QOL questionnaire

Let us start with the sample questionnaire first. This is just a sample questionnaire to be use for the course.
 Rupa Q yang sebenar:

Actual look of the sample Questionnaire. But it is too small and not readible. So the Qare copied into this blog. The questions are as follows:

Serial No :

Instructions

This questionnaire asks how you feel about your quality of life, health, and other areas of your life.

Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate. This can often be your first response.  Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about  your life in the last two weeks.

For example, thinking about the last two weeks, a question might ask:

		Not at all	A little	A moderate amount	Very Much	An extreme amount
1	How much do you worry about your health?	1	2	3	4	5

You should circle the number that best fits how much you have worried about your health over the last two weeks. So you would circle the number 4 if you worried about your health “Very much”, or circle number 1 if you have worried “Not at all” about your health. Please read each question,  assess your feelings, and circle the number on the scale for each question that gives the best answer  for you.

 Thank you for your help

	The following questions ask about how much you have experienced certain things in the last two weeks, for example, positive feelings such as happiness or contentment. If you have experienced these things an extreme amount circle the number next to “An extreme amount”. If you have not experienced these things at all, circle the number next to “Not at all”. You should circle one of the numbers in between if you wish to indicate your answer lies somewhere between “Not at all” and “Extremely”. Questions refer to the last two weeks.
		Not at all	A little	A moderate amount	Very Much	An extreme amount
F1.1	Do you worry about your pain or discomfort	1	2	3	4	5
F1.2	How difficult is it for you to handle any pain or discomfort?	1	2	3	4	5
F1.3	To what extent do you feel that (physical) pain prevents you from doing what you need to do?	1	2	3	4	5
F2.1	How easily do you get tired?	1	2	3	4	5
F2.2	How much are you bothered by fatigue?	1	2	3	4	5
F3.1	Do you have any difficulties with sleeping?	1	2	3	4	5
F3.2	How much do sleep problems worry you	1	2	3	4	5
F4.1	How much do you enjoy life?	1	2	3	4	5
F4.2	How positive do you feel about the future?	1	2	3	4	5
F4.3	How much do you experience positive feelings in your life?	1	2	3	4	5

G1	About You
1.	Gender	1 2	Male Female	1
2	Highest education received	1 2 3 4	Primary School Secondary School University Post-Graduate	2
3	What is your marital status?	1 2 3 4	Single Married Separated /Divorced Widowed	3
4	How is your health?	1 2 3 4 5	Very poor Poor Neither poor nor good Good Very  Good	4
5	Are you currently ill?	1 2	Yes…….. (go to Q6) No ………(end)	5
6	If yes, what is your diagnosis		________________

Thank You.