Attachment 2.
Abridged questionnaire from the World Health Organization (Whoqol - bref)
| Instructions | ||||||
|---|---|---|---|---|---|---|
| This questionnaire is about how you feel regarding your quality of life, your health and other aspects of your life. Please, answer all the questions. If you are not sure about which answer to give in any question, please choose among the options, the one which seems more appropriate. Often times, this may be your first choice. | ||||||
| Please, have in mind your values, aspirations, pleasures and concerns. We are asking what you think of your life, taking the last two weeks as reference. For instance, considering the last two weeks, one question could be: | ||||||
| nothing | very little | average | very much | complete | ||
| Do you get from others the support you need? | 1 | 2 | 3 | 4 | 5 | |
| You must circle the number which best corresponds to how much support you have got from others concerning your needs in the past two weeks. Therefore, you must circle number 4 if you felt you received “very much” support, as per described below: | ||||||
| nothing | very little | average | very much | Complete | ||
| Do you get from others the support you need? | 1 | 2 | 3 | 4 | 5 | |
| You must circle number 1 if you feel you received no support at all. | ||||||
| Questionnaire | ||||||
| Please, read each question, consider what you think and circle the number which seems to be the best answer for you. | ||||||
| very bad | bad | not bad, not good | good | very good | ||
| 1 | How do you assess your quality of life? | 1 | 2 | 3 | 4 | 5 |
| very unhappy | unhappy | not happy, not unhappy | happy | very happy | ||
| 2 | How happy are you with your health? | 1 | 2 | 3 | 4 | 5 |
| The following questions are about how much you have felt some things in the past two weeks. | ||||||
| nothing | very little | more or less | very much | Extremely | ||
| 3 | How much do you think your pain (physical) prevents you from doing what you need? | 1 | 2 | 3 | 4 | 5 |
| 4 | How much do you need some medical treatment for your daily life? | 1 | 2 | 3 | 4 | 5 |
| 5 | How much do you enjoy life? | 1 | 2 | 3 | 4 | 5 |
| 6 | How much do you feel your life makes sense? | 1 | 2 | 3 | 4 | 5 |
| 7 | How much can you concentrate? | 1 | 2 | 3 | 4 | 5 |
| 8 | How safe do you feel in your daily life? | 1 | 2 | 3 | 4 | 5 |
| 9 | How healthy is your physical environment (Climate, noise, pollution, attractive things)? | 1 | 2 | 3 | 4 | 5 |
| The following questions are about how completely you have felt or are able to do certain things in these past two weeks. | ||||||
| nothing | very little | average | very much | completely | ||
| 10 | Do you have enough energy for your daily life? | 2 | 3 | 4 | 5 | |
| 11 | Are you able to accept your physical appearance? | 2 | 3 | 4 | 5 | |
| 12 | Do you have enough money to pay for your needs? | 2 | 3 | 4 | 5 | |
| 13 | How available are for you the information you need in your day-to-day? | 2 | 3 | 4 | 5 | |
| 14 | How much opportunity for leisure do you have? | 2 | 3 | 4 | 5 | |
| The following questions ask about how well or how pleased you have felt concerning many aspects of your life in the past two weeks. | ||||||
| very bad | bad | not bad, not good | good | very good | ||
| 15 | How well are you able to move? | 1 | 2 | 3 | 4 | 5 |
| very unhappy | unhappy | not happy, not unhappy | happy | very happy | ||
| 16 | How happy are you with your sleep? | 2 | 3 | 4 | 5 | |
| 17 | How happy are you with your ability to perform your daily activities? | 2 | 3 | 4 | 5 | |
| 18 | How happy are you with your capacity to work? | 2 | 3 | 4 | 5 | |
| 19 | How happy are you with yourself? | 2 | 3 | 4 | 5 | |
| 20 | How happy are you with your personal relationships (friends, relatives, acquaintances, colleagues)? | 2 | 3 | 4 | 5 | |
| 21 | How happy are you with your sex life? | 2 | 3 | 4 | 5 | |
| 22 | How happy are you with the support you get from friends? | 2 | 3 | 4 | 5 | |
| 23 | How happy are you with the situation of the place where you live? | 2 | 3 | 4 | 5 | |
| 24 | How happy are you with your access to healthcare? | 2 | 3 | 4 | 5 | |
| 25 | How happy are you with your means of transportation? | 2 | 3 | 4 | 5 | |
| The following questions refer to how frequent you have felt or experienced certain things in the past two weeks. | ||||||
| never | sometimes | often | very often | Always | ||
| 26 | How often do you have negative feelings such as bad mood, despair, stress, depression? | 1 | 2 | 3 | 4 | 5 |
| Did somebody help you fill out this questionnaire?……………………………… | ||||||
| How long did it take you to fill out this questionnaire?…………………………… | ||||||
| Do you have any comments about this questionnaire?………………………… | ||||||
| THANK YOU FOR YOUR SUPPORT. | ||||||