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Zuletzt aktualisiert: 10. Dezember 2021 von admin
Welcome to your Survey
1. When were you born? [DD.MM.YYYY]
2. What gender are you?
3. How is your health situation in general?
4. Do you have one or more long term chronic diseases? (Chronic diseases are long- lasting diseases requiring continuous treatment and control, like diabetes or heart diseases.)
4.1. Diseases (for question 4)
5. To what extent are you permanently restricted by disease in the exercise of your daily activities? (At least the last six months.)
6. Please state your religious belief.
6.1. Other religious belief. (for question 6)
7. How many times a week do you visit your church/ mosque/ synagogue/ etc.?
8. Do you have a disability that is officially recognized by the pension office?
8.1. What percentage is the degree of disability at present? (in %)
9. Which people live with you in your household? Example: Person - age - gender Partner - 36 - f (for female)
13. How do you rate your german language skills?
14. Education in Germany: What is the highest degree you have achieved?
15. Schooling in your home country: What is the highest school degree you have?
16. What is the highest professional qualification you have achieved?
17. Are you currently employed? Employment here includes any income-related /paid occupation, disregarding the (contract) and/or period.
18. Which is your current professional position?
... civil servant:
19. Does one of the following statements apply to your current situation?
20. When was the last time you have required medical support from a doctor, dentist or their medical staff?
... did the practitioner have an immigration background?
21. Do you have a family doctor whom you consult first with health issues/ problems?
23. Have you been requiring (first) aid from an ambulance/ an emercengy room during the last 12 months (treatment without being admitted to the hospital// as an ambulant patient// excluding treatment you have received as an inpatient).
... how often did you require (first) aid from an ambulance/ an emercengy room during the last 12 months?
24. Have you been advised on any of your ambulant visits during the last 12 months regarding to your health behaviour?
... if so the advice regarded the following subjects/aspects. (Multiple answers possible)
25. How many nights did you spend at a hospital as an inpatient during the last 12 months? (from 0 to X)
27. How many calendar days have you been absent at work due to illness. Please include the days you have been admitted at the hospital/ as an inpatient.
28. In case you are contracted ( a contracted worker) please state how many days you have been on sick-leave admitted by a physician during the last 12 months. Please include the days you have been admitted at the hospital/ as an inpatient.
... number (see question 28)
29. How many nights in the last 12 months have you been on inpatient treatment in a hospital? (from 0 to X)
31. The participation in health check-ups/ a health examination for early diagnosis/recognition of diabetes, cardio-vascular- and kidney diseases is offered by the health insurances from the age of 35 years every two years.
... are you aware of those offers?
... did you ever participate in any health check-up?
... did you participate in any health check-up in the last 2 years?
32. Dental screening examinations are also recommended for adults. The german health care system provides two free of charge dental examinations a year, called dental control examination.Are you participating regularly, – at least once a year- in a dental control examination?
33. Which health insurance are you contracted with?
... do you have an complementary insurance policy in addition to the mentioned one above?
... if you are not sure which category your insurance belongs to, please state the exact name here:
34. General health condition How would you describe your general health condition?
35. In comparison to last year, how would you describe your current health condition?
36. Following you find a list of activities you may perform on a daily basis. If your state of health sets limits to performing these activities, please state the degree of restriction?
... exhausting activities (e.g. fast running, lifting heavy objects, strenuous exercise):
... moderate activities (e.g. moving a table, vacuuming, bowling, playing golf):
... lifting or carrying shopping bags:
... climbing a flight of steps:
... climbing a staircase:
... bowing, kneeling, bending down:
... walking more than 1 km by foot:
... walking several hundred metres by feet:
... walking one hundred metres by foot:
... bathing or putting on clothing:
37. Did you- due to your physical health condition- experience any difficulties at work or performing work related activities within the last 4 weeks?
... I could not be active as long as usual..
... I have accomplished less than I wanted.
... I could only do certain things.
... I had difficulties performing (for example I had to make a special effort).
38. Did you- due to your mental (health) condition- experience any difficulties at work or performing work-related activities within the last 4 weeks? (for example because you felt depressed or anxious)?
...I could not be active as long as usual.
... I had difficulty performing (for example I had to make a special effort).
39. Did any physical or mental health conditions affect your interaction with family members, friends, neighbours or colleagues at work during/within the last 4 weeks?
... If yes, how?
40. Have you been in pain within the last 4 weeks?
41. To what extend has the pain hindered you performing your daily activities during the last 4 weeks ( at home and at work)?
42. The following questions deal with your emotional state. We would like to ask you how you feel and how you have been doing. Please mark one choice for every line/row: Considering the last 4 weeks how often did you feel....
... full of energy?
... very nervous?
... so depressed that nothing could cheer you up?
... calm and relaxed?
... discouraged and sad?
43. Did your mental health condition affect your social behaviour, the way or frequency you interact with other people e.g. visiting relatives or friends?
44. To what extent does each of the following statements apply to you?
... I seem to get easier sick than other people.
... I'm as healthy as other people I know.
... I expect that my health is deteriorating.
... my health is excellent.
... how many times a week do you practice physical exercise until you feel out of breath or you sweat?
46. How much attention do you pay to adequate physical exercise overall?
47. How often do you exercise?
48. These questions are about the way you felt whilst using health care services // being under treatment. Please cross the box for the option that applies most.
... did you understand the diagnosis you were given?
... if you did not understand it at the first time –how often did you try to ask again to get a better understanding of your diagnosis?
... how often did the doctor in charge help you so you were able to understand everything?
... how often were you able to find someone helping you to understand your diagnosis?
49. What do you believe was the reason that kept people from helping you (to understand your diagnosis)?
50. Did you or a family member or a loved one became seriously ill, or did you suffer from delayed recovery, due to the fact that you did not understand your diagnosis or due to the lack of understanding that kept you from following medical advice?
51. If you do not use the health care system, what do you do to stay healthy?
... do you think that it is sufficient?
52. Do you believe to be solely responsible for your health, or do you see others responsible to keep you healthy such as for example doctors?
... I'm all solely responsible
... the doctor and the health system are responsible.
53. Are you willing to follow any of your doctors advice to gain/regain health?
54. What would be helping you to increase confidence in your doctor?
55. How many times did you understand the diagnosis, but the treatment did not help any?
56. Do you think the range of services provided by doctors/physicians/translators of your nationality and/or speaking your language is sufficient?
57. Having the same symptoms, would you go and see a doctor sooner in your home country than in Germany?
... did you postpone a necessary visit at the doctor here in Germany to be attended by a doctor in your home country (e.g. during a trip/vacation)?
... if yes, why?
58. Could the treatment also have taken place in Germany?
60. Do you think the medicine in your homeland is better than in Germany?
... Do you also use alternative medication to cure what you have been diagnosed with?
61. In these questions, we would like to ask you how much you feel better and more helped with to discuss any health issue/question with your spiritual representatives (Pastor / Iman / Rabbi / e.g..) compared to the representative of the health system (doctor / therapist / e.g.)? .... ( Please cross the box on each line that applies best.)
... I always go first to a spiritual representative.
... my spiritual representative understands me better and can help me better.
... how often are you being referred to a doctor by your spiritual representatives?
62. Is there anything about health or religion that you would like to tell us because it's important to you or because it did not occur in the survey?
Thank you for taking part in this survey!
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