Domain / Item
Medical information: How easy/difficult has it been to … (Responses: very easy, easy, neither easy nor difficulty, difficult, very difficult, not applicable)
learn about your health problem(s)?
learn what foods you should eat to stay healthy?
find information on the medications that you have to take?
understand changes to your treatment plan?
understand the reasons why you are taking some medicines?
find sources of medical information that you trust?
understand advice from different healthcare providers?
Medications: How much of a problem has it been for you to … (Responses: not at all, a little, somewhat, quite a bit, very much)
organize your medicines?
take more than one medicine every day?
take your medicines several times each day?
refill your medicines?
adjust your medicines (including the amount, type, or time when you take it)?
take your medicines as directed?
plan your daily activities around your medicine schedule?
Single-item indicators of medication bother: How bothered have you been by … (Responses: not at all, a little, somewhat, quite a bit, very much)
how much you have to rely on your medicine(s)?
side effects of your medicine(s)?
Medical appointments: How much of a problem has it been for you to … (Responses: not at all, a little, somewhat, quite a bit, very much)
make or keep your medical appointments?
schedule and keep track of your medical appointments?
make or keep appointments with different healthcare providers?
Monitoring health: How much of a problem has it been for you to … (Responses: not at all, a little, somewhat, quite a bit, very much)
monitor your health behaviors, e.g., tracking exercise, foods you eat, or medicines you take?
monitor your health condition, e.g., weighing yourself, checking blood pressure, or checking blood sugar?
Interpersonal challenges: How bothered have you been by … (Responses: not at all, a little, somewhat, quite a bit, very much)
feeling dependent on others for your healthcare needs?
others reminding you to do things for your health like take your medicine, watch what you eat, or schedule medical appointments?
your healthcare needs creating tension in your relationships with others
others not understanding your health situation
Medical & healthcare expenses: How easy/difficult has it been for you to … (Responses: very easy, easy, neither easy nor difficulty, difficult, very difficult, not applicable)
plan for the future because of your medical expenses?
pay for healthy foods?
pay for all of your medical expenses?
pay for your medicines?
understand what is and what is not covered by your health insurance?
Difficulty with healthcare services: How much do you agree/disagree with the following? (Responses: strongly agree, agree, disagree, strongly disagree, not applicable)
Have problems with different healthcare providers not communicating with each other about my medical care
Have to see too many different specialists for my health problem(s) or illness(es)
Have problems filling out forms related to my healthcare
Have problems getting appointments at times that are convenient for me
Have problems getting appointments with a specialist
Have to wait too long at my medical appointments
Have to wait too long at the pharmacy for my medicine
Role and social activity limitations: How much has your self-care interfered with your … (Responses: not at all, a little, somewhat, quite a bit, very much)
work (include work at home)?
family responsibilities?
daily activities?
hobbies and leisure activities?
ability to spend time with family and friends?
ability to travel for work or vacation?
Physical and mental exhaustion: How often did your self-care make you feel … (Responses: never, rarely, sometimes, often, always)
angry?
preoccupied?
depressed?
worn out?
frustrated?

Note. With the exception of items in the “difficulty with healthcare services” domain, all items reference a recall time period of the past 4 weeks. No recall time period is used for the difficulty with healthcare services items.