Mcma‎ster Health Index Questionnaire (MHIQ)

SECTION A:
 The questions in the first section ask about your health and whether you are able to do certain things.
1. Today‚ are you physically able to run a short distance‚ say 300 feet‚ if you are in a hurry? (This is about the length of a football field or soccer pitch.) (1) NO‚ (2) YES
2. Today‚ do you (or would you) have any physical difficulty at all with
(1) Difficulty‚ (2) No Difficulty
a.    walking as far as a mile?
b.    climbing up 2 flights of stairs?
c.    standing up from and/or sitting down in a chair?
d.    feeding yourself ?
e.    undressing?
f.     washing (face and hands)‚ sha‎ving (men)‚ and/or combing hair?
g.    shopping?
h.    cooking?
i.      dusting and/or light housework?
j.     cleaning floors?
3. Today‚ are you physically able to take part in any sports (hockey‚ swimming‚ bowling‚ golf‚ and so forth) or exercise regularly? (1) NO‚ (2) YES
4. At present‚ are you physically able to walk out-of-doors by yourself when the weather is good? (1) NO‚ (2) YES
If “YES” Go to “a” and If “NO” Go to “b”
a. What is the farthest you can walk by yourself?
1.    ONE MILE OR MORE P
2.    LESS THAN 1 MILE BUT MORE THAN 30 FEET (ABOUT THE SIDE OF A HOUSE)
3.    LESS THAN 30 FEET
b. Are you able to walk by yourself?
4.    BETWEEN ROOMS
5.    ONLY WITHIN A ROOM
6.    CAN’T WALK AT ALL
5. Today‚ do you (or would you) have any physical difficulty at all travelling by bus whenever necessary? (1) NO‚ (2) YES
6. Today‚ do you have any physical difficulty at all travelling by car whenever necessary? (1) NO‚ (2) YES
7. Do you have any physical difficulty at all driving a car by yourself?
(1) NO (or do not have a licence) Go to Q. 8
(2) YES a. Is this because of a physical disability? (1) NO‚ (2) YES
8. Do you wear glasses? (1) NO‚ (2) YES
If “YES” Go to “a & b” and If “NO” Go to “c & d”
a. Do you have any trouble seeing ordinary newsprint when you wear your glasses?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
b. Do you have a headache after watching television or reading when you wear your glasses?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
Go to Q. 9
c. Do you have any trouble seeing ordinary newsprint?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
d. Do you have a headache after watching television or reading?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
9. Do you wear a hearing aid? (1) NO‚ (2) YES
If “YES” Go to “a & b” and If “NO” Go to “c & d”
a. Do you have trouble hearing in a normal conversation with several other persons when you wear your hearing aid?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
b. Do you have trouble hearing the radio or television when you wear your hearing aid?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
c. Do you have any trouble seeing ordinary newsprint?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
d. Do you have a headache after watching television or reading?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
c. Do you have trouble hearing in a normal conversation with several other persons?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
d. Do you have trouble hearing the radio or television?
1.    NEVER
2.    SOMETIMES
3.    ALWAYS
SECTION B:
Often people’s health affects the way they feel about life. For these next questions‚ please circle the choice that is closest to the way you feel about each statement.
(1)If you STRONGLY AGREE
(2)If you AGREE
(3)If you are NEUTRAL
(4)If you DISAGREE
(5)If you STRONGLY DISAGREE
10. I sometimes feel that my life is not very useful.
11. Everyone should have someone in his life whose happiness means as much to him as his own.
12. I am a useful person to have around.
13. I am inclined to feel that I’m a failure.
14. Many people are unhappy because they do not know what they want out of life.
15. In a society where almost everyone is out for himself‚ people soon come to distrust each other.
16. I am a quick thinker.
17. Some people feel that they run their lives pretty much the way they want to and this is the case with me.
18. There are many people who don’t know what to do with their lives.
19. Most people don’t realize how much their lives are controlled by plots hatched in secret by others.
20. People feel affectionate toward me.
21. I would say I nearly always finish things once I start them.
22. When I make plans ahead‚ I usually get to carry out things the way I expected.
23. I think most married people lead trapped (frustrated or miserable) lives.
24. It’s hardly fair to bring children into the world the way things look for the future.
25. Some people feel as if other people push them around a good bit‚ and I feel this way too.
26. I am usually alert.
27. Nowadays a person has to live pretty much for today and let tomorrow take care of itself.
SECTION C:
This section contains some questions on general health and on your social activities.
28. How would you say your health is today? Would you say your health is (Circle your answer)
(1)VERY GOOD
(2)PRETTY GOOD
(3)NOT TOO GOOD
29. Taking all things together‚ how would you say things are today? Would you say you are
(1)VERY HAPPY
(2)PRETTY HAPPY
(3)NOT TOO HAPPY
30. In general‚ how satisfying do you find the way you’re spending your life today? Would you call it
(1)COMPLETELY SATISFYING
(2)PRETTY SATISFYING
(3)NOT VERY SATISFYING
31. How would you say your physical functioning is today? (By this we mean the ability to move around‚ see‚ hear‚ and talk.)
(1)GOOD
(2)GOOD TO FAIR
(3)FAIR
(4)FAIR TO POOR
(5)POOR
32. How would you say your social function is today? (By this we mean your ability to work‚ to have friends‚ and to get along with your family.)
(1)GOOD
(2)GOOD TO FAIR
(3)FAIR
(4)FAIR TO POOR
(5)POOR
33. How would you say your emotional functioning is today? (By this we mean your ability to remain in good spirits most of the time and to be usually happy and satisfied with your life.) (Circle your answer)
(1)GOOD
(2)GOOD TO FAIR
(3)FAIR
(4)FAIR TO POOR
(5)POOR
34. Are you presently working on a job for wages‚ either full- or part-time?
(1)YES _____ GO TO Q.35
2 NO . a. Are you presently
(1)ON VACATION
(2)ON SICK LEAVE
(3)RETIRED
(4)A STUDENT
(5)A HOUSEWIFE
(6)OTHER (please specify):
35. How much time‚ in a one-week period‚ do you usually spend watching television?
(1)NONE
(2)LESS THAN THREE HOURS A WEEK
(3)LESS THAN TWO HOURS A DAY
(4)TWO OR MORE HOURS A DAY
36. Which of the following describe your usual social and recreational activities?
a.    going to church? (1) NO‚ (2) YES
b.    going to a relative’s home? (1) NO‚ (2) YES
c.    any other activities? (please specify) ________________
37. Has anyone visited you in the last week? (Circle your answer)
a.    a relative? (1) NO‚ (2) YES
b.    a friend? (1) NO‚ (2) YES
c.    a religious group member? (1) NO‚ (2) YES
d.    a social agency representative? (1) NO‚ (2) YES
38. Do you have a telephone? (1) NO‚ (2) YES
39. Have you used your telephone in the last week to call
a.    a friend? (1) NO‚ (2) YES
b.    a religious group member? (1) NO‚ (2) YES
c.    a social agency representative? (1) NO‚ (2) YES
40. Have you been called in the last week by a social agency representative? (1) NO‚ (2) YES
41. How long has it been since you last had a holiday?
(Write in number “0” if presently on holidays.)
_____ MONTHS or _____YEARS S (≤ 12 months)
42. During the last year‚ have any of the following things happened to you?
a.    separation from your spouse? (1) NO‚ (2) YES
b.    divorce? (1) NO‚ (2) YES
c.    going on welfare during the last year? (1) NO‚ (2) YES
d.    trouble getting along with friends/relatives during the last year? (1) NO‚ (2) YES
e.    retired from work during the last year? (1) NO‚ (2) YES
f.     some other problem or change in your life? (please specify)
 
Physical‚ Emotional‚ Social function
 
 

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Chambers‚ L‚W.‚ MacDonald‚ L.A.‚ Tugwell‚ P.‚ et al. (1982). The Mcma‎ster Health Index Questionnaire as a measure of quality of life for patients with rheumatoid disease. J Rheumatol‚ 9:780–784.

Chambers‚ L‚W. The Mcma‎ster Health Index Questionnaire. In: Wenger NK‚ Mattson ME‚ Furberg CD‚ et al.‚ eds. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq‚ 1984:160–164.

Chambers‚ L‚W.‚ Haight‚ M.‚ Norman‚ G.‚ et al. (1987). Sensitivity to change and the effect of mode of administration on health status measurement. Med Care‚ 25:470–479.

Chambers‚ L‚W. (1993). The Mcma‎ster Health Index Questionnaire: an up‎date. In: Walker SR‚ Rosser RM‚ eds. Quality of life assessment: key issues in the 1990s. Dordrecht‚ Netherlands: Kluwer Academic Publishers :131–149.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS