QUESTION SET 2
PART 3: QUESTIONS ON ACTIVITIES AND PARTICIPATION D1.1 - D6.8
|Domain 1: Understanding and Communicating
Domain 1 includes questions about communication and thinking activities. Specific areas that are assessed include concentrating, remembering, problem solving, learning and communicating.
D1.1. How much difficulty did you have in concentrating on doing something for ten minutes?
This question is intended to determine the respondent's rating of difficulty with concentration for a short period, defined as 10 minutes. Generally, respondents have no problem understanding this item. If clarification is requested, however, respondents should be encouraged to think about their concentration in usual circumstances, not when they are preoccupied by a problem or in an unusually distracting environment. They may be cued to think about concentration while doing work tasks, reading, writing, drawing, playing a musical instrument, assembling a piece of equipment etc.
D1.2. How much difficulty did you have in remembering to do important things?
This is a question about memory for matters of day to day importance. It does not refer to memory for irrelevant content or to memory for detailed information from the past. Respondents should consider how well they remember to do things that are important to them or to their family. If note taking, electronic reminder systems or verbal cuing from personal assistants is usually in place as a memory aid, performance should be rated with this help taken into consideration.
D1.3. How much difficulty did you have in analysing and finding solutions to problems in day to day life?
This item refers to a complex activity involving many mental functions. If respondents are unsure, ask them to think about a problem they encountered in the past 30 days. Once a problem is identified, respondents should be asked to consider how well they:
- identified that a problem existed
- broke it down into manageable parts
- developed a list of possible solutions
- determined pros and cons of each solution
- determined the best solution given all considerations
- executed and evaluated the chosen solution
- selected an alternate solution if the first choice was not successful
D1.4. How much difficulty did you have in learning a new task, for example, learning how to get to a new place?
Learning a new route is offered as an example in this question however, respondents should not limit themselves to only this situation. If further clarification is requested or if the interviewer feels the respondent has difficulty to answer, the interviewer may ask the respondent to think about a situation in the past month where learning something new was required, such as learning a task at work (such as a new procedure or assignment), or a new activity (cooking, learning a language, a new sport).
When making the rating, respondents should consider how easily new information was acquired, how much assistance or repetition they needed in order to learn and how well what was learned was retained.
D1.5. How much difficulty did you have in generally understanding what people say?
The respondent should consider his/her usual mode of communication (i.e. spoken language, sign language, with an assistive device such as a hearing aid) and overall, rate the degree of difficulty in understanding the messages of others.
All situations encountered in the past 30 days by the individual should be considered, such as:
- when others speak quickly
- with background noise
- with distractions
Difficulties due to the fact that the language spoken is not one's mother tongue should be excluded when rating this question.
D1.6. How much difficulty did you have in starting and maintaining a conversation?
Both starting and maintaining conversation should be rated. If a respondent states that they have more trouble with starting than maintaining a conversation (or vice versa), they should average the amount of difficulty experienced with both activities to determine the final difficulty rating. Conversation includes use of whatever is the usual mode of communication (spoken, written, sign language, gestural). If assistive devices are used by the respondent for communication, the difficulty rating provided should take into account conversation while using those devices, assuming they are usually present. The respondent should consider any and all other factors of relevance to them in starting and maintaining a conversation such as hearing loss, language problems as after a stroke, stuttering, anxiety or any other factor related to a health condition.
Activities discussed in Domain 2 include standing, moving around inside the home, getting out of the home and walking a long distance.
D2.1. How much difficulty did you have in standing for long periods such as 30 minutes?
This question refers to situations where the person has to remain in a standing position for long time without leaning on something. For example, standing in a queue or waiting for a train.
D2.2. How much difficulty did you have in standing up from sitting down?
This question refers to standing up from sitting in a chair, on a bench or toilet. It does not refer to standing up from sitting on the floor.
D2.3. How much difficulty did you have in moving around inside your home?
This item refers to moving from room to room, and within rooms, using assistive devices or personal help that is usually in place. If the respondent lives in a house with multiple floors, this question also includes getting from one floor to another as needed. This will give a good idea of a person's mobility. A person who has problems moving inside the house is likely to have problems outside as well.
D2.4. How much difficulty did you have in getting out of your home?
This question seeks information about:
- mobility aspects of getting out of the home
- emotional or mental aspects of leaving the home (depression, anxiety, etc.)
For this question, "home" means the respondent's current dwelling, which might be a house, apartment, or nursing home.
D2.5. How much difficulty did you have in walking a long distance such as a kilometre [or equivalent]?
Distances should be converted into imperial measure where necessary.
Domain 3 asks about bathing, dressing, eating and staying alone.
D3.1. How much difficulty did you have in washing your whole body?
This question refers to washing one's entire body in the usual manner for the culture.
If respondents report that they have not washed their bodies in the past 30 days, interviewers should ask whether this is due to a health condition. If respondents report that it is due to a health condition, then the item should be coded "5" for extreme/cannot do. On the other hand, if respondents report that it is not due to a health condition, then the item should be coded "NA" for not applicable.
D3.2. How much difficulty did you have in getting dressed?
This question is intended to include all aspects of dressing the upper and lower body. Activities such as gathering clothing from storage areas (i.e. closet, dressers) and securing buttons, tying knots, etc., also should be considered when making the rating.
D3.3. How much difficulty did you have in eating?
This item refers to both feeding oneself (i.e. cutting food, getting food or drink from plate or glass to mouth) and swallowing (both food and drink). It also includes mental/emotional factors contributing to difficulty eating such as anorexia, bulimia, or depression. This question does not refer to meal preparation. If the respondent uses non-oral feeding (e.g.. tube feedings), this question refers to any difficulties experienced in self administering the non-oral feeding (e.g. feeding pump set up and cleaning).
D3.4. How much difficulty did you have in staying by yourself for a few days?
The intent of this question is to determine any difficulty staying alone for an extended period and remaining safe. If the individual did not experience this situation in the past 30 days, "not applicable" is the correct rating.
It is important for interviewers to probe responses of "none" for this question. This will help differentiate situations that were experienced without difficulty (in which case "1" is correct) from situations not experienced at all (in which case "NA" is correct).
|DOMAIN 4: Getting Along with People
Domain 4 assesses "getting along with people" and difficulties that might be encountered with these activities due to a health condition. In this context, "other people" may be those with whom one is intimate or one knows well (e.g. one's spouse or partner, one's family members or close friends), or those whom one does not know at all (e.g. strangers).
D4.1. How much difficulty did you have in dealing with people you do not know?
This item refers to interactions with strangers in any situation, such as:
- shop keepers
- service personnel
- asking someone for directions
When making the rating, respondents should consider both approaching such individuals, and interacting successfully with them to obtain their desired outcome.
D4.2. How much difficulty did you have in maintaining a friendship?
- staying in touch
- interacting with friends in customary ways
- initiating activities with friends
- participating in activities when invited
If respondents report that they have not engaged in friendship-maintenance activities in the past 30 days interviewers should ask whether this is due to a health condition. If respondents report that it is due to a health condition, then the item should be coded "5" for extreme/cannot do. On the other hand, if respondents report that it is not due to a health condition, then the item should be coded "NA" for not applicable.
D4.3. How much difficulty did you have in getting along with people who are close to you?
The respondent should consider those relationships that he or she defines as close. These may or may not be family relationships.
D4.4. How much difficulty did you have in making new friends?
- seeking opportunities to meet new people
- following up on invitations to get together
- social and communication actions to make contact and to develop a friendship
On occasion, participants will report that they have not engaged in friendship-making activities in the past 30 days. In this case, interviewers should ask whether this is due to a health condition (as defined by the WHODAS II). If respondents report that it is due to a health condition, then the item should be coded "5" for extreme/cannot do. On the other hand, if respondents report that it is not due to a health condition, then the item should be coded "NA" for not applicable.
D4.5. How much difficulty did you have in sexual activities?
The respondent should consider what he/she considers to be sexual activity when answering this question. However, if clarification is requested, this question refers to:
- sexual intercourse
- other intimate or sexual acts
If respondent says "none", the interviewer should probe this response to determine whether there was no difficulty when engaging in sexual activities ("none" should be coded) or no difficulty because the respondent never engaged in such activities ("NA" should be coded).
|DOMAIN 5: Life Activities
This domain includes questions about difficulty in day to day activities. These activities are those that people do on most days and include household, work and school activities.
D5.1. How much difficulty did you have in taking care of your household responsibilities?
This is a global question intended to elicit the respondent's appraisal of difficulty encountered in maintaining the household and in caring for family members or others with whom one is close.
- psychological needs of the household or family.
In some cultures, males may indicate that they do not have household responsibilities. In this situation, it should be clarified that
Household responsibilities include:
- managing finances
- car and home repairs
- caring for the outside area of the home
- picking up children from school
- helping with homework
- disciplining children and
- other examples that interviewers believe elucidate the household responsibilities of males in the culture.
The term "household" is very broad. In the case of respondents who do not have a stable dwelling place, there are still activities surrounding the upkeep and maintenance of their belongings. This question refers to those activities.
D5.2. How much difficulty did you have in doing your most important household tasks well?
The respondent provides ratings based on his/her own appraisal of the quality in which household tasks and responsibilities are carried out.
D5.3. How much difficulty did you have in getting all the household work done that you needed to do?
The respondent provides ratings based on his/her own appraisal whether all needed household work gets done (quantity of work). If necessary, interviewers may remind respondents that they are to report difficulties due to the health condition, not those that may be experienced for other reasons such as not having enough time (unless this reason is somehow linked back to a health condition).
D5.4. How much difficulty did you have in getting your household work done as quickly as needed?
This question refers to the timely meeting of expectations and needs of those with whom one lives (or is close) with respect to household tasks and responsibilities.
D5.5. How much difficulty did you have in your day to day work/school?
This is a global question intended to elicit the respondent's appraisal of difficulties encountered in day to day work or school activities. This might include but is not limited to attending on time, responding to supervision, supervising others, planning and organizing and meeting expectations in the workplace.
D5.6. How much difficulty did you have in doing your most important work/school tasks well?
Doing work or school tasks "well" refers to completing them as expected by one's supervisor or teacher, by one's own standards or as specified in job or school performance criteria.
D5.7. How much difficulty did you have in getting all the work done that you need to do?
This question refers to meeting work expectations in terms of amount of work (quantity).
D5.8. How much difficulty did you have in getting your work done as quickly as needed?
This question refers to meeting time deadlines related to the work tasks.
|DOMAIN 6: Participation in Society
Respondents are asked to consider how other people and the world in which they live restrict them in social participation, such as laws or other features. They must understand that they are not to report their own difficulties and activity limitations but rather problems encountered because of the society in which they live. In addition, questions are asked regarding the impact of the health condition. Respondents should be reminded that the focus is on the past 30 days.
D6.1. How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?
Examples of community activities include attending town meetings, fairs, leisure or sporting activities in the town, neighbourhood or community. The relevant issue being asked in this question is whether the individual is facilitated to participate in these activities or whether there are inhibitors to doing so.
If respondents are confused by the phrase "in the same way as anyone else can", they should be asked to use their best judgment to assess the extent to which average people in their community are able to join community activities, and then to compare their degree of difficulty in joining community activities in relation to this assessment.
If a person does not usually join in community activities "NA" will be recorded next to the question.
This question will allow to see if there is an element of exclusion because of the nature of a health condition.
D6.2. How much of a problem did you have because of barriers or hindrances in the world around you?
The intent of this question is to determine how much has stood in the way of the respondent being able to realize aspirations and plans as other people can. The concept here is external interference faced by the individual as created by the world or other people. Barriers could be physical such as the lack of ramps to get into church, social such as laws that discriminate against persons with disabilities and/or the negative attitudes of people that create the barrier.
D6.3. How much of a problem did you have living with dignity because of the attitudes and actions of others?
The respondent should consider problems he has had in living with stature or pride in who he is, what he is doing, and/or how he lives his life.
D6.4. How much time did you spend on your health condition, or its consequences?
This question intends to capture an overall rating or snapshot of the portion of the past 30 days spent by the respondent in dealing with any aspect of the health condition. This may include time spent for visits to a treatment centre, time spent managing financial matters related to the health condition, such as payment of bills, reimbursement of insurance or benefits, time spent in obtaining information about the health condition or in educating others about it, etc.
D6.5. How much have you been emotionally affected by your health condition?
This question refers to the degree to which the respondent has felt an emotional impact due to the health condition. Emotions may include anger, sorrow, regret, thankfulness, appreciation, or any other positive or negative emotions.
D6.6. How much has your health been a drain on the financial resources of you or your family?
Family is broadly defined to include relatives as well as those to whom the respondent is not related but considers to be like family, including those who may be sharing in the financial aspects of the health condition. The focus of this question is on the depletion of personal savings or current income to meet the needs created by a health condition. If a respondent has experienced a significant financial drain but the family has not, or vice versa, she should respond to the question based on the drain experienced by either party.
D6.7. How much of a problem did your family have because of your health problems?
The focus here is on problems created by the interaction of this health condition with the world in which the person lives. The question seeks information on problems that are borne by the family, which might include financial, emotional, physical problems, etc. Note the definition of family as stated in D6.6.
D6.8. How much of a problem did you have in doing things by yourself for relaxation or pleasure?
The respondent should consider leisure interests which are currently pursued and those that he/she would like to pursue but cannot due to the health condition and restrictions imposed by the society. Examples might include a respondent who has the desire to read novels but is restricted from doing so because the local library does not carry large print books for use by individuals with low vision or a respondent who enjoys watching movies on video but cannot do so because very few are produced with subtitles for the deaf. An overall rating of problems encountered should be provided.