WHODAS 2.0

This questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with alcohol or drugs.

Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. For each question, please circle only one response.

Answer questions based upon THE PAST 30 (THIRTY) Days

Name*

Todays Date:

D1.1 Concentrating on doing something for ten minutes?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D1.2 Remembering to do important things?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D1.3 Analysing and finding solutions to problems in day-to-day life?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D1.4 Learning a new task, for example, learning how to get to a new place?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D1.5 Generally understanding what people say?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D1.6 Starting and maintaining a conversation? *

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D2.1 Standing for long periods such as 30 minutes?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D2.2 Standing up from sitting down?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D2.3 Moving around inside your home?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D2.4 Getting out of your home?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D2.5 Walking a long distance such as a kilometre [or equivalent]?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D3.1 Washing your whole body?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D3.2 Getting dressed?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D3.3 Eating?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D3.4 Staying by yourself for a few days?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D4.1 Dealing with people you do not know?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D4.2 Maintaining a friendship?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D4.3 Getting along with people who are close to you?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D4.4 Making new friends?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D4.5 Sexual activities?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.1 Taking care of your household responsibilities?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.2 Doing most important household tasks well?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.3 Getting all the household work done that you needed to do?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.4 Getting your household work done as quickly as needed?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.5 Your day-to-day work/school?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.6 Doing your most important work/school tasks well?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.7 Getting all the work done that you need to do?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D5.8 Getting your work done as quickly as needed?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.1 How much of a problem did you have in joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can? *

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.2 How much of a problem did you have because of barriers or hindrances in the world around you?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.3 How much of a problem did you have living with dignity because of the attitudes and actions of others?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.4 How much time did you spend on your health condition, or its consequences?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.5 How much have you been emotionally affected by your health condition?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.6 How much has your health been a drain on the financial resources of you or your family?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.7 How much of a problem did your family have because of your health problems?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

D6.8 How much of a problem did you have in doing things by yourself for relaxation or pleasure?*

0 - None1 - Mild2 - Moderate3 - Severe4 - Extreme or cannot do

H1 Overall, in the past 30 days, how many days were these difficulties present? Record number of days ?*

H2 In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition? Record number of days?*

H3 In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition? Record number of days?*

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