Illness
1. Concerning my use of prescribed medicines:
A. I do not or rarely use any medicines at all
B. I use one or two medicinal drugs regularly
C. I need to use three or four medicinal drugs regularly
D. I use five or more medicinal drugs regularly
2. To what extent do I rely on medicines or a medical aid (NOT glasses or a hearing aid). (For example: walking frame‚ wheelchair‚ prosthesis etc)
A. I do not use any medicines and/or medical aids
B. I occasionally use medicines and/or medical aids
C. I regularly use medicines and/or medical aids
D. I have to constantly use medicines and/or medical aids
3. Do I need regular medical treatment from a doctor or other health professional?
A. I do not need regular medical treatment
B. Although I have some regular medical treatment‚ I am not dependent on this
C. I am dependent on having regular medical treatment
D. My life is dependent upon regular medical treatment
Independent living
4. Do I need any help looking after myself?
A. I need no help at all
B. Occasionally I need some help with personal care tasks
C. I need help with the more difficult personal care tasks
D. I need help daily with most or all personal care tasks
5. When doing household tasks: (For example: preparing food‚ gardening‚ using the video recorder‚ radio‚ telephone or washing the car)
A. I need no help at all
B. Occasionally I need some help with household tasks
C. I need help with the more difficult household tasks
D. I need daily help with most or all household tasks
6. Thinking about how easily I can get around my home and community:
A. I get around my home and community by myself without any difficulty
B. I find it difficult to get around my home and community by myself
C. I cannot get around the community by myself‚ but I can get around my home with some difficulty
D. I cannot get around either the community or my home by myself
Social relationships
7. Because of my health‚ my relationships (for example: with my friends‚ partner or parents) generally:
A. Are very close and warm
B. Are sometimes close and warm
C. are seldom close and warm
D. I have no close and warm relationships
8. Thinking about my relationship with other people:
A. I have plenty of friends‚ and am never lonely
B. Although I have friends‚ I am occasionally lonely
C. I have some friends‚ but am often lonely for company
D. I am socially isolated and feel lonely
9. Thinking about my health and my relationship with my family
B. There are some parts of my family role I cannot carry out
C. There are many parts of my family role I cannot carry out
D. I cannot carry out any part of my family role
Physical senses
10. Thinking about my vision‚ including when using my glasses or contact lenses if needed:
A. I see normally
B. I have some difficulty focusing on things‚ or I do not see them sharply. For example: small print‚ a newspaper‚ or seeing objects in the distance.
C. I have a lot of difficulty seeing things. My vision is blurred. For example: I can see just enough to get by with.
D. I only see general shapes‚ or am blind. For example: I need a guide to move around.
11. Thinking about my hearing‚ including using my hearing aid if needed:
A. I hear normally
B. I have some difficulty hearing or I do not hear clearly. For example: I ask people to speak up‚ or turn up the TV or radio volume.
C. I have difficulty hearing things clearly. For example: Often I do not understand what is said. I usually do not take part in conversations because I cannot hear what is being said.
D. I hear very little indeed. For example: I cannot fully understand loud voices speaking directly to me.
12. When I communicate with others: (for example: by talking‚ listening‚ writing or signing)
A. I have no trouble speaking to them or understanding what they are saying.
B. I have some difficulty being understood by people who do not know me. I have no trouble understanding what others are saying to me.
C. I am only understood by people who know me well. I have real trouble understanding what others are saying to me.
D. I cannot adequately communicate with others
Psychological well-being
13. If I think about how I sleep
A. I am able to sleep without difficulty most of the time
B. My sleep is interrupted some of the time but I am usually able to go back to sleep without difficulty
C. My sleep is interrupted most nights‚ but I am usually able to go back to sleep without difficulty
D. I sleep in short bursts only. I am awake most of the night
14. Thinking about how I generally feel:
A. I do not feel anxious‚ worried or depressed
B. I am slightly anxious‚ worried or depressed
C. I feel moderately anxious‚ worried or depressed
D. I am extremely anxious‚ worried or depressed
15. How much pain or discomfort do I experience?
A. None at all
B. I have moderate pain
C. I suffer from severe pain
D. I suffer from unbearable pain.
This instrument can be found pages 69-71 of Compendium of Clinical Measures for Community Rehabilitation‚ available online at: http://www.health.qld.gov.au/qhcrwp/docs/clinical_measure.pdf
A=0‚ B=1‚ C=2‚ D=3
Hawthorne‚ G‚ Richardson‚ J & Osborne R 1999‚ „The AQOL instrument: a psychometric measure of HRQoL‟‚ Quality of Life Research‚ vol. 8‚ pp. 209-224.
Murphy B‚ Herrman H‚ Hawthorne G‚ Pinzone T‚ Evert H 2000. Australian WHOQOL instruments: Users manual and interpretation guide. Australian WHOQOL Field Study Centre‚ Melbourne‚ Australia. http://search.unimelb.edu.au/#gsc.tab=0&gsc.q=WHOQOL%20&gsc.sort=