SW. Work Self-Completion Questionnaire Module

Start of SW. Work Self-Completion Questionnaire
 
SWACHE1

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
 
SWWAKE1

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
 
SWMOB1

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
 
SWMEM1

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
 
SWRESP1

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
 
SWSAD1

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
 
SWWORK1

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
 
SWMOB2

elizabeth vignette: work could do in last 30 days limited due to mobility prob.

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. ELIZABETH HAS ALMOST CONSTANT PAIN IN HER BACK AND THIS SOMETIMES PREVENTS HER FROM DOING HER WORK. HOW MUCH IS ELIZABETH LIMITED IN THE KIND OR AMOUNT OF WORK SHE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWACHE2

geoffrey vignette: work could do in last 30 days limited due to aches and pains

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. GEOFFREY SUFFERS FROM BACK PAIN THAT CAUSES STIFFNESS IN HIS BACK ESPECIALLY AT WORK BUT IT IS RELIEVED WITH LOW DOSES OF MEDICATION. HE DOES NOT HAVE ANY PAINS OTHER THAN THIS GENERALISED DISCOMFORT. HOW MUCH IS GEOFFREY LIMITED IN THE KIND OR AMOUNT OF WORK HE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWMOB3

christine vignette: work could do in last 30 days limited due to mobility prob.

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. CHRISTINE HAS PAIN IN HER BACK AND LEGS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. IT GETS WORSE WHILE SHE IS WORKING. ALTHOUGH MEDICATION HELPS, SHE FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS AT WORK. HOW MUCH IS CHRISTINE LIMITED IN THE KIND OR AMOUNT OF WORK SHE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWSAD2

richard vignette: work could do in last 30 days limited due to depression

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. RICHARD FEELS WORRIED ALL THE TIME. HE GETS DEPRESSED ONCE A WEEK AT WORK FOR A COUPLE OF DAYS IN A ROW, THINKING ABOUT WHAT COULD GO WRONG AND THAT HIS BOSS WILL DISAPPROVE OF HIS CONDITION. BUT HE IS ABLE TO COME OUT OF THIS MOOD IF HE CONCENTRATES ON SOMETHING ELSE. HOW MUCH IS RICHARD LIMITED IN THE KIND OR AMOUNT OF WORK HE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWSAD3

katherine vignette: work could do in last 30 days limited due to depression

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. KATHERINE HAS MOOD SWINGS WHILST AT WORK. WHEN SHE GETS DEPRESSED, EVERYTHING SHE DOES AT WORK IS AN EFFORT FOR HER AND SHE NO LONGER ENJOYS HER USUAL ACTIVITIES AT WORK. THESE MOOD SWINGS ARE NOT PREDICTABLE AND OCCUR TWO OR THREE TIMES A MONTH. HOW MUCH IS KATHERINE LIMITED IN THE KIND OR AMOUNT OF WORK SHE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWSAD4

anthony vignette: work could do in last 30 days limited due to depression

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. ANTHONY GENERALLY ENJOYS HIS WORK. HE GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT HE USUALLY ENJOYS BUT IS ABLE TO CARRY ON WITH HIS DAY-TO-DAY ACTIVITIES AT WORK. HOW MUCH IS ANTHONY LIMITED IN THE KIND OR AMOUNT OF WORK HE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWACHE3

linda vignette: work could do in last 30 days limited due to aches and pains

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. LINDA HAS HAD HEART PROBLEMS IN THE PAST AND SHE HAS BEEN TOLD TO WATCH HER CHOLESTEROL LEVEL. SOMETIMES IF SHE FEELS STRESSED AT WORK SHE FEELS PAIN IN HER CHEST AND OCCASIONALLY IN HER ARMS. HOW MUCH IS LINDA LIMITED IN THE KIND OR AMOUNT OF WORK SHE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWMOB4

colin vignette: work could do in last 30 days limited due to mobility prob.

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. COLIN HAS BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. HIS BLOOD PRESSURE GOES UP QUICKLY IF HE FEELS UNDER STRESS. COLIN DOES NOT EXERCISE MUCH AND IS OVERWEIGHT. HOW MUCH IS COLIN LIMITED IN THE KIND OR AMOUNT OF WORK HE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
SWACHE4

jennifer vignette: work could do in last 30 days limited due to aches and pains

WE WOULD LIKE TO GIVE YOU SOME EXAMPLES OF PEOPLE WITH HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE PEOPLE WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. PLEASE ASSUME THAT THE PEOPLE HAVE THE SAME AGE, EDUCATION AND WORK HISTORY THAT YOU HAVE. OTHER THAN THE CONDITIONS MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. JENNIFER HAS UNDERGONE TRIPLE BYPASS HEART SURGERY. SHE IS A HEAVY SMOKER AND STILL EXPERIENCES SEVERE CHEST PAIN SOMETIMES. HOW MUCH IS JENNIFER LIMITED IN THE KIND OR AMOUNT OF WORK SHE COULD DO?

-9 not answered
-1 item not applicable
1 not limited
2 mildly
3 moderately
4 severly
5 extremely
 
End of SW. Work Self-Completion Questionnaire