Table 1.
Baseline questionnaire
| Domain | Item synopsis |
|---|---|
| Eye care utilization | When was the last time you had an eye exam in which your pupils were dilated? |
| Trouble seeing | Do you have any trouble seeing, even when wearing glasses or contact lenses? (Yes/no) |
| Visual task difficulty | Because of your eyesight: |
| How much difficulty do you have reading ordinary print in newspapers? | |
| How much difficulty do you have going down steps, stairs, or curbs in dim light or at night? | |
| How much difficulty do you have finding something on a crowded shelf? (Difficulty scale)a | |
| Accessibility/transportation | How much difficulty did you have finding a way to get here? (Difficulty scale)a |
| I’m more likely to go to the eye doctor if the doctor’s office is near a place I shop. (Agree/disagree scale)b | |
| Review of chronic medical conditions | Have you ever been told by a doctor or other health professional that you have[…]? (Yes/no) |
| Attitudes about eye care | It is important to go to the eye doctor at least once every 2 years. |
| There is no need to go to the eye doctor if you’re not having a problem with your eyes. (Agree/disagree scale)b | |
| Knowledge about glaucoma | A person can have glaucoma and not know it. |
| Glaucoma can be controlled. | |
| Vision lost from glaucoma can be restored. | |
| A complete glaucoma exam consists only of measuring eye pressure. | |
| People at risk for glaucoma should have an eye examination through dilated pupils. (True/false) | |
| Cost of eye care | Is the cost of an eye exam a problem for you? |
| Is the cost of buying eyeglasses a problem for you? | |
| If the doctor prescribed eye drops for you in order to treat an eye problem you have, would the cost of prescription eye drops be a problem for you? (Problem Scale)c |
Notes:
a
Difficulty scale response options: no difficulty, a little difficulty, moderate difficulty, extreme difficulty, unable to do because of eyesight, unable to do this for other reasons.
b
Agree/disagree scale response options: strongly agree, somewhat agree, somewhat disagree, strongly disagree.
c
Problem scale response options: not a problem at all, a little bit of a problem, somewhat of a problem, a big problem.