UPDAttachment 14 - RTI Spanish_Chinese Cognitive Testing Report Final 05-04-09

UPDAttachment 14 - RTI Spanish_Chinese Cognitive Testing Report Final 05-04-09.pdf

Medicare Health Outcomes Survey (HOS) and Supporting Regulations at 42 CFR 422.152

UPDAttachment 14 - RTI Spanish_Chinese Cognitive Testing Report Final 05-04-09

OMB: 0938-0701

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May 4, 2009

Cognitive Testing of the Health
Outcomes Survey:
Spanish and Chinese Translations
Round 2 Final Report

Prepared for
National Committee for Quality Assurance
1100 13th Street, NW
Washington, DC 20005

Prepared by
RTI International
Claudia Squire
Mandy Sha
Rosanna Quiroz
Michelle Yuan
Georgina McAvinchey
Sonia Reed
Leticia Rodriguez
3040 Cornwallis Road
Research Triangle Park, NC 27709

RTI Project Number 0209480.005

RTI Project Number
0209480.005

Cognitive Testing of the Health
Outcomes Survey:
Spanish and Chinese Translations
Round 2 Final Report

Prepared for
National Committee for Quality Assurance
1100 13th Street, NW
Washington, DC 20005

Prepared by
RTI International
Claudia Squire
Mandy Sha
Rosanna Quiroz
Michelle Yuan
Georgina McAvinchey
Sonia Reed
Leticia Rodriguez
3040 Cornwallis Road
Research Triangle Park, NC 27709

_________________________________
RTI International is a trade name of Research Triangle Institute.

CONTENTS
Section
1

Page
Research Design............................................................................................................ 1-1
1.1

Introduction .......................................................................................................... 1-1

1.2

Research Design................................................................................................... 1-1

1.3

Recruitment Procedures and Eligibility Requirements ........................................ 1-1

1.4

Data Collection .................................................................................................... 1-1

Spanish Interviews ........................................................................................................ 2-1
2.1

Respondent Characteristics .................................................................................. 2-1

2.2

Mailing Materials ................................................................................................. 2-2
2.2.1 Postcard .................................................................................................... 2-2
2.2.2 Survey Cover Letter ................................................................................. 2-3

2.3

Directions to Complete the Survey ...................................................................... 2-4

2.4

General Issues ...................................................................................................... 2-5
2.4.1 Visual Layout ........................................................................................... 2-5
2.4.2 Skip Pattern Compliance.......................................................................... 2-5

2.5

Item-Specific Findings ......................................................................................... 2-5

Chinese Interviews ........................................................................................................ 3-1
3.1

Mailing Materials (Survey Cover Letter) ............................................................ 3-2

3.2

Directions to Complete the Survey ...................................................................... 3-4

3.3

General Issues ...................................................................................................... 3-5
3.3.1 Visual Layout ........................................................................................... 3-5
3.3.2 Skip Pattern Compliance.......................................................................... 3-6

3.4

Item-Specific Findings ......................................................................................... 3-6

iii

Questionnaire Layout and Visual Guide: Next Steps ................................................... 4-1

References ..............................................................................................................................R-1
Appendixes
Appendix A; Round 2 Materials—Spanish ................................................................. A-1
Appendix B: Round 2 Materials—Chinese ..................................................................B-1
Appendix C: Question Wording ...................................................................................C-1

LIST OF FIGURES
Number

Page

4-1. Possible Construction of Q42 and Q43 Using the Detection Method .......................... 4-4

LIST OF TABLES
Number

Page

2-1. Spanish Interview Respondent Characteristics ............................................................. 2-1
3-1. Chinese Interview Respondent Characteristics ............................................................. 3-1

SECTION 1
RESEARCH DESIGN
1.1

Introduction

This report summarizes findings from Round 2 of the Cognitive Testing for the Health
Outcomes Survey: Cognitive Testing in Spanish and Chinese. RTI International is conducting the
study for the National Committee for Quality Assurance (NCQA).
The research design for this project consists of two tasks: (1) testing the Spanish-language
version of the Health Outcomes Survey (HOS) with Spanish-speaking respondents and (2) testing
the Chinese-language version of the HOS with Chinese-speaking respondents. This report presents
findings from the second round of cognitive interviews conducted in March 2009.
1.2

Research Design

In this round, we conducted nine cognitive interviews in Spanish and nine cognitive
interviews in Chinese with respondents to test their understanding of the survey items. The
interviews focused on suggested changes based on the results of the first round of interviews.
1.3

Recruitment Procedures and Eligibility Requirements

Spanish respondents were recruited by First in Focus Research, Inc., in Raleigh, North
Carolina. To be eligible for the study, respondents had to be age 65 or older, speak Spanish as their
primary language, and be able to read in Spanish. Specifications were given to the recruiter to
achieve diversity in gender, education, and country of origin.
Chinese respondents were recruited by Multicultural Resources, Inc., located in the Los
Angeles, California, area. To be eligible for the study, respondents had to be age 65 or older and
speak Chinese as their primary language; because HOS is designed to use traditional Chinese
characters, they must also be able to read those characters. Specifications were given to the recruiter
to achieve diversity in gender, education, Chinese-speaking region of origin, and Chinese dialect
(Mandarin, Cantonese).
1.4

Data Collection

All of the Spanish interviews were conducted at one of two RTI offices depending on
respondent preference. The Chinese interviews were conducted at a professional focus group facility
in Los Angeles, California. A trained moderator conducted the interviews using a semistructured
interview guide developed by RTI in consultation with NCQA and the Centers for Medicare &
Medicaid Services (CMS). Each interview lasted approximately 90 minutes. After the interview,
respondents were provided with an honorarium of $75.

1-1

SECTION 2
SPANISH INTERVIEWS
2.1

Respondent Characteristics

A total of nine Spanish-speaking respondents were recruited from the Raleigh-Durham
area for Round 2 interviews. Table 2-1 shows the specific breakdown of the respondents’
characteristics. Because regional difference contribute to linguistic differences, respondents were
recruited from different countries of origin: three respondents from Mexico (one male and two
females), two respondents from South America (one male from Peru and one female from
Venezuela), two individuals from Central America (one female from Panama and one male from
Nicaragua), and two respondents from Cuba (one male and one female). Their ages ranged from
65 to 78 years old. The majority of respondents had a high school degree or less (six), one had
some college education, and two had a college degree.
Table 2-1. Spanish Interview Respondent Characteristics
Characteristics

Round 2

Gender
Male
Female
Education
Less than high school
High school graduate
Some college/posthigh school education
College graduate of higher
Country of Origin
Mexico
Central America (Panama and Nicaragua)
South America (Peru and Venezuela)
Cuba
Moved to United States
Before 1980
1980–1989
1990–1999
2000–2005
Since 2006

4
5
5
1
1
2
3
2
2
2
1
1
4
3
0

2-1

Although all of the respondents recruited for this round indicated that they were able to
read well enough to complete a survey, we found that three respondents had very limited reading
skills. In one instance, the respondent was able to complete about half of the survey on his own
(the interviewer read the remaining questions to the respondent). In the other two cases, the
interviewer administered the survey.
2.2

Mailing Materials
The mailing materials (postcard and survey cover letter) tested in Round 2 are included in

Appendix A.

2.2.1 Postcard
As part of our cognitive testing protocol, respondents were asked to read a copy of the
text used for the initial postcard sent to selected sample members.
Changes Made to the Postcard for Round 2

Acronym CMS was dropped from the beginning of the third sentence to mirror the
English wording (“Su nombre fue seleccionado al azar” for “Your name was selected
at random.”)

Mr. Walter Stone’s title and the acronym CMS were translated for language
consistency: “Funcionario Privado”/“Centros de Servicios de Medicare y Medicaid”
for “CMS Privacy Officer.”

Corrected typographical errors: 1) “muchisimo” to read “muchísimo” on the fifth line
of the first paragraph (it needed a graphic accent) and 2) “este pendiente” to “esté
pendiente” at the beginning of the second paragraph. (The word “este” needed a
graphic accent.)

Findings

Seven of the nine respondents seemed to understand the main point of the postcard.
While only three respondents specifically said that they would be receiving a survey
in the mail, the other four understood that they would be asked questions about the
health services they receive at a later time. The remaining two respondents were not
able to explain what the postcard said. These respondents had little or no formal
education and were not familiar with the survey process.

We found that Mr. Walter Stone’s title was not clear to the participants (“Funcionario
Privado.”) The title used was understood as “Private Officer” rather than “Privacy
Officer.”

Recommendations

Overall, the revised postcard worked well. We recommend using the version of the
postcard tested in Round 2 (see Appendix A) with the following change: after
2-2

reviewing the translation of Mr. Stone’s title, we recommend using “Funcionario de
Privacidad.” This language is used on Internet Web sites referring to privacy issues
for various health care entities across the United States (e.g., the national and North
Carolina state Health and Human Services Department: www.dhs.gov,
www.dhhs.state.nc.us). “Funcionario de Privacidad” is also used on Internet sites
referring to Medicare and Medicaid services (e.g.,
http://www.uchsc.edu/htc/documents/HIPAA_Normativas_Privacidad_Espanol.pdf).

2.2.2 Survey Cover Letter
As part of our cognitive testing protocol, respondents were asked to read the HOS cover
letter sent to respondents with the survey.
Changes Made to the Survey Cover Letter for Round 2

Spelled out CMS to avoid confusion for respondents unfamiliar with the acronym.

Mr. Stone’s title was translated to read “Funcionario Privado de Los Centros de
Servicios de Medicare y Medicaid.”

The term for “postage paid return envelope” (“franqueo pagado”) was changed to
“con porte de correo pre-pagado.” The revised sentence reads: “Para su comodidad, le
adjuntamos un sobre con porte de correo pre-pagado” (“For your convenience, a
postage-paid return envelope is enclosed”).

The term for “research company” (“compañía de investigación”) was revised to say
“compañía que realiza estudios” (“company that performs studies”).

Findings

Similar to our findings in Round 1, many respondents had difficulty explaining the
content of the cover letter. Some respondents understood that the letter discussed
health services, but only one respondent understood that he would be asked to
complete a survey. We think the difficulty experienced by these respondents is, in
part, because of the length of the letter. Several respondents seemed overwhelmed by
the amount of information included in it.

The revised translation for “postage paid return envelope” (“con porte de correo prepagado”) did not work as well as expected. It was a high language phrase for some of
the respondents.

Recommendations

To thoroughly test the efficacy and culture-appropriateness of the cover letter
language, more time needs to be devoted to its testing. We recommend a separate
cognitive testing effort to concentrate on supporting materials. For example, cutting
some of the information to shorten the letter or using shorter paragraphs to help keep
respondents from feeling overwhelmed will aid comprehension.

2-3

2.3

Although this was not tested in Round 2, based on discussions among Spanishlanguage experts on the team, we recommend using a simpler translation for
“postage-paid return envelope”: “Para su comodidad, le adjuntamos un sobre que no
necesita estampilla de correo” (“For your convenience, we are enclosing an envelope
that does not need post office stamps.”). We think this wording will be easier for
respondents with lower levels of education to understand.

Although only one respondent said he would have liked for CMS’ mailing address to
be included, we think this is a good idea because some Spanish-speaking respondents,
particularly those with lower education levels, may not have a computer or feel
comfortable talking on the telephone. We suggest adding this information after the
e-mail address is given. We recommend the following wording: “También puede
escribirnos por correo regular a: X” (“You can also write to us via regular mail at:
X”). If this recommendation is accepted, apply the additional wording to the English
and Chinese-language versions of the cover letter for consistency.

You may want to consider including a due date for returning the survey. One
respondent said that it was not clear to him when he should complete the survey.
Including a date for return may encourage respondents to complete the survey in a
timely manner. The sentence could say “Sírvase llenar el cuestionario y devolverlo en
el sobre adjunto a más tardar el X” (“Please complete the questionnaire and return in
the enclosed envelope by X”). If this recommendation is accepted, apply the
additional wording to the English and Chinese-language versions of the cover letter
for consistency.

Finally, we recommend using the revised translation of the title for Mr. Walter Stone
(“Funcionario de Privacidad”) as discussed in Section 2.2.1 under Recommendations.

Directions to Complete the Survey

Changes Made to the “Medicare Health Outcomes Survey Instructions” Page for Round 2

The term “franqueo pagado” (postage paid envelope) was changed to “con porte de
correo pagado” as revised for the survey letter.

Finding

Overall, most of the respondents understood the directions. A couple of the
respondents who had the lowest levels of education had some difficulty, particularly
with the amount of text presented.

Recommendations

The term “con porte de correo pagado” should be revised to be consistent with our
previous recommendation for the survey cover letter (see Section 2.2.2). We
recommend saying “Para su comodidad, le adjuntamos un sobre que no necesita
estampilla de correo” (“For your convenience, we are enclosing an envelope that does
not need post office stamps.”). Although this recommendation was not tested in
Round 2, our team of Spanish-language experts thinks this translation will work well.

2-4

2.4

One respondent noted that the phrase “Responda a cada pregunta pensando en sí
mismo” (“Answer each question”) sounds too strong and mandatory in Spanish. We
suggest adding the words “Por favor” (“Please”) to the beginning of the sentence.

General Issues

2.4.1 Visual Layout
Most respondents had difficulty using the matrices in Q2, Q3, Q4, Q6, Q10, Q14, Q15,
and Q16. In these questions, response categories are placed between the stem question and the
question items. Respondents often believed that they should answer the stem question only and
were confused about the answer category labeling and the question items. These items are
discussed separately under Item-Specific Findings in Section 2.5. Please also refer to Section 4
for more detailed information about these general issues and further recommendations.

2.4.2 Skip Pattern Compliance
Following skip patterns was still difficult for the six respondents who completed the selfadministered survey during Round 2. The type of skip instruction used for Q33 and Q34 was
especially problematic (an instruction was included above Q34 to answer that question if they
answered “yes” to Q33). Most respondents simply ignored the skip instruction and answered
Q34, either because they did not notice it or did not know what it was for. Because similar
problems were found in the Chinese testing, we have included a more detailed discussion of this
issue in Section 4.
2.5

Item-Specific Findings

In this section, we discuss survey items that were altered for Round 2, as well as items
where we deemed more testing was needed based on findings from Round 1. The survey tested
in Round 2 is included in Appendix A. In addition, Appendix C includes a table documenting the
translations tested in Round 1 and 2, as well as our final recommendations for question wording.

2-5

Q2.* The following items are about activities you might do during a typical day. Does your
health now limit you in these activities? If so, how much? a. Moderate activities, such
as moving a table, pushing a vacuum cleaner, bowling, or playing golf; b. Climbing
several flights of stair [Yes, limited a lot; Yes, limited a little; No, no limited at all]
* Question 2 is part of the VR-12

Changes Made to Question 2, 2a, 2b for Round 2

For Q2a, the list of activities was revised to add the Spanish translation for the term
“bowling” (the English term was still included) and to add more common activities in
the Hispanic culture: “jugar al boliche o ‘bowling’ o caminar o nadar a ritmo
moderado” (“play bowling or ‘bowling,’ or walking or swimming at a moderate
pace.”). “Jugar al golf” (“playing golf”) was dropped, because this is not a common
sport among Latin American individuals. There were no revisions for Q2 and Q2b.

Findings for Question 2, 2a, 2b

Six of the nine respondents (two from Cuba and four from Mexico) did not
understand the translation for “bowling” (“jugar al boliche”). Although the translation
is correct, certain countries do not use the term and/or the activity is not practiced
there.

Five respondents had trouble with the matrix layout of this question. They attempted
to answer the stem question by marking the labeling of an answer category. They did
not realize that the answer categories are associated with Q2a and Q2b.

Recommendations for Question 2, 2a, and 2b

Consider dropping the term “bowling” from the list of activities on Q2a. The rest of
the activities tested in Round 2 tested well and were culturally appropriate. However,
it should be confirmed that the additional activities tested in this round (walking or
swimming at a moderate pace) are considered appropriately moderate by the survey
author. If the activities are modified in Q2a, make those modifications in the Englishand Chinese-language versions to anchor the intended meaning of “moderate activity”
consistently.

Consider not using the matrix in this question. See Section 4, Questionnaire Layout
and Visual Guide, for more discussion and recommendations.

2-6

Q3.* During the past 4 weeks, have you had any of the following problems with your work or
other regular daily activities as a result of your physical health? a. Accomplished less
than you would like; b. Were limited in the kind of work or other activities. [No, none of
the time; Yes, a little of the time; Yes, some of the time; Yes, most of the time; Yes, all of
the time]
* Question 3 is part of the VR-12

Changes Made to Question 3, 3a, and 3b for Round 2

We simplified the question format by shortening the stem question and placing a
question mark and ellipsis to show a sense of continuation for the respondent to
answer Q3a and Q3b. We placed “a causa de su salud física” (“as a result of your
physical health”) at the end of Q3a and Q3b, to see the respondents’ reaction.

Findings for Question 3, 3a, and 3b

One respondent interpreted “trabajo” (“work”) to mean a paid job. Because she does
not work for money, she skipped this question. The issue of whether work should be
interpreted as a job for money, or some other way, was discussed during our Round 1
debriefing call.

One respondent thought that Q3a was incomplete. After reading the question he
asked, “Accomplished less what….?” He was unable to answer the question.

Even though the question was simplified, it still posed serious difficulty for most
respondents, who wanted to answer the stem question before reading Q3a and Q3b.
They immediately thought they had to respond to the stem question. In some cases,
respondents had difficulty even after the interviewer explained how to navigate
through the question. For example, a couple of respondents tried to mark their
answers to both Q3a and Q3b in the same row.

Recommendations for Question 3, 3a, and 3b

Consider adding wording to define “work.” Our recommendation will depend on how
CMS wants respondents to interpret the term. If a definition of “work” is added, apply
the same definition to the English and Chinese-language versions for consistency.
Alternatively, use “do work” or “work that you do” instead of “work” to
communicate that it is work in general, and not a “job.” This approach tested well in a
recent cognitive testing project of the American Housing Survey (Carter et al., 2009).

Although only one respondent thought Q3a was incomplete, our team suggests adding
“activities” to the question (“Accomplished fewer activities than you would like”). If
this change is adopted, we recommend making this change to the English and Chinese
versions for consistency.

2-7

Consider not using the matrix in this question. See Section 4, Questionnaire Layout
and Visual Guide, for more discussion and recommendations.

Q4.* During the past 4 weeks, have you had any of the following problems with your work or
other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)? a. Accomplished less than you would like; b. Didn’t do work or
other activities as carefully as usual. [No, none of the time; Yes, a little of the time; Yes,
some of the time; Yes, most of the time; Yes, all of the time]
* Question 4 is part of the VR-12

Changes Made to Question 4, 4a, and 4b for Round 2

The format of Q4 was simplified by replacing a question mark at the end of the stem
question, followed by ellipsis. The phrase “a causa de algún problema emocional”
(“as a result of any emotional problems”) was deleted from Q4 and placed at the end
of Q4a and Q4b.

Findings for Question 4, 4a, and 4b

As with Q3, one respondent interpreted “trabajo” (“work”) to mean a paid job.
Because she does not work for money, she skipped this question.

One respondent thought that Q4a was incomplete. After reading the question he
asked, “Accomplished less what….?” He was unable to answer the question.

As with Q3, even though the question was simplified, the question posed serious
difficulty for most respondents because of the same issues encountered in Q2 and Q3.

Recommendations for Question 4, 4a, and 4b

For “work,” see the recommendation section of Q3.

Although only one respondent thought Q4a was incomplete, our team suggests adding
“activities” to the question (“Accomplished fewer activities than you would like”). If
this change is adopted, we recommend making this change to the English and Chinese
versions for consistency.

Consider not using the matrix in this question. See Section 4, Questionnaire Layout
and Visual Guide, for more discussion and recommendations.

2-8

Q5.* During the past 4 weeks, how much did pain interfere with your normal work (including
both work outside the home and housework)? [Not at all, A little bit, Moderately, Quite a
bit, Extremely]
* Question 5 is part of the VR-12

Changes Made to Question 5 for Round 2

An explanation of the term “dolor” (“pain”) was added at the end: “sensación de
molestia o sufrimiento físico” (“sensation of physical hurt or discomfort”).

Findings for Question 5

Adding a definition for “pain” seemed to be helpful for respondents. However, some
respondents who were not experiencing pain were confused by the question. One
respondent asked, “What pain are they referring to?”

Some respondents noted that the response categories were long and not commonly
used in Spanish, particularly the adverbs “medianamente” for “moderately” and
“extremadamente” (“extremely”).

One respondent interpreted the term “trabajo” (“work”) to mean paid work only.
Because she is not employed, she did not answer this question.

Recommendations for Question 5

Although this was not tested in Round 2, based on discussions among Spanishlanguage experts on the team, we recommend using a new set of translation to
describe the answer scale: Nada, Un poco, Algo, Bastante, and Mucho (Not at all, A
little bit, Some, Quite a bit, and A lot). This new set of translation is shorter and
simpler, and does not use uncommon adverbs. It would have been ideal to have tested
this with respondents in Round 1 and Round 2, especially using “Algo” to describe
“Moderate,” however, we think this answer scale is an improvement over the original.

For “work,” see the recommendation section in Q3.

2-9

Q6.* How much of the time during the past 4 weeks: a. Have you felt calm and peaceful? b.
Did you have a lot of energy? c. Have you felt downhearted and blue? [All
of the time, Most of the time, A good bit of the time, Some of the time, A little of the time,
None of the time]
* Question 6 is part of the VR-12

Changes Made to Question 6, 6a, and 6b for Round 2

No changes were made to the question in Round 2.

Findings for Question 6, 6a, and 6b

As with Q2, Q3, and Q4, many respondents had difficultly using the matrices.

One respondent did not understand the term “sosegado” for “peaceful.”

Some respondents were overwhelmed by the number of answer choices.

Recommendations for Question 6, 6a, and 6b

Although only one respondent had trouble understanding the term “sosegado,” we
recommend using the term “en paz” (“in peace”) for Q6a.

Although we think the number of answer categories could be reduced, we understand
that this question is part of another instrument and likely cannot be changed.

Consider not using the matrix in this question. See Section 4, Questionnaire Layout
and Visual Guide, for more discussion and recommendations.

Q8.

Compared to one year ago, how would you rate your physical health in general now?
[Much better, Slightly better, About the same, Slightly worse, Much worse]

Q9.

Compared to one year ago, how would you rate your emotional problems (such as
feeling anxious, depressed or irritable) in general now? [Much better, Slightly better,
About the same, Slightly worse, Much worse]

Changes Made to Questions 8 and 9 for Round 2

No changes were made to these questions in Round 2.

Finding for Questions 8 and 9

All respondents appeared to understand the questions as intended.

Recommendation for Questions 8 and 9

No recommendations.

2-10

Q10. Because of a health or physical problem, do you have any difficulty doing the following
activities without special equipment or help from another person? a. Bathing;
b. Dressing; c. Eating; d. Getting in or out of chairs; e. Walking; f. Using the toilet [No, I
do not have difficulty; Yes, I have difficulty; I am unable to do this activity]
Changes Made to Question 10a-f for Round 2

The term “baño” (“bathroom”) was added to subquestion f. The revised question
reads “Usar el inodoro o baño” (“Using the toilet or bathroom”).

Finding for Question 10a–f

The additional term “baño” did not work as intended. Most respondents understood it
as the actual bathroom, not the toilet. While it is true that some Latin American
countries use the term “baño” for “toilet,” the respondents we spoke with in Round 2
said that they thought of “baño” as the room where they take a shower or wash their
hands.

Recommendation for Question 10a–f

Although this was not tested in Round 2, the Spanish-language team recommends
using the term “taza del baño” in addition to “toilet.” This term was mentioned by
several respondents when asked what term they use for toilet.

These next questions ask about your physical and mental health during the past 30 days.
Q11. Now, thinking about your physical health, which includes physical illness and injury, for
how many days during the past 30 days was your physical health not good? (Please enter
a number between “0” and “30” days. If no days, please enter “0” days.) [days]
Q12. Now, thinking about your mental health, which includes stress, depression, and problems
with emotions, for how many days during the past 30 days was your mental health not
good? (Please enter a number between “0” and “30” days. If no days, please enter “0”
days.) [days]
Q13. During the past 30 days, for about how many days did poor physical or mental health
keep you from doing your usual activities, such as self-care, work, or recreation? (Please
enter a number between “0” and “30” days. If no days, please enter “0” days.) [days]
Change Made to Questions 11, 12, and 13 for Round 2

The answer instructions were separated from the question by a couple of rows and the
parentheses were removed.

Findings for Questions 11, 12, and 13

Separating the answer instructions and removing the parentheses seemed to work
well. Unlike the last round, respondents understood the question and answer
instructions without difficulty.

2-11

Five respondents had trouble understanding how to record their answer in the answer
boxes. One respondent said, “Where do I write my answer?” Another one started
writing the number right after the question, and some of them wrote a two-digit
number in one box only.

Recommendation for Questions 11, 12, and 13

We recommend providing a straight line for respondents to record their answer. Our
team thinks this will be easier and less confusing for respondents. For Q53 (weight)
and Q54 (height), we tested a version in this round for which respondents recorded
their answers on a straight line. This worked well. All of the respondents were able to
use the format without difficulty.

Q16. During the past 4 weeks, how much of the time have you had any of the following
problems with your legs and feet? a. Numbness or loss of feeling in your feet; b. Tingling
or burning sensation in your feet especially at night; c. Decreased ability to feel hot or cold
with your feet; d. Sores or wounds on your feet that did not heal [All of the time, Most of
the time, Some of the time, A little of the time, None of the time]
Change Made to Question 16a-d for Round 2

Q16c was revised to read: “Sus pies ya no sienten que las cosas puedan estar calientes
o frías” (“Your feet no longer feel that things may be hot or cold”). All other
subquestions remained the same.

Findings for Question 16a–d

This revision for Q16c worked well for most respondents; however, the revised
translation changed the meaning from “decreased feeling” to “no feeling.” Therefore,
we recommend the alternate translation below.

As with other questions with this format, respondents had difficulty following the
format of this set of questions.

Recommendations for Question 16a–d

Because the version that we tested in Round 2 may change the meaning of the
question, we recommend the following translation: “Ha disminuído su sensación de
que las cosas puedan estar calientes o frías.” (Your feeling of things being hot or cold
has decreased). This version still uses the term “decrease,” but it is used as a verb
rather than as a noun. We believe respondents may understand this version more
easily.

Consider not using matrix in this question. See Section 4, Questionnaire Layout and
Visual Guide, for more discussion and recommendations.

2-12

Q17. During the past 4 weeks, how would you describe any arthritis pain you usually had?
[None, Very mild, Mild, Moderate, Severe]
Change Made to Question 17 for Round 2

The term “arthritis” was corrected to read “artritis” in Spanish, rather than in English.

Findings for Question 17

Almost all of the respondents understood the question as intended and were familiar
with arthritis pain. One respondent had not heard the term before and thought it was a
“sickness of the blood.”

Two respondents did not understand the answer option “leve” for “mild.”

Recommendations for Question 17

We recommend adopting the version of this question tested in Round 2 (using the
Spanish term for arthritis).

For “very mild” and “mild,” consider replacing “muy leve” and “leve” with “muy
poco dolor” (very little pain) and “poco dolor” (little pain), respectively. The
replacement is a reasonable transition from the translation for “none,” which says
“ningún dolor” (no pain). To be consistent, edit the translation for the next two
categories so that they also include the word “dolor” (pain) next to the existing
adjective that describes moderate and severe. The complete set of translation would
say: “Ningún dolor, Muy poco dolor, Poco dolor, Dolor moderado, Dolor intenso”
(“No pain, Very little pain, Little pain, Moderate pain, Intense pain”). While it would
be ideal to test these response categories, we think they are an improvement over the
original.

Q18. Can you see well enough to read newspaper print (with your glasses or contacts if that’s
how you see best)? [Yes, No]
Q19. Can you hear most of the things people say (with a hearing aid if that’s how you hear
best)? [Yes, No]
Changes Made to Questions 18 and 19 for Round 2

Q18 was revised to read: “¿Puede ver lo suficientemente bien como para leer la letra
del periódico, con o sin lentes?” (“Can you see well enough to read a newspaper
print, with or without glasses?”). The parenthesis was dropped for the wording “with
or without your glasses or contacts.”

Q19 was revised to read: “¿Puede oír la mayoría de las cosas que la gente dice, con o
sin un aparato para el oído?” (“Can you hear most of the things people say, with or
without a hearing aid?”). The parenthesis was dropped for the wording “with or
without a hearing aid.”

2-13

Findings for Questions 18 and 19

The revised version of Q18 was still problematic. Respondents did not think this was
a “yes” or “no” answer. They all answered, “I can read with glasses, not without
them.” Even after probing, respondents could not answer the question as intended.

Q19, however, was not a big problem. Most respondents understood it better than
Q18 and were able to answer either “yes” or “no.”

Recommendations for Questions 18 and 19

In order to guide respondents in answering Question 18 as intended (i.e. “yes” or
“no”), we recommend using a more direct way to convey “with or without glasses” in
the original translation. The Spanish language experts discussed different options, and
feel that “regardless of whether you need glasses or not” would be the most natural
way. The recommended final version is:

Q18
¿Puede ver lo suficientemente bien como para leer la letra del periódico, sin importar si
necesita lentes on no? (Can you see well enough to read newspaper print, regardless of
whether you need glasses or not?)

Although Q19 posed little problems to Round 2 respondents, in order to be consistent
with the approach and format in Q18, we recommend the following final version:

Q19
¿Puede oír la mayoría de las cosas que la gente dice, sin importar si necesita un aparato
para el oído o no? (Can you hear most of the things people say, regardless of whether you
need a hearing aid or not?)
Testing this revised wording with additional respondents would be ideal.

2-14

Medical terms on Q20 through Q32 were probed only as needed.
Q20. Has a doctor ever told you that you had: Hypertension or high blood pressure [Yes, No]
Q21. Has a doctor ever told you that you had: Angina pectoris or coronary artery disease [Yes,
No]
Q22. Has a doctor ever told you that you had: Congestive heart failure [Yes, No]
Q23. Has a doctor ever told you that you had: A myocardial infarction or heart attack [Yes, No]
Q24. Has a doctor ever told you that you had: Other heart conditions, such as problems with
heart valves or the rhythm of your heartbeat [Yes, No]
Q25. Has a doctor ever told you that you had: A stroke [Yes, No]
Q26. Has a doctor ever told you that you had: Emphysema, or asthma, or COPD (chronic
obstructive pulmonary disease) [Yes, No]
Q27. Has a doctor ever told you that you had: Crohn’s disease, ulcerative colitis, or
inflammatory bowel disease [Yes, No]
Q28. Has a doctor ever told you that you had: Arthritis of the hip or knee [Yes, No]
Q29. Has a doctor ever told you that you had: Arthritis of the hand or wrist [Yes, No]
Q30. Has a doctor ever told you that you had: Osteoporosis, sometimes called thin or brittle
bones [Yes, No]
Q31. Has a doctor ever told you that you had: Sciatica (pain or numbness that travels down your
leg to below your knee) [Yes, No]
Q32. Has a doctor ever told you that you had: Diabetes, high blood sugar, or sugar in the urine
[Yes, No]
Change Made to Questions 20 through 32 for Round 2

The term “coronaries” on Q21 was corrected to say “coronarias.”

Finding for Questions 20 through 32

Most respondents had no problems answering these questions. Some of them forgot
what the introductory question was after reading a few of them.

Recommendations for Questions 20 through 32

Use the revised version of Q21 that has the correct spelling of “coronarias.”

Consider repeating the introductory question every four or five questions so
respondents can remember what the main question is about. If this recommendation is

2-15

accepted, apply the same condition to the English and Chinese-language versions for
consistency.
Q33. Has a doctor ever told you that you had: Any cancer (other than skin cancer) [Yes, No]
If you answered “yes” to Question 33 above (that you have had cancer), go to Question 34. If
you answered “no” to Question 33, go to Question 35.
Q34. Are you currently under treatment for: a. Colon or rectal cancer; b. Lung cancer; c. Breast
cancer; d. Prostate cancer [Yes, No]
Change Made to Questions 33 and 34a-d for Round 2

The skip instruction after Q33 was revised as follows: “Si contestó que “sí” a la
pregunta 33, pase a la pregunta 34. Si contestó “no” a la pregunta 33, vaya a la
pregunta 35.” (“If you answered “yes” to question 33, go to question 34. If you
answered “no” to question 33, skip to question 35.”) Questions 34a–d were not
changed.

Finding for Questions 33 and 34a–d

Three of the nine respondents did well following this skip pattern instruction. Three
other individuals still seemed confused about how to follow the skip pattern. Even
though they answered “No” to Q33, they still answered Q34. Two other respondents
were administered the telephone mode and this was not applicable to them.

Recommendation for Questions 33 and 34a–d

It appears that the revised instruction worked somewhat better than the previous
version. We recommend using the revised skip pattern instruction. However, we
recommend more testing in this area. Section 4 includes a detailed discussion on
problems with skip instructions.

Q35. In the past 4 weeks, how often has low back pain interfered with your usual daily
activities (work, school or housework)? [All of the time, Most of the time, Some of the
time, A little of the time, None of the time]
Changes Made to Question 35 for Round 2

There were no changes to this question because it tested well during Round 1.

Finding for Question 35

Respondents had no issues with this question and understood it as intended.

Recommendation for Question 35

No changes recommended.

2-16

The next questions are about different periods of time.
Q36. In the past year, have you had 2 weeks or more during which you felt sad, blue or
depressed; or when you lost interest or pleasure in things that you usually cared about or
enjoyed? [Yes, No]
Q37. In the past year, have you felt depressed or sad much of the time? [Yes, No]
Q38. Have you ever had 2 years or more in your life when you felt depressed or sad most days,
even if you felt okay sometimes? [Yes, No]
Q39. How much of the time in the past week did you feel depressed? [Less than one day, One
or two days, Three or four days, More than four days]
Change Made to Questions 36 through 39 for Round 2

A short introduction was added before this series of questions saying: “Las siguientes
preguntas se refieren a diferentes periodos de tiempo” (“The next questions are about
different periods of time”) for further clarification to the respondent.

Findings for Questions 36 through 39

It appears that, even with the added introduction, some respondents struggled with the
changing time periods. In addition, a couple of respondents were confused by the
introduction.

One other respondent said that the response option “Nunca” (“Never”) was missing
from the list of response categories for Q39.

Recommendation for Questions 36 through 39

Since the introduction did not help simplify this set of questions we recommend
dropping it. Ideally, questions are arranged so that a set of questions asks about the
same time period. We understand in this case that it may not be possible.

Q42. Many people experience problems with urinary incontinence, the leakage of urine. In the
past 6 months, have you accidentally leaked urine? [Yes, No]
Changes Made to Question 42 for Round 2

An alternate translation for “urine leakage” (“escape de orina”) was tested in this
round: “Muchas personas tienen problemas de incontinencia urinaria o la orina se
sale en forma involuntaria. Durante los últimos 6 meses, ¿se ha orinado en forma
involuntaria accidentalmente?” (“Many people experience problems with urinary
incontinence or the urine leaks involuntarily. In the past 6 months, have you
accidentally leaked urine involuntarily?”)

Finding for Question 42

No problems noted.

2-17

Recommendation for Question 42

We recommend using the revised wording tested in Round 2.

Q43. How much of a problem, if any, was the urine leakage for you? [A big problem, A small
problem, Not a problem]
Changes Made to Question 43 for Round 2

No changes were made to this question.

Finding for Question 43

Respondents were asked whether they preferred the term used for “leakage of urine”
in this question or the revised term (“sale en forma involuntaria”) tested in the
previous question. All preferred the revised version.

Recommendation for Question 43

We recommend using the revised term for “urine leakage” in this question.

Q44. Have you talked with your current doctor or other health provider about your urine
leakage problem? [Yes, No]
Changes Made to Question 44 for Round 2

No changes were made to this question.

Finding for Question 44

No problems noted.

Recommendation for Question 44
•

Although not tested in Round 2, based on discussions of findings for Q42, we recommend using
the revised term for “urine leakage” tested in Q42.
¿Ha hablado usted con su médico actual u otro personal médico sobre su problema de que la
orina se salga en forma involuntaria? (Have you talked with your current doctor or other health
provider about your involuntary urine leakage?)

Q45. There are many ways to treat urinary incontinence including bladder training, exercises,
medication and surgery. Have you received these or any other treatments for your current
urine leakage problem? [Yes, No]
Change Made to Question 45 for Round 2

The term “bladder training” (“entrenamiento de la vejiga”) was replaced by
“ejercicios de la vejiga” (“bladder exercises”).

2-18

Finding for Question 45

Respondents seemed to prefer the term for bladder exercises (“ejercicios de la
vejiga”). However, most of the respondents were not able to describe what bladder
exercises were.

Recommendation for Question 45

We recommend using the term for bladder exercises. However, we think further
testing with respondents who have urinary incontinence would be helpful.

Q46. In the past 12 months, did you talk with a doctor or other health provider about your level
of exercise or physical activity? For example, a doctor or other health provider may ask if
you exercise regularly or take part in physical exercise. [Yes, No, I had no visits in the
past 12 months]
Changes Made to Question 46 for Round 2

No changes were made to this question.

Finding for Question 46

Most respondents understood this question as intended. However, in some cases,
respondents answered this question based on whether they exercised (as opposed to
whether they talked with their doctor about exercise or physical activity).

Recommendation for Question 46

No changes recommended.

Q47. In the past 12 months, did a doctor or other health provider advise you to start, increase
or maintain your level of exercise or physical activity? For example, in order to improve
your health, your doctor or other health provider may advise you to start taking the stairs,
increase walking from 10 to 20 minutes every day or to maintain your current exercise
program. [Yes, No]
Changes Made to Question 47 for Round 2

The original translation for “going up and down the stairs” was revised from “tomar
las escaleras” to “subir o bajar las escaleras,” which is how it is commonly said in
Spanish.

Finding for Question 47

The revised term tested well. No problems were noted.

Recommendation for Question 47

We recommend using the revised version of the question tested in Round 2.

2-19

Q48. A fall is when your body goes to the ground without being pushed. In the past 12 months,
did you talk with your doctor or other health provider about falling or problems with
balance or walking? [Yes, No, I had no visits in the past 12 months]
Changes Made to Question 48 for Round 2

No changes were made to this question.

Finding for Question 48

As we found in the first round, most respondents answered based on whether they
have fallen or had problems with balance or walking, not whether they have spoken
with their doctor about these issues.

Recommendation for Question 48

Although we think it might work well to reverse the order of Q48 and Q49 (ask
respondents whether they have fallen first, and then if they have spoken with their
doctor), we understand that these questions are part of a HEDIS measure so that may
not be possible. If that cannot be considered, we recommend putting the text “talk
with your doctor or other health provider” in bold type. If the recommendation of
adding bold type is accepted, apply the same stimulus in the English and Chineselanguage versions for consistency.

Q51. Has your doctor or other health provider done anything to help prevent falls or treat
problems with balance or walking? Some things they might do include: Suggest that you
use a cane or walker. Check your blood pressure lying or standing. Suggest that you do an
exercise or physical therapy program. Suggest a vision or hearing testing. [Yes, No, I had
no visits in the past 12 months]
Changes Made to Question 51 for Round 2

The original version of this question was a three-part question consisting of 1) the
core question, 2) four bulleted examples, and, 3) three response options. In this round,
we revised the question so that the core question was combined with the shortened
version of the examples since several respondents in Round 1 thought that they had to
answer “yes” or “no” for each example.

In addition to making this format change, we also made the following revisions to
simplify the examples:
1) Wording was shortened to say “el uso de un bastón” (“the use of a cane”) rather
than “Sugerir que use un bastón o un andador” (“Suggest that you use a cane or
walker.”)
2) Wording was shortened to say “medirse la presión o tensión arterial” (“check your
blood pressure”) rather than “medirle la presión o tensión arterial cuando usted está
acostado o de pie” (“check your blood pressure lying or standing.”)

2-20

3) Wording was shortened to say “ejercicios o terapia física” (“exercise or physical
therapy”), rather than “Sugerir que participe en un programa de ejercicios o de terapia
física” (“Suggest that you do an exercise or physical therapy program”)
4) No changes
Finding for Question 51

The revised version worked very well. Respondents were able to follow the format
without difficulty.

Recommendations for Question 51

The revised format worked well for this question. Respondents were able to read the
stem question followed by the example activities.

Although the simplified wording of the examples worked well, we are concerned that
removing “walker” from the first example may change the meaning of the example in
that respondents may focus only on canes and not other walking devices. Since
respondents in Round 1 understood the term for walker (andador), we recommend
keeping it in the example. We recommend making the other changes to the examples
with the caveat that “lying or standing” (from “check your blood pressure” example)
can be removed without changing the health measure.

Q52. Have you ever had a bone density test to check for osteoporosis, sometimes thought of as
“brittle bones”? This test may have been done to your back, hip, wrist, heel or finger.
[Yes, No]
Change Made to Question 52 for Round 2

The translation for “heel” was corrected to read “talón.”

Finding for Question 52

No problems noted.

Recommendation for Question 52

We recommend using the revised version of the question as tested in Round 2.

Q53. How much do you weigh in pounds (lbs.)? [90 lbs. or less, 91–100 lbs., 101–110 lbs.,
111–120 lbs., 121–130 lbs., 131–140 lbs., 141–150 lbs., 151–160 lbs., 161–170 lbs., 171–
180 lbs., 181–190 lbs., 191–200 lbs., 201–210 lbs., 211–220 lbs., 221–230 lbs., 231–240
lbs., 241–250 lbs., 251–260 lbs., 261–270 lbs., 271–280 lbs., 281–290 lbs., 291–300 lbs.,
301–310 lbs., 311–320 lbs., 321 lbs. or more]
Change Made to Question 53 for Round 2

The response categories were dropped and lines were added for the respondent to
answer in either weight system.

2-21

Finding for Question 53

Some respondents gave their weight in pounds and others in kilograms.

Recommendation for Question 53

If the revised version is adopted, operational issues must be considered. The data
capture system in place needs to be modified to accept numbers rather than codes
associated with the original predetermined categories. Alternatively, data entry staff
must be trained to input the correct codes.

To aid the decision in whether to adopt the revised version, we recommend
examining HOS data to see whether item nonresponse and data quality pose an issue
in Q53. For the purpose of testing the translation with a diverse population, the test
respondents recruited for the Spanish-language cognitive interviews included recent
immigrants and non-Medicare recipients. This population may differ significantly
from the intended HOS audience, who is expected to be more acculturated about U.S.
measurement. A data-driven approach combined with the qualitative results presented
here would be a prudent way to determine if a change in how the weight information
should be captured.

Q54. How tall are you without shoes on in feet (ft.) and inches (in.)? (If 1/2 in., please round
up.) [5 ft. 00 in. or less, 5 ft. 01 in., 5 ft. 02 in., 5 ft. 03 in., 5 ft. 04 in., 5 ft. 05 in., 5 ft. 06
in., 5 ft. 07 in., 5 ft. 08 in., 5 ft. 09 in., 5 ft. 10 in., 5 ft. 11 in., 6 ft. 00 in., 6 ft. 01 in., 6 ft.
02 in., 6 ft. 03 in. or more]
Change Made to Question 54 for Round 2

The response categories were dropped and lines were added for the respondent to
provide their height in either feet/inches or meters/centimeters.

Finding for Question 54

Some respondents gave their height in feet/inches and others in meters/centimeters.

Recommendation for Question 54

See discussion in the recommendation section of Question 53.

Q58. Would you describe your race? Please mark one or more. [American Indian or Alaskan
Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander,
White, Another race]
Changes Made to Question 58 for Round 2

No changes were made to this question.

Finding for Question 58

We found the same issues as with prior testing of the question. Most Hispanic
individuals do not identify themselves with any of these race categories.

2-22

Recommendation for Question 58

We understand that this question must be asked as is. Problems with this question
should be taken into account when interpreting the data.

Q61. Is the house or apartment you currently live in: [Owned or being bought by you, Owned or
being bought by someone in your family other than you, Rented for money, Not owned
and one in which you live without payment of rent, None of the above]
Changes Made to Question 61 for Round 2

The term “alquilada por dinero” (“rented for money”) was changed to “alquilada”
(“rented”).

Finding for Question 61

This worked well for almost all respondents. Only one respondent from Mexico did
not understand the term and suggested using the term “rentada” (this means the same
thing as “alquilada”).

Recommendation for Question 61

We recommend using the revised version of this question as tested in Round 2.

Q62. Who completed this survey form? [Person to whom survey was addressed, Family
member or relative of person to whom the survey was addressed, Friend of person to
whom the survey was addressed, Professional caregiver of person to whom the survey was
addressed]
Changes Made to Question 62 for Round 2

No changes were made to this question.

Finding for Question 62

One respondent had problems with this question and could not answer it. It also
appears that the first option “La persona a la que se dirigió la encuesta” (“Person to
whom survey was addressed”) could be a difficult concept because it refers to third
person referent. That is, respondents who are completing the survey themselves must
think of themselves as a third person.

Recommendation for Question 62

In order to make the first response option more intuitive to respondents, we
recommend replacing it with “La persona elegida para la encuesta” (“Person selected
for the survey”). This is a conceptual issue, rather than translation.

2-23

SECTION 3
CHINESE INTERVIEWS
A total of nine respondents were recruited from the Los Angeles area and interviewed for
Round 2 testing. Table 3-1 shows the specific breakdown of the respondents’ characteristics. In
general, they reflect the established recruitment goals. About the same number of men and
women participated, as well as Mandarin and Cantonese speakers. The majority of the
respondents completed high school, and two had only some years of formal education. More
respondents came from China, followed by Taiwan, and all but one respondent were Medicare
recipients. Overall, the recruiting reflected a well-represented mix of characteristics that mirror
those of the intended HOS respondents.
Table 3-1. Chinese Interview Respondent Characteristics
Characteristics

Round 2

Gender
Male

Female

Education
Less than high school

High school graduate

Some college/posthigh school education

College graduate of higher

Chinese Dialect
Mandarin

Cantonese

Region of Origin
China

Taiwan

Medicare
Medicare recipient

Some other arrangement

3-1

After all Round 1 interviews were completed and documented, the Chinese-language
team met to reassess the translation issues identified in the cover letter and the questionnaire.
Alternative translations were developed to be included in the Round 2 testing. All of the
proposed alternative translations were tested in Round 2. Thus, in addition to testing the same
materials as in Round 1, Round 2 interviews also tested the suggested changes by presenting to
respondents a set of show cards comparing the original translations with the alternative
translations and by asking for their assessment of the different versions of translations.
3.1

Mailing Materials (Survey Cover Letter)

The survey cover letter was tested in all nine interviews. Because of time constraint, the
testing focused on the first three paragraphs of the letter where changes were made.
Changes Made to the Survey Cover Letter for Round 2

Replaced 調查 (investigation) with 問卷 (questionnaire).

Replaced 高質素 with 高素質 to mean “high quality” in the letter. Another alternate
translation for high quality, 高質量, was also presented to the respondents using a
show card.

Added 紅藍卡 (red and blue card) in parentheses to the current translation of
“Medicare.” The phrase 聯邦保健 （紅藍卡）was tested.

Replaced 閣下 (the formal honorific “you”) with 您 (the more commonly used
honorific “you”).

Findings

Most of the respondents understood from the first three paragraphs that the letter was
about research related to health insurance offered by the federal government. Unlike
Round 1 respondents, they did not interpret the survey as an “investigation” but
simply a “questionnaire” because the revised translation no longer referred to a
survey investigation.

Mandarin and Cantonese speakers from Round 1 testing interpreted the translation of
“high quality” differently. Although Cantonese speakers did not take issue with the
original translation 高質素 (gao zi su), the Mandarin speakers thought it was a typo
and thought the wording should be “gao su zi.” During Round 2 testing, all
respondents understood both alternate translations 高素質 and 高質量. Several
respondents commented that 高質量 sounded more commonplace and thus
preferable.
3-2

During Round 1 testing, it was found that the translation of “Medicare” was not
indicative enough to most respondents because it literally says “Federal health plan.”
All respondents seemed to have a basic understanding of the English terms
“Medicare” or “MediCal” but referred to it as 紅藍卡 (red and blue card) in Chinese.
Round 2 testing added 紅藍卡 (red and blue card) in parentheses, and all respondents,
even non-Medicare recipient, interpreted the term as intended.

For the translation of “you,” almost all respondents preferred 您 (the more commonly
used honorific “you”), saying that it is more natural, more friendly, and still honorific.
Several respondents pointed out that 閣下 (the formal honorific “you”) sounded
archaic and elitist.

Recommendations

To avoid undue interpretations of the purpose of HOS, replace 調查 (investigation)
with 問卷 (questionnaire). The usage has been confirmed with respondents. This
recommendation is also supported by prior research conducted by the Census Bureau
(Pan et al., 2006) and establishes respondents’ expectations that the questionnaire is
self-administered.

Replace 高質素 with 高質量 to mean “high quality.” The new term was well
understood by all Mandarin and Cantonese speakers.

Consider adding 紅藍卡 (red and blue card) in parentheses to the current translation
of “Medicare.” This translation was used by Chinese speakers on the pragmatic level
and found to be helpful in indicating the study’s relation to Medicare. Usage was
confirmed and preferred by the vast majority of the test respondents.
However, leave the translation as is if it is believed that name recognition has been
established because HOS has been collecting data under the current Chinese name for
a few years.

Replace 閣下 (the formal honorific “you”) with 您 (the more commonly used
honorific “you”). It does not dilute the respectful tone of the letter and is used in the
translation of the HOS survey questions.

To thoroughly test the efficacy and culture-appropriateness of the cover letter
language, more time needs to be devoted to its testing. Recommend a separate
cognitive testing effort to concentrate on supporting materials.

3-3

3.2

Directions to Complete the Survey

Changes Made to the “Medicare Health Outcomes Survey Instructions” Page for Round 2

Replaced 調查 (investigation) with 問卷 (questionnaire).

Added 紅藍卡 (red and blue card) in parentheses to the current translation of
“Medicare.” See a detailed discussion in the recommendation section of the Section
3.1.

Restructured the postage-paid sentence and the instruction to contact MORPACE.
Added 研究公司 (research company) to clarify the role of MORPACE.

Replaced 科研 with 研究 to mean “study.”

Findings

During Round 1 testing, several respondents misunderstood the “postage-paid”
sentence, possibly because the syntax was too complex. Round 2 respondents were
presented with a new, restructured translation. They all demonstrated clear
understanding of the phrases as intended. When they later saw the original translation,
few had issues with it. This is likely because they had already developed
comprehension from reading the new translation with the simplified syntax.

All respondents who read the confidentiality statement understood it. They
commented that they are not concerned about data security unless the questions are
sensitive. To thoroughly test the efficacy of the confidentiality language to Chinesespeaking seniors, more time needs to be devoted to its testing. Recommend a separate
cognitive testing effort to concentrate on supporting materials.

The sentence that instructs respondents to contact MORPACE was restructured based
on Round 1 respondents’ feedback. Round 2 respondents demonstrated good
comprehension of the new sentence and commented that the language sounds natural.
During Round 1 testing, regional differences were observed for the translation for
“study” in this instruction. For example, respondents from Taiwan interpreted it as
hard science research. A new translation 研究 was tested in Round 2 and was
understood by all respondents as intended. Adding 研究公司 (research company) to
MORPACE also clarified its role.

Directions to complete the sample questions were tested with all respondents. While
the instruction of marking X were clearly understood in the first part of the sample
questions, most respondents were confused by the descriptions about how to handle
the routing instructions at Q34. For example, one respondent thought that if she saw
italicized text she needed to answer the next question. Several other respondents were
trying to make sense of it by bringing what they learned earlier about marking an X
for their answer. As explained by a respondent: “if you answer yes to a question, you
3-4

need to put an X there; if you answer no, you don’t need to do anything.” The
directions were in prose and seemed too abstract to those respondents.
Recommendations

Replace 調查 (investigation) with 問卷 (questionnaire).

Consider adding 紅藍卡 (red and blue card) in parentheses to the current translation
of “Medicare.” See a detailed discussion in the recommendation section of Section
3.1.

To aid comprehension and add naturalness, replace the postage-paid sentence and the
instruction to contact MORPACE with the restructured versions. The original
translation followed the English syntax too closely. Because respondents will not
know who MORPACE is and it is only in English, add the word 研究公司 (research
company) to increase their credibility. Naturalness of these sentences has been
confirmed with respondents.

To aid comprehension of Chinese speakers from Taiwan, replace 科研 with a
commonly understood term 研究 to mean “study.” Usage has been confirmed and
preferred by almost all respondents.

3.3

For the directions about routing instructions at Q34, see recommendations made in
Section 4, Questionnaire Layout and Visual Guide.

General Issues

3.3.1 Visual Layout
Many respondents did not seem familiar with the convention of a self-administered
survey. Some were only able to continue with interviewer intervention. For example, several
respondents did not know where to start or did not know that they were asked to mark their
answers in the squares. Some respondents were unable to follow the intended order for reading
the information or differentiate between the answer category labeling and question items,
although a few became “trained” after they familiarized themselves with the layout of the
questionnaire. Specifically, because the horizontal response categories appear before the items,
some respondents read the categories first and selected an answer without reading the items. This
issue is discussed further in Section 4, Questionnaire Layout and Visual Guide. Additionally, the
boldface type used to highlight emphasized wordings in the English version did not work well in
the Chinese version. Because the Chinese language does not use roman letters, it does not
usually bold text, and boldface type does not stand out as much (especially when printed). We

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added underline to the emphasized wordings, and several respondents commented on how words
stood out.

3.3.2 Skip Pattern Compliance
Only two respondents were able to follow the intended skip pattern correctly. The
branching instructions in this questionnaire appear before Q34 and in Q42, Q43, Q46, and Q62.
Among those who failed to comply with the skip pattern, the majority did notice the routing
instruction about answering Q34 if they had answered “no” to Q33 about having cancer.
However, most provided an answer to Q34 anyway, while a few decided to leave it blank. On the
other hand, few respondents noticed the arrow leading to the skip instructions (e.g., ÎGo to
Question 43) or knew what it meant. This issue is discussed further in Section 4, Questionnaire
Layout and Visual Guide.
3.4

Item-Specific Findings

In this section, we discuss survey items that were altered for Round 2, as well as items for
which we deemed more testing was needed based on findings from Round 1. The survey tested
in Round 2 is included in Appendix B. In addition, Appendix C includes a table documenting the
translations tested in Rounds 1 and 2, as well as our final recommendations for question
wording. If a recommendation is global and discussed for a question, it is not mentioned again in
subsequent questions.
Q2.* The following items are about activities you might do during a typical day. Does your
health now limit you in these activities? If so, how much? a. Moderate activities, such
as moving a table, pushing a vacuum cleaner, bowling, or playing golf; b. Climbing
several flights of stair [Yes, limited a lot; Yes, limited a little; No, no limited at all]
* Question 2 is part of the VR-12

Changes Made to Question 2 for Round 2

Replaced 日常生活的一天之中可能進行的活動 with 日常生活中可能進行的活動
to mean “activities you might do during a typical day.”

Replaced 搬桌子 with 移動桌子 to mean “moving a table.”

Replaced 使用吸塵機清潔地面 with 推吸塵機 to mean “pushing a vacuum cleaner.”

Replaced 上幾層樓梯 with 上好幾層樓梯 to mean “climb several flights of stairs.”

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Underlined the boldface text.

Findings for Question 2

During Round 1 testing, the translation of “the following items are about activities
you might do during a typical day” was problematic to some respondents, and we
noted that it followed the English syntax too closely. An alternate translation was
tested in Round 2 and worked well. Respondents interpreted it to mean “things you
would usually do during a day,” “daily activities,” or “routine activities during a
normal day.”

We found from Round 1 that the perception of “moving a table” or “pushing a
vacuum cleaner” was affected by the translation. The original translation for “moving
a table” could be interpreted to mean to lift a table, and the latter literally says using a
vacuum cleaner to clean the floor. A number of respondents commented that those
two activities were not “moderate” to them. New translations were used in Round 2
for these two examples. Respondents demonstrated little confusion, and several
commented that they considered these two activities “moderate.”

We learned from Round 1 testing that some of the “moderate activities” examples
may not be culturally appropriate. Similar comments were made by Round 2
respondents. Most of the seniors we interviewed do not bowl or play golf. A number
of respondents commented that those two activities demand a high level of strength
and energy or they are played more frequently by non-Asians and wealthier people. In
Round 2, we probed on culturally appropriate examples suggested by Round 1
respondents, such as playing badminton or ping pong, practicing Tai Chi, and
walking for exercise. All respondents seemed familiar with these activities and
provided positive feedback.

Most respondents understood the concept of “moderate activities.” However, we
found that “moderate” is subjective and different people rated “moderate” differently:
some considered playing badminton or ping pong too rigorous, while others agreed
that they are good examples of “moderate activities.” Some commented that Tai Chi
or walking is more moderate than playing badminton or ping pong. This feedback
highlighted the importance of the examples provided because they will provide an
anchor to the respondents on what the questionnaire designer intends to define as
“moderate.”

Respondents were probed on the term “climb several flights of stairs.” In Round 1,
two respondents commented that the translation 上幾層樓梯 sounded like a question,
asking how many stairs (s)he climbs. Thus, we offered a new translation 上好幾層樓
梯 in Round 2 and asked respondents to compare it with the original one.
Respondents demonstrated little difficulty understanding both translations but felt that
the new translation implied more than two flights of stairs and could be as much as
ten flights. The original translation 幾層樓梯 meant two or three flights of stairs to
them.
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In Round 1, two respondents found the concept of “limited” too complicated and
could not make sense of it. To gather more evidence, we continued testing it in Round
2. Most respondents demonstrated little difficulty understanding the concept or
providing answers to Q2. They were also able to point out the difference between
“limited a lot” and “limited a little.” As explained by one respondent: ‘“limited a lot’
means very difficult or basically not able to perform a task while ‘limited a little’
means still able to do it but feels a little difficult.” They understood it well and
provided relevant example of activities.

One respondent commented on 是 (Yes) in “是，有很大的限制” (Yes, limited a lot).
It was felt the leading “yes” was awkward and unnecessary in Chinese. She suggested
deleting it, saying the remaining phrase is sufficient in conveying the meaning of
“limited a lot.”

As discussed in Section 4, underlining emphasized words seemed to work well in
Round 2 in giving respondents the same visual guidance and stimulus intended by
boldface type.

Recommendations for Question 2

To add naturalness, we recommend replacing 日常生活的一天之中可能進行的活動
with 日常生活中可能進行的活動 to mean “activities you might do during a typical
day.” Usage has been confirmed and preferred by all respondents.

The original translation of “moving a table” and “pushing a vacuum cleaner” seemed
to be more complex than intended. To better convey the intent of these two examples,
we recommend replacing 搬桌子 with 移動桌子 and replace 使用吸塵機 with 推吸
塵機. No Round 2 respondents exhibited similar difficulties found in Round 1.

Respondents had different interpretation of what constitutes “moderate” activities.
The current examples could anchor understanding; however, some may not be
culturally appropriate (i.e., most Asian seniors do not participate in these activities).
We recommend that the question designer confirm the definition and range of
“moderate” activities and consider using alternative examples as appropriate: playing
badminton or ping pong, practicing Tai Chi, and walking for exercise.

We recommend confirming the definition and intent of “climb several flights of
stairs.” If it means three to ten flights of stairs, we recommend using 上好幾層樓梯.

We agreed with our respondent’s comment that the word 是 in 是，有很大的限制
(the “Yes” in “Yes, limited a lot”) sounds unnatural in Chinese. Responses in Chinese
are usually in a complete sentence that includes a positive or negative response and
without the need to say “yes” first. Although we did not test it with other respondents
in Round 2, based on internal discussions among Chinese-language experts on the

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team, we recommend deleting 是 from 是，有很大的限制 and applying the change
throughout the questionnaire if applicable.

Underline the boldface text.

Changes Made to Question 3 for Round 2

Replaced 實際做完的比想做的要少 with 實際做完的事的比想做的要少，也就是
力不從心 to mean “accomplished less than you would like”; added a commonly
known Chinese proverb 力不從心 (cannot complete what the heart desires) to the
original translation.

Replaced 工作 with 做事 to mean “work.” Another alternate translation 做事情 was
also tested.

Replaced 偶爾 with 很少時間 to mean “a little of the time.”

Underlined the boldface text.

Findings for Question 3

When probed on the new translation of “accomplished less than you would like,” all
respondents understood it as intended: getting less work done than you want to. The
newly added Chinese proverb 力不從心 (cannot accomplish what the heart desires)
received positive feedback from most respondents who said that the proverb further
facilitates the understanding.

The question text and the second item both referred to 工作, and several Round 1
respondents questioned whether it implied a “job.” New translation 做事 was used in
Round 2 and found to be effective in including meanings of a job and work in
general. As most respondents explained, 做事 could mean working for pay at a
workplace, doing household chores, or performing other tasks. We also probed on an

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alternate translation 做事情, but it sounded like performing a specific task to several
respondents.

During the Round 1 testing, two respondents commented on the response categories.
They felt that there is little difference between “some of the time” and “a little of the
time” in the translation. This echoes a comment given by a 2008 HOS respondent,
according to the comments file provided to us. In Round 2, we presented a new
translation for “a little of the time” 很少時間 and implemented further testing. In
general, it worked better but was not liked by all. One respondent suggested another
translation 極少時間 for “a little of the time.”

Recommendations for Question 3

To add naturalness and correct its grammar, we recommend replacing 實際做完的的
比想做的要少 with 實際做完的事比想做的要少，也就是力不從心. We also
added a commonly known Chinese proverb 力不從心 (cannot accomplish what the
heart desires). All respondents liked the proverb and felt that it helped better
communicate the intent of this item.

We replaced 工作 with 做事 so that it does not only imply a job. Usage has been
confirmed by respondents. We recommend applying new translation throughout the
questionnaire if applicable.

To address the comments provided by cognitive interview respondents and 2008 HOS
survey respondents, We recommend using new translation 極少時間 for “a little of
the time” (i.e., replace 偶爾 with 極少時間). Although we were unable to test it with
other Round 2 respondents, based on discussions among Chinese-language experts on
the team, we felt that this translation better communicates the measurement distance
to “some of the time.” We recommend applying new translation throughout the
questionnaire if applicable.

We recommend underlining the boldface text.

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Q4.* During the past 4 weeks, have you had any of the following problems with your work or
other regular daily activities as a result of any emotional problems (such as feeling
depressed or anxious)? [a. Accomplished less than you would like; b. Didn’t do work or
other activities as carefully as usual]
* Question 4 is part of the VR-12

Changes Made to Question 4 for Round 2

Replaced 情緒方面的原因 with 心理方面的原因 to mean “emotional problems.”

Underlined the boldface text.

Finding for Question 4

In Round 2, we further tested the translation for “emotional problems” by presenting
five different translations (including the original term): 心理方面, 情緒方面, 心情方
面, 精神方面, and 情感方面. Respondents were probed on each and asked to do a
comparison. The original translation 情緒方面 was understood as intended by more
respondents. Respondents interpreted it using words such as “unhappy,” “depressed,”
“sad,” “worried,” “anxious,” and “bad mood.” The other four terms generated varied
interpretations. For example, several respondents misinterpreted 心理方面 to be
another Chinese term 心裏 (in the heart/mind); 精神方面 was referred to as soul,
spirit, or mental illness; 情感方面 was thought to be related to love or hate. Although
different respondents preferred different terms among these five, their understanding
of 情緒方面 seemed closest to what is intended.

Recommendation for Question 4

No recommendations except to underline the boldface text. Continue to use 情緒方面
to mean “emotional problems.” Usage has been confirmed with most respondents.

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Changes Made to Question 5 for Round 2

Replaced 工作 with 做事 to mean “work.”

Underlined the boldface text.

Finding for Question 5

No problem noted. See discussions on “work” in Q3.

Recommendations for Question 5

We recommend replacing 工作 with 做事 to mean “work.”

We recommend underlining the boldface text.

Changes Made to Question 6 for Round 2

Restructured translation of the introductory statement “these questions are about how
you feel and how things have been with you during the past 4 weeks” to add
naturalness.

Replaced 心情不好，悶悶不樂 with 心情不好，不開心 (feels in a bad mood or
unhappy).

Underlined the boldface text.

Findings for Question 6

Respondents had no problem understanding the restructured introductory statement.
The revised translation for “how you feel” and “how things have been with you”
sounded more natural to them.

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For the term “downhearted and blue,” several Round 1 respondents commented that
part of the translation (悶悶不樂) referred to sadness through a long period of time. If
either “downhearted” or “blue” was meant to describe more temporary feelings of
unhappiness, they preferred 不開心. We revisited this issue in Round 2 and
specifically probed on three translations of “downhearted and blue”: 心情不好，不
開心, 悶悶不樂. Similar explanations were received from several respondents who
interpreted 悶悶不樂 to mean long-lasting sadness. Overall, all respondents had no
problem describing this state of mind using relevant words such as “bad mood,”
“unhappy,” or “sadness.”

Recommendations for Question 6

We recommend using the new, restructured introductory statement. Replace the
sentence with 下列問題是有關過去四個星期內您的感覺和近況. The original
translation for “how you feel” literally means “self-feeling,” which can be interpreted
as self-awareness. For “how things have been with you,” the original translation said
“other circumstances.” Usage of the new translation was confirmed and preferred by
most respondents.

We recommend confirming the definition and intent for “downhearted and blue.” If
either “downhearted” or “blue” is meant to describe sadness through a long period of
time, We recommend using 心情不好, 悶悶不樂. If both terms refer to more
temporary feeling of unhappiness, use 心情不好, 不開心.

Q8.

We recommend underlining the boldface text.

Compared to one year ago, how would you rate your physical health in general now?
[Much better, Slightly better, About the same, Slightly worse, Much worse]

Changes Made to Question 8 for Round 2

No changes were made to this item except underlining the boldface text.

Finding for Question 8

No problem noted.

Recommendations for Question 8

No recommendations except to underline the boldface text.

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Q9.

Changes Made to Question 9 for Round 2

Replaced 情緒方面的原因 with 心理方面的原因 to mean “emotional problems.”

Underlined the boldface text.

Finding for Question 9

Although Q9 also asked about emotional problems, the translation for “emotional
problems” is different from that in Q4. In Round 2, we used consistent translation and
implemented further testing. See findings in Q4.

Recommendations for Question 9

We recommend underlining the boldface text.

In Q4, we discussed the translation for “emotional” and recommended using the
original term 情緒. Usage has been confirmed with most respondents. As best
practices for translation dictate, the questionnaire should be edited to use consistent
terminology. The final recommendation 情緒 should be used consistently in Q4 and
Q9.

Q10. Because of a health or physical problem, do you have any difficulty doing the following
activities without special equipment or help from another person? a. Bathing; b.
Dressing; c. Eating; d. Getting in or out of chairs; e. Walking; f. Using the toilet [No, I do
not have difficulty; Yes, I have difficulty; I am unable to do this activity]
Changes Made to Question 10 for Round 2

Replaced 上下椅子 with 坐到椅子上或站起來 to mean “getting in and out of
chairs.”

Underlined the boldface text.

Finding for Question 10

When probed on the translation 上下椅子 for “getting in or out of chairs,” several
Round 1 respondents did not understand it as intended. Some did not know what it
meant, while others thought it referred to climbing onto a tall chair to reach
somewhere. In Round 2, we tested a new translation 坐到椅子上或站起來 and also
had respondents compare it with the original version. All respondents understood and
clearly preferred the new version. The original translation 上下椅子 was still

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confusing to respondents. They commented that 上下椅子 sounded awkward and
unclear in the Chinese language.
Recommendations for Question 10

The original translation 上下椅子 is too concise and not descriptive enough for the
action of getting in and out of chairs. We recommend using 坐到椅子上或站起來.
Usage has been confirmed and preferred by all respondents. The recommended
translation is a longer phrase. With careful editing, the phrase can still fit in available
space in the questionnaire without causing changes in visual layout.

We recommend underlining the boldface text.

Q13. During the past 30 days, for about how many days did poor physical or mental health
keep you from doing your usual activities, such as self-care, work, or recreation? (Please
enter a number between “0” and “30” days. If no days, please enter “0” days.)
Changes Made to Question 13 for Round 2

Underlined the boldface text including “poor” that is bolded in English version.

Finding for Question 13

No problems noted.

Recommendations for Question 13

No recommendations except to underline all boldface text including the translation of
“poor.” The English version also bolded “poor,” but that boldface type was not found
in the Chinese version.

Q15. During the past 4 weeks, how often have you felt short of breath under the following
conditions? a. When lying down flat; b. When sitting or resting; c. When walking less than
one block; d. When climbing one flight of stairs [All of the time, Most of the time, Some
of the time, A little of the time, None of the time]
Changes Made to Question 15 for Round 2

Replaced 走了不到一條街道的時候 with 走了不到一個街區 (block) 的時候 to
mean “walking less than one block.”

Underlined the boldface text.

Finding for Question 15

The original translation 走了不到一條街道的時候 literally means “walking less than
one street,” and most Round 1 respondents interpreted it to mean “walking until you
reach the end of the street.” Although the concept of blocks is foreign in most

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Chinese-speaking regions, we found that our respondents understood it. Even
monolingual respondents knew the word “block” in English when they heard it. In
Round 2, we offered alternate translations, such as 街區 and 街口, all of which share
the word “street” in it. We also added “block” in English in the parentheses following
each translation. 街口 (block) was found to be the most appropriate translation. Most
respondents understood the concept and the English word “block.” They liked 街口
because it sounded natural and clear. As several respondents explained, it meant
“walking until you reach the next street corner.”
Recommendations for Question 15

Block is a difficult concept to translate because it does not exist in the Chinese
language. We recommend using 還沒走到下一個街口 (block) 的時候 to mean
“walking less than one block.” We found that most respondents, including
monolinguals, have a basic understanding of the concept and even the English word.
Thus, adding “block” in English in the parentheses can facilitate understanding.
Usage has been confirmed and preferred by most respondents.

We recommend underlining the boldface text.

Q16. During the past 4 weeks, how much of the time have you had any of the following
problems with your legs and feet? a. Numbness or loss of feeling in your feet; b. Tingling
or burning sensation in your feet especially at night; c. Decreased ability to feel hot or cold
with your feet; d. Sores or wounds on your feet that did not heal. [All of the time, Most of
the time, Some of the time, A little of the time, None of the time]
Changes Made to Question 16a–d for Round 2

Replaced 腳麻木或失去感覺 with 腳發麻或沒感覺 to mean “numbness or loss of
feeling in your feet.”

Replaced 刺疼 with 刺痛 to mean “tingling or burning.”

Edited the translation of items a, b, c, and d to reflect the reference to feet.

Underlined the boldface text.

Findings for Question 16a–d

For “numbness or loss of feeling in your feet,” most respondents understood both
translations, but several commented that there is a difference between them: the
original translation 腳麻木或失去感覺 sounds very serious and could be permanent,
as illustrated by this comment: “it is a medical condition, like a nerve problem.” The
alternate one 腳發麻或沒感覺 sounds temporary, as a respondent explained, “when
you don’t move your feet for a while and it is numb. Once you move you can regain
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the feeling.” The part that says “loss of feeling” was particularly problematic to some
respondents, who felt that the translation 沒感覺 by itself lacked context.

No other problems noted.

Recommendations for Question 16a–d

We agreed with our respondents after further examining the translations of
“numbness or loss of feeling in your feet.” We recommend that the question designer
confirm the definition and intent of this phrase. If it implies permanency, recommend
using 腳麻木或失去感覺. If not, we recommend using the original translation, but
add the context of “in your feet” next to the part of the translation for loss of feeling:
腳發麻或腳沒感覺.

We replaced 刺疼 with 刺痛 to mean “tingling or burning.”

We noted that the English version had reference to feet (e.g., “in/on/with your feet) in
items a, b, c, and d, but it was not included in the translation. For consistency, we
recommend editing the translation to reflect the reference to feet.

We recommend underlining the boldface text.

Q17. During the past 4 weeks, how would you describe any arthritis pain you usually had?
[None, Very Mild, Mild, Moderate, Severe]
Changes Made to Question 17 for Round 2

No changes were made to this item except underlining the boldface text including
“past 4 weeks.”

Recommendation for Question 17

No recommendations except to underline all boldface text. We noted that the English
version bolded “past 4 weeks,” but the Chinese translation did not show boldface type
at all. We recommend bolding and underlining this translation to keep the same
stimulus across language versions.

Q19. Can you hear most of the things people say (with a hearing aid if that’s how you hear
best)? [Yes, No]
Change Made to Question 19 for Round Changes Made to Question 19 for Round 2

Moved “with a hearing aid if that’s how you hear best” to the end of the sentence (it
was in the middle of the sentence in the translation) and revised its translation so it
did not start with a verb: 您能不能聽清楚周圍人講話時大部份的內容？（如果您
用助聽器，請包括戴助聽器後的聽覺。）.

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Findings for Question 19

In Round 1, four respondents misunderstood the question. They thought Q19 only
applied to people who used hearing aids and people without hearing aids did not need
to answer this question. We noted that the original translation of “with a hearing aid if
that’s how you hear best” was placed in parentheses in the middle of the sentence and
started with a verb “include,” which might have given some respondents the
impression that they needed to have a hearing aid. For Round 2 testing, we moved it
to the end of the sentence in parentheses and it did not start with a verb. Most
respondents had no problem understanding the question. The restructured question
seemed more effective because respondents proceeded to answer the question
regardless of whether they have a hearing aid. When asked to compare the new
translation with the original one, four respondents preferred the new translation,
citing its clearer and more natural language. Three actually preferred the original
because the parenthesis is placed in the middle of the sentence (note that this had
caused major misunderstanding among four Round 1 respondents). They did not take
issue with the original translation possibly because they had read the new one first
and established comprehension.

In addition, several respondents commented that 您的視力能不能讓您 (literally
means “can your sight enable you to”) in Q18 sounded awkward and unnatural. They
also pointed out that the translation for “print,” 油印字 in Q18, is not needed because
it refers to dot matrix print that is no longer in use. Using 字 (word) is sufficient to
mean “print.”

Recommendations for Question 19

We moved the parenthesis to the end of the sentence to avoid confusion; further
refine the translation of “with a hearing aid if that’s how you hear best” by adding a
conjunction 也 to imply “if necessary”; use new translation 您能不能聽清周圍人講
話時大部份的內容（也包括戴助聽器後的聽覺）？

We noted that the English version bolded “most,” but the Chinese translation did not
show boldface type at all. We recommend bolding and underlining this translation to
keep the same stimulus across language versions.

The previous question (Q18) follows the same sentence structure where the text in
parentheses is placed in the middle of the sentence. To be consistent with Q19, Q18
should be revised to 您能不能看清報纸上的字(也包括戴眼鏡後的視力)? We
recommend replacing 油印字 with 字 to mean “print.”

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Q20–33: Has a doctor ever told you that you had: [20. Hypertension or high blood pressure,
21.Angina pectoris or coronary artery disease, 22. Congestive heart failure, 23. A
myocardial infarction or heart attack, 24. Other heart conditions, such as problems with
heart valves or the rhythm of your heartbeat, 25. A stroke, 26. Emphysema, or asthma, or
COPD (chronic obstructive pulmonary disease), 27. Crohn’s disease, ulcerative colitis, or
inflammatory bowel disease, 28. Arthritis of the hip or knee, 29. Arthritis of the hand or
wrist, 30. Osteoporosis, sometimes called thin or brittle bones, 31. Sciatica (pain or
numbness that travels down your leg to below your knee), 32. Diabetes, high blood sugar,
or sugar in the urine, 33. Any cancer (other than skin cancer) ]
Change Made to Questions 20–33 for Round 2

Revised the translation that erroneously refers to question numbers in quantity rather
than as an ordinal number. Since this is a global issue, we applied the revision
throughout the questionnaire.

Findings for Questions 20–33

During Round 1 testing, we learned that the word for “hip” in Q28 for “arthritis of the
hip” was rarely seen or used. We implemented further testing in Round 2. Although
several respondents never heard of the condition and thus did not know the word, two
respondents recognized it. When interviewers explained what the survey meant by
“arthritis of the hip,” no respondents could offer alternative translations.

As for skip pattern compliance, Round 2 respondents exhibited similar difficulties as
found in Round 1. Only two respondents followed the branching instruction between
Q33 and Q34 appropriately. For those respondents who noticed the instruction, they
seemed to understand the words and the sentences, but they could not apply the
instructions to what they were doing. Section 4 discusses in detail the issues regarding
how the branching instructions are presented.

Recommendations for Questions 20–33

The translation that referred to Q33 sounded as if it was “33 questions” rather than
question 33. We recommend revising the translation to say “question 33.” We
recommend applying the revision throughout the questionnaire.

As discussed in Chapter 4, to improve skip pattern compliance, we recommend the
detection method for further testing.

Restructured translation of the question for naturalness. Replaced 在過去的四個星期
內，您有多少時間由於後腰的疼痛妨礙了您的日常活動(如工作、上學、或娛

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樂)? with 過去的四個星期內，您可能由於後腰的疼痛妨礙了您的日常活動 (如
做事、上學、或娛樂)。您有多少時間是這樣?

Underlined the boldface text.

Findings for Question 35

In Round 2, we offered an alternate translation and had respondents compare it with
the original version. Most respondents seemed to prefer the original version but felt
that it could be improved, such as the translation of “work” and its naturalness.

We also noted that the translation of “housework” is an error, and it literally means
entertainment.

Recommendations for Question 35

To add more naturalness and clarification to the question, we recommend revising the
translation to 在過去的四個星期內，您有多少時間因爲後腰疼痛的關係而妨礙了
您的日常活動(如做事、上學、或家務)? Although we were unable to test the newly
added conjunction with all Round 2 respondents, those who read it provided positive
feedback and commented that it made the sentence easier to understand.

We recommend correcting the translation error for “housework” and replacing 娛樂
with 家務 to mean “housework.”

We recommend underlining the boldface text.

Q36. In the past year, have you had 2 weeks or more during which you felt sad, blue or
depressed; or when you lost interest or pleasure in things that you usually cared about or
enjoyed? [Yes, No]
Q37. In the past year, have you felt depressed or sad much of the time? [Yes, No]
Q38. Have you ever had 2 years or more in your life when you felt depressed or sad most days,
even if you felt okay sometimes? [Yes, No]
Q39. How much of the time in the past week did you feel depressed? [Less than one day, One
or two days, Three or four days, More than four days]
Changes Made to Questions 36–39 for Round 2

To be consistent with the use of the traditional character set throughout the
questionnaire, we corrected Q39 that used the simplified character set.

Underlined the boldface text.

3-20

Finding for Questions 36–39

During Round 1 testing, three respondents did not notice the change in time period in
Q36–Q39 or found the changing time periods confusing. With the newly added
underlines, Round 2 respondents who read these questions seemed to notice the
transition in time periods more.

Recommendations for Questions 36–39

To be consistent with the rest of the questionnaire, we recommend using the
traditional character set in Q39.

We recommend underlining the boldface text.

Q40. In general, compared to other people your age, would you say that your health is:
[Excellent, Very good, Good, Fair, Poor]
Changes Made to Question 40 for Round 2

No changes were made to this item.

Finding for Question 40

No problems noted.

Recommendation for Question 40

No recommendations.

Q42. Many people experience problems with urinary incontinence, the leakage of urine. In the
past 6 months, have you accidentally leaked urine? [Yes, No]
Changes Made to Question 42 for Round 2

Revised the translation and added 小便滲漏 to mean “leakage of urine.”

Underlined the boldface text.

Findings for Question 42

During Round 1 testing, we noted that “leakage of urine” and “leaked urine” do not
appear in the Chinese translation. The English version had both urinary incontinence
and leakage of urine, but the Chinese version only said urinary incontinence. We
added the translation for leakage of urine and tested it with Round 2 respondents.
Almost all respondents interpreted it as intended. They described the situation as
“someone loses control of urination, and the urine leaks accidentally even if (s)he
doesn’t want it to.” Several respondents commented that the translation was easy to
understand and did not sound too undesirable.

As discussed in Section 3.3, the skip instructions remained challenging for most
respondents. Only two respondents followed them at Q42 appropriately. The other
3-21

respondents either did not notice the skip instructions or did not know what they are
for. They proceeded to read Q43 after they answered No to Q42.
Recommendations for Question 42

We recommend adding the translation of “leakage of urine” 小便滲漏 to the question.
Usage has been confirmed with respondents.

We recommend underlining the boldface text.

Q43. How much of a problem, if any, was the urine leakage for you? [A big problem, A small
problem, Not a problem]
Changes Made to Question 43 for Round 2

No changes were made to this item.

Finding for Question 43

See findings under Q42. Most respondents proceeded to read Q43 after they answered
No to Q42.

Recommendation for Question 43

As discussed in Chapter 4, we recommend the detection method to increase skip
pattern compliance.

No changes were made to this item.

Finding for Question 45

One respondent who reported urinary incontinence in Q42 seemed familiar with
“bladder training.” As explained by her: “it’s a muscle training used to manage
urinary incontinence. My doctor provided me with some information. It’s about
training the muscles under the lower stomach.” To test the translation of “bladder
training,” we asked all respondents to comment on the translation. Several
respondents were also able to discern the meaning by looking at the words although
they never heard of the term. One respondent who practiced yoga pointed out that this
type of resistance training also existed in yoga.

Recommendation for Question 45

No recommendations. We recommend keeping the translation as is.

3-22

46. In the past 12 months, did you talk with a doctor or other health provider about your
level of exercise or physical activity? For example, a doctor or other health provider may
ask if you exercise regularly or take part in physical exercise. [Yes, No, I had no visits in
the past 12 months]
Change Made to Question 46 for Round 2

Restructured the translation to make it less verbose. Moved the examples to a separate
line.
Replaced
在過去的十二個月內，您有沒有與您的醫生及其他醫療保健人員談起過您的運
動量或體育鍛練的情況？例如：您的醫生及其他醫療保健人員可能問過您是否
經常鍛練身體或參加任何體育活動。
with
在過去的十二個月內，您有沒有與您的醫生及其他醫療保健人員談起過您的運
動量或身體鍛練的情況？
例如：他們可能問過您是否經常鍛練身體或參加任何體育活動。

Findings for Question 46

Respondents found the question easy to read and had no problem providing an
answer. Those who answered “yes” to the questions explained what specifically they
talked to the doctor about. As illustrated by one respondent: “When my doctor asked
me if I exercise, I reported that I walk, play basketball or do other exercises from time
to time.”

During Round 1 testing, one respondent commented that the current translation for
“physical activity” sounded like professional sports such as a marathon. We offered
an alternate translation 身體鍛練 and tested it in Round 2. Respondents understood
the term as intended. Several commented that the alternate translation covered a great
variety of activities and provided examples such as walking, Tai Chi, etc.

Recommendations for Question 46

We recommend using the restructured question including the alternative translation
for “physical activity” and move the examples to a separate line. This way, the
translation appears less verbose, and it was preferred by more Round 2 respondents.

We recommend underlining the boldface text.

3-23

Restructured the translation to make it less verbose. Moved the examples to a separate
line.
Replaced
在過去的十二個月內，您的醫生及其他醫療保健人員有沒有建議您去鍛練身體
或參加體育活動，增加身體鍛練或體育活動的量，或維持原有的活動量？例
如：為了提高您的身體健康，您的醫生及其他醫療保健人員可能建議您走樓梯
鍛練，每天走路從十分鐘增加到二十分鐘，或維持目前的鍛練計劃。
with
在過去的十二個月內，醫生及其他保健人員有沒有建議您開始鍛練身體或參加
體育活動，或者建議您增加或維持原有的活動量？
例如：為了提高您的身體健康，他們可能建議您走樓梯鍛練，每天走路從十分
鐘增加到二十分鐘，或維持目前的鍛練計劃。

Finding for Question 47

In Round 1, several respondents commented that the question is too long and
repetitive. We noted that although the English version was concise (start, increase or
maintain your level of exercise or physical activity), the Chinese translation was
verbose. This led to comprehension issues, and several respondents thought Q47 was
very similar to Q46. In Round 2, respondents exhibited little difficulties with the
restructured question or with providing an answer. Several respondents commented
on the difference between Q46 and Q47, saying that Q46 was about their
conversation with the doctor on exercise, while Q47 was about the doctor’s advice for
them. Several respondents answered “yes” to one question and “no” to the other one,
which was also an indication of their understanding of the difference between Q46
and Q47.

Recommendations for Question 47

We recommend using the restructured question including moving the examples to a
separate line to create a visual divide. Usage has been confirmed with respondents.

We recommend underlining the boldface text.
3-24

Replaced 難保持平衡 with 容易失去平衡 to mean “problems with balance.”

Underlined the boldface text.

Finding for Question 48

The original translation for “problems with balance” 難保持平衡 literally means
“hard to maintain balance.” Several Round 1 respondents offered an alternate
translation 容易失去平衡 (easy to lose balance). In Round 2, it was preferred by
most respondents. They were able to explain the problem as intended and paraphrase
it in their own words: “feeling unbalanced while walking” or “easy to fall.”

Recommendations for Question 48

We recommend replacing 難保持平衡 with 容易失去平衡 to mean “problems with
balance.” Usage has been confirmed and preferred by most respondents.

Underline the boldface text.

Q50. In the past 12 months, have you had a problem with balance or walking? [Yes, No]
Changes Made to Question 50 for Round 2

Replaced 保持平衡有過困難 with 容易失去平衡 to mean “have a problem with
balance.”

Underlined the boldface text.

Finding for Question 50

The term “balance” was discussed in Q48.

Recommendations for Question 50

For consistency with Q48, we recommend replace 保持平衡有過困難 with 容易失
去平衡 to mean “have a problem with balance.”

We recommend underlining the boldface text.

3-25

No changes were made to this item except underlining the boldface text.

Finding for Question 52

No problems noted.

Recommendation for Question 52

No recommendations except to underline the boldface text.

Q53. How much do you weigh in pounds (lbs.)?
Changes Made to Question 53 for Round 2

No changes were made to this item.

Finding for Question 53

No problems noted.

Recommendation for Question 53

No recommendations.

Q54. How tall are you without shoes on in feet (ft.) and inches (in.)? (If 1/2 in., please round
up.)
Changes Made to Question 54 for Round 2

Revised the presentation of the height categories to correctly reflect that inches are
not decimals.

Finding for Question 54

Only one respondent who is a new immigrant (entered U.S. in 2006) reported her
height using the metric system. All other respondents appeared comfortable using feet
and inches for height.

Recommendation for Question 54

We recommend using revised presentation of the height categories to reflect that
inches are not decimals. There was an editing error in the original translation where
the categories used decimal points to mean inches, such as 5.04 ft. If it meant 5 ft. 4
in., these two measurements are not equivalent. New immigrants may be more
familiar with the metric system. However, the intended HOS audience is Medicare

3-26

recipients, who are expected to have lived or worked in the U.S. for an extended
period of time and thus use the U.S. standard for height and weight.
Q59. What is your current marital status? [Married, Divorced, Separated, Widowed, Never
married]
Changes Made to Question 59 for Round 2

No changes were made to this item.

Finding for Question 59

No problems noted.

Recommendation for Question 59

No recommendations.

Q60. What is the highest grade or level of school that you have completed? [8th grade or less,
Some high school, but did not graduate, High school graduate or GED, Some college or 2
year degree, 4 year college graduate, More than a 4 year college degree]
Changes Made to Question 60 for Round 2

No changes were made to this item, but each respondent was presented with two sets
of response categories.

Finding for Question 60

We noted before the field period that the current translation is not equivalent to the
English version. First, the translation presented the education categories as
educational attainment, not highest level of schooling received as intended in the
English. For example, while the second category in the English version says “Some
high school, but did not graduate,” the translation says “graduated from middle
school,” and so forth. An additional issue is different educational systems outside of
the U.S. The English version of the first category says “8th grade or less,” but there is
no 8th grade in Chinese schools. Perhaps that was why the translation said
“elementary school” only.
During the interviews, we gave respondents an additional set of categories that
reflected the highest level of schooling received as intended in the English. We kept
“graduated from elementary school” because there is no 8th grade in Chinese schools,
and we expect most of the senior survey participants completed their elementary
education outside of the U.S.
Using the current categories, respondents had no trouble picking out the answer.
When the new set of categories (using the corrected translation) was presented,
several respondents changed their answers to a higher level of schooling. This may
not be surprising because the new set of categories offers choices for the highest level
of schooling received.

3-27

When the respondents compared the two sets of categories, more respondents
preferred the new categories because they are more precise.
Recommendation for Question 60

If HOS has been collecting data using the current categories and the data capture
system is set up this way, we recommend leaving them as is (and survey results
should acknowledge that they are not equivalent). Our Round 2 findings showed that
the categories affect respondent reporting, and the new set of categories render data
closer to the intended answer categories. But collecting new HOS data using the
corrected translation may result in a mismatch between previous data collected,
unless categories are further collapsed during data analysis.

Revised the translation to accurately reflect the English version; adapted the
translation of a similar question used in the Chinese translation of the decennial
Census form (Pan et al., 2008).
Replaced
1. 擁有，自己購買的
2. 擁有，家裏其他人買的
3. 租用的
4. 不擁有，但也不需付房租
5. 其他
with
1. 屬於您，您自己購買的
2. 屬於您家人，您家裏的其他人買的
3. 租用的，需要付房租
4. 不屬於您或您家人，但可以免租金住
5. 上述情況都不適用，屬於其他情況

3-28

Finding for Question 61

The new translation seemed to work well among all respondents. The type of
difficulties and confusion observed in Round 1 did not surface among Round 2
respondents. One respondent suggested revising 但可以免租金住 to 不需要付房租
to mean “you live without payment of rent” in the fourth category.

Recommendation for Question 61

We recommend using the revised translation to accurately reflect the English version
except that we can further refine the translation of “you live without payment of
rent.” The Chinese-language experts on the team agreed with the translation
suggestion by the Round 2 respondent. Although we were unable to test it with all
Round 2 respondents, recommend using 不需要付房租 to mean “you live without
payment of rent” in the fourth category. The syntax is similar to that of the third
category and is expected to work well.

Replaced English word “investigation” with “survey/questionnaire”; revised Chinese
translation of the first two response categories to reflect the change and also improved
the translation.

Finding for Question 62

We probed on the first response category 參加問卷研究的人自己 (person and self to
whom survey/questionnaire was addressed). All respondents showed clear
understanding of this phrase, saying that it meant “myself” or “the person who got the
questionnaire.”

Recommendations for Question 62

We recommend using revised translations for the response categories.

Q63. What is the name of the person who completed this survey form? Please print clearly.
[First Name, Last Name]
Changes Made to Question 63 for Round 2

Replaced 正體字 with 正楷 to mean “please print clearly.”

Underlined the boldface text.

3-29

Finding for Question 63

No problems noted.

Recommendations for Question 63

The original translation of “please print clearly” 正體字 could also mean using
traditional Chinese characters. The Chinese translation of the decennial Census form
used 正楷 (Pan et al., 2008), and we recommend adopting it.

We recommend underlining the boldface text.

Q64. Which of the following categories best represents the combined income for all family
members in your household for the past 12 months? [Less than $5,000, $5,000–$9,999,
$10,000–$19,999, $20,000–$29,999, $30,000–$39,999, $40,000–$49,999, $50,000–
$79,999, $80,000–$99,999, $100,000 or more, Don’t know]
Changes Made to Question 64 for Round 2

Replaced 您家庭 (所有成員) 去年的年收入 with 您住戶裏所有家庭成員的總收入
to mean “combined income for all family members in your household.”

Revised the format of most response categories. For example, revised “$5,000$9,999” to “From $5,000 to $9,999.”

Underlined the boldface text.

Findings for Question 64

During Round 1 testing, we confirmed findings from prior literature that household
was a difficult concept to convey in Chinese because a Chinese family is usually
recognized by bloodline. The Chinese translation of the decennial Census form used
住戶成員 to mean household members (Pan et al., 2008). We adopted this translation
in Round 2 and restructured the syntax. The changes seemed to work very well. All
respondents showed accurate comprehension of the question and were able to
distinguish family members in and outside of the household. However, the concept of
“in the past 12 months” was not very clear to some respondents because they assumed
that it meant yearly. Several respondents suggested deleting the word 內 from the
translation for “in the past 12 months” to better convey that the 12 months should
count back from the current month.

Most respondents felt that the original format with a dash between dollar amounts
would be adequate.

Recommendations for Question 64

We recommend using the new translation to mean “combined income for all family
members in your household.” Usage has been confirmed with all respondents.
3-30

To avoid confusion, We recommend deleting the word 內 from the translation for “in
the past 12 months.”

Although most Round 2 respondents felt that the simplified format of using a dash
between dollar amounts would be adequate, we recommend using more descriptive
ways, such as “From $5,000 to $9,999.” The descriptive format is more natural in the
Chinese language.

We recommend underlining the boldface text.

3-31

SECTION 4
QUESTIONNAIRE LAYOUT AND VISUAL GUIDE: NEXT STEPS
In both the Spanish- and Chinese-language interviews, we learned that many of
respondents had not completed a questionnaire on their own before. A few respondents
volunteered that because of their age and limited English language skills, their children usually
complete forms for them, or that they had simply never been surveyed before. Thus, they lacked
a general familiarity with conventions of filling out self-administered surveys. Some respondents
did not know where to start, how to indicate their answer, or how to follow the intended order of
the questions. Only with interviewer intervention were the cognitive interviews able to continue.
Another major obstacle in both languages was skip-pattern compliance.
Although our cognitive interview respondents did not constitute a statistical sample, we
expect that the actual respondents to the Spanish- and Chinese-language versions of HOS will
also have limited experience with surveys in general. They are seniors over 65 years of age and
are likely to speak little or no English. The lack of familiarity with survey conventions presents a
complex challenge for HOS, which is self-administered. Unless there is outside help,
respondents must first grasp the concept of answering a questionnaire before they can complete
it. To minimize respondent burden, we recommend collecting HOS data with both Spanish- and
Chinese-speaking seniors in person. However, if a mail survey is the desired mode because of
practical considerations, we recommend revising the current visual layout of the questionnaire to
guide the respondents to follow the intended navigation path and to process the written
information.
The current design has a number of inconsistencies and issues, including the arrangement
and banking of answer categories, the alignment of the number codes, direction of the scales, and
the use of matrices. With a more sophisticated page layout, the number of the questionnaire
pages may be reduced. These issues exist in the original, English language version and carry
over to the Spanish- and Chinese-language versions because the translation text was pasted to the
same layout. In both rounds of testing, Spanish- and Chinese-speaking seniors exhibited
difficulties with the layout, such as not being able to manage multi-item questions. For example,
matrices are used heavily in this questionnaire. A matrix question shows a series of individual
question items down the left side of the page while the answer categories are found across the
top of the page in horizontal orientation (Dillman, 2000). Many of our test respondents,
particularly those who participated in the Spanish-language interviews, had trouble following the
intended order of the design, which is to relate rows to columns. And because the column
labeling and horizontal response categories appear before the items, some respondents read the
4-1

categories first and marked the labeling as an answer without reading the items. We recommend
minimizing the use of matrices.
In the Chinese-language version, the visual layout has additional problems not found in
the English version (thus, the same stimulus is not delivered between recipients of the English
and Chinese versions). In addition, the spacing between answer categories is inconsistent. As
explained in Dillman (2000), this type of issue can be consequential because the spacing is not
consistent with the measurement intent. Question 3, for instance, shows the boxes for the answer
categories spaced unevenly between the middle and the extreme values to the right. The Chineselanguage labeling for the answer categories is also spaced unevenly between the extreme values.
Additionally, the second bullet point is missing in the “sample questions” section at the
beginning of the questionnaire. In the Spanish-language version, the visual layout is largely
consistent with the English version except that questions may not appear on the same page.
These issues can be fixed with more meticulous editing.
To create a common stimulus for every respondent and for better data quality, visual
layout is considered critical in self-administered questionnaire design (Dillman et al., 1999;
Dillman, 2000; Wang and Sha, 2009), and the leading mail survey literature provides well-tested
recommendations. Our findings from the Spanish and Chinese-language cognitive interviews
also showed that the problems seem to have been exacerbated by a lack of familiarity with
survey conventions. We recommend addressing the layout and formatting inconsistencies
that have been identified and, if possible, conduct further laboratory testing followed by a
field experiment to examine their application to HOS.
Because skip-pattern compliance directly affects data quality and data missingness, and
seemed to be a universal problem experienced by respondents in both languages, we recommend
an alternative design. In the paragraphs below, we discuss the issue and our recommendations.
The HOS instrument contains two types of branching instructions:
1. Explanatory text: In the English version, the explanatory text is an incomplete
sentence (if you answered “yes” to Q33 [that you have cancer]) that ends with a
comma. This explanatory text is placed on the top of the page, positioned right above
Q34. In the Spanish-language version, Q33, the explanatory text, and Q34 are placed
on the same page, and the text is also in an incomplete sentence followed by a
comma. In the Chinese-language version, the explanatory text directs respondents to

4-2

answer Q34 if the answer to Q33 is “yes” (have cancer), but Q33 is placed on the
bottom of the previous, separate page.1
2. Skip instructions in Q42, Q43, Q46, and Q62: In the English version, the skip
instructions are preceded by an arrow positioned to the right of the associated
response categories. The arrows and instructions are aligned according to the answer
category that has the longest string of text. In the Spanish-language version, the
arrows and instructions are positioned to the immediate right of the associated answer
categories. In the Chinese-language version, the arrow and instructions are positioned
to the far right, while the answer categories are on the far left.
Our findings showed that very few respondents complied with the intended skip pattern.
For the first type of branching instruction, many respondents went on to answer Q34 when they
did not answer “yes” in Q33. This happened among those who noticed the instruction and even
demonstrated an understanding of its meaning. An explanation was given at the beginning of the
survey, but the directions were in prose and would be conceivably abstract for respondents who
do not already know what to expect in skip instructions. For the second type of branching
instructions, most respondents did not notice it or did not know what it was for. As a result, those
respondents did not benefit from either branching.
Based on the relevant mail survey literature (Redline et al., 2003), we recommend using
the “detection” method for indicating skip instructions for respondents. It uses an arrow pointed
to the right to indicate the path for respondents who answer “no” in Q42. In addition, a
directional arrow points downward to the next question if the answer was “yes.” At Q43, there is
a reminder phrase in parentheses that the response to the previous question should have been
answered “yes.” Figure 4-1 illustrates how Q42 and Q43 might be constructed using the
detection method. We say might because Figure 4-1 kept some design elements in use by HOS,
such as answer boxes, font, page layout, etc., but some were part of the visual layout issues
discussed earlier in the first section. A study or an experiment can be conducted to examine the
application of the detection method to HOS.

The third bullet point of the “sample questions” section of the directions to fill out the questionnaire aims to
describe the purpose of this explanatory text. Few respondents in the Chinese interviews could picture what it
was describing, possibly because the text uses words and sentences to describe an abstract concept. As a
comparison, the Round 2 respondents in the Chinese interviews understood the sample question in the first bullet
point well. It probably was simpler to grasp because it was demonstrated visually and the context was clear.

4-3

Figure 4-1. Possible Construction of Q42 and Q43 Using the Detection Method
42. Many people experience problems with urinary incontinence, the leakage of urine. In the
past 6 months, have you accidentally leaked urine?
1

Yes
No

Go to Question 46

43. (If Yes) How much of a problem, if any, was the urine leakage for you?
1

A big problem
A small problem
Not a problem

If the detection method cannot be adopted and tested, we recommend at least
implementing the following:
•

Placing Q33, the branching instruction, and Q34 on the same page in the Chinese version of
the survey (they already are in the Spanish version). Then they are simultaneously visible.
The branching instruction should be in a complete sentence and indicate what the alternative
is, that is, what respondents should do if they answered “no” in Q33. The current instruction
offers no such directions in any language. In Round 2, the Spanish-language team tested a
revised version of this branching instruction in Spanish that instructed respondents what they
should do if they answered “no” in Q33. The interviewers reported that instructing
respondents about what the alternative is seemed to improve compliance, but only somewhat.
The “sample question” related to this branching instruction given at the beginning of the
survey was in prose and would be conceivably abstract for respondents who do not already
know what to expect in skip instructions. Showing the directions visually as is done in the
first sample question would be ideal (Chinese speakers in Round 2 consistently interpreted
the visual example in the first sample question as intended, but not always the prose), but
could only be done if this branching instruction is redesigned. At the very least, rewrite the
prose in a more concise way.

4-4

•

For Q42, Q43, Q46, and Q62, move the skip instructions right next to the associated answer
categories so the instructions are where the respondents need to see them. There may also be
some value in using “skip to” and “go to” in the skip instructions to help respondents
understand where to go next, but the impact may be limited.

These suggestions allow the survey to stay within the current design.

4-5

REFERENCES
Carter, G., McAvinchey, G., Reed, L.M., Rodriguez, S.M., Schoua-Glusberg, A., and Sha, M.
(2009, January). Cognitive testing of Spanish language translation of selected questions
in the American Housing Survey (AHS) final report. Washington, DC: U.S. Census
Bureau.
Dillman, D. A. (2000) Mail and Internet surveys. 2nd ed. Wiley: New York.
Dillman, D. A., Redline, C. D., & Carley-Baxter, L. R. (1999). Influence of type of question on
skip pattern compliance in self-administered questionnaires. Proceedings of the Section
on Survey Research Methods, American Statistical Association.
Pan, Y, Hinsdale, M., Schoua-Glusberg, A., & Park, H. (2006). Cognitive testing of translations
of ACS CAPI materials in multiple languages. Report prepared for the U.S. Census
Bureau.
Pan, Y., Sha, M., Park, H., & Schoua-Glusberg, A. (2008, August). 2010 Census language
program: Pretesting of Census 2010 questionnaire in five languages. Report prepared for
the U.S. Census Bureau.
Redline, C., Dillman, D. A., Dajani, A. N., & Scaggs, M. A. (2003). Improving navigational
performance in U.S. Census 2000 by altering the visually administered languages of
branching instructions. Journal of Official Statistics, 19(4), 403-419.
Wang, K. & Sha, M. (2009). Effects of instruction placement on item missingness: Results from
a mail survey quasi-experiment. Unpublished manuscript.

R-1

APPENDIX A:
ROUND 2 MATERIALS—SPANISH

HOS MAILING MATERIALS

[TARJETA]
ENCUESTA DE MEDICARE SOBRE LA SALUD

Estimado beneficiario del programa Medicare:
En un esfuerzo por enterarnos más sobre la calidad de la asistencia que se brinda a los
beneficiarios del programa Medicare, los Centros de Servicios de Medicare y Medicaid (CMS
por sus siglas en inglés) están llevando a cabo una encuesta a los beneficiarios. Esta
encuesta se llama Encuesta de Medicare Sobre la Salud. Su nombre ha sido seleccionado al
azar de entre todos los miembros inscritos en su plan de cuidado médico. Agradecemos
muchísimo el tiempo que tome para llenar la encuesta.
Por favor esté pendiente de la Encuesta de Medicare Sobre la Salud que le llegará por correo
en unos días.
Gracias por ayudar con esta encuesta importante.
Atentamente,

Walter Stone
Funcionario Privado
Centros de Servicios de Medicare y Medicaid

A-1

[CARTA]
Estimado beneficiario del programa Medicare:
Los Centros de Servicios de Medicare y Medicaid (CMS, por sus siglas en inglés) es la agencia
federal que administra el programa Medicare. Nuestra responsabilidad es garantizar que usted
reciba cuidado médico de alta calidad. Una de las maneras en que podemos cumplir con esa
responsabilidad es enterarnos directamente por usted cómo afecta su salud el cuidado médico
que está recibiendo actualmente en el programa Medicare.
Los Centros de Servicios de Medicare y Medicaid están realizando una encuesta a las
personas con Medicare llamada Encuesta de Medicare Sobre la Salud. Su nombre ha sido
seleccionado al azar por CMS, de entre las personas con Medicare en su plan de salud. Le
agradeceríamos que dedique unos minutos para completar este cuestionario. Para su
comodidad le adjuntamos un sobre con porte de correo pre-pagado.
Sus respuestas a la encuesta proporcionarán información sobre el estado de su salud. Dentro
de dos años nos pondremos en contacto con usted para pedirle que complete la encuesta
nuevamente. Sus respuestas a las dos encuestas se compararán para determinar si el cuidado
médico que usted recibe lo mantiene tan sano como sea posible. Después de que se termine el
estudio, sus respuestas serán compartidas con su plan de salud. Su plan usará esta
información para mejorar la calidad de los servicios que ofrece.
Es muy importante para nosotros enterarnos sobre su salud. Aunque su participación es
voluntaria, esperamos que no deje pasar la ocasión de responder al cuestionario. Sus
respuestas no afectarán los beneficios que recibe de Medicare.
RTI International es una compañía que realiza estudios sobre la salud y trabaja con Medicare
para llevar a cabo esta encuesta. Si tiene algún problema para completar el cuestionario o tiene
preguntas sobre el mismo, por favor llame gratuitamente a RTI International a 1-800-334-8571
o escribir por correo electrónico a RTI International a quiroz@rti.org.
Gracias por ayudar con esta encuesta importante.
Atentamente,

Walter Stone
Funcionario Privado
Centros de Servicios de Medicare y Medicaid
Anexos

A-2

HOS SURVEY: SPANISH

Encuesta de Medicare Sobre la Salud
2008

A-3

Instrucciones para la Encuesta de Medicare Sobre la Salud
Esta encuesta contiene preguntas sobre usted y su salud. Responda a cada
pregunta pensando en usted mismo. Por favor, tome su tiempo para llenar esta
encuesta. Sus respuestas son muy importantes para nosotros. Si no le es posible
llenar esta encuesta, un familiar o un “representante” pueden llenar la información
sobre usted.
Por favor, devuelva la encuesta con sus respuestas. Para su comodidad, le
adjuntamos un sobre con porte de correo pre-pagado.
Preguntas de ejemplo:
¾ Responda a las preguntas poniendo una ‘X’ en la casilla de la respuesta apropiada, de

la siguiente manera:
56. ¿Es usted hombre o mujer?
1
2

Hombre
Mujer

¾ Por cada pregunta, asegúrese de leer todas las opciones de respuesta antes de marcar
una casilla con una ‘X.’
¾ A veces se le indica que responda a una pregunta de esta encuesta sólo cuando haya
respondido afirmativamente a una pregunta anterior. En ese caso aparecerá una
instrucción en letra itálica como la siguiente:
Si ha respondido que "sí" a la pregunta 33 (que usted ha tenido cáncer), vaya a la pregunta
34. Si contestó “no”, vaya a la pregunta 35.

Toda información que podría identificar a cualquier persona que llene esta
encuesta será estrictamente confidencial. Esta información se utilizará sólo
para el propósito de este estudio y no se revelará ni se proporcionará para
ningún otro propósito sin su autorización.
Si usted tiene preguntas o desea saber más sobre el estudio, por favor llame a
[ROSANNA QUIROZ] a [1-800-334-8571].

A-4

Encuesta de Medicare Sobre la Salud

En general, ¿diría que su salud es?:
Excelente
1

Muy Buena

Buena

Regular

Las siguientes frases se refieren a actividades que usted podría hacer durante un día típico.
¿Su estado de salud actual lo limita para hacer estas actividades? Si es así, ¿cuánto?
Sí, me
limita
mucho

ACTIVIDADES
a. Actividades moderadas, tales como mover una
mesa, empujar una aspiradora, jugar al boliche o
“bowling” o caminar o nadar a ritmo
moderado……………………………………………..

b. Subir varios pisos por la escalera.........................

Mala

Sí, me
limita un
poco

No, no me
limita en
absoluto

Durante las últimas 4 semanas, ¿ha tenido alguno de los siguientes problemas con su
trabajo u otras actividades diarias regulares?:…
No,
nunca

Sí,
muy
pocas
veces

Sí,
algunas
veces

Sí, casi
siempre

Sí,
siempre

a. ¿Ha realizado menos de lo
que le hubiera gustado a
causa de su salud física?........

b. ¿Ha tenido limitaciones en
cuanto al tipo de trabajo u
otras actividades a causa de
su salud física? ........................

A-5

Durante las últimas 4 semanas, ¿ha tenido usted alguno de los siguientes problemas
emocionales con su trabajo u otras actividades diarias regulares?:...
No,
nunca

Sí,
muy
pocas
veces

Sí,
algunas
veces

Sí, casi
siempre

Sí,
siempre

a. ¿Ha realizado menos de lo
que le hubiera gustado a
causa de algún problema
emocional?.................................

b. ¿Ha hecho el trabajo u otras
actividades con menos
cuidado que lo usual a causa
de algún problema
emocional?.................................

Nada en absoluto
1

Ligeramente

Medianamente

Bastante

Extremadamente

Estas preguntas se refieren a cómo se siente usted y a cómo le han ido las cosas durante las
últimas 4 semanas. Por cada pregunta, por favor dé la respuesta que más se acerca a la manera
como se ha sentido usted.
6. ¿Cuánto tiempo durante las últimas 4 semanas...

Siempre

Casi
siempre

Muchas
veces

Algunas
veces

Casi
nunca

Nunca

a. se ha sentido tranquilo y
sosegado?.......................

b. ha tenido mucha
energía? ..........................

c. se ha sentido
desanimado y triste? .......

A-6

Durante las últimas 4 semanas, ¿cuánto tiempo su salud física o sus problemas
emocionales han interferido con sus actividades sociales (como visitar amigos, parientes,
etc.)?
Siempre
1

Casi siempre

Algunas veces

Casi nunca

Nunca

Ahora quisiéramos hacerle algunas preguntas sobre cómo puede haber cambiado su salud.
8.

Comparando su salud física con la de hace un año, ¿cómo la calificaría en general ahora?
Mucho mejor
1

Algo mejor

Más o menos
igual

Algo peor

Mucho peor

Comparando sus problemas emocionales (por ejemplo, tener ansiedad, estar deprimido o
irritable) con los de hace un año, ¿cómo los calificaría en general ahora?
Mucho mejor

Algo mejor

Más o menos
igual

Algo peor

Mucho peor

Anteriormente en la encuesta se le pidió que indicara si tenía alguna limitación en sus actividades.
A continuación le haremos unas cuantas preguntas más en esta área.
10. A causa de un problema físico o de salud, ¿tiene alguna dificultad para hacer las siguientes
actividades sin equipo especial o ayuda de otra persona?
No, No Tengo
Dificultad

Sí, Tengo
Dificultad

No Puedo Hacer
Esta Actividad

a. Bañarse ...............................

b. Vestirse ................................

c. Comer ..................................

d. Sentarse o levantarse de la
silla ......................................

e. Caminar ...............................

f. Usar el inodoro o baño ........

A-7

Las siguientes preguntas se refieren a su salud física y mental durante los últimos 30 días.
11. Ahora, pensando en su salud física, que incluye padecimientos físicos y lesiones, ¿cuántos
días durante los últimos 30 días no fue buena su salud física?
Por favor, escriba un número entre "0" y "30" días. Si su respuesta es “ningún día”, por favor
escriba “0” días.
días
12. Ahora, pensando en su salud mental, que incluye tensión, depresión y problemas
emocionales, ¿por cuántos días durante los últimos 30 días no fue buena su salud mental?
Por favor escriba un número entre "0" y "30" días. Si su respuesta es “ningún día”, por favor
escriba “0” días.
días
13. Durante los últimos 30 días, ¿por cuántos días le impidió su mal estado de salud física o
mental realizar sus actividades normales como cuidados de sí mismo, trabajar o participar en
actividades recreativas?
Por favor escriba un número entre "0" y "30" días. Si su respuesta es “ningún día”, por favor
escriba “0” días.
días

Ahora vamos a hacerle algunas preguntas sobre problemas médicos específicos.
14. Durante las últimas 4 semanas, ¿con qué frecuencia ha tenido los siguientes problemas?
Siempre

Casi
siempre

Algunas
veces

Casi
nunca

Nunca

a. Dolor o presión en el pecho
cuando hace ejercicio .................

b. Dolor o presión en el pecho
mientras descansa. .....................

15. Durante las últimas 4 semanas, ¿con qué frecuencia ha sentido que le faltaba la respiración o
el aliento en las siguientes circunstancias?
Siempre

Casi
siempre

Algunas
veces

Casi
nunca

Nunca

a. Al estar acostado ..........................

b. Al estar sentado o descansando ...

c. Al caminar menos de una
cuadra ...........................................

d. Al subir un piso por las
escaleras .......................................

A-8

16. Durante las últimas 4 semanas, ¿con qué frecuencia ha tenido usted alguno de los
siguientes problemas en las piernas y los pies?
Casi
siempre

Siempre
a. Adormecimiento,
entumecimiento o pérdida de
sensación en los pies ................

Algunas
veces

Casi
nunca

Nunca

c. Sus pies ya no sienten que las
cosas puedan estar calientes o
frías ...........................................

d. Llagas o heridas en los pies,
que no han sanado ...................

b. Sensación de hormigueo o
ardor en los pies,
especialmente en la noche .......

17. ¿Cómo describiría cualquier dolor de artritis o de las articulaciones que por lo general ha
sentido durante las últimas 4 semanas?
Ningún dolor
1

Muy leve
2

Leve
3

Moderado

Intenso

Sí

18. ¿Puede ver lo suficientemente bien como para leer la letra del periódico, con o
sin lentes?..........................................................................................

19. ¿Puede oír la mayoría de las cosas que la gente dice, con o sin aparato
para el oído? ......................................................................................

¿Alguna vez le ha dicho un médico que usted padecía de…?

Sí

20. Hipertensión o presión alta de la sangre ...........................................

21. Angina de pecho o enfermedad de las arterias coronarias ...............

22. Insuficiencia cardíaca ........................................................................

23. Un infarto de miocardio o ataque al corazón .....................................

A-9

¿Alguna vez le ha dicho un médico que usted padecía de…?

Sí

25. Un ataque de apoplejía (derrame cerebral, embolia cerebral) ..........

26. Enfisema o asma o enfermedad pulmonar obstructiva crónica ........

27. Enfermedad de Crohn, colitis ulcerativa o enfermedad inflamatoria
intestinal ............................................................................................

28. Artritis de la cadera o de la rodilla .....................................................

29. Artritis de la mano o de la muñeca ....................................................

30. Osteoporosis, conocida a veces como huesos frágiles o
quebradizos .......................................................................................

31. Ciática (dolor o entumecimiento que baja por la pierna hasta
debajo de la rodilla) ...........................................................................

32. Diabetes o exceso de azúcar en la sangre o en la orina ...................

33. Cualquier tipo de cáncer (aparte del cancer de piel) .........................

Si ha respondido que "sí" a la pregunta 33 (que usted ha tenido cáncer), vaya a la pregunta
34. Si contestó “no”, vaya a la pregunta 35.

34. Actualmente, ¿está recibiendo tratamiento para:
Sí

a. cáncer del colon o del recto? .......................................................

b. cáncer de los pulmones? .............................................................

c. cáncer de mama o seno? ............................................................

d. cáncer de la próstata? .................................................................

A-10

35. En las últimas 4 semanas, ¿con qué frecuencia el dolor lumbar (en la parte baja de la
espalda o cintura) ha afectado sus actividades diarias normales (trabajo, escuela o
quehaceres domésticos)?
Siempre
1

Casi siempre
2

Algunas
veces

Casi nunca

Nunca

Las siguientes preguntas se refieren a diferentes períodos de tiempo.
Sí

36. En el último año, ¿ha habido 2 semanas o más durante las cuales se
ha sentido triste, melancólico o deprimido; o durante las cuales ha
perdido el interés o el placer en las cosas que normalmente le
interesaban o de las que disfrutaba? ..............................................

37. Durante el último año, ¿se ha sentido deprimido o triste la mayor parte
del tiempo? ......................................................................................

38. ¿Ha tenido alguna vez en su vida 2 años o más en los que se ha
sentido deprimido o triste la mayoría de los días, aún cuando se ha
sentido bien algunas veces? ...........................................................

39. ¿Por cuánto tiempo durante la última semana usted se sintió
deprimido/a?
Menos de un día
1

Uno o dos días

Tres o cuatro días

Más de cuatro días
4

40. En general, comparado con otras personas de su edad, ¿diría que su salud es:
1
2
3
4
5

Excelente?
Muy buena?
Buena?
Regular?
Mala?

A-11

41. ¿Usted fuma todos los días, algunos días o no fuma nada?
Todos los días

Algunos días

No fumo nada

No sé

42. Muchas personas tienen problemas de incontinencia urinaria o la orina se sale en forma
involuntaria. Durante los últimos 6 meses, ¿se ha orinado en forma involuntaria
accidentalmente?
1

Sí Î Pase a la pregunta 43
No Î Pase a la pregunta 46

43. ¿Cuánto problema fue para usted el escape de orina?
1

Un problema grande

Pase a la pregunta 44

Un problema pequeño Î Pase a la pregunta 44
No fue problema

Pase a la pregunta 46

44. ¿Ha hablado usted con su médico actual u otro personal médico sobre su problema de
escape de orina?
1

Sí
No

45. Hay muchas maneras de tratar la incontinencia urinaria, incluyendo ejercicios de la vejiga,
tratamiento con medicamentos e intervención quirúrgica u operación. ¿Ha recibido usted estos
u otros tratamientos para su actual problema de escape de orina?
1
2

Sí
No

A-12

46. En los últimos 12 meses, ¿ha hablado usted con un doctor u otro personal médico sobre el
nivel de ejercicios o actividad física que usted hace? Por ejemplo, un doctor u otro personal
médico puede preguntarle si usted hace ejercicios o participa en ejercicios físicos.
1
2
3

SíÎ Pase a la pregunta 47
NoÎ Pase a la pregunta 47
No he acudido al médico durante los últimos 12 meses Î Pase a la pregunta 48

47. En los últimos 12 meses, ¿un doctor u otro personal médico le ha aconsejado que empiece,
aumente o mantenga su nivel de ejercicios o actividad física? Por ejemplo, con el fin de
mejorar su salud, su médico u otro personal médico puede aconsejarle que empiece a subir o
bajar las escaleras, que aumente el tiempo que camina de 10 a 20 minutos al día o que
mantenga su programa actual de ejercicios.
1
2

Sí
No

48. Una caída es cuando su cuerpo va a dar al suelo sin que lo empujen. En los últimos 12
meses, ¿ha hablado con un doctor u otro personal médico sobre caerse o sobre problemas de
equilibrio o problemas para caminar?
1
2
3

Sí
No
No he acudido al médico durante los últimos 12 meses

49. ¿Se ha caído durante los últimos 12 meses?
1
2

Sí
No

50. En los últimos 12 meses, ¿ha tenido problemas de equilibrio o problemas para caminar?
1
2

Sí
No

A-13

51. ¿Su doctor u otro personal médico le ha recomendado algo para ayudarlo(a) a prevenir caídas
o tratar sus problemas de balance o de caminar? Por ejemplo: el uso de un bastón, medirse la
presión o tensión arterial, ejercicios o terapia física o sugerirle que se haga un examen de la
vista o del oído.
Sí

No he acudido al médico durante los últimos 12 meses

52. ¿Usted se ha hecho alguna vez una prueba de densidad ósea para comprobar si tiene o no
osteoporosis, conocida a veces como “huesos quebradizos”? Esta prueba puede habérsele
hecho a la espalda, la cadera, la muñeca, el talón o los dedos.
1
2

53.

Sí
No

¿Cuánto pesa usted? Puede escribir su peso en libras o en kilos,
________ libras o ________ kilos

54. ¿Cuál es su estatura sin los zapatos ? Puede escribir su estatura en pies y pulgadas o en
metros y centímetros
______ pies ______ pulgadas o _______metro(s)

centímetros

55. ¿En qué año nació? Por favor escriba solamente el año de su nacimiento.

56. ¿Es usted hombre o mujer?
1
2

Hombre
Mujer

57. ¿Es usted de origen o ascendencia hispanoamericana o latinoamericana?
1
2

Sí, soy hispano o latino
No, no soy hispano ni latino

A-14

58. ¿Cómo describiría su raza? Por favor marque una o más.
a
b
c
d
e
f

Indígena norteamericano o nativo de Alaska
Asiático
Negro o afroamericano
Nativo de Hawai o de otras islas del Pacífico
Blanco
Otra raza

59. ¿Cuál es su estado civil actual?
1
2
3
4
5

Casado
Divorciado
Separado
Viudo
Nunca se ha casado

60. ¿Cuál es el grado o nivel escolar más alto que ha terminado?
1
2
3

4
5
6

61.

8 grado o menos
Del 9 al 12 grado (secundaria superior, preparatoria, bachillerato) pero sin graduarse
Graduado de la escuela secundaria o superior, preparatoria o bachillerato, o diploma de
equivalencia
Algo de universidad o graduado de carrera de 2 años
Graduado de 4 años de universidad
Estudios de postgrado

¿Es la casa o apartamento en que vive usted actualmente:
1
2
3
4
5

su propiedad o está en proceso de ser comprada por usted?
la propiedad de algún familiar o está en proceso de ser comprada por un familiar?
alquilada?
no es su propiedad y vive allí sin pagar renta?
ninguna de las anteriores?

A-15

62. ¿Quién llenó este cuestionario?
1
2
3
4

La persona a la que se dirigió la encuesta Î Pase a la pregunta 64
Un familiar o pariente de la persona a quien se dirigió la encuesta
Un amigo de la persona a quien se dirigió la encuesta
Un profesional de cuidado de salud de la persona a quien se dirigió la encuesta

63. Si usted no completó el cuestionario y otra persona lo hizo por usted, ¿cuál es el nombre de la
persona que llenó este formulario? Por favor escriba claramente con letra de imprenta.

PRIMER NOMBRE

APELLIDO

64. ¿Cuál de las siguientes categorías describe mejor el ingreso total de todos los miembros
de su hogar durante los últimos 12 meses?
1
2
3
4
5
6
7
8
9
10

Menos de $5,000
$5,000–$9,999
$10,000–$19,999
$20,000–$29,999
$30,000–$39,999
$40,000–$49,999
$50,000–$79,999
$80,000–$99,999
$100,000 o más
No sé

USTED HA COMPLETADO LA ENCUESTA. GRACIAS.

A-16

“De conformidad con la Ley de reducción del papeleo (Paperwork Reduction Act) de 1995, nadie está
obligado a responder a una recopilación de datos que no exhiba un número de control válido de la
Oficina de Administración y Presupuesto (OMB en inglés). El número de control válido para esta
encuesta es 0938-0701. Se calcula que el tiempo necesario para completar esta encuesta es un
promedio de 20 minutos, incluyendo el tiempo requerido para revisar las instrucciones, buscar fuentes de
datos existentes, recolectar los datos necesarios, y completar y revisar el formulario. Si tiene algún
comentario sobre la precisión del cálculo de tiempo o sugerencias para mejorar este formulario, por favor
escriba a CMS, 7500 Security Boulevard, C3-16-27, Baltimore, Maryland 21244-1850.”

Insert Vendor Contact Information Here

A-17

APPENDIX B:
ROUND 2 MATERIALS—CHINESE

MAILING MATERIALS

敬 愛 的 聯 邦 保 健 受 益 人/紅 藍 卡 持 有 者：
「 聯 邦 醫 療 保 險 及 醫 療 補 助 服 務 中 心 」是 聯 邦 政 府 的 機 構 ，專 門 管 轄「 聯
邦 保 健 (紅 藍 卡)」的 運 作 ，以 確 保您 所 得 到 的 是 一 個 高 素 質的 醫 療 護 理 。
「 聯 邦 醫 療 保 險 及 醫 療 補 助 服 務 中 心 」現 將 對 持 有「 聯 邦 保 健 (紅 藍 卡)」
的 人 士 進 行 一 次「 聯 邦 保 健 (紅 藍 卡) 健 康 狀 況 」問 卷 研 究 。您 是 由「 聯 邦 醫 療 保
險 及 醫 療 補 助 服 務 中 心 」在 抽 樣 調 查 方 式 中 被 選 中 參 加 這 次研 究。我 們 極 希 望
您 能 填 寫 這 份 問 卷 ，然 後 用 隨 函 附 上 的 回 郵 信 封 寄 回 本 辦 事 處 。
您 的 回 覆 將 會 提 供 有 關 您 的 健 康 狀 況 的 資 料 。兩 年 之 後 , 您 將 會 再 次 接 到
同 樣 的 問 卷 。我 們 會 將 兩 份 問 卷 的 答 案 做 比 較 分 析 ，以 確 定 照 顧 您 的 醫 療 護 理
能 否 使 您 滿 意 。分 析 完 成 後 ，您 的 答 案 將 會 送 至 閣 下 的 保 健 計 劃 ，而您 的 保 健 計
劃將會以此資料為依據用來改善醫療護理的質素。
了 解 您 的 健 康 狀 況 ，對 我 們 來 說 是 非 常 重 要 的 。雖 然 參 與 這 次 調 查 完 全 是
自 願 性 的 ，但 我 們 極 希 望 您 能 儘 量 回 答 這 些 問 題 。您 所 提 供 的 所 有 資 料 對 您 現
有的聯邦醫療保障福利將不會有任何影響。
哈 特 研 究 公 司 將 與 我 們「 聯 邦 醫 療 保 險 及 醫 療 補 助 服 務 中 心 」聯 合 執 行
這 次 研 究 。如 果 您 有 困 難 完 成 這 份 問 卷， 或 者 您 希 望 得 到 一 份 英 文 問 卷 ，請 與
哈 特 研 究 公 司 免 費 電 話 1-800-334-8975 聯 繫。您 也 可 以 用 電 子 郵 件 的 方 式 與 他 們
聯 繫 。他 們 的 電 子 郵 件是 survey@hartresearch.org：
多謝您的合作！

Walter Stone
CMS Privacy Officer
敬

啟

B-1

HOS SURVEY: CHINESE

「聯邦保健(紅藍卡)」健康狀況問卷說明
這是一份詢問您健康狀況的問卷。請您花一些時間，根據您自身的情況，回答這份問卷
上的每一個問題。您的回答對我們很重要。如果您覺得填寫這份問卷有困難，您可以請
家人或朋友替您回答這份有關您健康狀況的問卷。
請將填寫完的問卷寄還給我們。请使用我们提供的回郵信封, 您不需支付郵资。
➢

回答問題時，請仔細閱讀所有的答案，然後做出選擇。請在您覺得最恰當的答案方格內畫
“X” 。例如：
56.

➢

您的性別？
1

男

女

問卷上有一些前後相關的問題。如果您給前一個問題的答案是肯定的，那您就需要回答隨
後的一個問題。相反，您就無需回答隨後的一個問題。如果這種前後相關的問題出現的
話，您會看到用斜體字寫的說明，如以下：

在回答上面第 33 題時, 如果您的答案是 “有” (比如 “有” 癌症),請繼續回答以下的問題。
我們會嚴格保密任何能確認填表人身份的各種資料。我們所收集的資料只會被用於這項
科研。如果沒有得到您的允許，我們不會透露或公開任何資料。
對於這項研究 ，如果您有任何問題或者希望了解更多信息，請致電MORPACE研究公
司，他們的免費電話是1-866-721-0097。您也可以用電子郵件的方式與他們聯繫。他們
的電子郵件是：hos@morpace.com

OMB 0938‐0701 Version 02‐1
© 2008 美國國家質量保証委員會 (NCQA) 版權所有。未經NCQA的書面同意，任何個人與
團體不得擅自複製或傳送這項健康狀況問卷的内容。

問卷上的第一至第九個問題：“VR-12 健康問卷” 的幾個問題來源於 “36個健康問題問卷”，
並在它們的基礎上做了一些修改。

OMB 0938-0701

B-2

「聯邦保健(紅藍卡)」健康狀況問卷
1. 總的說來，您認為您的健康狀況是：
極好
1

很好
2

好

一般

差

以下的問題是關於您在日常生活中可能進行的活動。您目前的健康狀況是否會限制您

從事這些活動？如果限制的話，限制到什麼程度？
是，有很

活動

大的限制

是，有

不，沒有

一點限制 任何限制

a. 中等程度的活動，比如移動桌子、推吸塵機
、玩保齡球、或打高爾夫球.............

b. 上好幾層樓梯.........................................................

3
3

3. 在過去四個星期內，您在做事或進行其他日常活動時是否因為身體健康的原因而遇到
過下列的問題？

不，

是，

從來沒有 很少時間 有時候 大部份時間 常常如此
a. 實際做完的事或活動比想做
的要少，也就是力不從
心................

b. 做某些事或其他活動時受到
限制....................

4. 在過去四個星期內，您在做事或進行其他日常活動中是否因為心理方面的原因（比
如，感到沮喪、或焦慮）而遇到過下列的問題？？

不，

是，

從來沒有 很少時間 有時候 大部份時間 常常如此
a. 實際做完的事或活動的比想
做的要少，也就是力不從心.....

b. 做事或進行其他活動時不如
往常細心.........................
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B-3

5. 在過去四個星期內，您身體上的疼痛對您的日常活动（包括在外做事和家務）有多大
影響？
毫無影響

有很少影響

有一些影響

有較大影響

有極大影響

下列問題是有關過去四個星期內您的感覺和近況。回答每一項時，請選擇一個最
接近您的感覺的答案。
6. 在過去四個星期內，有多少時間：

常常

大部份

相當多

如此

時間

從來

很少時
有時候

間

沒有

您感到心平氣和 ...............

您感到精力充沛 ...............

您覺得心情不好，不開心

7. 在過去四個星期內，有多少時間您的身體健康或心理狀況妨礙了您的社交活動（比
如，探親、訪友等）？
常常
1

大部份時間
2

有時候
3

很少時間

從來沒有
5

接下來我們想詢問您，在過去的一年內您的健康狀況是否發生過任何變化。
8. 與一年前相比較，您認為您目前的健康狀況大致如何？
好多了
1

好一些
2

差不多
3

差一些
4

差多了
5

9. 與一年前相比較，您認為您目前的心理狀況 (比如，沮喪、焦慮或易怒) 大致如何？
好多了
1

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好一些
2

差不多
3

B-4

差一些
4

差多了
5

前面，我們曾詢問過有關您在日常活動中是否受限制。下面，我們還想問幾個
這方面的問題。
10. 如果在沒有任何特殊設備或他人幫助的情況下，您會不會因為身體健康問題在做下列
活動時有困難？

不，沒有困難

a. 洗澡或淋浴..................................

b. 穿衣服 .........................................

c. 吃飯 .............................................

d. 坐到椅子上或站起來

e. 走路 .............................................

f. 上洗手間 .....................................

對，有困難
2
2
2
2
2
2

沒有能力做

3
3
3
3
3
3

下列問題是有關您在過去三十天內的身心健康的情況。
11. 回顧一下在過去的三十天中，您有多少天覺得身體狀況不太好 (如患疾病或受傷)？
(請填上天數，即從 0‐30 天。如果您不存在這方面的問題，請填上 “0” 天。)

天

12. 回顧一下在過去的三十天中，您有多少天覺得心理狀況不太好 (如壓抑、焦慮、情緒
問題等)？(請填上天數，即從 0‐30 天。如果您不存在這方面的問題，請填上 “0” 天。)

天

13. 在過去的三十天中，您大約有多少天因為身心健康的問題而無法從事日常活動 (如照
顧自己、工作或娛樂)？(請填上天數，即從 0‐30 天。如果您不存在這方面的問題，請
填上 “0” 天。)

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天

B-5

以下我們所要問的幾個問題是關於幾種常見疾病的情況。
14. 在過去四個星期內，有多少時間您遇到了以下的問題？
常常如此 大部份時間

a. 運動時覺得胸疼或胸悶

有時候 很少時間 從來沒有

b. 休息時覺得胸疼或胸悶

15. 在過去四個星期內，有多少時間您在以下的幾種情況下會感到喘不過氣來？
常常如此 大部份時間

有時候 很少時間 從來沒有

a. 平躺的時候 ……………..

坐着或休息的時候 ……..

走了不到一個街區

（block）的時候

上了一層樓梯的時候 …..

16. 在過去四個星期內，有多少時間您的腿和腳有過以下幾種問題？
常常如此 大部份時間

腳發麻或沒感覺 ……….

腳有刺痛的感覺，尤其在

有時候 很少時間 從來沒有

晚上

腳漸漸失去對冷熱的感覺

腳上的傷痛不易癒合……

17. 在過去四個星期內，您因關節炎引起的疼痛有多大？
完全沒有
1

OMB 0938-0701

很輕微
2

輕微
3

有一些
4

B-6

劇烈
5

能

不能

18. 您的視力能不能讓您看清報
纸上的油印字？（如果您帶眼镜，請包括戴眼鏡後的視力。）

19. 您能不能聽清楚周圍人講話時大部份的內容？
（如果您用助聽器，請包括戴助聽器後的聽覺。）

是否曾有醫生告訴過您患有下列任何疾病？

有

20. 高血壓………………………………………………………………

21. 心絞痛或冠狀動脈性心臟病 (冠心病) ........................................

22. 充血性心臟衰竭 …………………………………………………..

23. 心肌梗塞 …………………………………………………………..

24. 其他心臟病，比如心臟瓣膜病或心律不整 ……………………..

25. 中風 ………………………………………………………………..

26. 肺氣腫或哮喘或慢性支氣管炎 …………………………………...

27. 節段性回腸炎，潰瘍性結腸炎或炎性腸病 ……………………...

28. 髖關節炎或膝關節炎 ………………………………………………

29. 手腕或手指關節炎 …………………………………………………

30. 骨質疏鬆症 …………………………………………………………

31. 坐骨神經痛 …………………………………………………………

32. 糖尿病，高血糖或尿糖 ……………………………………………

33. 任何癌症 (皮膚癌除外) ..............................................................

OMB 0938-0701

B-7

沒有

如果對以上第 33 題，您的答案是“有” (即您有癌症)，請回答以下的問題 ：
34. 您目前有沒有在接受下列任何一種癌症的治療？

有

結腸或直腸癌 …………………………………………………

肺癌 ...................................................................................

乳腺癌 ...............................................................................

前列腺癌 ………………………………………………………

沒有

35. 在過去的四個星期內，您可能由於後腰的疼痛妨礙了您的日常活動 (如做事、上學、或娛
樂)。您有多少時間是這樣？
常常

大部份時間

有時候
3

很少
4

從來沒有

有

沒有

36. 在過去的一年內，您有沒有過一連兩個多星期
感到悲傷、沮喪、及失去興趣或樂趣去做您
通常喜歡做的事情？……………………………………………….

37. 在過去的一年內，您有沒有常常感到沮喪或悲傷？…………….

38. 在您的一生中，即使您有時候感覺良好，但
您有沒有在大部份時間感到沮喪或悲傷，而且
這種感覺一連持續兩年多時間？…………………………………..
39. 在過去的一個星期裏，您有多少時間感到憂鬱？
少於一天
1

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一至二天
2

三至四天
3

B-8

四天以上
4

40. 總括說來，與您的同年人相比較，您認為您的健康狀況是：
1
2
3
4
5

極好

很好

好

一般

差

41. 您目前是每天都要抽煙，還是隔幾天抽一次，或者根本就不抽煙？
1
2
3
4

每天

隔幾天

根本就不抽煙

不知道

42. 許多人有小便失禁或小便滲漏的問題。在過去的六個月裏，您是否有過不小心小便滲
漏的問題？
1
2

有

請回答第 43 個問題

沒有

請跳至第 46 個問題

43. 對您來說，小便滲漏是個多大的問題？
1
2
3

是個大問題

請回答第 44 個問題

是個小問題

請回答第 44 個問題

根本不是問題

請跳至第 46 個問題

44. 您與您的醫生有沒有討論過您有小便失禁的問題？
1
2

有

沒有

45. 有許多種方法可以治療小便失禁，比如，膀胱訓練、運動、藥物、及手術。您有沒有
接受過任何這些治療方法？
1
2

有

沒有

OMB 0938-0701

B-9

46. 在過去的十二個月內，您有沒有與您的醫生及其他醫療保健人員談起過您的運動量
或身體鍛練的情況？
例如：他們可能問過您是否經常鍛練身體或參加任何體 育活動。
1
2
3

有

請回答第 47 個問題

沒有

請回答第 47 個問題

過去的十二個月裏我沒去看過病 (大夫)

請跳至第 48 個問題

47. 在過去的十二個月內，醫生及其他保健人員有沒有建議您開始鍛練身體或參加體育活
動，或者建議您增加或維持原有的活動量？
例如：為了提高您的身體健康，他們可能建議您走樓梯鍛練，每天走路從十分鐘增加
到二十分鐘，或維持目前的鍛練計劃。
1
2

有

沒有

48. 跌跤是您的身體在沒人推動的情況下跌倒在地面。在過去的十二個月裏，您有沒有與
您的醫生及其他醫療保健人員談起過您有跌跤、容易失去平衡或走路有困難的問題？
1
2
3

有

沒有

過去的十二個月裏我沒去看過病 (大夫)

49. 在過去的十二個月內，您有沒有跌過跤？
1
2

有

沒有

50. 在過去的十二個月內，您會不會容易失去平衡或走路時有過困難？
1
2

有

沒有

OMB 0938-0701

B-10

51. 醫生及其他保健人員有沒有做任何事情來防止您跌跤或者治療您的平衡
或走路的問題，比如：
建議您走路時使用枴杖
檢查您躺著或站著時的血壓
建議您做鍛練或參加理療
建議您去做視力及聽力的檢查
1
2
3

有

沒有

過去的十二個月裏我沒去看過病 (大夫)

52. 您有沒有接受過骨密度檢查，檢驗您是否有骨質疏鬆症。這項檢查有時候在您的後
背、臀部、手腕、腳跟、或手指上進行。
1
2

有

沒有

53. 您的體重是多少 (磅)？
01

90 磅以下

151–160 磅

221–230 磅

291–300 磅

91–100 磅

161–170 磅

231–240 磅

301–310 磅

101–110 磅

171–180 磅

241–250 磅

311–320 磅

111–120 磅

181–190 磅

251–260 磅

321 磅以上

121–130 磅

191–200 磅

261–270 磅

131–140 磅

201–210 磅

271–280 磅

141–150 磅

211–220 磅

281–290 磅

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B-11

54. 您的身高是多少？
01

5 英尺或以下

5 英尺 4

5 英尺 8 英寸

6 英尺

5 英尺 9 英寸

6 英尺 1 英

英寸
02

5 英尺 1 英寸

5 英尺 5

英寸
03

5 英尺 2 英寸

5 英尺 6

寸
11

5 英尺 10 英寸

英寸
04

5 英尺 3 英寸

5 英尺 7

寸
12

5 英尺 11 英寸

英寸

56. 您的性别？

男

女

57. 您是西班牙人的後裔嗎？
1
2

是

不是

58. 您認為您屬於以下的哪一個人種？(請選擇所有合適的答案。)
1

美國印第安人或阿拉斯加土著居民

亞裔

黑人或美籍非洲人

夏威夷土著居民或其他太平洋島嶼土著居民

白人

其他人種

OMB 0938-0701

6 英尺 3 英
寸或更高

55. 您是哪一年出生的？只需填寫出生年份。

6 英尺 2 英

B-12

59. 您目前的婚姻狀況？
1

已婚
離婚

2
3

分居

喪偶

未婚

60. 您的教育程度如何？
1
2
3
4
5
6

小學

初中畢業

高中畢業

大專畢業

大學畢業

研究生

61. 您目前所居住的房屋或公寓是屬於以下的哪一類？
1

屬於您的，或您自己購買的

屬於您家人的，或您家裏的其他人買的

租用的，需要付房租

不屬於您或您家人的，但可以免租金住用

上述情況都不適用，屬於其他情況

62. 誰填寫了這項調查表？

請跳至第 64 個問題

參加問卷研究的人自己

參加問卷研究者的家人或親屬

朋友

家庭健康助理，私人保健員，或者有執照的護士助理

OMB 0938-0701

B-13

63. 這個人的姓名是什麽？ 請用正楷填寫。
名
姓
64. 在過去的 12 個月内，您住戶裏所有家庭成員的總收入是多少美元？
01

低於$5,000 美元

從 $5,000 到 $9,999 美元

從 $10,000 到 $19,999 美元

從 $20,000 到 $29,999 美元

從 $30,000 到 $39,999 美元

從 $40,000 到 $49,999 美元

從 $50,000 到 $79,999 美元

從 $80,000 到 $99,999 美元

多於$100,000 美元

不知道

您已經完成了這个個問卷。 謝謝!

OMB 0938-0701

B-14

根據 1995 年減少紙張使用法案，如果問卷上沒有有效的 OMB 控 制數碼，任何人都
無須回答問卷上的任何問題。這項問卷持有有效的 OMB 控制數碼：0938－0701。完
成這份問卷，估計需要二十分鐘。這包括閱讀問卷的說明，尋找現有的資料，收集和
整理所需的資料，以及完成和審閱所提供的信息。如果您對完成這份問卷所估計的時
間或對如何改進這項問卷有任何看法，請寫信給:
CMS
7500 Security Boulevard, C3-16-27
Baltimore, Maryland 21244-1850
您也可以與 MORPACE 聯繫。他們的免費電話是 1-866-721-0097；他們的電子郵件
是：hos@morpace.com

OMB 0938-0701

B-15

APPENDIX C:
QUESTION WORDING

SPANISH TESTING

Table 2. HOS Testing- Spanish
HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

In general, would you say your
health is: [Excellent, Very good,
Good, Fair, Poor]

En general, ¿diría que su salud
es? [Excelente, Muy Buena,
Buena, Regular, Mala]

No translation changes tested

No changes recommended

Q2.

The following items are about
activities you might do during a
typical day. Does your health now
limit you in these activities? If so,
how much? [Yes, limited a lot; Yes,
limited a little; No, not limited at all]

Las siguientes frases se refieren a
actividades que usted podría hacer
durante un día típico. ¿Su estado
de salud actual lo limita para
hacer estas actividades? Si es así,
¿cuánto? [Sí, me limita mucho; Sí,
me limita un poco; No, no me limita
en absoluto]

No translation changes tested

No changes recommended

Q2a.

Moderate activities, such as
moving a table, pushing a vacuum
cleaner, bowling, or playing golf. If
so, how much? [Yes, limited a lot;
Yes, limited a little; No, not limited
at all]

Actividades moderadas, tales
como mover una mesa, empujar
una aspiradora, o jugar al bowling
o al golf [Sí, me limita mucho; Sí,
me limita un poco; No, no me limita
en absoluto]

Actividades moderadas, tales
como mover una mesa, empujar
una aspiradora, jugar al boliche o
“bowling” o caminar o nadar a ritmo
moderado [Sí, me limita mucho; Sí,
me limita un poco; No, no me limita
en absoluto]

Actividades moderadas, tales
como mover una mesa, empujar
una aspiradora, o caminar o nadar
a ritmo moderado. Si es así,
¿cuánto? [Sí, me limita mucho; Sí,
me limita un poco; No, no me limita
en absoluto]
(Moderate activities, such as
moving a table, pushing a vacuum
cleaner or walking or swimming at
a moderate pace. If so, how much?
[Yes, limited a lot; Yes, limited a
little; No, not limited at all])

Q2b.

Climbing several flights of stairs. If
so, how much? [Yes, limited a lot;
Yes, limited a little; No, not limited
at all]

Subir varios pisos por la escalera
[Sí, me limita mucho; Sí, me limita
un poco; No, no me limita en
absoluto]

No translation changes tested

No changes recommended

Q3.

During the past 4 weeks, have you
had any of the following problems
with your work or other regular
daily activities as a result of your
physical health? [No, none of the
time; Yes, a little of the time; Yes,
some of the time; Yes, most of the
time; Yes, all of the time]

Durante las últimas 4 semanas,
¿ha tenido usted alguno de los
siguientes problemas con su
trabajo u otras actividades diarias
regulares a causa de su salud
física? [No, nunca; Sí, muy pocas
veces; Sí, algunas veces; Sí, casi
siempre; Sí, siempre]

Durante las últimas 4 semanas,
¿ha tenido alguno de los siguientes
problemas con su trabajo u otras
actividades diarias regulares? [No,
nunca; Sí, muy pocas veces; Sí,
algunas veces; Sí, casi siempre;
Sí, siempre] (Deleted “a causa de
su salud física” for “as a result of
your physical health”)

Round 1 wording

C-1

Q1.

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Accomplished less than you
would like. [No, none of the time;
Yes, a little of the time; Yes, some
of the time; Yes, most of the time;
Yes, all of the time]

Ha realizado menos de lo que le
hubiera gustado [No, nunca; Sí,
muy pocas veces; Sí, algunas
veces; Sí, casi siempre; Sí,
siempre]

¿Ha realizado menos de lo que le
hubiera gustado a causa de su
salud física? [No, nunca; Sí, muy
pocas veces; Sí, algunas veces;
Sí, casi siempre; Sí, siempre]

Ha realizado menos actividades
de lo que le hubiera gustado [No,
nunca; Sí, muy pocas veces; Sí,
algunas veces; Sí, casi siempre;
Sí, siempre]
(Accomplished fewer activities
than you would like. [No, none of
the time; Yes, a little of the time;
Yes, some of the time; Yes, most
of the time; Yes, all of the time])

Q3b.

Were limited in the kind of work or
other activities. [No, none of the
time; Yes, a little of the time; Yes,
some of the time; Yes, most of the
time; Yes, all of the time]

Ha tenido limitaciones en cuanto al
tipo de trabajo u otras actividades
[No, nunca; Sí, muy pocas veces;
Sí, algunas veces; Sí, casi
siempre; Sí, siempre]

¿Ha tenido limitaciones en cuanto
al tipo de trabajo u otras
actividades a causa de su salud
física? [No, nunca; Sí, muy pocas
veces; Sí, algunas veces; Sí, casi
siempre; Sí, siempre]

Round 1 wording

Q4.

During the past 4 weeks, have you
had any of the following problems
with your work or other regular
daily activities as a result of any
emotional problems (such as
feeling depressed or anxious)?
[No, none of the time; Yes, a little
of the time; Yes, some of the time;
Yes, most of the time; Yes, all of
the time]

Durante las últimas 4 semanas,
¿ha tenido usted alguno de los
siguientes problemas con su
trabajo u otras actividades diarias
regulares a causa de algún
problema emocional (como
sentirse deprimido o ansioso)? [No,
nunca; Sí, muy pocas veces; Sí,
algunas veces; Sí, casi siempre;
Sí, siempre]

Durante las últimas 4 semanas,
¿ha tenido usted alguno de los
siguientes problemas emocionales
con su trabajo u otras actividades
diarias regulares? [No, nunca; Sí,
muy pocas veces; Sí, algunas
veces; Sí, casi siempre; Sí,
siempre] (Deleted “a causa del
algún problema emocional” for “as
a result of any emotional
problems”)

Round 1 wording

Q4a.

Accomplished less than you
would like. [No, none of the time;
Yes, a little of the time; Yes, some
of the time; Yes, most of the time;
Yes, all of the time]

Ha realizado menos de lo que le
hubiera gustado [No, nunca; Sí,
muy pocas veces; Sí, algunas
veces; Sí, casi siempre; Sí,
siempre]

¿Ha realizado menos de lo que le
hubiera gustado a causa de algún
problema emocional? [No, nunca;
Sí, muy pocas veces; Sí, algunas
veces; Sí, casi siempre; Sí,
siempre]

Ha realizado menos actividades
de lo que le hubiera gustado. [No,
nunca; Sí, muy pocas veces; Sí,
algunas veces; Sí, casi siempre;
Sí, siempre]
(Accomplished fewer activities
than you would like. [No, none of
the time; Yes, a little of the time;
Yes, some of the time; Yes, most
of the time; Yes, all of the time])

C-2

Q3a.

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Didn't do work or other activities as
carefully as usual. [No, none of
the time; Yes, a little of the time;
Yes, some of the time; Yes, most
of the time; Yes, all of the time]

Ha hecho el trabajo u otras
actividades con menos cuidado
que lo usual [No, nunca; Sí, muy
pocas veces; Sí, algunas veces;
Sí, casi siempre; Sí, siempre]

¿Ha hecho el trabajo u otras
actividades con menos cuidado
que lo usual a causa de algún
problema emocional? [No, nunca;
Sí, muy pocas veces; Sí, algunas
veces; Sí, casi siempre; Sí,
siempre] (Added wording)

Round 1 wording

Q5.

During the past 4 weeks, how
much did pain interfere with your
normal work (including both work
outside the home and housework)?
[Not at all, A little bit, Moderately,
Quite a bit, Extremely]

Durante las últimas 4 semanas,
¿cuánto interfirió el dolor con su
trabajo normal (incluyendo tanto el
trabajo fuera de casa como los
quehaceres domésticos)? [Nada
en absoluto, Ligeramente,
Medianamente, Bastante,
Extremadamente]

Durante las últimas 4 semanas,
¿cuánto interfirió el dolor con su
trabajo normal (incluyendo tanto el
trabajo fuera de casa como los
quehaceres domésticos)? Se
entiende como dolor, una
sensación de molestia o
sufrimiento físico. [Nada, Un poco,
Algo, Bastante, and Mucho]
(During the past 4 weeks, how
much did pain interfere with your
normal work (including both work
outside the home and housework)?
By pain, we mean a sensation of
physical hurt or discomfort. [Not at
all, A little bit, Some, Quite a bit,
and A lot])

Q6.

How much of the time during the
past 4 weeks: [All of the time,
Most of the time, A good bit of the
time, Some of the time, A little of
the time, None of the time]

¿Cuánto tiempo durante las
últimas 4 semanas: [Siempre,
Casi siempre, Muchas veces,
Algunas veces, Casi nunca,
Nunca]

No translation changes tested

No changes recommended

Q6a.

Have you felt calm and peaceful?
[All of the time, Most of the time, A
good bit of the time, Some of the
time, A little of the time, None of
the time]

se ha sentido tranquilo y
sosegado? [Siempre, Casi
siempre, Muchas veces, Algunas
veces, Casi nunca, Nunca]

No translation changes tested

se ha sentido tranquilo y en paz?
[Siempre, Casi siempre, Muchas
veces, Algunas veces, Casi nunca,
Nunca]
(Have you felt calm and in peace?
[All of the time, Most of the time, A
good bit of the time, Some of the
time, A little of the time, None of
the time])

C-3

Q4b.

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

C-4

Q6b.

Did you have a lot of energy? [All
of the time, Most of the time, A
good bit of the time, Some of the
time, A little of the time, None of
the time]

ha tenido mucha energía?
[Siempre, Casi siempre, Muchas
veces, Algunas veces, Casi nunca,
Nunca]

No translation changes tested

No changes recommended

Q6c.

Have you felt downhearted and
blue? [All of the time, Most of the
time, A good bit of the time, Some
of the time, A little of the time,
None of the time]

se ha sentido desanimado y triste?
[Siempre, Casi siempre, Muchas
veces, Algunas veces, Casi nunca,
Nunca]

No translation changes tested

No changes recommended

Q7.

During the past 4 weeks, how
much of the time has your
physical health or emotional
problems interfered with your
social activities (like visiting with
friends, relatives, etc.)? [All of the
time, Most of the time, Some of the
time, A little of the time, None of
the time]

Durante las últimas 4 semanas,
¿cuánto tiempo su salud física o
sus problemas emocionales han
interferido con sus actividades
sociales (como visitar amigos,
parientes, etc.)? [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q8.

Compared to one year ago, how
would you rate your physical
health in general now? [Much
better, Slightly better, About the
same, Slightly worse, Much worse]

Comparando su salud física con
la de hace un año, ¿cómo la
calificaría en general ahora?
[Mucho mejor, Algo mejor, Más o
menos igual, Algo peor, Mucho
peor]

No translation changes tested

No changes recommended

Q9.

Compared to one year ago, how
would you rate your emotional
problems (such as feeling
anxious, depressed or irritable) in
general now? [Much better,
Slightly better, About the same,
Slightly worse, Much worse]

Comparando sus problemas
emocionales (por ejemplo, tener
ansiedad, estar deprimido o
irritable) con los de hace un año,
¿cómo los calificaría en general
ahora? [Mucho mejor, Algo mejor,
Más o menos igual, Algo peor,
Mucho peor]

No translation changes tested

No changes recommended

Q10.

Because of a health or physical
problem, do you have any difficulty
doing the following activities
without special equipment or
help from another person? [No, I
do not have difficulty; Yes, I have
difficulty; I am unable to do this
activity]

A causa de un problema físico o de
salud, ¿tiene alguna dificultad para
hacer las siguientes actividades
sin equipo especial o ayuda de
otra persona? [No, No Tengo
Dificultad; Sí, Tengo Dificultad; No
Puedo Hacer; Esta Actividad]

No translation changes tested

No changes recommended

Spanish: Round 1

Q10a.

Bathing [No, I do not have difficulty;
Yes, I have difficulty; I am unable
to do this activity]

Bañarse [No, No Tengo Dificultad;
Sí, Tengo Dificultad; No Puedo
Hacer; Esta Actividad]

No translation changes tested

No changes recommended

Q10b.

Dressing [No, I do not have
difficulty; Yes, I have difficulty; I am
unable to do this activity]

Vestirse [No, No Tengo Dificultad;
Sí, Tengo Dificultad; No Puedo
Hacer; Esta Actividad]

No translation changes tested

No changes recommended

Q10c.

Eating [No, I do not have difficulty;
Yes, I have difficulty; I am unable
to do this activity]

Comer [No, No Tengo Dificultad;
Sí, Tengo Dificultad; No Puedo
Hacer; Esta Actividad]

No translation changes tested

No changes recommended

Q10d.

Getting in or out of chairs [No, I do
not have difficulty; Yes, I have
difficulty; I am unable to do this
activity]

Sentarse o levantarse de la silla
[No, No Tengo Dificultad; Sí,
Tengo Dificultad; No Puedo Hacer;
Esta Actividad]

No translation changes tested

No changes recommended

Q10e.

Walking [No, I do not have
difficulty; Yes, I have difficulty; I am
unable to do this activity]

Caminar [No, No Tengo Dificultad;
Sí, Tengo Dificultad; No Puedo
Hacer; Esta Actividad]

No translation changes tested

No changes recommended

Q10f.

Using the toilet [No, I do not have
difficulty; Yes, I have difficulty; I am
unable to do this activity]

Usar el inodoro [No, No Tengo
Dificultad; Sí, Tengo Dificultad; No
Puedo Hacer; Esta Actividad]

Usar el inodoro o baño [No, No
Tengo Dificultad; Sí, Tengo
Dificultad; No Puedo Hacer; Esta
Actividad]

Usar el inodoro o taza del baño
[No, No Tengo Dificultad; Sí,
Tengo Dificultad; No Puedo Hacer;
Esta Actividad]
(Using the toilet or bathroom bowl
[No, I do not have difficulty; Yes, I
have difficulty; I am unable to do
this activity])

Q11.

Now, thinking about your physical
health, which includes physical
illness and injury, for how many
days during the past 30 days was
your physical health not good?
(Please enter a number between
"0" and "30" days. If no days,
please enter “0” days.) [days]

Ahora, pensando en su salud
física, que incluye padecimientos
físicos y lesiones, ¿cuántos días
durante los últimos 30 días no fue
buena su salud física? (Por favor
escriba un número entre "0" y "30"
días. Si su respuesta es “ningún
día”, por favor escriba “0” días.)
[días]

Ahora, pensando en su salud
física, que incluye padecimientos
físicos y lesiones, ¿cuántos días
durante los últimos 30 días no fue
buena su salud física?
Por favor, escriba un número entre
"0" y "30" días. Si su respuesta es
“ningún día”, por favor escriba “0”
días. [días] (Parentheses deleted,
space added)

As tested in Round 2, replacing
boxes with a line for respondents to
record their answer.
(Same English wording as original)

C-5

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Now, thinking about your mental
health, which includes stress,
depression, and problems with
emotions, for how many days
during the past 30 days was your
mental health not good? (Please
enter a number between "0" and
"30" days. If no days, please enter
“0” days.) [days]

Ahora, pensando en su salud
mental, que incluye tensión,
depresión y problemas
emocionales, ¿por cuántos días
durante los últimos 30 días no fue
buena su salud mental? (Por favor
escriba un número entre "0" y "30"
días. Si su respuesta es “ningún
día”, por favor escriba “0” días.)
[días]

Ahora, pensando en su salud
mental, que incluye tensión,
depresión y problemas
emocionales, ¿por cuántos días
durante los últimos 30 días no fue
buena su salud mental?
Por favor escriba un número entre
"0" y "30" días. Si su respuesta es
“ningún día”, por favor escriba “0”
días. [días]
(Parentheses deleted, space
added)

As tested in Round 2, replacing
boxes with a line for respondents to
record their answer.

During the past 30 days, for about
how many days did poor physical
or mental health keep you from
doing your usual activities, such as
self-care, work, or recreation?
(Please enter a number between
"0" and "30" days. If no days,
please enter “0” days.) [days]

Durante los últimos 30 días, ¿por
cuántos días le impidió su mal
estado de salud física o mental
realizar sus actividades normales
como cuidados de sí mismo,
trabajar o participar en actividades
recreativas? (Por favor escriba un
número entre "0" y "30" días. Si su
respuesta es “ningún día”, por
favor escriba “0” días.) [días]

Durante los últimos 30 días, ¿por
cuántos días le impidió su mal
estado de salud física o mental
realizar sus actividades normales
como cuidados de sí mismo,
trabajar o participar en actividades
recreativas?
Por favor escriba un número entre
"0" y "30" días. Si su respuesta es
“ningún día”, por favor escriba “0”
días. [días] (Parentheses deleted,
space added)

As tested in Round 2, replacing
boxes with a line for respondents to
record their answer.

Q14.

During the past 4 weeks, how
often have you had any of the
following problems? [All of the time,
Most of the time, Some of the time,
A little of the time, None of the
time]

Durante las últimas 4 semanas,
¿con qué frecuencia ha tenido los
siguientes problemas? [Siempre,
Casi siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q14a.

Chest pain or pressure when you
exercise [All of the time, Most of
the time, Some of the time, A little
of the time, None of the time]

Dolor o presión en el pecho
cuando hace ejercicio [Siempre,
Casi siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q14b.

Chest pain or pressure when
resting [All of the time, Most of the
time, Some of the time, A little of
the time, None of the time]

Dolor o presión en el pecho
mientras descansa [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q12.

Q13.

(Same English wording as original)

C-6

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

C-7

Q15.

During the past 4 weeks, how
often have you felt short of breath
under the following conditions? [All
of the time, Most of the time, Some
of the time, A little of the time,
None of the time]

Durante las últimas 4 semanas,
¿con qué frecuencia ha sentido
que le faltaba la respiración o el
aliento en las siguientes
circunstancias? [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q15a.

When lying down flat [All of the
time, Most of the time, Some of the
time, A little of the time, None of
the time]

Al estar acostado [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q15b.

When sitting or resting [All of the
time, Most of the time, Some of the
time, A little of the time, None of
the time]

Al estar sentado o descansando
[Siempre, Casi siempre, Algunas
veces, Casi nunca, Nunca]

No translation changes tested

No changes recommended

Q15c.

When walking less than one block
[All of the time, Most of the time,
Some of the time, A little of the
time, None of the time]

Al caminar menos de una cuadra
[Siempre, Casi siempre, Algunas
veces, Casi nunca, Nunca]

No translation changes tested

No changes recommended

Q15d.

When climbing one flight of stairs
[All of the time, Most of the time,
Some of the time, A little of the
time, None of the time]

Al subir un piso por las escaleras
[Siempre, Casi siempre, Algunas
veces, Casi nunca, Nunca]

No translation changes tested

No changes recommended

Q16.

During the past 4 weeks, how
much of the time have you had any
of the following problems with your
legs and feet? [All of the time, Most
of the time, Some of the time, A
little of the time, None of the time]

Durante las últimas 4 semanas,
¿con qué frecuencia ha tenido
usted alguno de los siguientes
problemas en las piernas y los
pies? [Siempre, Casi siempre,
Algunas veces, Casi nunca,
Nunca]

No translation changes tested

No changes recommended

Q16a.

Numbness or loss of feeling in your
feet [All of the time, Most of the
time, Some of the time, A little of
the time, None of the time]

Adormecimiento, entumecimiento o
pérdida de sensación en los pies
[Siempre, Casi siempre, Algunas
veces, Casi nunca, Nunca]

No translation changes tested

No changes recommended

Q16b.

Tingling or burning sensation in
your feet especially at night [All of
the time, Most of the time, Some of
the time, A little of the time, None
of the time]

Sensación de hormigueo o ardor
en los pies, especialmente en la
noche [Siempre, Casi siempre,
Algunas veces, Casi nunca,
Nunca]

No translation changes tested

No changes recommended

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Decreased ability to feel hot or cold
with your feet [All of the time, Most
of the time, Some of the time, A
little of the time, None of the time]

Disminución de la capacidad para
sentir calor o frío en los pies
[Siempre, Casi siempre, Algunas
veces, Casi nunca, Nunca]

Sus pies ya no sienten que las
cosas puedan estar calientes o
frías [Siempre, Casi siempre,
Algunas veces, Casi nunca,
Nunca]

Ha disminuído su sensación de
que las cosas puedan estar
calientes o frías. [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]
(Your feeling of things being hot or
cold has decreased [All of the time,
Most of the time, Some of the time,
A little of the time, None of the
time])

Q16d.

Sores or wounds on your feet that
did not heal [All of the time, Most of
the time, Some of the time, A little
of the time, None of the time]

Llagas o heridas en los pies, que
no han sanado [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Q17.

During the past 4 weeks, how
would you describe any arthritis
pain you usually had? [None, Very
Mild, Mild, Moderate, Severe]

¿Cómo describiría cualquier dolor
de arthritis o de las articulaciones
que por lo general ha sentido
durante las últimas 4 semanas?
[Ningún dolor, Muy leve, Leve,
Moderado, Intenso]

¿Cómo describiría cualquier dolor
de artritis o de las articulaciones
que por lo general ha sentido
durante las últimas 4 semanas?
[Ningún dolor, Muy leve, Leve,
Moderado, Intenso] (Corrected
typographical error)

¿Cómo describiría cualquier dolor
de artritis o de las articulaciones
que por lo general ha sentido
durante las últimas 4 semanas?
[Ningún dolor, Muy poco dolor,
Poco dolor, Dolor moderado, Dolor
intenso]
(During the past 4 weeks, how
would you describe any arthritis
pain you usually had? [No pain,
Very little pain, Little pain,
Moderate pain, Intense pain])

Q18.

Can you see well enough to read
newspaper print (with your glasses
or contacts if that's how you see
best)? [Yes, No]

¿Puede ver lo suficientemente bien
como para leer la letra del
periódico (con anteojos o lentes de
contacto si es así como ve mejor)?
[Sí, No]

¿Puede ver lo suficientemente bien
como para leer la letra del
periódico, con o sin lentes? [Sí, No]

¿Puede ver lo suficientemente bien
como para leer la letra del
periódico, sin importar si necesita
lentes on no? [Sí, No]
(Can you see well enough to read
newspaper print, regardless of
whether you need glasses or not?
[Yes, No])

Q19.

Can you hear most of the things
people say (with a hearing aid if
that's how you hear best)? [Yes,
No]

¿Puede oír la mayoría de las
cosas que la gente dice (con un
aparato para el oído si es así como
oye mejor)? [Sí, No]

¿Puede oír la mayoría de las
cosas que la gente dice, con o sin
aparato para el oído? [Sí, No]
(Deleted wording)

¿Puede oír la mayoría de las cosas
que la gente dice, sin importar si
necesita un aparato para el oído o
no? [Sí, No]
(Can you hear most of the things
people say, regardless of whether
you need a hearing aid or not?
[Yes, No])

C-8

Q16c.

Spanish: Round 1

Q20.

Has a doctor ever told you that you
had: Hypertension or high blood
pressure [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Hipertensión o presión alta de la
sangre [Sí, No]

No translation changes tested

No changes recommended

Q21.

Has a doctor ever told you that you
had: Angina pectoris or coronary
artery disease [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Angina
de pecho o enfermedad de las
arterias coronaries [Sí, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Angina
de pecho o enfermedad de las
arterias coronarias [Sí, No]
(Corrected typographical error)

As tested in Round 2
(Has a doctor ever told you that
you had: Angina pectoris or
coronary artery disease [Yes, No])

Q22.

Has a doctor ever told you that you
had: Congestive heart failure [Yes,
No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Insuficiencia cardíaca [Sí, No]

No translation changes tested

No changes recommended

Q23.

Has a doctor ever told you that you
had: A myocardial infarction or
heart attack [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Un
infarto de miocardio o ataque al
corazón [Sí, No]

No translation changes tested

No changes recommended

Q24.

Has a doctor ever told you that you
had: Other heart conditions, such
as problems with heart valves or
the rhythm of your heartbeat [Yes,
No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Otros
problemas del corazón, tales como
problemas con las válvulas del
corazón o con el ritmo del latido de
su corazón [Sí, No]

No translation changes tested

No changes recommended

Q25.

Has a doctor ever told you that you
had: A stroke [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Un
ataque de apoplejía (derrame
cerebral, embolia cerebral) [Sí, No]

No translation changes tested

No changes recommended

Q26.

Has a doctor ever told you that you
had: Emphysema, or asthma, or
COPD (chronic obstructive
pulmonary disease) [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Enfisema o asma o enfermedad
pulmonar obstructiva crónica [Sí,
No]

No translation changes tested

No changes recommended

Q27.

Has a doctor ever told you that you
had: Crohn’s disease, ulcerative
colitis, or inflammatory bowel
disease [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Enfermedad de Crohn, colitis
ulcerativa o enfermedad
inflamatoria intestinal [Sí, No]

No translation changes tested

No changes recommended

Q28.

Has a doctor ever told you that you
had: Arthritis of the hip or knee
[Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Artritis
de la cadera o de la rodilla [Sí, No]

No translation changes tested

No changes recommended

C-9

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

Spanish: Round 1

Q29.

Has a doctor ever told you that you
had: Arthritis of the hand or wrist
[Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Artritis
de la mano o de la muñeca [Sí, No]

No translation changes tested

No changes recommended

Q30.

Has a doctor ever told you that you
had: Osteoporosis, sometimes
called thin or brittle bones [Yes,
No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Osteoporosis, conocida a veces
como huesos frágiles o
quebradizos [Sí, No]

No translation changes tested

No changes recommended

Q31.

Has a doctor ever told you that you
had: Sciatica (pain or numbness
that travels down your leg to below
your knee) [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Ciática
(dolor o entumecimiento que baja
por la pierna hasta debajo de la
rodilla) [Sí, No]

No translation changes tested

No changes recommended

Q32.

Has a doctor ever told you that you
had: Diabetes, high blood sugar, or
sugar in the urine [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?: Diabetes
o exceso de azúcar en la sangre o
en la orina [Sí, No]

No translation changes tested

No changes recommended

Q33.

Has a doctor ever told you that you
had: Any cancer (other than skin
cancer) [Yes, No]

¿Alguna vez le ha dicho un médico
que usted padecía de…?:
Cualquier tipo de cáncer (aparte
del cancer de piel) [Sí, No]

No translation changes tested

No changes recommended

Skip
instru
ction

If you answered “yes” to Question
33 above (that you have had
cancer),

Si ha respondido que "sí" a la
pregunta 33 (que usted ha tenido
cáncer),

Si ha respondido que "sí" a la
pregunta 33 (que usted ha tenido
cáncer), vaya a la pregunta 34. Si
contestó “no”, vaya a la pregunta
35.

As tested in Round 2
(If you answered “yes” to Question
33 above (that you have had
cancer), go to Question 34. If you
answered “no” to Question 33, go
to Question 35.

Q34.

Are you currently under treatment
for: [Yes, No]

Actualmente, ¿está recibiendo
tratamiento para: [Sí, No]

No translation changes tested

No changes recommended

Q34a.

Colon or rectal cancer [Yes, No]

cáncer del colon o del recto? [Sí,
No]

No translation changes tested

No changes recommended

Q34b.

Lung cancer [Yes, No]

cáncer de los pulmones? [Sí, No]

No translation changes tested

No changes recommended

Q34c.

Breast cancer [Yes, No]

cáncer de mama o seno? [Sí, No]

No translation changes tested

No changes recommended

Q34d.

Prostate cancer [Yes, No]

cáncer de la próstata? [Sí, No]

No translation changes tested

No changes recommended

C-10

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

Spanish: Round 1

Q35.

In the past 4 weeks, how often has
low back pain interfered with your
usual daily activities (work, school
or housework)? [All of the time,
Most of the time, Some of the time,
A little of the time, None of the
time]

En las últimas 4 semanas, ¿con
qué frecuencia el dolor lumbar (en
la parte baja de la espalda o
cintura) ha afectado sus
actividades diarias normales
(trabajo, escuela o quehaceres
domésticos)? [Siempre, Casi
siempre, Algunas veces, Casi
nunca, Nunca]

No translation changes tested

No changes recommended

Intro

N/A

Las siguientes preguntas se
refieren a diferentes periodos de
tiempo
The next questions are about
different periods of time.

We do not recommend using the
introduction.

Q36.

In the past year, have you had 2
weeks or more during which you
felt sad, blue or depressed; or
when you lost interest or pleasure
in things that you usually cared
about or enjoyed? [Yes, No]

En el último año, ¿ha habido 2
semanas o más durante las cuales
se ha sentido triste, melancólico o
deprimido; o durante las cuales ha
perdido el interés o el placer en las
cosas que normalmente le
interesaban o de las que
disfrutaba? [Sí, No]

No translation changes tested

No changes recommended

Q37.

In the past year, have you felt
depressed or sad much of the
time? [Yes, No]

Durante el último año, ¿se ha
sentido deprimido o triste la mayor
parte del tiempo? [Sí, No]

No translation changes tested

No changes recommended

Q38.

Have you ever had 2 years or
more in your life when you felt
depressed or sad most days, even
if you felt okay sometimes? [Yes,
No]

¿Ha tenido alguna vez en su vida 2
años o más en los que se ha
sentido deprimido o triste la
mayoría de los días, aún cuando
se ha sentido bien algunas veces?
[Sí, No]

No translation changes tested

No changes recommended

Q39.

How much of the time in the past
week did you feel depressed?
[Less than one day, One or two
days, Three or four days, More
than four days]

¿Por cuánto tiempo durante la
última semana usted se sintió
deprimido/a? [Menos de un día,
Uno o dos días, Tres o cuatro días,
Más de cuatro días]

No translation changes tested

No changes recommended

Q40.

In general, compared to other
people your age, would you say
that your health is: [Excellent, Very
good, Good, Fair, Poor]

En general, comparado con otras
personas de su edad, ¿diría que su
salud es: [Excelente?, Muy
buena?, Buena?, Regular?, Mala?]

No translation changes tested

No changes recommended

C-11

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

C-12

Q41.

Do you now smoke every day,
some days, or not at all? [Every
day, Some days, Not at all, Don’t
know]

¿Usted fuma todos los días,
algunos días o no fuma nada?
[Todos los días, Algunos días, No
fumo nada, No sé]

No translation changes tested

No changes recommended

Q42.

Many people experience problems
with urinary incontinence, the
leakage of urine. In the past 6
months, have you accidentally
leaked urine? [Yes, No]

Muchas personas tienen
problemas de incontinencia
urinaria o escape de orina. Durante
los últimos 6 meses, ¿se le ha
escapado accidentalmente la
orina? [Sí, No]

Muchas personas tienen
problemas de incontinencia
urinaria o la orina se sale en forma
involuntaria. Durante los últimos 6
meses, ¿se ha orinado en forma
involuntaria accidentalmente? [Sí,
No]

As tested in Round 2
(Many people experience problems
with urinary incontinence or the
urine leaks involuntarily. In the
past 6 months, have you
accidentally leaked urine
involuntarily? [Yes, No])

Q43.

How much of a problem, if any,
was the urine leakage for you? [A
big problem, A small problem, Not
a problem]

¿Cuánto problema fue para usted
el escape de orina? [Un problema
grande, Un problema pequeño, No
fue problema]

No translation changes tested

¿Cuánto problema fue para usted
que la orina se saliera en forma
involuntaria?
(How much of a problem, if any,
was the involuntary urine leakage
for you? [A big problem, A small
problem, Not a problem])

Q44.

Have you talked with your current
doctor or other health provider
about your urine leakage problem?
[Yes, No]

¿Ha hablado usted con su médico
actual u otro personal médico
sobre su problema de escape de
orina? [Sí, No]

No translation changes tested

¿Ha hablado usted con su
médico actual u otro personal
médico sobre su problema de
que la orina se salga en forma
involuntaria?
(Have you talked with your current
doctor or other health provider
about your involuntary urine
leakage? [Yes, No])

Q45.

There are many ways to treat
urinary incontinence including
bladder training, exercises,
medication and surgery. Have you
received these or any other
treatments for your current urine
leakage problem? [Yes, No]

Hay muchas maneras de tratar la
incontinencia urinaria, incluyendo
el entrenamiento de la vejiga,
ejercicios, tratamiento con
medicamentos e intervención
quirúrgica u operación. ¿Ha
recibido usted estos u otros
tratamientos para su actual
problema de escape de orina? [Sí,
No]

Hay muchas maneras de tratar la
incontinencia urinaria, incluyendo
ejercicios de la vejiga, tratamiento
con medicamentos e intervención
quirúrgica u operación. ¿Ha
recibido usted estos u otros
tratamientos para su actual
problema de escape de orina? [Sí,
No]

As tested in Round 2
(There are many ways to treat
urinary incontinence including
bladder exercises, medication and
surgery. Have you received these
or any other treatments for your
current urine leakage problem?
[Yes, No])

Spanish: Round 1

Q46.

In the past 12 months, did you talk
with a doctor or other health
provider about your level of
exercise or physical activity? For
example, a doctor or other health
provider may ask if you exercise
regularly or take part in physical
exercise. [Yes, No, I had no visits
in the past 12 months]

En los últimos 12 meses, ¿ha
hablado usted con un doctor u otro
personal médico sobre el nivel de
ejercicios o actividad física que
usted hace? Por ejemplo, un
doctor u otro personal médico
puede preguntarle si usted hace
ejercicios o participa en ejercicios
físicos. [Sí, No, No he acudido al
médico durante los últimos 12
meses]

No translation changes tested

No changes recommended

Q47.

In the past 12 months, did a
doctor or other health provider
advise you to start, increase or
maintain your level of exercise or
physical activity? For example, in
order to improve your health, your
doctor or other health provider may
advise you to start taking the stairs,
increase walking from 10 to 20
minutes every day or to maintain
your current exercise program.
[Yes, No]

En los últimos 12 meses, ¿un
doctor u otro personal médico le ha
aconsejado que empiece, aumente
o mantenga su nivel de ejercicios o
actividad física? Por ejemplo, con
el fin de mejorar su salud, su
médico u otro personal médico
puede aconsejarle que empiece a
tomar las escaleras, que aumente
el tiempo que camina de 10 a 20
minutos al día o que mantenga su
programa actual de ejercicios. [Sí,
No]

En los últimos 12 meses, ¿un
doctor u otro personal médico le ha
aconsejado que empiece, aumente
o mantenga su nivel de ejercicios o
actividad física? Por ejemplo, con
el fin de mejorar su salud, su
médico u otro personal médico
puede aconsejarle que empiece a
subir o bajar las escaleras, que
aumente el tiempo que camina de
10 a 20 minutos al día o que
mantenga su programa actual de
ejercicios. [Sí, No]

As tested in Round 2
(In the past 12 months, did a
doctor or other health provider
advise you to start, increase or
maintain your level of exercise or
physical activity? For example, in
order to improve your health, your
doctor or other health provider may
advise you to start going up and
down the stairs, increase walking
from 10 to 20 minutes every day or
to maintain your current exercise
program. [Yes, No])

Q48.

A fall is when your body goes to
the ground without being pushed.
In the past 12 months, did you talk
with your doctor or other health
provider about falling or problems
with balance or walking? [Yes, No,
I had no visits in the past 12
months]

Una caída es cuando su cuerpo va
a dar al suelo sin que lo empujen.
En los últimos 12 meses, ¿ha
hablado con un doctor u otro
personal médico sobre caerse o
sobre problemas de equilibrio o
problemas para caminar? [Sí, No,
No he acudido al médico durante
los últimos 12 meses]

No translation changes tested

No changes recommended

Q49.

Did you fall in the past 12
months? [Yes, No]

¿Se ha caído durante los últimos
12 meses? [Sí, No]

No translation changes tested

No changes recommended

Q50.

In the past 12 months, have you
had a problem with balance or
walking? [Yes, No]

En los últimos 12 meses, ¿ha
tenido problemas de equilibrio o
problemas para caminar? [Sí, No]

No translation changes tested

No changes recommended

C-13

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Q51.

Has your doctor or other health
provider done anything to help
prevent falls or treat problems with
balance or walking? Some things
they might do include: Suggest that
you use a cane or walker. Check
your blood pressure lying or
standing. Suggest that you do an
exercise or physical therapy
program. Suggest a vision or
hearing testing. [Yes, No, I had no
visits in the past 12 months]

¿Su doctor u otro personal médico
le ha realizado algo para
ayudarlo/a a prevenir caidas o
tratar sus problemas de balance o
de caminar? Algunas cosas
pueden incluir: Sugerir que use un
bastón o un andador. Medirle la
presión o tensión arterial cuando
usted está acostado o de pie.
Sugerir que participe en un
programa de ejercicios o de terapia
física. Sugerir que se haga un
examen de la vista o del oído. [Sí,
No, No he acudido al médico
durante los últimos 12 meses]

¿Su doctor u otro personal médico
le ha recomendado algo para
ayudarlo(a) a prevenir caídas o
tratar sus problemas de balance o
de caminar? Por ejemplo: el uso de
un bastón, medirse la presión o
tensión arterial, ejercicios o terapia
física o sugerirle que se haga un
examen de la vista o del oído. [Sí,
No, No he acudido al médico
durante los últimos 12 meses]

¿Su doctor u otro personal médico
le ha recomendado algo para
ayudarlo(a) a prevenir caídas o
tratar sus problemas de balance o
de caminar? Por ejemplo: el uso de
un bastón o un andador, medirse la
presión o tensión arterial, ejercicios
o terapia física o sugerirle que se
haga un examen de la vista o del
oído. [Sí, No, No he acudido al
médico durante los últimos 12
meses]
(Has your doctor or other health
provider recommended anything to
help you prevent falls or treat
problems with balance or walking?
For example: Using a cane or
walker, checking your blood
pressure, exercising or going to
physical therapy, getting your
vision or hearing tested. [Yes, No, I
had no visits in the past 12
months])

Q52.

Have you ever had a bone density
test to check for osteoporosis,
sometimes thought of as “brittle
bones”? This test may have been
done to your back, hip, wrist, heel
or finger. [Yes, No]

¿Usted se ha hecho alguna vez
una prueba de densidad ósea
para comprobar si tiene o no
osteoporosis, conocida a veces
como “huesos quebradizos”? Esta
prueba puede habérsele hecho a la
espalda, la cadera, la muñeca, el
alon o los dedos. [Sí, No]

As tested in Round 2
(Have you ever had a bone
density test to check for
osteoporosis, sometimes thought
of as “brittle bones”? This test may
have been done to your back, hip,
wrist, heel or finger. [Yes, No])

C-14

HOS English Version

Spanish: Round 1

Q53.

How much do you weigh in pounds
(lbs.)? [90 lbs. or less, 91–100 lbs.,
101–110 lbs., 111–120 lbs., 121–
130 lbs., 131–140 lbs., 141–150
lbs., 151–160 lbs., 161–170 lbs.,
171–180 lbs., 181–190 lbs., 191–
200 lbs., 201–210 lbs., 211–220
lbs., 221–230 lbs., 231–240 lbs.,
241–250 lbs., 251–260 lbs., 261–
270 lbs., 271–280 lbs., 281–290
lbs., 291–300 lbs., 301–310 lbs.,
311–320 lbs., 321 lbs. or more]

¿Cuánto pesa usted en libras? [90
libras o menos, 91–100 libras,
101–110 libras, 111–120 libras,
121–130 libras, 131–140 libras,
141–150 libras, 151–160 libras,
161–170 libras, 171–180 libras,
181–190 libras, 191–200 libras,
201–210 libras, 211–220 libras,
221–230 libras, 231–240 libras,
241–250 libras, 251–260 libras,
261–270 libras, 271–280 libras,
281–290 libras, 291–300 libras,
301–310 libras, 311–320 libras,
321 libras o más]

¿Cuánto pesa usted? Puede
escribir su peso en libras o en
kilos, [libras o kilos]

¿Cuánto pesa usted? Puede
escribir su peso en libras o en
kilos.
__________ libras o
__________ kilos
(How much do you weigh? You can
write your weight in pounds or
kilograms.
__________ pounds or
__________ kilograms)

Q54.

How tall are you without shoes on
in feet (ft.) and inches (in.)? (If 1/2
in., please round up.) [5 ft. 00 in. or
less, 5 ft. 01 in., 5 ft. 02 in., 5 ft. 03
in., 5 ft. 04 in., 5 ft. 05 in., 5 ft. 06
in., 5 ft. 07 in., 5 ft. 08 in., 5 ft. 09
in., 5 ft. 10 in., 5 ft. 11 in., 6 ft. 00
in., 6 ft. 01 in., 6 ft. 02 in., 6 ft. 03
in. or more]

¿Cuál es su estatura sin los
zapatos en el sistema de pies (pi.)
y pulgadas (pul.)? (Si es ½ pul.,
redondéela a la próxima pulgada.)
[5 pi. 00 pul. o menos, 5 pi. 01 pul.,
5 pi. 02 pul., 5 pi. 03 pul., 5 pi. 04
pul., 5 pi. 05 pul., 5 pi. 06 pul., 5 pi.
07 pul., 5 pi. 08 pul., 5 pi. 09 pul., 5
pi. 10 pul., 5 pi. 11 pul., 6 pi. 00
pul., 6 pi. 01 pul., 6 pi. 02 pul., 6 pi.
03 pul. o más]

¿Cuál es su estatura sin los
zapatos ? Puede escribir su
estatura en pies y pulgadas o en
metros y centímetros [pies,
pulgadas o, metro(s), centímetros]

¿Cuál es su estatura sin los
zapatos? Puede escribir su
estatura en pies y pulgadas o en
metros y centímetros.
______pies ______pulgadas
___metro(s) __centímetros
(How tall are you without shoes
on? You can write in your height in
feet and inches or in meters and
centimeters.
_______ feet __________inches
_____meter(s) ______centimeters)

Q55.

In what year were you born?
Please provide your year of birth
only. [Year]

¿En qué año nació? Por favor
escriba solamente el año de su
nacimiento. [año]

No translation changes tested

No changes recommended

Q56.

Are you male or female? [Male,
Female]

¿Es usted hombre o mujer?
[Hombre, Mujer]

No translation changes tested

No changes recommended

Q57.

Are you of Hispanic or Latino origin
or descent? [Yes, Hispanic or
Latino, No, not Hispanic or Latino]

¿Es usted de origen o ascendencia
hispanoamericana o
latinoamericana? [Sí, soy hispano
o latino; No, no soy hispano ni
latino]

No translation changes tested

No changes recommended

C-15

HOS English Version

Spanish: Round 2

Recommended Spanish Wording

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

How would you describe your
race? Please mark one or more.
[American Indian or Alaskan
Native, Asian, Black or African
American, Native Hawaiian or
Other Pacific Islander, White,
Another race]

¿Cómo describiría su raza? Por
favor marque una o más. [Indígena
norteamericano o nativo de Alaska,
Asiático, Negro o afroamericano,
Nativo de Hawai o de otras islas
del Pacífico, Blanco, Otra raza]

No translation changes tested

No changes recommended

Q59.

What is your current marital status?
[Married, Divorced, Separated,
Widowed, Never married]

¿Cuál es su estado civil actual?
[Casado, Divorciado, Separado,
Viudo, Nunca se ha casado]

No translation changes tested

No changes recommended

Q60.

What is the highest grade or level
of school that you have completed?
[8th grade or less, Some high
school, but did not graduate, High
school graduate or GED, Some
college or 2 year degree, 4 year
college graduate, More than a 4
year college degree]

¿Cuál es el grado o nivel escolar
más alto que ha terminado? [8
grado o menos; Del 9 al 12 grado
(secundaria superior, preparatoria,
bachillerato) pero sin graduarse;
Graduado de la escuela
secundaria o superior, preparatoria
o bachillerato, o diploma de
equivalencia; Algo de universidad o
graduado de carrera de 2 años;
Graduado de 4 años de
universidad; Estudios de
postgrado]

No translation changes tested

No changes recommended

Q61.

Is the house or apartment you
currently live in: [Owned or being
bought by you, Owned or being
bought by someone in your family
other than you, Rented for money,
Not owned and one in which you
live without payment of rent, None
of the above]

¿Es la casa o apartamento en que
vive usted actualmente: [su
propiedad o está en proceso de ser
comprada por usted?, la propiedad
de algún familiar o está en proceso
de ser comprada por un familiar?,
alquilada a cambio de dinero?, no
es su propiedad y vive allí sin
pagar renta?, ninguna de las
anteriores?]

¿Es la casa o apartamento en que
vive usted actualmente: [su
propiedad o está en proceso de ser
comprada por usted?, la propiedad
de algún familiar o está en proceso
de ser comprada por un familiar?,
alquilada?, no es su propiedad y
vive allí sin pagar renta?, ninguna
de las anteriores?]

As tested in Round 2
(Is the house or apartment you
currently live in: [Owned or being
bought by you, Owned or being
bought by someone in your family
other than you, Rented, Not owned
and one in which you live without
payment of rent, None of the
above]

C-16

Q58.

C-17

HOS English Version

Spanish: Round 1

Spanish: Round 2

Recommended Spanish Wording

Q62.

Who completed this survey form?
[Person to whom survey was
addressed, Family member or
relative of person to whom the
survey was addressed, Friend of
person to whom the survey was
addressed, Professional caregiver
of person to whom the survey was
addressed]

¿Quien llenó este cuestionario? [La
persona a la que se dirigió la
encuesta, Un familiar o pariente de
la persona a quien se dirigió la
encuesta, Un amigo de la persona
a quien se dirigió la encuesta, Un
profesional de cuidado de salud de
la persona a quien se dirigió la
encuesta]

No translation changes tested

¿Quién llenó este cuestionario? [La
persona elegida para la encuesta,
Un familiar o pariente de la
persona elegida para la encuesta,
Un amigo de la persona elegida
para la encuesta, Un profesional
de cuidado de salud de la persona
elegida para la encuesta]
(Who completed this survey form?
[Person selected for the survey,
Family member or relative of the
person selected for the survey,
Friend of the person selected for
the survey, Professional caregiver
of the person selected for the
survey])

Q63.

What is the name of the person
who completed this survey form?
Please print clearly.

¿Cuál es el nombre de la persona
que llenó este formulario? Por
favor escriba claramente con letra
de imprenta.

No translation changes tested

No changes recommended

Q64.

Which of the following categories
best represents the combined
income for all family members in
your household for the past 12
months? [Less than $5,000,
$5,000–$9,999, $10,000–$19,999,
$20,000–$29,999, $30,000–
$39,999, $40,000–$49,999,
$50,000–$79,999, $80,000–
$99,999, $100,000 or more, Don’t
know]

¿Cuál de las siguientes categorías
describe mejor el ingreso total de
todos los miembros de su hogar
durante los últimos 12 meses?
[Menos de $5,000, $5,000–$9,999,
$10,000–$19,999, $20,000–
$29,999, $30,000–$39,999,
$40,000–$49,999, $50,000–
$79,999, $80,000–$99,999,
$100,000 o más, No sé]

No translation changes tested

No changes recommended

CHINESE TESTING

Table 2. Chinese HOS
HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-19

Q1.

In general, would you say your
health is: [Excellent, Very good,
Good, Fair, Poor]

總的說來，您認為您的健康狀況是
： [極好, 很好, 好, 一般, 差]

No translation changes tested

No changes recommended

Q2.
(Global
changes
for
underlining
boldface
text in
English
version,
and for
recommended
answer
categories)

The following items are about
activities you might do during a
typical day. Does your health
now limit you in these activities?
If so, how much? [Yes, limited a
lot; Yes, limited a little; No, not
limited at all]

以下的問題是有關您在一天的日常
生活中可能進行的活動。您目前的
健康狀況是否會限制您從事這些活
動？如果限制的話，限制到什麼程
度？

以下的問題是關於您在日常生活中
可能進行的活動。您目前的健康狀
況是否會限制您從事這些活動？如
果限制的話，限制到什麼程度？

以下的問題是關於您在日常生活中
可能進行的活動。您目前的健康狀
況是否會限制您從事這些活動？如
果限制的話，限制到什麼程度？
(The following questions are about
activities you might do in your daily
normal life. Does your health now
limit you in doing these activities?
If limited, limited to what level?
[Limited a lot; Limited a little; Not
limited at all])

Q2a.

Moderate activities, such as
moving a table, pushing a vacuum
cleaner, bowling, or playing golf. If
so, how much? [Yes, limited a lot;
Yes, limited a little; No, not limited
at all]

中等程度的活動，比如搬桌子、使
用吸塵機清潔地面、玩保齡球、或
打高爾夫球 [是，有很大的限制;
是，有一點限制; 不，沒有
任何限制]

中等程度的活動，比如移動桌子、
推吸塵機、玩保齡球、或打高爾夫
球 [是，有很大的限制; 是，有
一點限制; 不，沒有任何限制]

中等程度的活動，比如移動桌子、
推吸塵機、玩保齡球、或打高爾夫
球 [有很大的限制; 有一點限制;
沒有任何限制]
(Mid-level activities, for example,
moving a table, pushing a vacuum
cleaner, playing bowling, or playing
golf. )

Q2b.

Climbing several flights of stairs.
If so, how much? [Yes, limited a
lot; Yes, limited a little; No, not
limited at all]

上幾層樓梯 [是，有很大的限制;
是，有一點限制;
不，沒有任何限制]

上好幾層樓梯 [是，有很
大的限制; 是，有一點限制;
不，沒有任何限制]

If “climb several flights of stairs”
means three or more flights of
stairs, use
上好幾層樓梯 [有很大的限制;
有一點限制; 沒有任何限制]
(Climbing quite a few flights of
stairs)

C-20

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

Q3.
Global
changes
for
recommended
answer
categories

During the past 4 weeks, have
you had any of the following
problems with your work or other
regular daily activities as a result
of your physical health? [No,
none of the time; Yes, a little of
the time; Yes, some of the time;
Yes, most of the time; Yes, all of
the time]

在過去四個星期內，您在工作或其
他日常活動中是否因為身體健康的
原因而遇到過下列的問題？ [不，
從來沒有; 是， 偶爾; 是， 有時;
是， 大部份時間; 是， 常常如此]

在過去四個星期內，您在做事或進
行其他日常活動時是否因為身體健
康的原因而遇到過下列的問題？
[不， 從來沒有; 是， 很少時間;
是， 有時候; 是， 大部份時間;
是， 常常如此]

在過去四個星期內，您在做事或進
行其他日常活動時是否因為身體健
康的原因而遇到過下列的問題？
[從來沒有; 極少時間; 有時候;
大部份時間; 常常如此]
(During the past 4 weeks, have
you encountered any of the
following problems when doing
work or other regular daily activities
because of physical health?
[None of the time; Very little of the
time; Some of the time; Most of the
time; All of the time])

Q3a.

Accomplished less than you
would like. [No, none of the time;
Yes, a little of the time; Yes, some
of the time; Yes, most of the time;
Yes, all of the time]

實際做完的比想做的要少 [不，
從來沒有; 是， 偶爾; 是， 有時;
是， 大部份時間; 是， 常常如此]

實際做完的事或活動比想做的要少
，也就是力不從心 [不，
從來沒有; 是， 很少時間; 是，
有時候; 是， 大部份時間; 是，
常常如此]

實際做完的事或活動比想做的要少
，也就是力不從心 [從來沒有;
極少時間; 有時候; 大部份時間;
常常如此]
(Completed fewer things than you
would like, that is, cannot complete
what the heart desires)

Q3b.

Were limited in the kind of work or
other activities. [No, none of the
time; Yes, a little of the time; Yes,
some of the time; Yes, most of the
time; Yes, all of the time]

工作或其他活動的種類受到限制
[不， 從來沒有; 是， 偶爾; 是，
有時; 是， 大部份時間; 是，
常常如此]

做某些事或其他活動時受到限制
[不， 從來沒有; 是， 很少時間;
是， 有時候; 是， 大部份時間;
是， 常常如此]

做某些事或其他活動時受到限制
[從來沒有; 極少時間; 有時候;
大部份時間; 常常如此] (Were
limited when doing some types of
work or other activities.)

Q4.

During the past 4 weeks, have
you had any of the following
problems with your work or other
regular daily activities as a result
of any emotional problems
(such as feeling depressed or
anxious)? [No, none of the time;
Yes, a little of the time; Yes, some
of the time; Yes, most of the time;
Yes, all of the time]

在過去四個星期內，您在工作或其
他日常活動中是否因為情緒方面的
原因（比如，感到沮喪或焦慮）而
遇到過下列的問題？ [不，
從來沒有; 是， 偶爾; 是， 有時;
是， 大部份時間; 是， 常常如此]

在過去四個星期內，您在做事或進
行其他日常活動中是否因為心理方
面的原因（比如，感到沮喪、或焦
慮）而遇到過下列的問題？ [不，
從來沒有; 是， 很少時間; 是，
有時候; 是， 大部份時間; 是，
常常如此]

在過去四個星期內，您在做事或進
行其他日常活動中是否因為情緒方
面的原因（比如，感到沮喪、或焦
慮）而遇到過下列的問題？
[從來沒有; 極少時間; 有時候;
大部份時間; 常常如此] (During
the past 4 weeks, have you
encountered any of the following
problems when doing work or other
regular daily activities because of
emotional reasons (for example,
feeling depressed or anxious)?)

Chinese: Round 1

Chinese: Round 2

Q4a.

Accomplished less than you
would like. [No, none of the time;
Yes, a little of the time; Yes, some
of the time; Yes, most of the time;
Yes, all of the time]

實際做完的比想做的要少 [不，
從來沒有; 是， 偶爾; 是， 有時;
是， 大部份時間; 是， 常常如此]

實際做完的事或活動的比想做的要
少，也就是力不從心 [不，
從來沒有; 是， 很少時間; 是，
有時候; 是， 大部份時間; 是，
常常如此]

實際做完的事或活動的比想做的要
少，也就是力不從心 [從來沒有;
極少時間; 有時候; 大部份時間;
常常如此] (Completed fewer
things than you would like, that is,
cannot complete what the heart
desires)

Q4b.

Didn't do work or other activities
as carefully as usual. [No, none
of the time; Yes, a little of the time;
Yes, some of the time; Yes, most
of the time; Yes, all of the time]

工作或從事其他活動時
不如往常細心 [不， 從來沒有;
是， 偶爾; 是， 有時; 是，
大部份時間; 是， 常常如此]

做事或進行其他活動時不如往常細
心 [不， 從來沒有; 是，
很少時間; 是， 有時候; 是，
大部份時間; 是， 常常如此]

做事或進行其他活動時不如往常細
心 [從來沒有; 極少時間; 有時候;
大部份時間; 常常如此] (When
doing work or other activities, not
as careful as usual.)

Q5.

During the past 4 weeks, how
much did pain interfere with your
normal work (including both work
outside the home and
housework)? [Not at all, A little bit,
Moderately, Quite a bit, Extremely]

在過去四個星期內，您身體上的疼
痛對您的日常工作（包括上班和家
務）有多大影響？ [毫無影響,
有很少影響, 有一些影響,
有較大影響, 有極大影響]

在過去四個星期內，您身體上的疼
痛對您的日常活动（包括在外做事
和家務）有多大影響？ [毫無影響,
有很少影響, 有一些影響,
有較大影響, 有極大影響]

在過去四個星期內，您身體上的疼
痛對您的日常活动（包括在外做事
和家務）有多大影響？ [毫無影響,
有很少影響, 有一些影響,
有較大影響, 有極大影響]
（During the past 4 weeks, how
big of an effect does the pain in
your body have in your daily
normal work (including doing work
outside and household chores?）

Introductory
Statement
before
Q6

These questions are about how
you feel and how things have
been with you during the past 4
weeks. For each item, please give
the one answer that comes
closest to the way you have been
feeling.

下列問題是有關您在過去四個星期
內的自我感覺和其他一些情况。回
答每一個問題時請選擇一個最接近
您的感覺的答案。

下列問題是有關過去四個星期內您
的感覺和近況.
回答每一個問題時請選擇一個最接
近您的感覺的答案。

下列問題是有關過去四個星期內您
的感覺和近況.
回答每一項時請選擇一個最接近您
的感覺的答案。 (These questions
are about your feelings and recent
circumstances during the past 4
weeks. When answering each
item, please select one answer that
is closest to your feeling.)

Q6.

How much of the time during the
past 4 weeks: [All of the time,
Most of the time, A good bit of the
time, Some of the time, A little of
the time, None of the time]

在過去四個星期內，有多少時間：
[常常如此, 大部份時間, 相當多
時間, 有時, 偶爾, 從來沒有]

No translation changes tested

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories

Q6a.

Have you felt calm and peaceful?
[All of the time, Most of the time, A
good bit of the time, Some of the
time, A little of the time, None of
the time]

您感到心平氣和 [常常如此,
大部份時間, 相當多時間, 有時,
偶爾, 從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

C-21

HOS English Version

Recommended Chinese Wording

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-22

Q6b.

Did you have a lot of energy? [All
of the time, Most of the time, A
good bit of the time, Some of the
time, A little of the time, None of
the time]

您感到精力充沛 [常常如此,
大部份時間, 相當多時間, 有時,
偶爾, 從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

Q6c.

Have you felt downhearted and
blue? [All of the time, Most of the
time, A good bit of the time, Some
of the time, A little of the time,
None of the time]

您覺得心情不好，悶悶不樂 [常常
如此, 大部份時間, 相當多時間,
有時, 偶爾, 從來沒有]

您覺得心情不好，不開心
[常常如此, 大部份時間,
相當多時間, 有時候, 很少時間,
從來沒有]

If either “downhearted” or “blue” is
meant to describe sadness through
a long period of time,
您覺得心情不好，悶悶不樂 [常常
如此, 大部份時間, 相當多時間,
有時候, 極少時間, 從來沒有] (You
felt in a bad mood and low in
spirits)
If both terms refer to more
temporary feeling of unhappiness,
您覺得心情不好，不開心
[常常如此, 大部份時間,
相當多時間, 有時候, 極少時間,
從來沒有](You felt in a bad mood
and unhappy.)

Q7.

在過去四個星期內，有多少時間您
的身體健康或情緒問題妨礙了您的
社交活動（比如，探親、訪友等）
？ [常常有, 大部份時間有,
有時有, 偶爾有, 從來沒有]

在過去四個星期內，有多少時間您
的身體健康或心理狀況妨礙了您的
社交活動（比如，探親、訪友等）
？ [常常, 大部份時間, 有時候,
很少時間, 從來沒有]

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories

Q8.

Compared to one year ago, how
would you rate your physical
health in general now? [Much
better, Slightly better, About the
same, Slightly worse, Much
worse]

與一年前相比較，您認為您目前的
健康狀況大致如何？ [好多了,
好一些, 差不多, 差一些, 差多了]

No translation changes tested

No changes recommended except
to underline boldface text
(Compared to one year ago, what
do you think of your current health
condition in general?)

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-23

Q9.

Compared to one year ago, how
would you rate your emotional
problems (such as feeling
anxious, depressed or irritable) in
general now? [Much better,
Slightly better, About the same,
Slightly worse, Much worse]

與一年前相比較，您認為您目前的
心理狀況
(比如，沮喪、焦慮或易怒)
大致如何？ [好多了, 好一些,
差不多, 差一些, 差多了]

與一年前相比較，您認為您目前的
情緒狀況(比如，沮喪、焦慮或易怒
) 大致如何？ [好多了, 好一些,
差不多, 差一些, 差多了]
(Compared to one year ago,
what would you think of your
current emotion (for example,
feeling anxious, depressed or
irritable) in general?)

Q10.
Global
changes
for
recommended
answer
categories

Because of a health or physical
problem, do you have any
difficulty doing the following
activities without special
equipment or help from another
person? [No, I do not have
difficulty; Yes, I have difficulty; I
am unable to do this activity]

如果在沒有任何特殊設備或他人幫
助的情況下，您會不會因為身體健
康問題在做下列活動時有困難？
[不，沒有困難; 對，有困難;
沒有能力做]

No translation changes tested

No changes recommended except
to underline boldface text and
change answer categories to:
[沒有困難;有困難; 沒有能力做] (If
under circumstances that there is
no special equipment or help
from others, do you have any
difficulty doing the following
activities because of physical
health problems? [I do not have
difficulty; I have difficulty; I am
unable to do this activity])

Q10a.

Bathing [No, I do not have
difficulty; Yes, I have difficulty; I
am unable to do this activity]

洗澡或淋浴 [不，沒有困難;
對，有困難; 沒有能力做]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

Q10b.

Dressing [No, I do not have
difficulty; Yes, I have difficulty; I
am unable to do this activity]

穿衣服 [不，沒有困難;
對，有困難; 沒有能力做]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

Q10c.

Eating [No, I do not have difficulty;
Yes, I have difficulty; I am unable
to do this activity]

吃飯 [不，沒有困難; 對，有困難;
沒有能力做]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

Q10d.

Getting in or out of chairs [No, I do
not have difficulty; Yes, I have
difficulty; I am unable to do this
activity]

上下椅子 [不，沒有困難;
對，有困難; 沒有能力做]

坐到椅子上或站起來
[不，沒有困難; 對，有困難;
沒有能力做]

坐到椅子上或站起來 [沒有困難;
有困難; 沒有能力做] Getting in
chairs or getting up

Q10e.

Walking [No, I do not have
difficulty; Yes, I have difficulty; I
am unable to do this activity]

走路 [不，沒有困難; 對，有困難;
沒有能力做]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

Q10f.

Using the toilet [No, I do not have
difficulty; Yes, I have difficulty; I
am unable to do this activity]

上洗手間 [不，沒有困難;
對，有困難; 沒有能力做]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories

C-24

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

Q11.

回顧一下在過去的三十天中，您有
多少天覺得身體狀況不太好
(如患疾病或受傷)？(請填上天數，
即從 0-30
天。如果您不存在這方面的問題，
請填上 “0” 天。) [天]

No translation changes tested

No changes recommended except
to underline boldface text (Thinking
back to the past 30 days, how
many days did you feel that
physical condition was not good
(for example, suffer from illness or
injury)? (Please enter a number of
days, that is, from "0" to "30" days.
If you did not have these problems,
please enter “0” days.) [days])

Q12.

回顧一下在過去的三十天中，您有
多少天覺得心理狀況不太好
(如壓抑、焦慮、情緒問題等)？(請
填上天數，即從 0-30
天。如果您不存在這方面的問題，
請填上 “0” 天。) [天]

No translation changes tested

No changes recommended except
to underline boldface text (Thinking
back to the past 30 days, how
many days did you feel that your
mental condition was not good (for
example, stress, depression, and
problems with emotions, etc)?
(Please enter a number of days,
that is, from "0" to "30" days. If you
did not have these problems,
please enter “0” days.) [days])

Q13.

During the past 30 days, for
about how many days did poor
physical or mental health keep
you from doing your usual
activities, such as self-care, work,
or recreation? (Please enter a
number between "0" and "30"
days. If no days, please enter “0”
days.) [days]

在過去的三十天中，您大約有多少
天因為身心健康的問題而無法從事
日常活動
(如照顧自己、工作或娛樂)？(請填
上天數，即從 0-30
天。如果您不存在這方面的問題，
請填上 “0” 天。) [天]

No translation changes tested
except to underline the translation
intended to mean “poor”. That word
was bolded in the English original
text but no emphasis was indicated
in the Chinese translation.

在過去的三十天中，您大約有多少
天因為身心健康的問題而無法從事
日常活動
(如照顧自己、做事或娛樂)？

Q14.

During the past 4 weeks, how
often have you had any of the
following problems? [All of the
time, Most of the time, Some of
the time, A little of the time, None
of the time]

在過去四個星期內，有多少時間您
遇到了以下的問題？ [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories.

Q14a.

Chest pain or pressure when you
exercise [All of the time, Most of
the time, Some of the time, A little
of the time, None of the time]

運動時覺得胸疼或胸悶 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories.

C-25

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

Q14b.

Chest pain or pressure when
resting [All of the time, Most of the
time, Some of the time, A little of
the time, None of the time]

休息時覺得胸疼或胸悶 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories.

Q15.

During the past 4 weeks, how
often have you felt short of breath
under the following conditions?
[All of the time, Most of the time,
Some of the time, A little of the
time, None of the time]

在過去四個星期內，有多少時間您
在以下的幾種情況下會感到喘不過
氣來？ [常常如此, 大部份時間,
有時, 偶爾, 從來沒有]

No translation changes tested

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories.

Q15a.

When lying down flat [All of the
time, Most of the time, Some of
the time, A little of the time, None
of the time]

平躺的時候 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories.

Q15b.

When sitting or resting [All of the
time, Most of the time, Some of
the time, A little of the time, None
of the time]

坐着或休息的時候 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories.

Q15c.

When walking less than one block
[All of the time, Most of the time,
Some of the time, A little of the
time, None of the time]

走了不到一條街道的時候
[常常如此, 大部份時間, 有時,
偶爾, 從來沒有]

走了不到一個街區（block）的時候
[常常如此, 大部份時間, 有時候,
很少時間, 從來沒有]

還沒走到下一個街口（block）的時
候[常常如此, 大部份時間,
有時候, 極少時間, 從來沒有]
(Walking but not reaching the next
street corner (block)

Q15d.

When climbing one flight of stairs
[All of the time, Most of the time,
Some of the time, A little of the
time, None of the time]

上了一層樓梯的時候 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

No translation changes tested

No changes recommended except
to apply global changes in the
answer categories.

Q16.

During the past 4 weeks, how
much of the time have you had
any of the following problems with
your legs and feet? [All of the
time, Most of the time, Some of
the time, A little of the time, None
of the time]

在過去四個星期內，有多少時間您
的腿和腳有過以下幾種問題？
[常常如此, 大部份時間, 有時,
偶爾, 從來沒有]

No translation changes tested

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories.

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-26

Q16a.

Numbness or loss of feeling in
your feet [All of the time, Most of
the time, Some of the time, A little
of the time, None of the time]

麻木或失去感覺[常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

腳發麻或沒感覺 [常常如此,
大部份時間, 有時候, 很少時間,
從來沒有]

If “numbness or loss of feeling”
implies permanency, no changes
recommended except to apply
global changes in the answer
categories.
If not, use
腳發麻或腳沒感覺 [常常如此,
大部份時間, 有時候, 極少時間,
從來沒有] (Feet felt numb or feet
had no feeling)

Q16b.

Tingling or burning sensation in
your feet especially at night [All of
the time, Most of the time, Some
of the time, A little of the time,
None of the time]

有刺疼的感覺，尤其在晚上[常常如
此, 大部份時間, 有時, 偶爾,
從來沒有]

腳有刺痛的感覺，尤其在晚上
[常常如此, 大部份時間, 有時候,
很少時間, 從來沒有]

腳有刺痛的感覺，尤其在晚上
[常常如此, 大部份時間, 有時候,
極少時間, 從來沒有] (Feet felt
tingling or burning sensation,
especially at night)

Q16c.

Decreased ability to feel hot or
cold with your feet [All of the time,
Most of the time, Some of the
time, A little of the time, None of
the time]

漸漸失去對冷熱的感覺[常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

腳漸漸失去對冷熱的感覺
[常常如此, 大部份時間, 有時候,
很少時間, 從來沒有]

腳漸漸失去對冷熱的感覺
[常常如此, 大部份時間, 有時候,
極少時間, 從來沒有] (Feet
gradually lost feelings with cold or
heat)

Q16d.

Sores or wounds on your feet that
did not heal [All of the time, Most
of the time, Some of the time, A
little of the time, None of the time]

傷痛不易癒合 [常常如此,
大部份時間, 有時, 偶爾,
從來沒有]

腳上的傷痛不易癒合 [常常如此,
大部份時間, 有時候, 很少時間,
從來沒有]

腳上的傷痛不易癒合 [常常如此,
大部份時間, 有時候, 極少時間,
從來沒有] (Sores or wounds on the
feet were not easy to heal)

Q17.

During the past 4 weeks, how
would you describe any arthritis
pain you usually had? [None, Very
Mild, Mild, Moderate, Severe]

在過去四個星期內，您因關節炎引
起的疼痛有多大？ [完全沒有,
很輕微, 輕微, 有一些, 劇烈]

No translation changes tested

No changes recommended except
to underline boldface text and
apply global changes in the answer
categories.

Q18.

Can you see well enough to read
newspaper print (with your
glasses or contacts if that's how
you see best)? [Yes, No]

您的視力 (包括戴眼鏡後的視力)
能不能讓您看清報纸上的油印字？
[能, 不能]

您的視力能不能讓您看清報
纸上的油印字？（如果您帶眼镜，
請包括戴眼鏡後的視力。） [能,
不能]

您能不能看清報纸上的字(也包括戴
眼鏡後的視力)? [能, 不能] (Can
you see the newspaper print clearly
enough (also include sight with
glasses or contacts)?)

Q19.

Can you hear most of the things
people say (with a hearing aid if
that's how you hear best)? [Yes,
No]

您的聽覺(包括戴了助聽器後的聽覺
)能不能讓您聽清楚周圍人講話的大
部份內容？ [能, 不能]

您能不能聽清楚周圍人講話時大部
份的內容？（如果您用助聽器，請
包括戴助聽器後的聽覺。） [能,
不能]

您能不能聽清周圍人講話時大部份
的內容（也包括戴助聽器後的聽覺
）？[能, 不能] (Can you hear
most of the content people talk
about clearly (also include hearing
with a hearing aid)?)

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-27

Q20.

Has a doctor ever told you that
you had: Hypertension or high
blood pressure [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 高血壓 [有, 沒有]

No translation changes tested

No changes recommended

Q21.

Has a doctor ever told you that
you had: Angina pectoris or
coronary artery disease [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？:
心絞痛或冠狀動脈性心臟病
(冠心病) [有, 沒有]

No translation changes tested

No changes recommended

Q22.

Has a doctor ever told you that
you had: Congestive heart failure
[Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 充血性心臟衰竭 [有,
沒有]

No translation changes tested

No changes recommended

Q23.

Has a doctor ever told you that
you had: A myocardial infarction
or heart attack [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 心肌梗塞 [有, 沒有]

No translation changes tested

No changes recommended

Q24.

Has a doctor ever told you that
you had: Other heart conditions,
such as problems with heart
valves or the rhythm of your
heartbeat [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？:
其他心臟病，比如心臟瓣膜病或心
律不整 [有, 沒有]

No translation changes tested

No changes recommended

Q25.

Has a doctor ever told you that
you had: A stroke [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 中風 [有, 沒有]

No translation changes tested

No changes recommended

Q26.

Has a doctor ever told you that
you had: Emphysema, or asthma,
or COPD (chronic obstructive
pulmonary disease) [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？:
肺氣腫或哮喘或慢性支氣管炎 [有,
沒有]

No translation changes tested

No changes recommended

Q27.

Has a doctor ever told you that
you had: Crohn’s disease,
ulcerative colitis, or inflammatory
bowel disease [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？:
節段性回腸炎，潰瘍性結腸炎或炎
性腸病 [有, 沒有]

No translation changes tested

No changes recommended

Q28.

Has a doctor ever told you that
you had: Arthritis of the hip or
knee [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 髖關節或膝關節炎 [有,
沒有]

No translation changes tested

No changes recommended

Q29.

Has a doctor ever told you that
you had: Arthritis of the hand or
wrist [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 手腕或手指關節炎 [有,
沒有]

No translation changes tested

No changes recommended

Q30.

Has a doctor ever told you that
you had: Osteoporosis,
sometimes called thin or brittle
bones [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 骨質疏鬆症 [有, 沒有]

No translation changes tested

No changes recommended

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-28

Q31.

Has a doctor ever told you that
you had: Sciatica (pain or
numbness that travels down your
leg to below your knee) [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 坐骨神經痛 [有, 沒有]

No translation changes tested

No changes recommended

Q32.

Has a doctor ever told you that
you had: Diabetes, high blood
sugar, or sugar in the urine [Yes,
No]

是否曾有醫生告訴過您患有下列任
何疾病？: 糖尿病，高血糖或尿糖
[有, 沒有]

No translation changes tested

No changes recommended

Q33.

Has a doctor ever told you that
you had: Any cancer (other than
skin cancer) [Yes, No]

是否曾有醫生告訴過您患有下列任
何疾病？: 任何癌症 (皮膚癌除外)
[有, 沒有]

No translation changes tested

No changes recommended

Q34.

Are you currently under treatment
for: [Yes, No]

您目前有沒有在接受下列任何一種
癌症的治療？ [有, 沒有]

No translation changes tested

No changes recommended

Q34a.

Colon or rectal cancer [Yes, No]

結腸或直腸癌 [有, 沒有]

No translation changes tested

No changes recommended

Q34b.

Lung cancer [Yes, No]

肺癌 [有, 沒有]

No translation changes tested

No changes recommended

Q34c.

Breast cancer [Yes, No]

乳腺癌 [有, 沒有]

No translation changes tested

No changes recommended

Q34d.

Prostate cancer [Yes, No]

前列腺癌 [有, 沒有]

No translation changes tested

No changes recommended

Q35.

In the past 4 weeks, how often
has low back pain interfered with
your usual daily activities (work,
school or housework)? [All of the
time, Most of the time, Some of
the time, A little of the time, None
of the time]

在過去的四個星期內，您有多少時
間由於後腰的疼痛妨礙了您的日常
活動 (如工作、上學、或娛樂)？
[常常有, 大部份時間有, 有時有,
很少有, 沒有]

在過去的四個星期內，您可能由於
後腰的疼痛妨礙了您的日常活動
(如做事、上學、或娛樂)。您有多
少時間是這樣？ [常常,
大部份時間, 有時候, 很少,
從來沒有]

在過去的四個星期內，您有多少時
間因爲後腰疼痛的關係妨礙了您的
日常活動(如做事、上學、或家務)?
[常常, 大部份時間, 有時候,
極少時間, 從來沒有] (In the past
4 weeks, how much of the time
has it interfered with your usual
daily activities (like doing work,
going to school or housework) due
to the cause of low back pain?)

Q36.

In the past year, have you had 2
weeks or more during which you
felt sad, blue or depressed; or
when you lost interest or pleasure
in things that you usually cared
about or enjoyed? [Yes, No]

在過去的一年內，您有沒有過一連
兩個多星期感到悲傷、沮喪、及失
去興趣或樂趣去做您通常喜歡做的
事情？ [有, 沒有]

No translation changes tested

No changes recommended except
to underline boldface text

Q37.

In the past year, have you felt
depressed or sad much of the
time? [Yes, No]

在過去的一年內，您有沒有常常感
到沮喪或悲傷？ [有, 沒有]

No translation changes tested

No changes recommended except
to underline boldface text

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-29

Q38.

Have you ever had 2 years or
more in your life when you felt
depressed or sad most days, even
if you felt okay sometimes? [Yes,
No]

在您的一生中，即使您有時候感覺
良好，但您有沒有在大部份時間感
到沮喪或悲傷，而且這種感覺一連
持續兩年多時間？ [有, 沒有]

No translation changes tested

No changes recommended except
to underline boldface text

Q39.

How much of the time in the past
week did you feel depressed?
[Less than one day, One or two
days, Three or four days, More
than four days]

在過去的一個星期裏，您有多少時
間感到忧郁？
[少於一天,一至二天, 三至四天,
四天以上]

在過去的一個星期裏，您有多少時
間感到憂鬱？
[少於一天,一至二天, 三至四天,
四天以上]

在過去的一個星期裏，您有多少時
間感到憂鬱？
[少於一天,一至二天, 三至四天,
四天以上] (In the past week, how
much of the time did you feel
depressed?)

Q40.

In general, compared to other
people your age, would you say
that your health is: [Excellent,
Very good, Good, Fair, Poor]

總括說來，與您的同年人相比較，
您認為您的健康狀況是：[極好,
很好, 好, 一般, 差]

No translation changes tested

No changes recommended

Q41.

Do you now smoke every day,
some days, or not at all? [Every
day, Some days, Not at all, Don’t
know]

您目前是每天都要抽煙，還是隔幾
天抽一次，或者根本就不抽煙？
[每天, 隔幾天, 根本就不抽煙,
不知道]

No translation changes tested

No changes recommended

Q42.

Many people experience problems
with urinary incontinence, the
leakage of urine. In the past 6
months, have you accidentally
leaked urine? [Yes, No]

許多人有小便失禁的問題。在過去
的六個月裏，您是否不小心有過小
便失禁？ [有, 沒有]

許多人有小便失禁或小便滲漏的問
題。在過去的六個月裏，您是否有
過不小心小便滲漏的問題？ [有,
沒有]

許多人有小便失禁或小便滲漏的問
題。在過去的六個月裏，您是否不
小心有過小便滲漏？ [有, 沒有]
(Many people have problems with
urinary incontinence or the leakage
of urine. In the past 6 months,
have you accidentally leaked
urine?)

Q43.

How much of a problem, if any,
was the urine leakage for you? [A
big problem, A small problem, Not
a problem]

對您來說，小便失禁是個多大的問
題？ [是個大問題, 是個小問題,
根本不是問題]

對您來說，小便滲漏是個多大的問
題？ [是個大問題, 是個小問題,
根本不是問題]

對您來說，小便滲漏是個多大的問
題？ [是個大問題, 是個小問題,
根本不是問題] (For you, how big
of a problem was the urine
leakage?)

Q44.

Have you talked with your current
doctor or other health provider
about your urine leakage
problem? [Yes, No]

您與您的醫生有沒有討論過您有小
便失禁的問題？ [有, 沒有]

您與您的醫生有沒有討論過您有小
便滲漏的問題？ [有, 沒有]

您與您的醫生有沒有討論過您有小
便滲漏的問題？ [有, 沒有] (Have
you discussed with your doctor that
you had urine leakage problem?)

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-30

Q45.

有許多種方法可以治療小便失禁，
比如，膀胱訓練、運動、藥物、及
手術。您有沒有接受過任何這些治
療方法？ [有, 沒有]

No translation changes tested

No changes recommended

Q46.

In the past 12 months, did you
talk with a doctor or other health
provider about your level of
exercise or physical activity? For
example, a doctor or other health
provider may ask if you exercise
regularly or take part in physical
exercise. [Yes, No, I had no visits
in the past 12 months]

在過去的十二個月內，您有沒有與
您的醫生及其他醫療保健人員談起
過您的運動量或體育鍛練的情況？
例如：您的醫生及其他醫療保健人
員可能問過您是否經常鍛練身體或
參加任何體育活動。 [有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)]

在過去的十二個月內，您有沒有與
您的醫生及其他醫療保健人員談起
過您的運動量或身體鍛練的情況？
例如：他們可能問過您是否經常鍛
練身體或參加任何體 育活動。
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)]

在過去的十二個月內，您有沒有與
您的醫生及其他醫療保健人員談起
過您的運動量或身體鍛練的情況？
例如：他們可能問過您是否經常鍛
練身體或參加任何體育活動。 [有,
沒有,
過去的十二個月裏我沒去看過病
(大夫)]
(In the past 12 months, did you
talk with your doctor or other health
provider about the amount of your
exercise or circumstances
surrounding your physical
activities?
For example, they may have asked
if you often exercise or take part in
any physical activities. [Yes, No, I
had not seen doctor in the past 12
months])

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-31

Q47.

In the past 12 months, did a
doctor or other health provider
advise you to start, increase or
maintain your level of exercise or
physical activity? For example, in
order to improve your health, your
doctor or other health provider
may advise you to start taking the
stairs, increase walking from 10 to
20 minutes every day or to
maintain your current exercise
program. [Yes, No]

在過去的十二個月內，您的醫生及
其他醫療保健人員有沒有建議您去
鍛練身體或參加體育活動，增加身
體鍛練或體育活動的量，或維持原
有的活動量？例如：為了提高您的
身體健康，您的醫生及其他醫療保
健人員可能建議您走樓梯鍛練，每
天走路從十分鐘增加到二十分鐘，
或維持目前的鍛練計劃。 [有,
沒有]

在過去的十二個月內，醫生及其他
保健人員有沒有建議您開始鍛練身
體或參加體育活動，或者建議您增
加或維持原有的活動量？
例如：為了提高您的身體健康，他
們可能建議您走樓梯鍛練，每天走
路從十分鐘增加到二十分鐘，或維
持目前的鍛練計劃。 [有, 沒有]

在過去的十二個月內，醫生及其他
保健人員有沒有建議您開始鍛練身
體或參加體育活動，或者建議您增
加或維持原有的活動量？
例如：為了提高您的身體健康，他
們可能建議您走樓梯鍛練，每天走
路從十分鐘增加到二十分鐘，或維
持目前的鍛練計劃。 [有, 沒有]
(In the past 12 months, did a
doctor or other health provider
advise you to start, increase or
maintain your level of exercise or
physical activity?
For example, in order to improve
your health, they may advise you to
take the stairs to exercise, increase
walking from 10 to 20 minutes
every day or to maintain your
current exercise program. [Yes,
No])

Q48.

A fall is when your body goes to
the ground without being pushed.
In the past 12 months, did you
talk with your doctor or other
health provider about falling or
problems with balance or walking?
[Yes, No, I had no visits in the
past 12 months]

跌跤是您的身體在沒人推動的情況
下跌倒在地面。在過去的十二個月
裏，您有沒有與您的醫生及其他醫
療保健人員談起過您有跌跤、難保
持平衡或走路有困難的問題？ [有,
沒有,
過去的十二個月裏我沒去看過病
(大夫)]

跌跤是您的身體在沒人推動的情況
下跌倒在地面。在過去的十二個月
裏，您有沒有與您的醫生及其他醫
療保健人員談起過您有跌跤、容易
失去平衡或走路有困難的問題？
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)]

跌跤是您的身體在沒人推動的情況
下跌倒在地面。在過去的十二個月
裏，您有沒有與您的醫生及其他醫
療保健人員談起過您有跌跤、容易
失去平衡或走路有困難的問題？
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)] (Falling is that your body
falls to the ground even if nobody
pushes it. In the past 12 months,
did you talk with your doctor or
other health provider that you had
problem of falling, felt easy to lose
balance or had difficulty with
walking?)

Q49.

Did you fall in the past 12
months? [Yes, No]

在過去的十二個月內，您有沒有跌
過跤？ [有, 沒有]

No translation changes tested

No changes recommended except
to underline boldface text

Q50.

In the past 12 months, have you
had a problem with balance or
walking? [Yes, No]

在過去的十二個月內，您有沒有在
保持平衡或走路時有過困難？ [有,
沒有]

在過去的十二個月內，您會不會容
易失去平衡或走路時有過困難？
[有, 沒有]

在過去的十二個月內，您會不會容
易失去平衡或走路時有過困難？
[有, 沒有] (In the past 12
months, have you felt easy to lose
balance or had difficulty with
walking?)

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-32

Q51.

Has your doctor or other health
provider done anything to help
prevent falls or treat problems with
balance or walking? Some things
they might do include: Suggest
that you use a cane or walker.
Check your blood pressure lying
or standing. Suggest that you do
an exercise or physical therapy
program. Suggest a vision or
hearing testing. [Yes, No, I had no
visits in the past 12 months]

您的醫生及其他醫療保健人員有沒
有做任何事情來防止您跌跤或者治
療您的平衡或走路的問題，比如：
建議您走路時使用枴杖.
檢查您躺著或站著時的血壓.
建議您做鍛練或參加理療.
建議您去做視力及聽力的檢查.
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)]

醫生及其他保健人員有沒有做任何
事情來防止您跌跤或者治療您的平
衡或走路的問題，比如：
建議您走路時使用枴杖.
檢查您躺著或站著時的血壓.
建議您做鍛練或參加理療.
建議您去做視力及聽力的檢查.
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)]

醫生及其他保健人員有沒有做任何
事情來防止您跌跤或者治療您的平
衡或走路的問題，比如：
建議您走路時使用枴杖.
檢查您躺著或站著時的血壓.
建議您做鍛練或參加理療.
建議您去做視力及聽力的檢查.
[有, 沒有,
過去的十二個月裏我沒去看過病
(大夫)] (Has the doctor or other
health provider done anything to
prevent you from falling or treat
your problems with balance or
walking? For example, suggest that
you use a cane or walker when
walking. Check your blood
pressure lying or standing. Suggest
that you do an exercise or
participate in a physical therapy
program. Suggest that you do
vision and hearing testing.)

Q52.

Have you ever had a bone
density test to check for
osteoporosis, sometimes thought
of as “brittle bones”? This test may
have been done to your back, hip,
wrist, heel or finger. [Yes, No]

您有沒有接受過骨密度檢查，檢驗
您是否有骨質疏鬆症。這項檢查有
時候在您的後背、臀部、手腕、腳
跟、或手指上進行。 [有, 沒有]

No translation changes tested

No changes recommended except
to underline boldface text

Q53.

How much do you weigh in
pounds (lbs.)? [90 lbs. or less, 91–
100 lbs., 101–110 lbs., 111–120
lbs., 121–130 lbs., 131–140 lbs.,
141–150 lbs., 151–160 lbs., 161–
170 lbs., 171–180 lbs., 181–190
lbs., 191–200 lbs., 201–210 lbs.,
211–220 lbs., 221–230 lbs., 231–
240 lbs., 241–250 lbs., 251–260
lbs., 261–270 lbs., 271–280 lbs.,
281–290 lbs., 291–300 lbs., 301–
310 lbs., 311–320 lbs., 321 lbs. or
more]

您的體重是多少 (磅)？
[90磅以下, 91–100磅, 101–
110磅, 111–120磅, 121–130磅,
131–140磅, 141–150磅, 151–
160磅, 161–170磅, 171–180磅,
181–190磅191–200磅, 201–
210磅, 211–220磅, 221–230磅,
231–240磅, 241–250磅, 251–
260磅, 261–270磅, 271–280磅,
281–290磅, 291–300磅, 301–
310磅, 311–320磅, 321磅以上]

No translation changes tested

No changes recommended

C-33

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

Q54.

How tall are you without shoes on
in feet (ft.) and inches (in.)? (If 1/2
in., please round up.) [5 ft. 00 in.
or less, 5 ft. 01 in., 5 ft. 02 in., 5 ft.
03 in., 5 ft. 04 in., 5 ft. 05 in., 5 ft.
06 in., 5 ft. 07 in., 5 ft. 08 in., 5 ft.
09 in., 5 ft. 10 in., 5 ft. 11 in., 6 ft.
00 in., 6 ft. 01 in., 6 ft. 02 in., 6 ft.
03 in. or more]

您的身高是多少？ [5.00英尺以下,
5.01英尺, 5.02英尺, 5.03英尺,
5.04英尺, 5.05英尺, 5.06英尺,
5.07英尺, 5.08英尺, 5.09英尺,
5.10英尺, 5.11英尺, 6.00英尺,
6.01英尺, 6.02英尺,
6.03英尺以上]

您的身高是多少？ [5英尺或以下,
5英尺1英寸, 5英尺2英寸,
5英尺3英寸, 5英尺4英寸,
5英尺5英寸, 5英尺6英寸,
5英尺7英寸, 5英尺8英寸,
5英尺9英寸, 5英尺10英寸,
5英尺11英寸, 6英尺, 6英尺1英寸,
6英尺2英寸, 6英尺3英寸或更高]

您的身高是多少？ [5英尺或以下,
5英尺1英寸, 5英尺2英寸,
5英尺3英寸, 5英尺4英寸,
5英尺5英寸, 5英尺6英寸,
5英尺7英寸, 5英尺8英寸,
5英尺9英寸, 5英尺10英寸,
5英尺11英寸, 6英尺, 6英尺1英寸,
6英尺2英寸, 6英尺3英寸或更高]
(What is your height?)

Q55.

In what year were you born?
Please provide your year of birth
only. [Year]

您是哪一年出生的？只需填寫出生
年份。

No translation changes tested

No changes recommended except
to underline boldface text

Q56.

Are you male or female? [Male,
Female]

您的性别？ [男, 女]

No translation changes tested

No changes recommended

Q57.

Are you of Hispanic or Latino
origin or descent? [Yes, Hispanic
or Latino, No, not Hispanic or
Latino]

您是西班牙人的後裔嗎？ [是,
不是]

No translation changes tested

No changes recommended

Q58.

How would you describe your
race? Please mark one or more.
[American Indian or Alaskan
Native, Asian, Black or African
American, Native Hawaiian or
Other Pacific Islander, White,
Another race]

您認為您屬於以下的哪一個人種？(
請選擇所有合適的答案。)
[美國印第安人或阿拉斯加土著居民
, 亞裔, 黑人或美籍非洲人,
夏威夷土著居民或其他太平洋島嶼
土著居民, 白人, 其他人種]

No translation changes tested

No changes recommended

Q59.

What is your current marital
status? [Married, Divorced,
Separated, Widowed, Never
married]

您目前的婚姻狀況？ [已婚, 離婚,
分居, 喪偶, 未婚]

No translation changes tested

No changes recommended

HOS English Version

Chinese: Round 1

C-34

Q60.

What is the highest grade or level
of school that you have
completed? [8th grade or less,
Some high school, but did not
graduate, High school graduate or
GED, Some college or 2 year
degree, 4 year college graduate,
More than a 4 year college
degree]

您的教育程度如何？ [小學,
初中畢業, 高中畢業, 大專畢業,
大學畢業, 研究生]

Q61.

您目前所居住的房屋或公寓是屬於
以下的哪一類？
[擁有，自己購買的;
擁有，家裏其他人買的; 租用的;
不擁有，但也不需付房租; 其他]

Chinese: Round 2
No changes were made to this
item, but each respondent was also
presented with an alternate set of
response categories:
[小學畢業或上過初中，但初中沒有
畢業;
初中畢業或上過高中，但高中沒有
畢業; 高中畢業;
大專畢業或上過大學，但大學沒有
畢業; 4年大學畢業; 硕士或博士]

您目前所居住的房屋或公寓是屬於
以下的哪一類？
[屬於您的，或您自己購買的;
屬於您家人的，或您家裏的其他人
買的; 租用的，需要付房租;
不屬於您或您家人的，但可以免租
金住用;
上述情況都不適用，屬於其他情況]

Recommended Chinese Wording
Recommend original translation if
HOS has been collecting data
using the current categories and
data capture system is set up this
way.
The corrected translation showed a
change in respondent reporting
that may be closer to the original
intent. However, collecting new
HOS data using the corrected
translation may result in a
mismatch between previous data
collected, unless categories are
further collapsed during data
analysis
您目前所居住的房屋或公寓是屬於
以下的哪一類？
[屬於您的，或您自己購買的;
屬於您家人的，或您家裏的其他人
買的; 租用的，需要付房租;
不屬於您或您家人的，但不需要付
房租;
上述情況都不適用，屬於其他情況]
( Which category does the house
or apartment you currently live in
belong to: [Owned by you, or
bought by yourself; Owned or
bought by some other person in
your family; Rented, need to pay
rent; Not owned by you or your
family member, but don’t need to
pay rent; None of the scenarios
above applied to my case, some
other category])

HOS English Version

Chinese: Round 1

Chinese: Round 2

Recommended Chinese Wording

C-35

Q62.

誰填寫了這項調查表？
[被調查者本人; 家人或親屬;
朋友;
家庭健康助理，私人保健員，或者
有執照的護士助理]

誰填寫了這項調查表？
[參加問卷研究的人自己;
參加問卷研究者的家人或親屬;
朋友;
家庭健康助理，私人保健員，或者
有執照的護士助理]

誰填寫了這份問卷？
[參加問卷研究的人自己;
參加問卷研究者的家人或親屬;
朋友;
家庭健康助理，私人保健員，或者
有執照的護士助理](Who filled out
this questionnaire? [Survey
participant him or herself; Family
member or relative of the survey
participant; Friend; Home Health
Aide, Private caregiver, or
registered nurse])

Q63.

What is the name of the person
who completed this survey form?
Please print clearly.

如果有人替被調查者本人填寫了這
項調查表，請將此人的姓名寫下來
(請用正體字) 。

這個人的姓名是什麽？
請用正楷填寫。

這個人的姓名是什麽？
請用正楷填寫。(What is this
person’s name? Please write
clearly.)

Q64.

Which of the following categories
best represents the combined
income for all family members
in your household for the past 12
months? [Less than $5,000,
$5,000–$9,999, $10,000–$19,999,
$20,000–$29,999, $30,000–
$39,999, $40,000–$49,999,
$50,000–$79,999, $80,000–
$99,999, $100,000 or more, Don’t
know]

您家庭 (所有成員)
去年的年收入是多少 (美元)？
[低於5,000美元, 5,0009,999美元, 10,000-19,999美元,
20,000-29,999美元, 30,00039,999美元, 40,000-49,999美元,
50,000-79,999美元, 80,00099,999美元, 多於100,000美元,
不知道]

在過去的12個月内，您住戶裏所有
家庭成員的總收入是多少美元？
[低於$5,000美元, 從 $5,000 到
$9,999美元, 從 $10,000 到
$19,999美元, 從 $20,000到
$29,999美元, 從 $30,000到
$39,999美元, 從 $40,000到
$49,999美元, 從 $50,000到
$79,999美元, 從 $80,000到
$99,999美元, 多於$100,000美元,
不知道] (How much is the total
income for all family members in
your household for the past 12
months? [Less than $5,000, From
$5,000 to $9,999, From $10,000 to
$19,999, From $20,000 to $29,999,
From $30,000 to $39,999, From
$40,000 to $49,999, From $50,000
to $79,999, From $80,000 to
$99,999, $100,000 or more, Don’t
know])

File Type	application/pdf
File Title	Microsoft Word - NCQA Round 2 Report Final2.doc
Author	smb
File Modified	2009-06-09
File Created	2009-05-06