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
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
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
A. My role in the family is unaffected by my health
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
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
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=