Domain / Item |
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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.