World Health Organization Disability Assessment Schedule 2.0

This questionnaire inquires about issues encountered by the individual about whom you are replying in your capacity as a friend, relative, or caregiver. Diseases or illnesses, various health problems that may be temporary or permanent, injuries, mental or emotional disorders, and problems with alcohol or drugs are all examples of health conditions. Think back over the last 30 days and, to the best of your ability, answer these questions by considering how tough the following activities were for your friend, relative, or caregiver. (Note: the questionnaire uses the term “relative” to mean ”friend,” ”relative,” or ”carer.”) For each question, please circle only one response.

H4a

I am the: Relative

1 = husband or wife

2 = parent

3 = son or daughter

4 = brother or sister

5 = other relative

6 = friend

7 = professional carer

8 = other (specify)

Clinician Use Only

Numeric scores assigned to each of the items:

1

2

3

4

5

Raw Item Score

Raw Domain Score

Average Domain Score

In the last 30 days, how much difficulty did your relative have in:

Understanding and communicating

D1.1

Concentrating on doing something for ten minutes?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

7

____

30

1.17

____

5

D1.2

Remembering to do important things?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D1.3

Analyzing and finding solutions to problems in day-to-day life?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D1.4

Learning a new task, for example, learning how to get to a new place?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D1.5

Generally understanding what people say?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

D1.6

Starting and maintaining a conversation?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

Getting around

D2.1

Standing for long periods, such as 30 minutes?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

0

____

25

0

____

5

D2.2

Standing up from sitting down?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D2.3

Moving around inside their home?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D2.4

Getting out of their home?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D2.5

Walking a long distance, such as a kilometer (or equivalent)?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

Self-care

D3.1

Washing his or her whole body?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

3

____

20

0.75

____

5

D3.2

Getting dressed?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D3.3

Eating?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D3.4

Staying by himself or herself for a few days?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

Because of their health condition, in the past 30 days, how much difficulty did your relative have in

Getting along with people

D4.1

Dealing with people he or she does not know?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

0

____

25

0

____

5

D4.2

Maintaining a friendship?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D4.3

Getting along with people who are close to him or her?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D4.4

Making new friends?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D4.5

Sexual activities?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

Life activities—Household

D5.1

Taking care of his or her household responsibilities?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

0

____

20

0

____

5

D5.2

Doing his or her most important household tasks well?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D5.3

Getting all the household work done that is needed?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D5.4

Getting the household work done as quickly as needed?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

Life activities—School/Work

If your relative works (paid, non-paid, self-employed) or goes to school, complete questions D5.5-D5.8, below. Otherwise, skip to D6.1.

In the past 30 days, how much difficulty did your relative have in:

D5.5

His or her day-to-day work/school?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

7

____

20

1.75

____

5

D5.6

Doing his or her most important work/school tasks well?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

D5.7

Getting all of the work done that is needed?

None

Mild

Moderate

Severe

Extreme or

cannot do

0

D5.8

Getting all the work done as quickly as needed?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

Participation in society

Participation in society in the past 30 days:

D6.1

How much of a problem did your relative have in joining in community activities (for example, festivities, religious, or other activities) in the same way as anyone else can?

None

Mild

Moderate

Severe

Extreme or

cannot do

4

24

____

40

3

____

5

D6.2

How much of a problem did your relative have because of barriers or hindrances around him or her?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

D6.3

How much of a problem did your relative have living with dignity because of the attitudes and actions of others?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

D6.4

How much time did your relative spend on his or her health condition or its consequences?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

D6.5

How much has your relative been emotionally affected by his or her health condition?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

D6.6

How much has his or her health been a drain on his or her financial resources or the financial resources of other relatives?

None

Mild

Moderate

Severe

Extreme or

cannot do

4

D6.7

How much of a problem did you or the rest of his or her family have because of his or her health problems?

None

Mild

Moderate

Severe

Extreme or

cannot do

3

D6.8

How much of a problem did your relative have in doing things by himself or herself for relaxation or pleasure?

None

Mild

Moderate

Severe

Extreme or

cannot do

2

General Disability Score (Total):

41

___

180

1.14

____

5