No difficulty

Mild difficulty

Moderate difficulty

Severe difficulty

Extreme difficulty or cannot do

Domain 1 of WHODAS 2.0 asks questions about communication and thinking activities. Specific areas that are assessed include concentrating, remembering, problem solving, learning and communicating.

This question is intended to determine the respondent’s rating of difficulty with concentration for a short period, defined here as 10 minutes. Generally, respondents understand this item. However, if clarification is requested, encourage the respondent to think about their concentration in usual circumstances, rather than when they are preoccupied by a problem or are in an unusually distracting environment. If necessary, prompt the respondent to think about their concentration while they were doing something such as work tasks, reading, writing, drawing, playing a musical instrument, assembling a piece of equipment, and so on.

This is a question about remembering matters of day-to-day importance. It does not refer to remembering irrelevant content or detailed information from the past. Ask respondents how well they remember to do things that are important to them or to their family. If a respondent normally uses some form of memory aid – for example, note-taking, electronic reminder systems or verbal cueing from personal assistants – then rate their performance with this aid taken into consideration.

This item refers to a complex activity involving many mental functions. If respondents are unsure of what the item means, ask them to think about a problem they encountered in the past 30 days. Once a problem is identified, respondents should be asked to consider how well they: • identified that a problem existed • broke it down into manageable parts • developed a list of possible solutions • determined the pros and cons of each solution • determined the best solution given all considerations • executed and evaluated the chosen solution • selected an alternate solution if the first choice was not successful.

In this question, learning a new route is offered as an example. If respondents ask for clarification or appear to be thinking only about learning how to get to a new place, encourage them to think of other situations in the past month where learning something new was required, such as: • a task at work (e.g. a new procedure or assignment) • school (e.g. a new lesson) • home (e.g. learning a new home-repair task) • leisure (e.g. learning a new game or craft). Ask respondents, when rating themselves, to consider how easily they acquired new information, how much assistance or repetition they needed in order to learn and how well they retained what they learned.

Ask respondents to consider their usual mode of communication (e.g. spoken language, sign language, use of an assistive device such as a hearing aid, etc.) and rate the overall degree of difficulty they have in understanding the messages of others.Respondents should consider all situations they have encountered in the past 30 days, such as: • when others spoke quickly • when there was background noise • when there were distractions. Difficulties due to different mother tongues should be excluded when rating this question.

Rate both starting and maintaining a conversation. If respondents state that they have more trouble starting than maintaining a conversation (or vice versa), ask them to average the amount of difficulty experienced with both activities to determine the final difficulty rating. Conversation includes use of whatever is the usual mode of communication (spoken, written, sign language, gestural). If respondents normally use assistive devices for communication, ensure that the difficulty rating provided takes into account conversation while using those devices. Ask respondents to consider any and all other factors related to a health condition and relevant to them in starting and maintaining a conversation. Examples might include hearing loss, language problems (e.g. as after a stroke), stuttering and anxiety

Activities discussed in Domain 2 of WHODAS 2.0 include standing, moving around inside the home, getting out of the home and walking a long distance.

This question refers to standing up from sitting in a chair, on a bench or a toilet. It does not refer to standing up from sitting on the floor.

This item refers to moving from room to room, and moving within rooms, using assistive devices or personal help that is usually in place. If a respondent lives in a house with multiple floors, this question also includes getting from one floor to another, as needed.

This question seeks information about: • physical (mobility) aspects of getting out of the home • emotional or mental aspects of leaving the home (e.g. depression, anxiety, etc.) For this question, “home” means the respondent’s current dwelling, which might be a house, apartment, or nursing home.

Convert distances into imperial measure where necessary (e.g. older people may be more familiar with miles than with kilometres).

Domain 3 asks about bathing, dressing, eating and staying alone.

This question refers to respondents washing their entire body in whatever manner is usual for their culture. If respondents report that they have not washed their bodies in the past 30 days, ask whether this is due to a health condition (as defined by WHODAS 2.0). If respondents report that it is due to a health condition, then code the item “5” for “Extreme or cannot do”. If respondents report that the lack of washing is not due to a health condition, then code the item “N/A” for “Not applicable”.

This question includes all aspects of dressing the upper and lower body. Ask respondents to consider activities such as gathering clothing from storage areas (i.e. closet, dressers) and securing buttons, tying knots, etc., when making the rating.

This item refers to: • feeding oneself: that is, cutting food, and getting food or drink from a plate or glass to the mouth • swallowing both food and drink • mental or emotional factors that may contribute to difficulty in eating, such as anorexia, bulimia, or depression. This item does not refer to meal preparation. If a respondent uses non-oral feeding (e.g. tube feedings), this question refers to any difficulties experienced in self-administering the non-oral feeding; for example, setting up and cleaning a feeding pump.

The intent of this question is to determine any difficulty respondents have in staying alone for an extended period and remaining safe. If respondents did not experience this situation in the past 30 days, “N/A” is the correct rating. If respondents give a rating of “None” for this question, probe the response to determine whether respondents stayed by themselves without difficulty (in which case “1” is correct) or whether they did not stay by themselves at all (in which case “N/A” is correct).

Domain 4 assesses getting along with other people, and difficulties that might be encountered with this due to a health condition. In this context, “people” may be those with whom the respondent is intimate or knows well (e.g. spouse or partner, family members or close friends), or those whom the respondent does not know at all (e.g. strangers).

This item refers to interactions with strangers in any situation, such as: • shop-keepers • service personnel • people from whom one is asking directions. When making the rating, ask respondents to consider both approaching such individuals, and interacting successfully with them to obtain a desired outcome.

This item includes: • staying in touch • interacting with friends in customary ways • initiating activities with friends • participating in activities when invited. Respondents will sometimes report that they have not engaged in friendship-maintenance activities in the past 30 days. In this case, ask whether this situation is due to a health condition (as defined by WHODAS 2.0). If respondents report that it is due to a health condition, then code the item “5” for “Extreme or cannot do”. If respondents report that it is not due to a health condition, then code the item “N/A”.

Ask respondents to consider any relationships that they define as close. These may be within or outside the family

This item includes: • seeking opportunities to meet new people • following up on invitations to get together • social and communication actions to make contact and to develop a friendship. On occasion, participants will report that they have not engaged in friendship-making activities in the past 30 days. In this case, interviewers should ask whether this is due to a health condition (as defined by the WHODAS 2.0). If respondents report that it is due to a health condition, then code the item “5” for “Extreme or cannot do”. If respondents report that it is not due to a health condition, then code the item “N/A”.

Ask respondents to think about what they consider to be sexual activities when answering this question. If asked for clarification, explain that this question refers to: • sexual intercourse • hugging • kissing • fondling • other intimate or sexual acts.

This domain includes questions about difficulty in day-to-day activities. These activities are those that people do on most days; they include household, work and school activities.

This global question is intended to elicit respondents’ appraisal of any difficulty they encounter in maintaining the household and in caring for family members or other people they are close to. Ask respondents to consider all types of household or family needs, including: • physical needs • emotional needs • financial needs • psychological needs. In some cultures, males may indicate that they do not have household responsibilities. In this situation, clarify that household responsibilities include: • managing finances • car and home repairs • caring for the outside area of the home • picking up children from school • helping with homework • disciplining children. Add any other examples that elucidate household responsibilities held by males in the culture, as necessary. Here, “household” is defined broadly. In the case of participants who do not have a stable dwelling place, there are still activities surrounding the upkeep and maintenance of their belongings. This question refers to those activities.

Ask respondents to provide ratings based on their own appraisal of how well household tasks are completed and whether needed household work gets done. If necessary, remind respondents that they are to report only difficulties due to the health condition, not those that may be experienced for other reasons such as not having enough time (unless this reason is somehow linked to a health condition).

This question refers to the timely meeting of expectations and needs of those respondents whom one lives with (or is close to), in relation to household tasks and responsibilities.

This global question is intended to elicit respondents’ appraisal of difficulties encountered in day-to-day work or school activities. This includes issues such as attending on time, responding to supervision, supervising others, planning and organizing, meeting expectations in the workplace and any other relevant activities.

Doing work or school tasks “well” refers to completing them as expected by a supervisor or teacher, by respondents’ own standards or as specified in the performance criteria for a job or school.

Domain 6 represents a shift from the line of questioning used in the first five domains. In this domain, respondents are asked to consider how other people and the world around them make it difficult for them to take part in society. Here, they are reporting not on their activity limitations but rather on the restrictions they experience from people, laws and other features of the world in which they find themselves. The underlined phrases in the introduction must be emphasized to help respondents shift their mindset and understand what is being asked. Respondents need to understand that the focus of these questions is on problems encountered because of the society in which they live rather than because of their own difficulties. This domain also includes questions about the impact of the health condition. The introduction to this domain specifically reminds respondents that the focus of this interview is on the past 30 days. However, this particular domain does not readily lend itself to such a limited time frame; therefore, it is important to ask respondents to attempt to remain focused on the 30-day reference period.

If necessary, clarify this question using other examples of community activities, such as attending town meetings, fairs, leisure or sporting activities in the town, neighbourhood or community. The relevant issue being asked in this question is whether respondents can participate in these activities or whether there are inhibitors to them doing so. If respondents appear confused by the phrase “in the same way anyone else can”, ask them to use their judgement to: • assess the extent to which average people in their community can join community activities; and • consider their personal level of difficulty in joining community activities in relation to the assessment.

The intent of this question is to determine how much has stood in the way of respondents being able to realize aspirations and plans as other people can. The concept here is what respondents face in terms of external interference created by the world or other people. Barriers could be: • physical – for example, the lack of ramps to get into church; and • social – for example, laws that discriminate against people with disabilities and negative attitudes of other people that create barriers.

Ask respondents to consider problems they have had in living with dignity or pride in who they are, what they are doing and how they live their lives.

This question seeks to capture an overall rating or snapshot of the portion of the past 30 days spent by respondents in dealing with any aspect of their health condition. This may include time spent in activities such as: • visiting a treatment centre; • managing financial matters related to their health condition, such as payment of bills, reimbursement of insurance or benefits; and • obtaining information about the health condition or in educating others about it.

This question refers to the degree to which respondents have felt an emotional impact due to their health condition. Emotions may include anger, sorrow, regret, thankfulness, appreciation, or any other positive or negative emotions.

Family is broadly defined to include relatives; however, it also includes those to whom respondents are not related but consider to be like family, including those who may be sharing in the financial aspects of the health condition. The focus of this question is on the depletion of personal savings or current income to meet the needs created by a health condition. If respondents have experienced a significant financial drain but their family has not, or vice versa, they should respond to the question based on the drain experienced by either party.

The focus here is on problems created by the interaction of a respondent’s health condition with the world in which the person lives. The question seeks information on problems that are borne by the family; these might include financial, emotional, physical problems, etc. The term “family” is defined above in D6.6.

Ask respondents to consider leisure interests that they currently pursue and those they would like to pursue but cannot due to the health condition and restrictions imposed by society. Examples might include a respondent who: • would like to read novels but is restricted from doing so because the local library does not carry large-print books; and • enjoys watching movies but cannot do so because few are produced with subtitles for the deaf. Provide an overall rating of problems encountered.