SH. Health Self-completion Questionnaire

The Health and Work self-completions are both made up of two sections. The first asks respondents to rate various aspects of their own situation on a 5-point scale. These questions focus on mobility, pain, cognition, sleep, and depression. In the second section of the two questionnaires, respondents are asked to rate the situation of various hypothetical people who experience different circumstances(vignettes) on the same 5-point scale used in the first section.

item label type description
SHACHE1 Question degree of aches and pains in last 30 days
SHWAKE1 Question difficulty in sleeping in last 30 days
SHMOB1 Question problem with moving around in last 30 days
SHMEM1 Question difficulty with concentrating/remembering things in last 30 days
SHRESP1 Question problem because of shortness of breath in last 30 days
SHSAD1 Question problem with feeling sad, low or depressed in last 30 days
SHWORK1 Question limited in kind/amount of work can do due to health problem
SHACHE2 Question paul vignette: degree of aches and pains in last 30 days
SHWAKE2 Question carol vignette: difficulty in sleeping in last 30 days
SHACHE3 Question henry vignette: degree of aches and pains in last 30 days
SHWAKE3 Question margaret vignette: difficulty in sleeping in last 30 days
SHACHE4 Question john vignette: degree of aches and pains in last 30 days
SHWAKE4 Question alice vignette: difficulty in sleeping in last 30 days
SHMOB2 Question tom vignette: problem with moving around in last 30 days
SHMEM2 Question mary vignette: difficulty with concentrating/remembering things in last 30 days
SHMOB3 Question david vignette: problem with moving around in last 30 days
SHMEM3 Question sue vignette: difficulty with concentrating/remembering things in last 30 days
SHMOB4 Question robert vignette: problem with moving around in last 30 days
SHMEM4 Question eve vignette: difficulty with concentrating/remembering things in last 30 days
SHRESP2 Question eric vignette: problem because of shortness of breath in last 30 days
SHSAD2 Question ann vignette: problem with feeling sad, low or depressed in last 30 days
SHRESP3 Question michael vignette: problem because of shortness of breath in last 30 days
SHSAD3 Question patricia vignette: problem with feeling sad, low, or depressed
SHRESP4 Question peter vignette: problem because of shortness of breath in last 30 days
SHSAD4 Question jean vignette: problem with feeling sad, low or depressed in last 30 days
Start of SH. Health Self-completion Questionnaire
 
SHACHE1

degree of aches and pains in last 30 days

OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS HAVE YOU HAD?
expand
 
SHWAKE1

difficulty in sleeping in last 30 days

IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY HAVE YOU HAD WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
expand
 
SHMOB1

problem with moving around in last 30 days

OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD WITH MOVING AROUND?
expand
 
SHMEM1

difficulty with concentrating/remembering things in last 30 days

OVERALL IN THE LAST 30 DAYS HOW MUCH DIFFICULTY HAVE YOU HAD WITH CONCENTRATING OR REMEMBERING THINGS?
expand
 
SHRESP1

problem because of shortness of breath in last 30 days

IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD BECAUSE OF SHORTNESS OF BREATH?
expand
 
SHSAD1

problem with feeling sad, low or depressed in last 30 days

OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD WITH FEELING SAD, LOW, OR DEPRESSED?
expand
 
SHWORK1

limited in kind/amount of work can do due to health problem

HOW MUCH ARE YOU LIMITED IN THE KIND OR AMOUNT OF WORK THAT YOU CAN DO DUE TO AN IMPAIRMENT OR HEALTH PROBLEM?
expand
 
SHACHE2

paul vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. PAUL HAS A HEADACHE ONCE A MONTH THAT IS RELIEVED AFTER TAKING A PILL. DURING THE HEADACHE HE CAN CARRY ON WITH HIS DAY-TO-DAY AFFAIRS. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID PAUL HAVE?
expand
 
SHWAKE2

carol vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. CAROL TAKES ABOUT TWO HOURS TO FALL ASLEEP EVERY NIGHT. SHE WAKES UP ONCE OR TWICE A NIGHT FEELING PANICKED AND TAKES MORE THAN AN HOUR TO FALL ASLEEP AGAIN. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID CAROL HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
expand
 
SHACHE3

henry vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. HENRY HAS PAIN THAT RADIATES DOWN HIS RIGHT ARM AND WRIST DURING HIS DAY AT WORK. THIS IS SLIGHTLY RELIEVED IN THE EVENINGS WHEN HE IS NO LONGER WORKING ON HIS COMPUTER. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID HENRY HAVE?
expand
 
SHWAKE3

margaret vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MARGARET WAKES UP ALMOST ONCE EVERY HOUR DURING THE NIGHT. WHEN SHE WAKES UP IN THE NIGHT, IT TAKES AROUND 15 MINUTES FOR HER TO GO BACK TO SLEEP. IN THE MORNING SHE DOES NOT FEEL WELL-RESTED. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID MARGARET HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
expand
 
SHACHE4

john vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. JOHN HAS PAIN IN HIS KNEES, ELBOWS, WRISTS AND FINGERS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. ALTHOUGH MEDICATION HELPS, HE FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID JOHN HAVE?
expand
 
SHWAKE4

alice vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ALICE FALLS ASLEEP EASILY AT NIGHT, BUT TWO NIGHTS A WEEK SHE WAKES UP IN THE MIDDLE OF THE NIGHT AND CANNOT GO BACK TO SLEEP FOR THE REST OF THE NIGHT. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID ALICE HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
expand
 
SHMOB2

tom vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. TOM HAS A LOT OF SWELLING IN HIS LEGS DUE TO HIS HEALTH CONDITION. HE HAS TO MAKE AN EFFORT TO WALK AROUND HIS HOME AS HIS LEGS FEEL HEAVY. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID TOM HAVE WITH MOVING AROUND?
expand
 
SHMEM2

mary vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MARY CAN CONCENTRATE WHILE WATCHING TV, READING A MAGAZINE OR PLAYING A GAME OF CARDS OR CHESS. ONCE A WEEK SHE FORGETS WHERE HER KEYS OR GLASSES ARE, BUT FINDS THEM WITHIN FIVE MINUTES. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID MARY HAVE WITH CONCENTRATING OR REMEMBERING THINGS?
expand
 
SHMOB3

david vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. DAVID DOES NOT EXERCISE. HE CANNOT CLIMB STAIRS OR DO OTHER PHYSICAL ACTIVITIES BECAUSE HE IS OBESE. HE IS ABLE TO CARRY THE GROCERIES AND DO SOME LIGHT HOUSEHOLD WORK. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID DAVID HAVE WITH MOVING AROUND?
expand
 
SHMEM3

sue vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. SUE IS KEEN TO LEARN NEW RECIPES BUT FINDS THAT SHE OFTEN MAKES MISTAKES AND HAS TO REREAD THEM SEVERAL TIMES BEFORE SHE IS ABLE TO DO THEM PROPERLY. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID SUE HAVE WITH CONCENTRATING AND REMEMBERING THINGS?
expand
 
SHMOB4

robert vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ROBERT IS ABLE TO WALK DISTANCES OF UP TO 200 METRES WITHOUT ANY PROBLEMS BUT FEELS TIRED AFTER WALKING ONE KILOMETRE OR CLIMBING MORE THAN ONE FLIGHT OF STAIRS. HE HAS NO PROBLEMS WITH DAY-TO-DAY ACTIVITIES, SUCH AS CARRYING FOOD FROM THE MARKET. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ROBERT HAVE WITH MOVING AROUND?
expand
 
SHMEM4

eve vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. EVE CANNOT CONCENTRATE FOR MORE THAN 15 MINUTES AND HAS DIFFICULTY PAYING ATTENTION TO WHAT IS BEING SAID TO HER. WHEN SHE STARTS A TASK, SHE NEVER MANAGES TO FINISH IT AND OFTEN FORGETS WHAT SHE WAS DOING. SHE IS ABLE TO LEARN THE NAMES OF PEOPLE SHE MEETS. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID EVE HAVE WITH CONCENTRATING OR REMEMBERING THINGS?
expand
 
SHRESP2

eric vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ERIC HAS NO PROBLEMS WITH WALKING SLOWLY. HE GETS OUT OF BREATH EASILY WHEN CLIMBING UPHILL FOR 20 METRES OR A FLIGHT OF STAIRS. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ERIC HAVE BECAUSE OF SHORTNESS OF BREATH?
expand
 
SHSAD2

ann vignette: problem with feeling sad, low or depressed in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ANN FEELS DEPRESSED MOST OF THE TIME. SHE WEEPS FREQUENTLY AND FEELS HOPELESS ABOUT THE FUTURE. SHE FEELS THAT SHE HAS BECOME A BURDEN ON OTHERS AND THAT SHE WOULD BE BETTER DEAD. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ANN HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
expand
 
SHRESP3

michael vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MICHAEL SUFFERS FROM RESPIRATORY INFECTIONS ABOUT ONCE EVERY YEAR. HE IS SHORT OF BREATH 3 OR 4 TIMES A WEEK AND HAD TO BE ADMITTED TO HOSPITAL TWICE IN THE PAST MONTH WITH A BAD COUGH THAT REQUIRED TREATMENT WITH ANTIBIOTICS. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID MICHAEL HAVE BECAUSE OF SHORTNESS OF BREATH?
expand
 
SHSAD3

patricia vignette: problem with feeling sad, low, or depressed

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. 23
PATRICIA FEELS NERVOUS AND ANXIOUS. SHE WORRIES AND THINKS NEGATIVELY ABOUT THE FUTURE, BUT FEELS BETTER IN THE COMPANY OF PEOPLE OR WHEN DOING SOMETHING THAT REALLY INTERESTS HER. WHEN SHE IS ALONE SHE TENDS TO FEEL USELESS AND EMPTY. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID PATRICIA HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
expand
 
SHRESP4

peter vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. PETER HAS BEEN A HEAVY SMOKER FOR 30 YEARS AND WAKES UP WITH A COUGH EVERY MORNING. HE GETS SHORT OF BREATH EVEN WHILE RESTING AND DOES NOT LEAVE THE HOUSE ANYMORE. HE OFTEN NEEDS TO BE PUT ON OXYGEN. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID PETER HAVE BECAUSE OF SHORTNESS OF BREATH?
expand
 
SHSAD4

jean vignette: problem with feeling sad, low or depressed in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. JEAN ENJOYS HER WORK AND SOCIAL ACTIVITIES AND IS GENERALLY SATISFIED WITH HER LIFE. SHE GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT SHE USUALLY ENJOYS BUT IS ABLE TO CARRY ON WITH HER DAY-TO-DAY ACTIVITIES. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID JEAN HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
expand
 
End of SH. Health Self-completion Questionnaire
Start of SH. Health Self-completion Questionnaire

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SHACHE1
degree of aches and pains in last 30 days

OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS HAVE YOU HAD?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHWAKE1
difficulty in sleeping in last 30 days

IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY HAVE YOU HAD WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMOB1
problem with moving around in last 30 days

OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD WITH MOVING AROUND?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMEM1
difficulty with concentrating/remembering things in last 30 days

OVERALL IN THE LAST 30 DAYS HOW MUCH DIFFICULTY HAVE YOU HAD WITH CONCENTRATING OR REMEMBERING THINGS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHRESP1
problem because of shortness of breath in last 30 days

IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD BECAUSE OF SHORTNESS OF BREATH?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHSAD1
problem with feeling sad, low or depressed in last 30 days

OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM HAVE YOU HAD WITH FEELING SAD, LOW, OR DEPRESSED?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHWORK1
limited in kind/amount of work can do due to health problem

HOW MUCH ARE YOU LIMITED IN THE KIND OR AMOUNT OF WORK THAT YOU CAN DO DUE TO AN IMPAIRMENT OR HEALTH PROBLEM?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely

========================================================================
SHACHE2
paul vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. PAUL HAS A HEADACHE ONCE A MONTH THAT IS RELIEVED AFTER TAKING A PILL. DURING THE HEADACHE HE CAN CARRY ON WITH HIS DAY-TO-DAY AFFAIRS. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID PAUL HAVE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHWAKE2
carol vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. CAROL TAKES ABOUT TWO HOURS TO FALL ASLEEP EVERY NIGHT. SHE WAKES UP ONCE OR TWICE A NIGHT FEELING PANICKED AND TAKES MORE THAN AN HOUR TO FALL ASLEEP AGAIN. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID CAROL HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHACHE3
henry vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. HENRY HAS PAIN THAT RADIATES DOWN HIS RIGHT ARM AND WRIST DURING HIS DAY AT WORK. THIS IS SLIGHTLY RELIEVED IN THE EVENINGS WHEN HE IS NO LONGER WORKING ON HIS COMPUTER. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID HENRY HAVE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHWAKE3
margaret vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MARGARET WAKES UP ALMOST ONCE EVERY HOUR DURING THE NIGHT. WHEN SHE WAKES UP IN THE NIGHT, IT TAKES AROUND 15 MINUTES FOR HER TO GO BACK TO SLEEP. IN THE MORNING SHE DOES NOT FEEL WELL-RESTED. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID MARGARET HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHACHE4
john vignette: degree of aches and pains in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. JOHN HAS PAIN IN HIS KNEES, ELBOWS, WRISTS AND FINGERS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. ALTHOUGH MEDICATION HELPS, HE FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS. OVERALL IN THE LAST 30 DAYS, WHAT DEGREE OF ACHES AND PAINS DID JOHN HAVE?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHWAKE4
alice vignette: difficulty in sleeping in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ALICE FALLS ASLEEP EASILY AT NIGHT, BUT TWO NIGHTS A WEEK SHE WAKES UP IN THE MIDDLE OF THE NIGHT AND CANNOT GO BACK TO SLEEP FOR THE REST OF THE NIGHT. IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID ALICE HAVE WITH SLEEPING, SUCH AS FALLING ASLEEP, WAKING UP FREQUENTLY DURING THE NIGHT OR WAKING UP TOO EARLY IN THE MORNING?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMOB2
tom vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. TOM HAS A LOT OF SWELLING IN HIS LEGS DUE TO HIS HEALTH CONDITION. HE HAS TO MAKE AN EFFORT TO WALK AROUND HIS HOME AS HIS LEGS FEEL HEAVY. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID TOM HAVE WITH MOVING AROUND?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMEM2
mary vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MARY CAN CONCENTRATE WHILE WATCHING TV, READING A MAGAZINE OR PLAYING A GAME OF CARDS OR CHESS. ONCE A WEEK SHE FORGETS WHERE HER KEYS OR GLASSES ARE, BUT FINDS THEM WITHIN FIVE MINUTES. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID MARY HAVE WITH CONCENTRATING OR REMEMBERING THINGS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMOB3
david vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. DAVID DOES NOT EXERCISE. HE CANNOT CLIMB STAIRS OR DO OTHER PHYSICAL ACTIVITIES BECAUSE HE IS OBESE. HE IS ABLE TO CARRY THE GROCERIES AND DO SOME LIGHT HOUSEHOLD WORK. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID DAVID HAVE WITH MOVING AROUND?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMEM3
sue vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. SUE IS KEEN TO LEARN NEW RECIPES BUT FINDS THAT SHE OFTEN MAKES MISTAKES AND HAS TO REREAD THEM SEVERAL TIMES BEFORE SHE IS ABLE TO DO THEM PROPERLY. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID SUE HAVE WITH CONCENTRATING AND REMEMBERING THINGS?
- - - - - - - - - - - - - - - - - - - - - - - - -
-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

========================================================================
SHMOB4
robert vignette: problem with moving around in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ROBERT IS ABLE TO WALK DISTANCES OF UP TO 200 METRES WITHOUT ANY PROBLEMS BUT FEELS TIRED AFTER WALKING ONE KILOMETRE OR CLIMBING MORE THAN ONE FLIGHT OF STAIRS. HE HAS NO PROBLEMS WITH DAY-TO-DAY ACTIVITIES, SUCH AS CARRYING FOOD FROM THE MARKET. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ROBERT HAVE WITH MOVING AROUND?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHMEM4
eve vignette: difficulty with concentrating/remembering things in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. EVE CANNOT CONCENTRATE FOR MORE THAN 15 MINUTES AND HAS DIFFICULTY PAYING ATTENTION TO WHAT IS BEING SAID TO HER. WHEN SHE STARTS A TASK, SHE NEVER MANAGES TO FINISH IT AND OFTEN FORGETS WHAT SHE WAS DOING. SHE IS ABLE TO LEARN THE NAMES OF PEOPLE SHE MEETS. OVERALL IN THE LAST 30 DAYS, HOW MUCH DIFFICULTY DID EVE HAVE WITH CONCENTRATING OR REMEMBERING THINGS?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHRESP2
eric vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ERIC HAS NO PROBLEMS WITH WALKING SLOWLY. HE GETS OUT OF BREATH EASILY WHEN CLIMBING UPHILL FOR 20 METRES OR A FLIGHT OF STAIRS. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ERIC HAVE BECAUSE OF SHORTNESS OF BREATH?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHSAD2
ann vignette: problem with feeling sad, low or depressed in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. ANN FEELS DEPRESSED MOST OF THE TIME. SHE WEEPS FREQUENTLY AND FEELS HOPELESS ABOUT THE FUTURE. SHE FEELS THAT SHE HAS BECOME A BURDEN ON OTHERS AND THAT SHE WOULD BE BETTER DEAD. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID ANN HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHRESP3
michael vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. MICHAEL SUFFERS FROM RESPIRATORY INFECTIONS ABOUT ONCE EVERY YEAR. HE IS SHORT OF BREATH 3 OR 4 TIMES A WEEK AND HAD TO BE ADMITTED TO HOSPITAL TWICE IN THE PAST MONTH WITH A BAD COUGH THAT REQUIRED TREATMENT WITH ANTIBIOTICS. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID MICHAEL HAVE BECAUSE OF SHORTNESS OF BREATH?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHSAD3
patricia vignette: problem with feeling sad, low, or depressed

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. 23
PATRICIA FEELS NERVOUS AND ANXIOUS. SHE WORRIES AND THINKS NEGATIVELY ABOUT THE FUTURE, BUT FEELS BETTER IN THE COMPANY OF PEOPLE OR WHEN DOING SOMETHING THAT REALLY INTERESTS HER. WHEN SHE IS ALONE SHE TENDS TO FEEL USELESS AND EMPTY. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID PATRICIA HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
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patricia vignette: problem with feeling sad, low or depressed in last 30 days

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SHRESP4
peter vignette: problem because of shortness of breath in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. PETER HAS BEEN A HEAVY SMOKER FOR 30 YEARS AND WAKES UP WITH A COUGH EVERY MORNING. HE GETS SHORT OF BREATH EVEN WHILE RESTING AND DOES NOT LEAVE THE HOUSE ANYMORE. HE OFTEN NEEDS TO BE PUT ON OXYGEN. IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID PETER HAVE BECAUSE OF SHORTNESS OF BREATH?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

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SHSAD4
jean vignette: problem with feeling sad, low or depressed in last 30 days

WE WILL GIVE YOU SOME EXAMPLES OF PEOPLE WITH SERIOUS AND LESS SERIOUS HEALTH PROBLEMS. WE WOULD LIKE TO KNOW HOW YOU EVALUATE THE HEALTH OF THESE PEOPLE. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE AND BACKGROUND THAT YOU HAVE. JEAN ENJOYS HER WORK AND SOCIAL ACTIVITIES AND IS GENERALLY SATISFIED WITH HER LIFE. SHE GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT SHE USUALLY ENJOYS BUT IS ABLE TO CARRY ON WITH HER DAY-TO-DAY ACTIVITIES. OVERALL IN THE LAST 30 DAYS, HOW MUCH OF A PROBLEM DID JEAN HAVE WITH FEELING SAD, LOW, OR DEPRESSED?
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-9 not answered
-1 item not applicable
1 none
2 mild
3 moderate
4 severe
5 extreme

End of SH. Health Self-completion Questionnaire