NHATS Round Section SS [SENSORY AND PHYSICAL IMPAIRMENTS AND SYMPTOMS] Sequence: 4 SS3PRE SS3PRE T ON FILE Now let's talk about how well {you hear/sp hears}. PRESS AND ENTER TO CONTINUE SS3 ssheringaid R SS3 HEARING AID USED DISPLAY QUESTION TEXT In the last month AS BOLD UNDERLINED TEXT In the last month, {have you/has {he/she}} used a hearing aid or other hearing device? 7 DEAF SS7PRE SS4a sshearphone R SS4A SP CAN USE TELEPHONE IF SS3= (, HEARING AID) DISPLAY "When {you use/sp uses} a hearing aid, {do you/does {he/she}} " ELSE DISPLAY "{Do you/does SP} " FOR ITEMS SS4a, SS4b, SS4c USE "SAME QUESTION STEM" DISPLAY {When {you use/sp uses} a hearing aid, {do you/does {he/she}}/{do you/does SP}} hear well enough to use the telephone? SS4b ssconvwradi R SS4B CONVERSATIN WTH TV RADIO Page of 0 NHATS Round :: SS
IF SS3= (, HEARING AID) DISPLAY "When {you use/sp uses} a hearing aid, {do you/does {he/she}}." ELSE DISPLAY "{Do you/does SP} " FOR ITEMS SS4a, SS4b, SS4c USE "SAME QUESTION STEM" DISPLAY {When {you use/sp uses} a hearing aid, {do you/does {he/she}}/{do you/does SP}} hear well enough to carry on a conversation in a room with a radio or TV playing? SS7PRE SS4c ssconvquiet R SS4C CONVERS IN QUIET ROOM IF SS3= (, HEARING AID) DISPLAY "When {you use/sp uses} a hearing aid, {do you/does {he/she}} " ELSE DISPLAY "{Do you/does SP} " FOR ITEMS SS4a, SS4b, SS4c USE "SAME QUESTION STEM" DISPLAY {When {you use/sp uses} a hearing aid, {do you/does {he/she}}/{do you/does SP}} hear well enough to carry on a conversation in a quiet room? SS7PRE SS7PRE T ON FILE Now I have a few questions about how well {you/sp} can see. PRESS AND ENTER TO CONTINUE SS7 ssglasseswr R SS7 WEARS GLASSES CONTCTS DISPLAY QUESTION TEXT "at a distance" IN BOLD UNDERLINED TEXT {Do you/does SP} wear glasses or contacts to help {you/him/her} see things at a distance? Page of 0 NHATS Round :: SS
7 BLIND SS3PRE SS8a ssseewellst R SS8A SEES ACROSS THE STREET IF SS7= (GLASSES/CONTACTS FOR DISTANCE) THEN DISPLAY "When {you use/sp uses} glasses or contacts, {do you/does {he/she}} " ELSE DISPLAY "{Do you/does SP} " FOR ITEMS SS8a AND SS8b, USE "SAME QUESTION STEM" DISPLAY {When {you use/sp uses} glasses or contacts, {do you/does {he/she}}/{do you/does SP}} see well enough to recognize someone across the street? SS0 SS8b ssseestvgls R SS8B TV ACROSS ROOM W GLASSES IF SS7= (GLASSES OR CONTACTS FOR DISTANCE), DISPLAY "When {you use/sp uses} glasses or contacts, {do you/does {he/she}} " ELSE DISPLAY "{Do you/does SP} " FOR ITEMS SS8a AND SS8b, USE "SAME QUESTION STEM" DISPLAY {When {you use/sp uses} glasses or contacts, {do you/does {he/she}}/{do you/does SP}} see well enough to watch television across the room? SS0 ssglasscls R SS0 WEAR GLS CONTCS SEE CLOS Page 3 of 0 NHATS Round :: SS
DISPLAY QUESTION TEXT "close up" AS BOLD UNDERLINED TEXT {Do you/does SP} wear glasses or contacts to help {you/him/her} see things close up? SS ssothvisaid R SS USED OTHER VISION AIDS In the last month, did {you/sp} use other vision aids such as a magnifying glass to help {you/him/her} see things close up? IF NEEDED: Vision aids include things like a magnifying glass, large-print books, and other tools to help people with vision impairments. SS ssglrednewp R SS CAN READ NEWSPAPER PRINT IF SS0 = (GLASSES OR CONTACTS FOR CLOSE UP) ) AND SS= (VISION AID) DISPLAY "When {you use/sp uses} glasses or contacts and vision aids", and "do you/does {he/she}" ELSE IF SS0= (GLASSES OR CONTACTS FOR CLOSE UP) AND SS NE DISPLAY "When {you use/sp uses} glasses or contacts", and "do you/does {he/she}" ELSE IF SS= (VISION AID) DISPLAY "When {you use/sp uses} vision aids", and "do you/does {he/she}" ELSE DISPLAY "{Do you/does SP}" {When {you use/sp uses} glasses or contacts/when {you use/sp uses} vision aids/when {you use/sp uses} glasses or contacts and vision aids}, {{do you/does {he/she}} /{Do you/does SP}} see well enough to read newspaper print? Page 4 of 0 NHATS Round :: SS
SS3PRE SS3PRE T ON FILE Now I have some questions about health related problems that {you/sp} may have had in the last month. PRESS AND ENTER TO CONTINUE SS3 ssprobchswl R SS3 PROBLEMS CHEW OR SWALLOW DISPLAY QUESTION TEXT "in the last month" AS BOLD UNDERLINED TEXT In the last month, did {you/sp} have problems with chewing or swallowing that caused difficulty when {you/he/she} ate? SS4 ssprobspeak R SS4 PROBLEMS SPEAKING DISPLAY QUESTION TEXT "in the last month" AS BOLD UNDERLINED TEXT In the last month because of {your/sp's} health, did {you/he/she} have any problems in speaking or in making {yourself/herself/himself} understood when {you talk/he talks/she talks)? SS5 sspainbothr R SS5 BOTHERED BY PAIN DISPLAY QUESTION TEXT "in the last month" AS BOLD UNDERLINED TEXT In the last month, {have you/has {he/she}} been bothered by pain? Page 5 of 0 NHATS Round :: SS
SS8a SS9 SS9 SS7 sspainlimts R SS7 PAIN EVER LIMTS ACTIVIT DISPLAY QUESTION TEXT "In the last month" AS BOLD UNDERLINED TEXT In the last month, has pain ever limited {your/sp's} activities? SS8A sspainmedof R SS8A LST MNTH OFTEN PAIN MED SHOWCARD SS In the last month, how often did {you/sp} take medication for pain? Would you say every day, most days, some days, rarely or never? 3 4 5 EVERY DAY (7 DAYS A WEEK) MOST DAYS (5-6 DAYS A WEEK) SOME DAYS (-4 DAYS A WEEK) RARELY (ONCE A WEEK OR LESS) NEVER BOX SS8B BOXSS8B T ON FILE If SS5= (PAIN) or SS8A= (PAIN MEDS EVERY DAY), (PAIN MEDS MOST DAYS), 3 (PAIN MEDS SOME DAYS), or 4 (PAIN MEDS RARELY), go to SS8B Otherwise, go to SS9 SS8B sspainwhe R SS8B BACK PAIN IN LAST MNTH sspainwhe sspainwhe3 sspainwhe4 R SS8B HIP PAIN IN LAST MONTH R SS8B KNEE PAIN IN LAST MNTH R SS8B FOOT PAIN IN LAST MNTH Page 6 of 0 NHATS Round :: SS
sspainwhe5 sspainwhe6 sspainwhe7 sspainwhe8 sspainwhe9 sspainwheo sspainwhe sspainwhe sspainwhe3 R SS8B HAND PAIN IN LAST MNTH R SS8B WRIST PAIN IN LAST MNTH R SS8B SHOULDR PAIN LST MNTH R SS8B HEAD PAIN IN LAST MNTH R SS8B NECK PAIN IN LAST MNTH R SS8B ARM PAIN IN LAST MNTH (from SS8c) R SS8B LEG PAIN IN LAST MNTH (from SS8c) R SS8B STOMACH PAIN LAST MNTH (from SS8c) R SS8B OTHR SPCFY PAIN LST MO SHOW CARD SS Please look at this card and tell me where {you have/sp has} had pain in the last month. SELECT ALL THAT APPLY 3 4 5 6 7 8 9 9 BACK HIPS KNEES FEET HANDS WRISTS SHOULDERS HEAD NECK OTHER PLACES (SPECIFY) SS9 SS9 SS9 SS9 SS9 SS9 SS9 SS9 SS9 SS8C SS8C T ON FILE SPECIFY OTHER PLACES SP HAD PAIN ENTER TEXT Length 50 SS9 ssprobbreat R SS9 BREATHING PROBLEMS In the last month, did {you/sp} have any breathing problems, including shortness of breath or difficulty breathing? Page 7 of 0 NHATS Round :: SS
SS SS SS SS0 ssprbbrlimt R SS0 BREATH PROBLS LIMT ACTIV In the last month, did {your/sp's} breathing problems ever limit {your/his/her} activities? SS ssstrnglmup R SS UPPER BOD STRENGTH LIMIT In the last month, did {you/sp} have limited strength or movement in {your/his/her} shoulders, arms, or hands? SS3 SS3 SS3 SS ssuplimtact R SS UP BOD STRNGTH LIMT ACT In the last month, did this problem with {your/sp's} shoulders, arms, or hands ever limit {your/his/her} activities? SS3 sslwrbodstr R SS3 LOWER BODY STRNGTH LIMIT In the last month, did {you/sp} have limited strength or movement in {your/his/her} hips, legs, knees, or feet? Page 8 of 0 NHATS Round :: SS
SS5 SS5 SS5 SS4 sslwrbodimp R SS4 LWER BOD STRNGTH IMT ACT In the last month, did this problem with {your/sp's} hips, legs, knees, or feet ever limit {your/his/her} activities? SS5 sslowenergy R SS5 LOW ENERGY IN LAST MONTH In the last month, did {you/sp} have low energy or {were you/was SP} easily exhausted? SS7 SS7 SS7 SS6 ssloenlmtat R SS6 LOW ENERGY EVER LIM ACT In the last month, did {your/sp's} low energy or exhaustion ever limit {your/his/her} activities? SS7 ssprbbalcrd R SS7 BALANCE OR COORD PROBS In the last month, did {you/sp} have problems with balance or coordination? Page 9 of 0 NHATS Round :: SS
SECTION PC SECTION PC SECTION PC SS8 ssprbbalcnt R SS8 BAL COORD PROB LIMIT ACT In the last month, did {your/sp's} balance or coordination problems ever limit {your/sp's} activities? PROGRAMMER INSTRUCTIONS: Go to Section PC Physical Capacity Page 0 of 0 NHATS Round :: SS