, or a ride to a hospital or any other help?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q7. If you were hospitalized and confined to bed, how much could each of them help you?

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q8. How long have you known each one of them?

“1” – less than 6 months; “2” – 6 to 12 months; “3” – 1 to 2 years; “4” – 2 to 5 years;  “5” – more than 5 years

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Q9. How frequently do you contact each one of them?

“5”-Daily / “4”-weekly / “3”-monthly / “2”-few times in a year / “1”-once a year or less

First name                                  Rating

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Mr./Ms.

Category: Social Questionnaire

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