SC. Self-Completion
SC. Self-Completion module of SHARE 2006
Start of SC. Self-Completion
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Q1_A
Pursue goals with energy
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I PURSUE MY GOALS WITH LOTS OF ENERGY.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I PURSUE MY GOALS WITH LOTS OF ENERGY.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_B
Usually expect the best
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. IN UNCERTAIN TIMES, I USUALLY EXPECT THE BEST.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. IN UNCERTAIN TIMES, I USUALLY EXPECT THE BEST.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_C
Optimistic about future
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I'M ALWAYS OPTIMISTIC ABOUT MY FUTURE.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I'M ALWAYS OPTIMISTIC ABOUT MY FUTURE.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_D
Not expect things to go my way
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I HARDLY EVER EXPECT THINGS TO GO MY WAY.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I HARDLY EVER EXPECT THINGS TO GO MY WAY.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_E
Find ways to solve problems
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I STILL FIND WAYS TO SOLVE A PROBLEM IF OTHERS HAVE GIVEN UP.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I STILL FIND WAYS TO SOLVE A PROBLEM IF OTHERS HAVE GIVEN UP.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_F
Rarely count of good things
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I RARELY COUNT ON GOOD THINGS HAPPENING TO ME.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. I RARELY COUNT ON GOOD THINGS HAPPENING TO ME.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q1_G
Feel prepared for my future
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. GIVEN MY PREVIOUS EXPERIENCES I FEEL WELL PREPARED FOR MY FUTURE.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT FOR YOU PERSONALLY. GIVEN MY PREVIOUS EXPERIENCES I FEEL WELL PREPARED FOR MY FUTURE.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q2_A
Believe parents should do best for children at own expense
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. PARENTS' DUTY IS TO DO THEIR BEST FOR THEIR CHILDREN EVEN AT THE EXPENSE OF THEIR OWN WELL-BEING.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. PARENTS' DUTY IS TO DO THEIR BEST FOR THEIR CHILDREN EVEN AT THE EXPENSE OF THEIR OWN WELL-BEING.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q2_B
Believe grandparents should be there for grandchildren
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO BE THERE FOR GRANDCHILDREN IN CASES OF DIFFICULTY (SUCH AS DIVORCE OF PARENTS OR ILLNESS).
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO BE THERE FOR GRANDCHILDREN IN CASES OF DIFFICULTY (SUCH AS DIVORCE OF PARENTS OR ILLNESS).
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q2_C
Believe grandparents should contribute to family
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO CONTRIBUTE TOWARDS THE ECONOMIC SECURITY OF GRANDCHILDREN AND THEIR FAMILIES.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO CONTRIBUTE TOWARDS THE ECONOMIC SECURITY OF GRANDCHILDREN AND THEIR FAMILIES.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q2_D
Believe grandparents should look after young grandchildren
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO HELP GRANDCHILDREN'S PARENTS IN LOOKING AFTER YOUNG GRANDCHILDREN.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
PLEASE TELL US HOW MUCH YOU AGREE OR DISAGREE WITH EACH STATEMENT. GRANDPARENTS' DUTY IS TO HELP GRANDCHILDREN'S PARENTS IN LOOKING AFTER YOUNG GRANDCHILDREN.
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-5. not answered
1. strongly agree
2. agree
3. neither agree nor disagree
4. disagree
5. strongly disagree
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Q3_A
State or family: financial support for elderly
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: FINANCIAL SUPPORT FOR OLDER PERSONS WHO ARE IN NEED?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: FINANCIAL SUPPORT FOR OLDER PERSONS WHO ARE IN NEED?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
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Q3_B
State or family: household chores for elderly
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: HELP WITH HOUSEHOLD CHORES FOR OLDER PERSONS WHO ARE IN NEED SUCH AS HELP WITH CLEANING, WASHING?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: HELP WITH HOUSEHOLD CHORES FOR OLDER PERSONS WHO ARE IN NEED SUCH AS HELP WITH CLEANING, WASHING?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
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Q3_C
State or family: personal care for elderly
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: PERSONAL CARE FOR OLDER PERSONS WHO ARE IN NEED SUCH AS NURSING OR HELP WITH BATHING OR DRESSING?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
IN YOUR OPINION, WHO Ã THE FAMILY OR THE STATE -- SHOULD BEAR THE RESPONSIBILITY FOR EACH OF THE FOLLOWING: PERSONAL CARE FOR OLDER PERSONS WHO ARE IN NEED SUCH AS NURSING OR HELP WITH BATHING OR DRESSING?
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-5. not answered
1. totally family
2. mainly family
3. both equally
4. mainly state
5. totally state
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Q4_A
Frequency of conflict with parents
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARENTS
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARENTS
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q4_B
Frequency of conflict with parents-in-law
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARENTS-IN-LAW
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARENTS-IN-LAW
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q4_C
Frequency of conflict with partner
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARTNER/SPOUSE
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: PARTNER/SPOUSE
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q4_D
Frequency of conflict with children
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: CHILDREN
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: CHILDREN
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q4_E
Frequency of conflict with other family members
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: OTHER FAMILY MEMBERS
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: OTHER FAMILY MEMBERS
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q4_F
Frequency of conflict with others
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: FRIENDS, COWORKERS, ACQUAINTAINCES
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
PLEASE TELL US HOW OFTEN, IF AT ALL, YOU EXPERIENCE CONFLICT WITH EACH OF THE FOLLOWING PERSONS: FRIENDS, COWORKERS, ACQUAINTAINCES
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q5
Frequency of concflict concerning upbringing of grandchildren
HOW OFTEN DO YOU EXPERIENCE CONFLICTS WITH YOUR CHILDREN OR CHILDREN-IN-LAW OVER THE EDUCATION AND BRINGING UP OF YOUR GRANDCHILD(REN)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
HOW OFTEN DO YOU EXPERIENCE CONFLICTS WITH YOUR CHILDREN OR CHILDREN-IN-LAW OVER THE EDUCATION AND BRINGING UP OF YOUR GRANDCHILD(REN)?
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-9. not applicable (e.g.filtered)
-5. not answered
1. often
2. sometimes
3. rarely
4. never
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Q6
Ever share a household with partner
DO YOU OR DID YOU EVER SHARE A HOUSEHOLD WITH A HUSBAND, WIFE OR PARTNER?
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-5. not answered
1. yes
5. no
DO YOU OR DID YOU EVER SHARE A HOUSEHOLD WITH A HUSBAND, WIFE OR PARTNER?
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-5. not answered
1. yes
5. no
If Ever share a household with partner (Q6) = 1. yes
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Q7_A
Whose responsibility to raise children
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: BRINGING UP CHILDREN
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: BRINGING UP CHILDREN
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
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Q7_B
Whose responsibility to earn money
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: EARNING MONEY
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: EARNING MONEY
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
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Q7_C
Whose responsibility to do household chores
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: COOKING, CLEANING THE HOUSE, LAUNDRY AND IRONING
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: COOKING, CLEANING THE HOUSE, LAUNDRY AND IRONING
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
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Q7_D
Whose responsibility to care for elderly
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: CARING FOR ELDERLY
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
WHO IN THE COUPLE TAKES OR TOOK THE MAIN RESPONSIBILITY FOR THE FOLLOWING TASKS: CARING FOR ELDERLY
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. myself only
2. myself mainly
3. myself and my partner equally
4. my partner mainly
5. my partner only
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Q8_A
Frequency pcp asks about physical activity
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK HOW MUCH PHYSICAL ACTIVITY YOU DO?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK HOW MUCH PHYSICAL ACTIVITY YOU DO?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
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Q8_B
Frequency pcp asks mentions regular exercise
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) TELL YOU THAT YOU SHOULD GET REGULAR EXERCISE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) TELL YOU THAT YOU SHOULD GET REGULAR EXERCISE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
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Q8_C
Frequency pcp asks about falling down
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK YOU ABOUT FALLING DOWN?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK YOU ABOUT FALLING DOWN?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
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Q8_D
Frequency pcp checks balance
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) CHECK YOUR BALANCE OR THE WAY YOU WALK?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) CHECK YOUR BALANCE OR THE WAY YOU WALK?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
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Q8_E
Frequency pcp asks about ask about drugs
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK YOU ABOUT ANY DRUGS YOU TAKE, EITHER BOUGHT OVER-THE-COUNTER OR DRUGS PRESCRIBED BY ANOTHER DOCTOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ASK YOU ABOUT ANY DRUGS YOU TAKE, EITHER BOUGHT OVER-THE-COUNTER OR DRUGS PRESCRIBED BY ANOTHER DOCTOR?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. at every visit
2. at some visits
3. never
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Q9_A
How encouranged to talk to pcp about physical health problems
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT PHYSICAL HEALTH PROBLEMS, SUCH AS PAIN, REDUCED MOBILITY, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT PHYSICAL HEALTH PROBLEMS, SUCH AS PAIN, REDUCED MOBILITY, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
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Q9_B
How encouranged to talk to pcp about emotional problems
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT EMOTIONAL, NERVOUS OR PSYCHIC PROBLEMS, SUCH AS STRESS, SADNESS, ANXIETY, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT EMOTIONAL, NERVOUS OR PSYCHIC PROBLEMS, SUCH AS STRESS, SADNESS, ANXIETY, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
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Q9_C
How encouranged to talk to pcp about sensitive health problems
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT SENSITIVE HEALTH PROBLEMS, SUCH AS SEXUAL LIFE, INCONTINENCE PROBLEMS, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT SENSITIVE HEALTH PROBLEMS, SUCH AS SEXUAL LIFE, INCONTINENCE PROBLEMS, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
========================================================================
Q9_D
How encouranged to talk to pcp about social problems
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT SOCIAL PROBLEMS THAT INFLUENCE YOUR HEALTH, SUCH AS FAMILY, WORK PROBLEMS, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
HOW MUCH DO YOU FEEL ENCOURAGED TO TALK WITH YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) ABOUT SOCIAL PROBLEMS THAT INFLUENCE YOUR HEALTH, SUCH AS FAMILY, WORK PROBLEMS, ETC.
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. strongly encouraged
2. rather encouraged
3. rather discouraged
4. strongly discouraged
========================================================================
Q10_A
How often pcp explains results
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) EXPLAIN TO YOU THE RESULTS OF MEDICAL EXAMS (LABORATORY, RADIOLOGY, ETC.)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) EXPLAIN TO YOU THE RESULTS OF MEDICAL EXAMS (LABORATORY, RADIOLOGY, ETC.)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
========================================================================
Q10_B
How often pcp explains treatment options
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) EXPLAIN TO YOU DIFFERENT TREATMENT OPTIONS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) EXPLAIN TO YOU DIFFERENT TREATMENT OPTIONS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
========================================================================
Q10_C
How often pcp listens to opinion
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) LISTEN TO YOUR OPINION AND TAKE YOUR PREFERENCES INTO ACCOUNT TO CHOSE TREATMENTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
IN GENERAL, HOW OFTEN DOES YOUR USUAL SOURCE OF CARE (DOCTOR OR NURSE) LISTEN TO YOUR OPINION AND TAKE YOUR PREFERENCES INTO ACCOUNT TO CHOSE TREATMENTS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. missing
1. always
2. mostly
3. rarely
4. never
========================================================================
Q11_A
Received flu vaccination
IN THE PAST 12 MONTHS HAVE YOU HAD A FLU VACCINATION?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
IN THE PAST 12 MONTHS HAVE YOU HAD A FLU VACCINATION?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q11_B
Checked blood pressure
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD PRESSURE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD PRESSURE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q11_C
Checked cholesterol
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD CHOLESTEROL?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD CHOLESTEROL?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q11_D
Checked blood sugar
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD SUGAR (FOR DIABETES SCREENING)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
IN THE PAST 12 MONTHS HAS A DOCTOR OR NURSE CHECKED YOUR BLOOD SUGAR (FOR DIABETES SCREENING)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q12
Had eye exam
IN THE LAST TWO YEARS, HAVE YOU HAD AN EYE EXAM PERFORMED BY AN EYE CARE PROFESSIONAL SUCH AS AN OPHTHALMOLOGIST OR OPTOMETRIST?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
IN THE LAST TWO YEARS, HAVE YOU HAD AN EYE EXAM PERFORMED BY AN EYE CARE PROFESSIONAL SUCH AS AN OPHTHALMOLOGIST OR OPTOMETRIST?
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q13
Had mammogram
IF YOU ARE A WOMAN: IN THE LAST TWO YEARS, HAVE YOU HAD A MAMMOGRAM (X-RAY OF THE BREAST)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. yes
5. no
IF YOU ARE A WOMAN: IN THE LAST TWO YEARS, HAVE YOU HAD A MAMMOGRAM (X-RAY OF THE BREAST)?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9. not applicable (e.g.filtered)
-5. not answered
1. yes
5. no
========================================================================
Q14_A
Have pets: dog
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? DOG
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? DOG
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q14_B
Have pets: cat
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? CAT
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? CAT
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q14_C
Have pets: bird
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? BIRD
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? BIRD
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q14_D
Have pets: fish
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? FISH
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? FISH
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
========================================================================
Q14_E
Have pets: other
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? OTHER PETS
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
DO YOU CURRENTLY HAVE ONE OR MORE OF THE FOLLOWING PETS IN YOUR HOUSEHOLD? OTHER PETS
- - - - - - - - - - - - - - - - - - - - - - - - -
-5. not answered
1. yes
5. no
End of SC. Self-Completion