WORLD HEALTH ORGANIZATION ISABILITY SSESSMENT SCHEDULE2.0 ...

1 WHODAS HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE 1 of 4 (36-item, self-administered)36-item version, self-administeredThis questionnaire asks about difficulties due to HEALTH conditions. HEALTH conditions include diseases or illnesses, other HEALTH problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please circle only one continue to next page ..In the past 30 days, how much difficulty did you have in:Understanding and on doing something for ten minutes?NoneMildModerateSevereExtreme or cannot to do important things?NoneMildModerateSevereExtreme or cannot and finding solutions to problems in day-to-day life?NoneMildModerateSevereExtreme or cannot a new task, for example, learning how to get to a new place?

2 NoneMildModerateSevereExtreme or cannot understanding what people say?NoneMildModerateSevereExtreme or cannot and maintaining a conversation?NoneMildModerateSevereExtre me or cannot doGetting for long periods such as 30 minutes?NoneMildModerateSevereExtreme or cannot up from sitting down?NoneMildModerateSevereExtreme or cannot around inside your home?NoneMildModerateSevereExtreme or cannot out of your home?NoneMildModerateSevereExtreme or cannot a long distance such as a kilometre [or equivalent]?NoneMildModerateSevereExtrem e or cannot doWHODAS-03(23 Nov09).book Page 1 Tuesday, November 24, 2009 1:30 PMWHODAS HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE Page 2 of 4 (36-item, self-administered) 36 SelfPlease continue to next page ..In the past 30 days, how much difficulty did you have your whole body?NoneMildModerateSevereExtreme or cannot dressed?NoneMildModerateSevereExtreme or cannot or cannot by yourself for a few days?

3 NoneMildModerateSevereExtreme or cannot doGetting along with with people you do not know?NoneMildModerateSevereExtreme or cannot a friendship?NoneMildModerateSevereExtreme or cannot along with people who are close to you?NoneMildModerateSevereExtreme or cannot new friends?NoneMildModerateSevereExtreme or cannot activities?NoneMildModerateSevereExtreme or cannot doLife care of your household responsibilities?NoneMildModerateSevereE xtreme or cannot most important household tasks well?NoneMildModerateSevereExtreme or cannot all the household work done that you needed to do?NoneMildModerateSevereExtreme or cannot your household work done as quickly as needed?NoneMildModerateSevereExtreme or cannot doWHODAS-03(23 Nov09).book Page 2 Tuesday, November 24, 2009 1:30 PMWHODAS HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE Page 3 of 4 (36-item, self-administered) 36 SelfIf you work (paid, non-paid, self- employed ) or go to school, complete questions , below.

4 Oth-erwise, skip to continue to next page ..Because of your HEALTH condition, in the past 30 days, how much difficulty did you have day-to-day work/school?NoneMildModerateSevereExtrem e or cannot your most important work/school tasks well?NoneMildModerateSevereExtreme or cannot all the work done that you need to do?NoneMildModerateSevereExtreme or cannot your work done as quickly as needed?NoneMildModerateSevereExtreme or cannot doParticipation in societyIn the past 30 much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?NoneMildModerateSevereExtreme or cannot much of a problem did you have because of barriers or hindrances in the WORLD around you?NoneMildModerateSevereExtreme or cannot much of a problem did you have living with dignity because of the attitudes and actions of others?NoneMildModerateSevereExtreme or cannot much time did you spend on your HEALTH condition, or its consequences?

5 NoneMildModerateSevereExtreme or cannot much have you been emotionally affected by your HEALTH condition?NoneMildModerateSevereExtreme or cannot much has your HEALTH been a drain on the financial resources of you or your family?NoneMildModerateSevereExtreme or cannot much of a problem did your family have because of your HEALTH problems?NoneMildModerateSevereExtreme or cannot much of a problem did you have in doing things by yourself for relaxation or pleasure?NoneMildModerateSevereExtreme or cannot doWHODAS-03(23 Nov09).book Page 3 Tuesday, November 24, 2009 1:30 PMWHODAS HEALTH ORGANIZATION DISABILITY ASSESSMENT SCHEDULE Page 4 of 4 (36-item, self-administered) 36 SelfThis completes the questionnaire. Thank , in the past 30 days, how many days were these difficulties present?Record number of days ____H2In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any HEALTH condition?

6 Record number of days ____H3In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any HEALTH condition?Record number of days ____WHODAS-03(23 Nov09).book Page 4 Tuesday, November 24, 2009 1:30 PM