. 2013 Sep 5;6:10.3402/gha.v6i0.21064. doi: 10.3402/gha.v6i0.21064

Appendix 1.

Text of mobility and cognition vignettes

Domain question	Vignette
Mobility – overall in the last 30 days, how much difficulty did [you/name_] have …. with moving around? …. with vigorous activity (such as cycling, working in fields, etc.)?	Severity level 1: [name_a] has no problems with walking, running or using her hands, arms and legs. She jogs 4 kilometers twice a week. Severity level 2: [name_b] is able to walk distances of up to 200 meters without any problems but feels tired after walking 1 kilometer or climbing up more than one flight of stairs. He has no problems with day-to-day physical activities, such as carrying food from the market. Severity level 3: [name_c] does not exercise. She cannot climb stairs or do other physical activities because she is obese. She is able to carry the groceries and do some light household work. Severity level 4: [name_d] 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. Severity level 5: [name_e] is paralyzed from the neck down. He is unable to move his arms and legs or to shift body position. He is confined to bed.
Cognition – Overall in the last 30 days, how much difficulty did [you/name_] have …. with concentrating or remembering things? …. learning a new task (e.g. learning how to get to a new place, learning a new game, learning a new recipe)?	Severity level 1: [name_a] is very quick to learn new skills at his work. He can pay attention to the task at hand for long uninterrupted periods of time. He can remember names of people, addresses, phone numbers and such details that go back several years. Severity level 2: [name_b] can concentrate while watching TV, reading a magazine or playing a game of cards or chess. He can learn new variations in these games with small effort. Once a week he forgets where his keys or glasses are, but finds them within 5 minutes. Severity level 3: [name_c] can find her way around the neighborhood and know where her own belongings are kept but struggles to remember how to get to a place she has only visited once or twice. She is keen to learn new recipes but finds that she often makes mistakes and has to reread several times before she is able to do them properly. Severity level 4: [name_d] cannot concentrate for more than 15 minutes and has difficulty paying attention to what is being said to him. Whenever he starts a task, he never manages to finish it and often forgets what he was doing. He is able to learn the names of people he meets but cannot be trusted to follow directions to a store by himself. Severity level 5: [name_e] does not recognize even close relatives and gets lost when he leaves the house unaccompanied. Even when prompted, he shows no recollection of events or recognition of relatives. It is impossible for him to acquire any new knowledge as even simple instructions leave him confused.

Domain question

Vignette

Mobility – overall in the last 30 days, how much difficulty did [you/name_] have …. with moving around? …. with vigorous activity (such as cycling, working in fields, etc.)?

Severity level 1: [name_a] has no problems with walking, running or using her hands, arms and legs. She jogs 4 kilometers twice a week.
Severity level 2: [name_b] is able to walk distances of up to 200 meters without any problems but feels tired after walking 1 kilometer or climbing up more than one flight of stairs. He has no problems with day-to-day physical activities, such as carrying food from the market.
Severity level 3: [name_c] does not exercise. She cannot climb stairs or do other physical activities because she is obese. She is able to carry the groceries and do some light household work.
Severity level 4: [name_d] 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.
Severity level 5: [name_e] is paralyzed from the neck down. He is unable to move his arms and legs or to shift body position. He is confined to bed.

Cognition – Overall in the last 30 days, how much difficulty did [you/name_] have …. with concentrating or remembering things? …. learning a new task (e.g. learning how to get to a new place, learning a new game, learning a new recipe)?

Severity level 1: [name_a] is very quick to learn new skills at his work. He can pay attention to the task at hand for long uninterrupted periods of time. He can remember names of people, addresses, phone numbers and such details that go back several years.
Severity level 2: [name_b] can concentrate while watching TV, reading a magazine or playing a game of cards or chess. He can learn new variations in these games with small effort. Once a week he forgets where his keys or glasses are, but finds them within 5 minutes.
Severity level 3: [name_c] can find her way around the neighborhood and know where her own belongings are kept but struggles to remember how to get to a place she has only visited once or twice. She is keen to learn new recipes but finds that she often makes mistakes and has to reread several times before she is able to do them properly.
Severity level 4: [name_d] cannot concentrate for more than 15 minutes and has difficulty paying attention to what is being said to him. Whenever he starts a task, he never manages to finish it and often forgets what he was doing. He is able to learn the names of people he meets but cannot be trusted to follow directions to a store by himself.
Severity level 5: [name_e] does not recognize even close relatives and gets lost when he leaves the house unaccompanied. Even when prompted, he shows no recollection of events or recognition of relatives. It is impossible for him to acquire any new knowledge as even simple instructions leave him confused.