Survey Text

2021
2020
2019
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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019
Survey form view entire document:  text  image
Question ID: VIS.0030.00.1
Variable: VISIONDF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty ^AGLASSCNTS? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
Fills:
^AGLASSCNTS
Description: seeing, even when wearing glasses or contact lenses/seeing
Instruction: If WEARGLSS_A=1 fill "seeing, even when wearing glasses or contact lenses"; else fill "seeing"
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: HEA.0030.00.1
Variable: HEARINGDF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty hearing^HEARAID? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
Fills:
^HEARAID
Description: even when using your hearing aid(s)
Instruction: If HEARAID_A=1, fill: ", even when using your hearing aid (s)"
else NO FILL
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: MOB.0010.00.1
Variable: DIFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty walking or climbing steps? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+
Skip Instructions:
1-4,RF,DK = [goto EQUIP_A]
Question ID: COM.0010.00.1
Variable: COMDIFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Using your usual language, do you have difficulty communicating, for example, understanding or being understood?

*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+
Skip Instructions:
1-4,RF,DK = [goto next section]
Question ID: COG.0010.00.1
Variable: COGMEMDFF_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty remembering or concentrating?

*Read if necessary: Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?

Response:

1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+
Skip Instructions:
1,RF,DK = [goto next section]
2-4 = [goto COGTYPEDFF_A]
Question ID: UPP.0010.00.1
Variable: UPPSLFCR_A
Interview Module: Adult
Content Type: Annual Core

Question Text:

Do you have difficulty with self care, such as washing all over or dressing? Would you say no difficulty, some difficulty, a lot of difficulty, or you cannot do this at all?
Response:
1 No difficulty
2 Some difficulty
3 A lot of difficulty
4 Cannot do at all
7 Refused
9 Do not Know
Universe:
Sample Adults 18+

Skip Instructions:
1-4,RF,DK = [goto UPPRAISE_A]