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famdis
1


2011 NHIS Questionnaire - Family
Family Disability: Version 2
Document Version Date: 30-May-12


Question ID: FDB.020_00.000

Instrument Variable Name: P2DFHEAR
QuestionText:
With this next set of questions, we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities. Though different, these questions may sound similar to ones I asked earlier. [fill 1: Are you/Is ALIAS] deaf or [fill 2: do you/does ALIAS] have serious difficulty hearing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 1 or older and random number generator=2
SkipInstructions:
(1,2,D,R) goto P2DFSEE


Question ID: FDB.040_00.000

Instrument Variable Name: P2DFSEE
QuestionText:
[fill 1: Are you/Is ALIAS] blind or [fill 2: do you/does ALIAS] have serious difficulty seeing even when wearing glasses?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 1 or older
SkipInstructions:
(1,2,D,R) if no more persons age 5 or older, goto next section;
else goto P2DFCON


Question ID: FDB.060_00.000

Instrument Variable Name: P2DFCON
QuestionText:
Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have serious difficulty concentrating, remembering, or making decisions?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 5 or older and random number generator=2
SkipInstructions:
(1,2,D,R) goto P2DFWALK


Question ID: FDB.080_00.000

Instrument Variable Name: P2DFWALK
QuestionText:
[fill 1: Do you/Does ALIAS] have serious difficulty walking or climbing stairs?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons age 5 or older and random number generator=2
SkipInstructions:
(1,2,D,R) goto P2DFDRES


Question ID: FDB.100_00.000

Instrument Variable Name: P2DFDRES
QuestionText:
[fill 1: Do you/Does ALIAS] have difficulty dressing or bathing?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 5 or older
SkipInstructions:
(1,2,D,R) if no more persons age 15 or older, goto next section;
else goto P2DFERR


Question ID: FDB.120_00.000

Instrument Variable Name: P2DFERR
QuestionText:
Because of a physical, mental, or emotional condition, [fill 1: do you/does ALIAS] have difficulty doing errands alone
such as visiting a doctor's office or shopping?
1 Yes
2 No
7 Refused
9 Don't know
UniverseText: All persons 15 or older
SkipInstructions:
(1,2,D,R) if no more persons age 1 or older, goto next section;
else return to P2DFHEAR for next person age 1 or older