Self-Care

Questions:

1. Overall in the last 30 days, how much difficulty did [name of person/you] have with self-care, such as washing or dressing [yourself/himself/herself]?
2. In the last 30 days, how much difficulty did [name of person/you] have in taking care of and maintaining [your/his/her] general appearance (e.g.grooming, looking neat and tidy etc.)

Response categories:

1. None
2. Mild
3. Moderate
4. Severe
5. Extreme/Cannot Do

Vignettes:

1. [Helena] pays a lot of attention to the way she looks. She requires no assistance with cleanliness, dressing and eating.***
   
2. [Sally] can put on clothes without assistance, but needs help with tying her shoelaces because she has a back problem that makes bending down impossible. She looks neat and tidy.
   
3. [Jeff] has no problems with cleanliness, dressing and eating. However, he has to wear clothes with special fasteners as joint problems prevent him from buttoning and unbuttoning clothes.
   
4. [Peter] can dress himself but does not dress appropriately. He may wear summer clothes to go out on a cold winter�s day or decide to put on several layers of different garments. If not prompted, he does not wash or groom himself.
   
5. [Anne] takes twice as long as others to put on and take off clothes, but needs no help with this. Although it requires an effort, she is able to bathe and groom herself, though less frequently than before. She does not require help with feeding.***
   
6. [Victor] usually requires no assistance with cleanliness, dressing and eating. He occasionally suffers from back pain and when this happens he needs help with bathing and dressing.***
   
7. [Lee] has recently broken his arm and has difficulties getting dressed. He can manage to put on clothes that do not button up but requires assistance with shirts or more complicated type of clothing. He needs help to wash and comb his hair and to brush his teeth.
   
8. [Rachel] feels pain and discomfort while washing bathing, and in combing her hair. As a result, she neglects her personal appearance. She needs assistance with putting on and taking off clothes. She does not need assistance with feeding.
   
9. [Peter] can wash his face and comb his hair, but cannot wash his whole body without help. He needs assistance with putting clothes on over his head, but can put garments on the lower half of his body. He does not require help with feeding.
   
10. [Sandra] lives on her own and has no relatives or friends nearby. Because of her arthritis, she is house-bound. She often stays all day in the same clothes that she has slept in as changing clothes is too painful. A neighbour helps her wash herself.***
    
11. [John] needs personal help to wash, groom or dress himself. He gets confused as to what item of clothing must go where, and the different function of items such as a toothbrush and hair brush.
    
12. [Jane] requires assistance to eat, wash, dress and take care of her general appearance because she has an intellectual impairment.
    
13. [Simon] requires assistance to wash, dress and feed himself. He is not able to make decisions about when he should do these activities.
    
14. [Sue] is quadriplegic and must be washed, groomed, dressed and fed by somebody else.***

*** Included in the final World Health Survey instrument in 2002.