| ENTRY SPECIFICATION |
{"name": "WHODAS 2",
days and answer these questions, thinking about how much difficulty you had
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
doing the following activities. In the past 30 days, how much DIFFICULTY did you
{"id": "s1303", "type": "IntroText",
"text": "Getting around"
},
{"id": "q5689", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D2.1. Standing for long periods such as 30 minutes?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
have in: "
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5690", "type": "ChoiceQuestion", "required": false, "inline": true,
},
"text": "D2.2. Standing up from sitting down?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "q5683", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5691", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D2.3. Moving around inside your home?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
"text": "D1.1. Concentrating on doing something for ten minutes?",
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"intro": "This questionnaire asks about difficulties due to health conditions. Health
]},
{"id": "q5692", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D2.4. Getting out of your home?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
conditions include diseases or illnesses, other health problems that may be
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5693", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D2.5. Walking a long distance such as a kilometer [or equivalent]?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
short or long lasting, injuries, mental or emotional problems, and problems with
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
alcohol or drugs.<br />Think back over the past 30 days and answer these
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "s1304", "type": "IntroText",
"text": "Self-care"
},
{"id": "q5694", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D3.1. Washing your whole body?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
"restartDays": 2,
questions, thinking about how much difficulty you had doing the following
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5695", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D3.2. Getting dressed?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5696", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D3.3. Eating?",
"choices":[
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5697", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D3.4. Staying by yourself for a few days?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
{"id": "c3", "text": "1. Mild", "quickKey": 1},
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "s1305", "type": "IntroText",
"text": "Getting along with people"
},
{"id": "q5698", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D4.1. Dealing with people you do not know?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
{"id": "c5", "text": "3. Severe", "quickKey": 3},
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5699", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"text": "D4.2. Maintaining a friendship?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
]},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5700", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D4.3. Getting along with people who are close to you?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
"printTitle": "World Health Organization Disability Assessment Schedule 2.0",
{"id": "q5684", "type": "ChoiceQuestion", "required": false, "inline": true,
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"text": "D1.2. Remembering to do important things?",
]},
{"id": "q5701", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D4.4. Making new friends?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"intro": "This questionnaire asks about difficulties due to health conditions. Health
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5702", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D4.5. Sexual activities?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
short or long lasting, injuries, mental or emotional problems, and problems with
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "s1306", "type": "IntroText",
"text": "Life activities"
},
{"id": "q5703", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.1. Taking care of your household responsibilities?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
alcohol or drugs.<br />Think back over the past 30 days and answer these
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
questions, thinking about how much difficulty you had doing the following
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5704", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.2. Doing most important household tasks well?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5705", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.3. Getting all the household work done that you needed to do?",
"columns": 2,
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
"choices":[
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5706", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.4. Getting your household work done as quickly as needed?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
"content":[
{"id": "c1", "text": "0. None", "quickKey": 0},
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "q5707", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": " Do you work (paid, non-paid, self-employed) or go to school?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c237", "text": "0. No", "quickKey": 0},
{"id": "c241", "text": "1. Yes", "quickKey": 1}
]},
{"id": "q5708", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.5. Your day-to-day work/school?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
{"id": "c5", "text": "3. Severe", "quickKey": 3},
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5709", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"text": "D5.6. Doing your most important work/school tasks well?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
]},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5710", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.7. Getting all the work done that you need to do?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
{"id": "q5685", "type": "ChoiceQuestion", "required": false, "inline": true,
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"text": "D1.3. Analyzing and finding solutions to problems in day-to-day life?",
]},
{"id": "q5711", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D5.8. Getting your work done as quickly as needed?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"intro": "This questionnaire asks about difficulties due to health conditions. Health
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "s1307", "type": "IntroText",
"text": "Participation in society"
},
conditions include diseases or illnesses, other health problems that may be
{"id": "q5712", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "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?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
{"id": "i736", "type": "IntroText",
short or long lasting, injuries, mental or emotional problems, and problems with
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5713", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.2. How much of a problem did you have because of barriers or hindrances in the
alcohol or drugs.<br />Think back over the past 30 days and answer these
world around you?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
questions, thinking about how much difficulty you had doing the following
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5714", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.3. How much of a problem did you have living with dignity because of the
attitudes and actions of others?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
"columns": 2,
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5715", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.4. How much time did you spend on your health condition, or its consequences?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"choices":[
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5716", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.5. How much have you been emotionally affected by your health condition?",
{"id": "c1", "text": "0. None", "quickKey": 0},
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5717", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.6. How much has your health been a drain on the financial resources of you or
your family?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
{"id": "c5", "text": "3. Severe", "quickKey": 3},
]},
{"id": "q5718", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.7. How much of a problem did your family have because of your health problems?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"text": "Understanding and communicating<br />This questionnaire asks about difficulties
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5719", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D6.8. How much of a problem did you have in doing things by yourself for
relaxation or pleasure?",
]},
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "q5686", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5720", "type": "IntegerQuestion", "required": false,
"text": "H1. Overall, in the past 30 days, how many days were these difficulties present?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
"text": "D1.4. Learning a new task, for example, learning how to get to a new place?",
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"controlWidth": 60, "min": 0, "max": 30},
{"id": "q5721", "type": "IntegerQuestion", "required": false,
"text": "H2. In the past 30 days, for how many days were you totally unable to carry out
your usual activities or work because of any health condition?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
"intro": "This questionnaire asks about difficulties due to health conditions. Health
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"controlWidth": 60, "min": 0, "max": 30},
{"id": "q5722", "type": "IntegerQuestion", "required": false,
"text": "H3. In the past 30 days, not counting the days that you were totally unable, for
how many days did you cut back or reduce your usual activities or work because
of any health condition?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
conditions include diseases or illnesses, other health problems that may be
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"controlWidth": 60, "min": 0, "max": 30}],
"rules":[
{"question": "q5707", "operator": "EQ", "value": "c237",
"skips":["q5708","q5709","q5710","q5711"]}]
}
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
due to health conditions. Health conditions include diseases or illnesses, other
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5687", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D1.5. Generally understanding what people say?",
health problems that may be short or long lasting, injuries, mental or emotional
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
questions, thinking about how much difficulty you had doing the following
activities. In the past 30 days, how much DIFFICULTY did you have in: ",
"columns": 2,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c3", "text": "1. Mild", "quickKey": 1},
problems, and problems with alcohol or drugs.<br />Think back over the past 30
{"id": "c4", "text": "2. Moderate", "quickKey": 2},
{"id": "c5", "text": "3. Severe", "quickKey": 3},
{"id": "c3035", "text": "4. Extreme or cannot do", "quickKey": 4}
]},
{"id": "q5688", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "D1.6. Starting and maintaining a conversation?",
"intro": "This questionnaire asks about difficulties due to health conditions. Health
conditions include diseases or illnesses, other health problems that may be
short or long lasting, injuries, mental or emotional problems, and problems with
alcohol or drugs.<br />Think back over the past 30 days and answer these
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