Study participants baseline interview

SHIPS
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Baseline Interview: Disability History
Record ID.

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Baseline Interview: Disability History
(Please repeat the reminder below if it has not been provided during this interview session.)
Reminder about resources to help you cope with distress.  
When you enrolled in this study, you were provided with a list of resources to help you cope
with negative feelings and reactions to these interviews.  These resources can also help you
with other problems in your life not related to the study.
If you do not remember receiving this information, we will provide it to you immediately
following this interview.
Interviewer prompt:
"The next questions ask about difficulties you may have doing certain activities."
[Do/Does] [you/he/she] have difficulty seeing, even if
wearing glasses? Would you say...

About how many years old were you when you started
having difficulty seeing, even if wearing glasses?
[Do/Does] [you/he/she] have difficulty hearing, even
if using a hearing aid(s)? Would you say...

About how many years old were you when you started
having difficulty hearing, even if using a hearing
aid(s)?
[Do/Does] [you/he/she] have difficulty walking or
climbing steps? Would you say...

About how many years old were you when you started
having difficulty walking or climbing steps?

05/01/2024 12:10pm

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________

projectredcap.org

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[Do/does] [you/he/she] have difficulty remembering or
concentrating? Would you say...

About how many years old were you when you started
having difficulty remembering or concentrating?
[Do/does] [you/he/she] have difficulty with self-care,
such as washing all over or dressing? Would you say...

About how many years old were you when you started
having difficulty with self-care, such as washing all
over or dressing?
Using [your/his/her] usual language, [do/does]
[you/he/she] have difficulty communicating, for
example understanding or being understood? Would you
say...

About how many years old were you when you started
having difficulty communicating, for example
understanding or being understood?

05/01/2024 12:10pm

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________
No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all
(Read response categories)

__________________________________

projectredcap.org