If receiving a state old age pension:



10/66 INDEP study questionnaires

Notes for interviewer

This questionnaire comprises three main elements

|Section |What is covered? |How long does it |Who should be interviewed? |

| | |take? | |

|Sections A-I |Household assets |60 to 90 minutes, |Head of household, or other household member who is best |

| |Household composition |depending upon |placed to answer questions about assets, income and |

|Household interview |Household economic activity (work) |number of |expenditure. This could be the index older person themselves,|

| |Household income |household members |or someone else that they, or others nominate. |

| |Household expenditure | | |

| |Debts and loans | |While the aim is to get all or as much as possible of the |

| |Health and care | |information from one key informant, it may be necessary to |

| |Quality of life | |ask or check with individual household members when the key |

| |Changes since last interview | |informant is unsure |

| | | | |

|Section AA |Index older person’s needs for care |2 minutes to 30 |A household member who is best placed to answer questions |

| | |minutes depending |about the index older person’s needs for care. This may be |

|Index older person |Who, among household members provides|upon needs for |the same key informant as was used for the household |

|informant interview |care, and what is the impact upon |care |interview, but SHOULD NOT be the index older person |

| |them | |themselves. If the older person lives alone then try to find |

| | | |a suitable non-coresident KI |

|Section BB |Self-reported health |20 to 30 minutes |The index older person, unless they lack capacity to |

| |Disability | |understand and respond to the questions, in which case a |

|Index older person |Personal income | |proxy interview should be conducted instead (Section CC) with|

|interview |Autonomy | |a key informant, probably the same informant as for Section |

| |Needs, met and unmet | |AA |

| |Life satisfaction | | |

Abbreviations

IOP = Index older person

KI = Key informant

HOH = Head of household

IV = Interview

IVW = Interviewers

STUDY FLOW CHART FOR APPROACHING, CONSENTING AND INTERVIEWING

[pic]

SECTION A: HOUSEHOLD PROFILE AND ASSETS

I am going to ask you some questions about this household.

|No. |Questions |Coding categories |Codes |

| |HOUSEHOLD IDENTIFIER |HOUSEID | |

|A1 |Is this the same household that the index older |0= No, the older person has moved location to | |

| |person lived in at the incidence wave interview?|another household | |

| | |1= Yes, they are living in the same household_ | |

| | |If 1 then go to A4 | |

|A2 |How long ago, in years, did the index older |Code Number of years | |

| |person move? | | |

| | | | |

|A3 |What were the main reason for the move? (code | |0=No, |

| |all that apply) | |OR 1= Yes |

| | |A3.1 Lack of financial security | |

| | |A3.2 Deterioration in health | |

| | |A3.3 Needs for care | |

| | |A3.4 Unsuitable living accommodation | |

| | |A3.5 Eviction/ Displacement | |

| | |A3.6 Bereavement | |

| | |A3.7 Older person’s preference | |

| | |A3.8 Preference of other family members | |

|A4 |Is this the index older person’s’ permanent |0=No | |

| |home? |1=Yes; If 1 then go to A5 | |

|A4.1 |Has the index older person another home? |0=No | |

| |China - is this the index older person’s |1= Yes | |

| |registered household | | |

|A5 |IVW: CODE WHETHER THE HOUSEHOLD OCCUPIES A |1= Single dwelling | |

| |SINGLE DWELLING OR A MULTIPLE DWELLING COMPOUND |2= Multiple dwelling | |

|A6 |IVW: CODE THE TYPE OF HOUSE IN WHICH THE |1= House or brick structure on a separate stand or| |

| |RESPONDENT LIVES |yard | |

| | |2= Traditional dwelling/Hut | |

| | |3= Flat in a block of flats | |

| | |4= Townhouse cluster/ semi-detached house | |

| | |5= House/Flat/Room in backyard | |

| | |6= Informal dwelling/shack, not in backyard | |

| | |7= Informal dwelling/shack, in a backyard | |

| | |8= Room(s)/Garage not in backyard but on a shared | |

| | |property | |

| | |9= other | |

|A7 |IVW: INDICATE THE TOTAL NUMBER OF BEDROOMS IN |Number of bedrooms | |

| |THE HOUSE | | |

|A8 |Is this dwelling…? |1= Owned by someone in the household | |

| | |2= Rented | |

| | |3= Owned by someone else, but no rent paid | |

|A9 |What is the main source of drinking water for |1= Piped (tap) water in dwelling | |

| |members of this household (code lowest |2= Piped (tap) water on site or in yard | |

| |applicable code)? |3= Public tap | |

| | |4= Water carrier/tanker | |

| | |5= Borehole on site | |

| | |6= Borehole off site/Communal | |

| | |7= Rainwater tank on site | |

| | |8= Flowing water/stream | |

| | |9= Dam/Pool/Stagnant water | |

| | |10= Well | |

| | |11= Spring | |

|A10 |What kind of toilet facility does your household|1=Flush toilet inside | |

| |have? (code lowest applicable code) |2=Flush toilet outside | |

| | |3=Chemical toilet | |

| | |4=Pit toilet | |

| | |5=Bucket toilet | |

| | |6=No toilet/Uses bush | |

|A11. |Which of the following items does the household have in working order? |0=No, OR 1= Yes |

|A11.1 |Telephone or cell phone | |

|A11.2 |Stove-electric or gas | |

|A11.3 |Stove-coal, wood or paraffin | |

|A11.4 |Electricity | |

|A11.5 |Television set | |

|A11.6 |Radio or stereo | |

|A11.7 |Refrigerator/deep freeze | |

|A11.8 |Sewing machine | |

|A11.9 |Bicycle | |

|A11.10 |Computer | |

|A12 |Does anyone in the household own any cars, vans, |0 = No | |

| |motorcycles, motorised agricultural vehicles, boats, |1 = Yes | |

| |horse- or oxen-drawn carts used for transport? | | |

| |If No = 0, skip to A.13 | | |

|IVW, if yes, enumerate and describe in this table all such vehicles, owned by any members of the household. Use one line of the|

|table for each vehicle and code the type of vehicle, the approximate value, and which member of the household is the main owner|

| |What kind of vehicle |Approximate value |Who owns this vehicle (use|

| |1=car | |ID number from grid) |

| |2=motorcycle | | |

| |3= van, truck or lorry | | |

| |4= tractor or other motorised agricultural vehicle | | |

| |5= horse and cart | | |

| |6= boat | | |

|A12.1 | | | |

|A12.2 | | | |

|A12.3 | | | |

|A12.4 | | | |

|A12.5 | | | |

|A12.6 | | | |

|A12.7 | | | |

|A12.8 | | | |

|A12.9 | | | |

|A12.10 | | | |

|LAND USED BY HOUSEHOLD | | |

|A.13 |Do you have land that you use to grow produce, or raise|0= No | |

| |livestock |1= Yes | |

| |If 0 = No, skip to A.16 | | |

|A.14 |Where is this land located? |1= Around house only | |

| | |2= Elsewhere | |

| | |3= Both around the house and | |

| | |elsewhere | |

|A.15 |What is the approximate area of this land in total? |Code area in hectares | |

|A.16 |Do you have any other land that is not currently used |0 = no, no other land | |

| |by members of the household to grow produce or raise |1 = yes, rented to others | |

| |livestock? |2 = yes, loaned to others (no | |

| |If 0, and A.13=0 skip to A23 |rent) | |

| |If 0, and A.13=1 skip to A19 |3 = yes, but not used | |

| |If 2 or 3, skip to A.18 | | |

|A.17 |How much does the household receive in rent for this |Code ANNUAL rental income in | |

| |land |local currency | |

|A.18 |What is the approximate area of this land in total? |Code area in hectares | |

|LAND OWNED BY HOUSEHOLD | | |

|A.19 |Is any of this land owned by members of the household. |0= No | |

| |If 0 = No, skip to A.21 |1= Yes | |

|A.20 |What is the total value of the land owned by each |Owner (code number from grid) |Approximate value in local|

| |household member who owns land? | |currency |

|A.20.1 |1st Household Member owning land | | |

|A.20.2 |2nd Household Member owning land | | |

|A.20.3 |3rd Household Member owning land | | |

|A.20.4 |4th Household Member owning land | | |

|LAND RENTED BY HOUSEHOLD | | |

|A.21 |Is any of the land rented by members of the household |0= No | |

| |from others? |1= Yes | |

| |If 0 = No, skip to A.23 | | |

|A.22 |What is the rent paid for the land? |Code total ANNUAL rent for all | |

| | |land rented by the household | |

|LIVESTOCK OWNED BY HOUSEHOLD | | |

|A.23 |Does anybody in the household own livestock? |0= No | |

| |If 0 = No, skip to SECTION B |1= Yes | |

| |If 1= yes, enter the number of animals in each category|Owner (code number from grid) |Number of animals |

| |below, signifying the main owner in each case | | |

|A.23.1 |Chickens, ducks and geese | | |

|A.23.2 |Pigs | | |

|A.23.3 |Horses, mules and donkeys | | |

|A.23.4 |Sheep and goats | | |

|A.23.4 |Cattle | | |

|A.23.5 |Other types of livestock | | |

|A.24 |What is the total value of these and any other |Code total estimated market | |

| |livestock owned by family members |value of livestock listed under| |

| | |A.19 | |

SECTION B: HOUSEHOLD COMPOSITION

|INTERVIEWER: CRITERIA FOR "PERSONS IN THIS HOUSEHOLD": |

| |

|All persons who |

| |

|(1) live under the same roof or in the same compound for at least three months of the last six months, and |

|(2) that the individuals understand themselves to be members of the same household. |

| |

|B0 |Do you have any live-in paid domestic help? |0=No, OR 1= Yes| |

| |(If 0, then go to B1.1) | | |

|B0.1 |Do you consider this person to be a member of the household (if 1, then |0=No, OR 1= Yes| |

| |enumerate them below) | | |

|B1.1 |How many persons live in this household aged 16 years and over? (Enter |MEN | |

| |actual number of persons if none = O) | | |

| | |WOMEN | |

| | |TOTAL | |

|B1.2 |How many persons live in this household aged 0 to 15 years? |BOYS | |

| |(Enter actual number of persons if none = O) | | |

| | |GIRLS | |

| | |TOTAL | |

|B1.3 |How many persons live in this household IN TOTAL? |TOTAL | |

|INTERVIEWER: ENSURE THAT MEN + WOMEN = TOTAL IN B1.1 AND BOYS + GIRLS = TOTAL IN B1.2. |

|FURTHER ENSURE THAT TOTAL IN B1.3 IS EQUAL TO NUMBER OF PERSONS IN HOUSEHOLD MATRIX IN B2C. |

B2A HOUSEHOLD MATRIX AT LAST ASSESSMENT

NOTE FOR INTERVIEWER - If A1 = 0 (index older person has moved since incidence phase 10/66 survey assessment), DO NOT COMPLETE THIS GRID – SKIP TO B2C

I am now going to ask you about all the persons who lived with the index person the last time we interviewed them in 200x

NOTE TO INTERVIEWER – DO NOT WRITE FULL NAME IN COLLUMN BA3. USE FIRST NAME/ NICKNAME ETC, SUFFICIENT ONLY FOR THIS INDIVIDUAL TO BE IDENTIFIED CONFIDENTLY ON REVISIT FOR QUALITATIVE INTERVIEW.

|BA1 |BA2 |BA3 |BA4 |BA5 |BA6 |BA7 |

| |All |All |All |All |All |All |

|Person Code |Person Name |Person gender |Person age |How long ago did X move into the |Did this person move into |Did this person move into |

| | | | |household (or how long ago were |the household wholly or |the household wholly or |

| | | | |they born for those born into the |partly to provide care for|partly to take on the role|

| | | | |household? |the index older person? |or responsibilities of |

| | | | | |0= No |someone else who is now |

| | | | |Write in Months; |1= Yes |providing care for the |

| | | | |0 if less than one month | |index older person? |

| | | | | | |0= No |

| | | | | | |1= Yes |

| | |1=female | | | | |

|Allocate new codes | |2=male | | | | |

|starting 101 | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

B2C HOUSEHOLD MATRIX – Current household composition

I am now going to ask you for information in respect of all persons who live in this household now

|All |All | |All |All |16 and over |All |

|BC1 |BC2 |BC3 |BC4 |BC5 |BC6 |BC7 |

| |All |If C2=0 |If C2>0 |If C2>0 |If C2>0 |If C2>0 |

|Person code |Number of months worked|What is the main reason X did not |How many hours does X |What job does X do? |In X’s main job does she/he |What is the location of X’s main job? |

| |in the last three |work last month? |USUALLY work per week? | |work as an | |

| |months | | | | |1= At home |

| | |1= Care for children |Hours ON AVERAGE |1= manager |1= Employee |2= Outside of home, within 1 km |

| |IVW - work is defined |2= Care for older relatives | |2=professional |2= Employer |3= Outside of home, within 1-3kms |

| |as full or part-time - |3= Chronic illness or disability | |3= associate professional |3= Unwaged family worker |4= Outside of home, 4-10kms |

| |paid employment/ |4= Student | |4=clerical |4= Is self-employed |5= outside of home, more than 10kms |

| |self-employment or |5= Retired | |5=shop keeper |5= Member of cooperative | |

| |helping out relatives /|6= Homemaker (unpaid housework) | |6=skilled labourer | | |

| |others in exchange for |7= Works occasionally | |7=semi-skilled labourer |Other (specify IN GRID | |

| |goods or services |8= Is looking for employment but cannot| |8=unskilled labourer | | |

| | |find | |9=agricultural worker | | |

| |Enter in Months; none=0|9= Has independent income and doesn’t | | | | |

| |0, go to C4 | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

SECTION D: HOUSEHOLD INCOME (Now I would like to ask you about the income that each person in this household receives CURRENTLY in a typical month)

We are interested in the total income received by members of the household currently, in a typical month. We are interested in the amount each person receives, only to get the most accurate estimate of the household’s total income. If a particular source of income is not, or cannot be linked to a particular person, then we can record this as income for the household as a whole.

IVW – Attempt, for each source of income, to attribute it to one or more individuals on the grid below. Only if this cannot be done should you enter the amount under ‘whole household’. Do net enter the same income twice, either under ‘whole household’ and a specific individual, or under several specific individuals

|Person Code|Whole household | | |

|(Enter |** | | |

|code) | | | |

|D24 |Think about the food produced consumed by the household in a typical month. If you had to buy this| |

| |food, about how much would it cost? |R |

|D25 |Does anyone in this household have a bank or savings account,|0=No | |

| |stocks or shares, or any other savings or investments that |1= Yes | |

| |could be used to meet household expenses, if necessary | | |

| |If 0=No, skip to Section E | | |

|D26 |Bank account |0=No | |

| |If 0 = No, skip to D28 |1= Yes | |

|D27 |Approximate total assets in household members bank accounts |Code amount in local currency | |

|D28 |Savings account |0=No | |

| |If 0 = No, skip to D30 |1= Yes | |

|D29 |Approximate total assets in household members savings |Code amount in local currency | |

| |accounts | | |

|D30 |Stocks and shares |0=No | |

| |If 0 = No, skip to D32 |1= Yes | |

|D31 |Approximate total assets in household members stocks and |Code amount in local currency | |

| |shares | | |

|D32 |Other savings or investments |0=No | |

| |If 0 = No, skip to Section E |1= Yes | |

|D33 |Approximate total assets in household members in other |Code amount in local currency | |

| |savings or investments | | |

SECTION E: HOUSEHOLD EXPENDITURE

Now I am going to ask you some questions about a couple about expenditure of this household.

|E1 |In the past 12 months, did this household have any major unforeseen or |0 = No | |

| |unexpected expenses, EXCLUDING those for health care? |1= Yes | |

| |If 0 = No, skip to E2 | | |

|E1.1 |What were these expenses and what were the amounts involved. |

| |IVW: indicate up to five expenses. Probe, if needed. Do NOT read out options. |

| |CODES |CODE |AMOUNT in local |

| |1= Funeral expenses; |(category of expense 1-7, |currency |

| |2= Expenses relating to other traditional customs or ceremonies, |see box to left) | |

| |including marriage and birth; | | |

| |3= Home improvements or new building; | | |

| |4= Maintenance, or repair of damage to property | | |

| |5= Legal expenses, fines | | |

| |6= Major purchases (car, equipment, furniture etc – include here only | | |

| |those items bought outright) | | |

| |7= other | | |

| |IVW – DO NOT CODE MEDICAL OR HEALTHCARE EXPENSES HERE | | |

|E1.2 |Major expense 1 | | |

|E1.3 |Major expense 2 | | |

|E1.4 |Major expense 3 | | |

|E1.5 |Major expense 4 | | |

|E1.6 |Major expense 5 | | |

|E2 |What is your best estimate of what the entire household spent on the |TOTAL EXPENDITURE ON ITEM |1= about the same |

| |following items in the last ONE MONTH? Is that about the same, more, |IN LAST MONTH |2 = more |

| |less or much less than in a typical month last year? | |3= less |

| |Note to IVW – CODE FOR EVERY ITEM - if no expenditure then code ‘0’ and| |4 = much less |

| |code whether this is the same, or less than last year | | |

|FOOD | | |

|E2.1 |Vegetables and fruit | | |

|E2.2 |Meat, chicken and/or fish | | |

|E2.3 |Other groceries (food items or comestibles used in food preparation) | | |

|E2.4 |Food eaten out, or bought from street vendor | | |

|HOUSEHOLD EXPENSES | | |

|E2.5 |Rent, mortgage or loan repayments on dwelling | | |

|E2.6 |Household rates | | |

|E2.7 |Electricity | | |

|E2.8 |Water | | |

|E2.9 |Fuel (coal, paraffin, oil, gas, wood) | | |

|E2.10 |Telephone and mobile phone bills | | |

|OTHER PERSONAL EXPENDITURE | | |

|E2.11 |Clothing and shoes (including any lay-bye payments) | | |

|E2.12 |Personal items (haircuts, toiletries, birthday gifts) | | |

|E2.13 |Transportation | | |

|E2.14 |Alcohol | | |

|E2.15 |Tobacco | | |

|E3 |What is your best estimate of what the entire household spent on the |TOTAL EXPENDITURE ON ITEM |1= about the same |

| |following items in the last ONE YEAR? Is that about the same, more, |IN LAST YEAR |2 = more |

| |less or much less than in the year before? | |3= less |

| |Note to IVW – CODE FOR EVERY ITEM - if no expenditure then code ‘0’ and| |4 = much less |

| |code whether this is the same, or less than last year | | |

|E3.1 |Money spent on/ invested in business, farming or livestock | | |

|E3.2 |School uniforms, books, transport to school (including tertiary | | |

| |education) | | |

|E3.3 |School fees, including payment for tuition (including tertiary | | |

| |education) | | |

|E3.4 |Membership fees for clubs or religious organisations | | |

|E3.5 |Burial society dues | | |

|E3.6 |Hire purchase repayments for furniture, appliances | | |

|E3.7 |Payment of other debts, instalments or micro-loans, etc. | | |

|E3.8 |Holidays and entertainment | | |

|E3.9 |Lottery and gambling | | |

|E3.10 |Money or goods given to people outside the household, including any | | |

| |charitable donations | | |

|E4 |About how much money does this household spend in a typical month on |1= R0-R399 | |

| |all its expenses? (ask and do not calculate) |2= R400- R799 | |

| | |3= R800- R1199 | |

| | |4= R1200- R1799 | |

| | |5= R1800- R2499 | |

| | |6= R2500- R4999 | |

| | |7= R5000- R9999 | |

| | |8= R10000 or more | |

SECTION F - HOUSEHOLD DEBTS AND LOANS, AND OTHER INDICATORS OF HOUSEHOLD STRAIN

|f.5 |Do any members of this household have any debts at |0 = No | |

| |present? |1 = Yes | |

| |If 0 = No, skip to F7 | | |

| |If 1=yes |IVW list up to six highest value debts. Probe, if needed. |

| |What debts do members of this household have at present |For each debt, ascertain nature of debt, monthly repayment, interest rate, outstanding debt, and identity of responsible |

| |and what are the amounts of these debts? |household member. |

|F6 |F6.1 |F6.2 |F6.3 |F6.4 |F6.5 |

| |Nature of debt |How much are you repaying each |Interest rate (annual %) |Outstanding amount owed on debt|Which household member is |

| |1=Credit card debt |month? |MV 999 |(including any interest |mainly responsible for this |

| |2= unpaid bills (electricity, gas, telephone, rates) | | |accumulated) |debt (code number from grid)? |

| |3= unpaid bills (food suppliers, or other traders) | | | | |

| |4= rent or mortgage arrears | | | | |

| |5= other | | | | |

|1 | | | | | |

|2 | | | | | |

|3 | | | | | |

|4 | | | | | |

|5 | | | | | |

|6 | | | | | |

|F7 |Has anyone in the household taken out a loan, for which at|0 = No | |

| |least some money is still owing? |1 = Yes | |

| |If 0 = No, skip to F11 | | |

|F8 |If yes |IVW list up to six highest value loans. Probe, if needed. |

| |From whom or from where did you obtain this loan? |For each loan, ascertain nature of loan, monthly repayment, interest rate, outstanding loan, and identity of responsible |

| |What was the main purpose of the loan? |household member. |

| |What is the outstanding amount of the loan? | |

| |What is the interest rate? | |

| |How much are you repaying each month? | |

| |F8.1 |F8.2 |F8.3 |F8.4 |F8.5 |F8.6 |

| |Purpose of loan |Origin of loan |How much are you repaying each |Interest rate (annual %) |Outstanding amount owed on loan|Which household member is |

| |1 =Home loan (to buy a house or|1. Bank, microlender or |month? | |(including interest |mainly responsible for this |

| |other property) |other institution | |MV = 999 |accumulated) |loan (code number from grid)? |

| |2 =Home improvement or |2. Family or friend | | | | |

| |renovation |3. Local money lender | | | | |

| |3 =other major purchase |4. advance of salary or | | | | |

| |4 =To cover health care costs |loan from employer | | | | |

| |5 =to cover education costs |5. Other | | | | |

| |6 =to cover general expenditure| | | | | |

| |(due to income shortfall) | | | | | |

| |7 =to cover major unforeseen or| | | | | |

| |unexpected expenses | | | | | |

| |8 = other | | | | | |

|1 | | | | | | |

|2 | | | | | | |

|3 | | | | | | |

|4 | | | | | | |

|5 | | | | | | |

|6 | | | | | | |

|F9 |How regularly is your household able to meet these loan |1= Most of the time | |

| |repayments? |2 – some of the time | |

| | |3 – occasionally | |

| | |4 - never | |

|F10 |In your opinion, will the household be able to pay off |1 = impossible | |

| |these loans? |2 = very difficult | |

| |If yes, |3 = we will manage, but with some difficulty | |

| |How difficult do you think that will be? |4 = we will manage, with no difficulty | |

|F11 |In the last three years, because of financial difficulty, |0= No or |Are you currently |

| |have you had to ….. |1=Yes |having to do this?|

| | | |0 = No |

| | | |1 = Yes |

|F11.1 |Ask friends and relatives for help? | | |

|F11.2 |Ask an employer for help? | | |

|F11.3 |Ask a religious organisation, or an NGO for help? | | |

|F11.4 |Borrow from a bank, moneylender or loan shark? | | |

|F11.5 |Cut down on food consumption? | | |

|F11.6 |Try to find extra work? | | |

|F11.7 |Run up an account with a shop? | | |

|F11.8 |Apply for a grant? | | |

|F11.9 |Apply for food parcels/food vouchers? | | |

|F11.10 |Draw on your savings, sell stocks or shares | | |

|F11.11 |Any other action to address the financial difficulty? | | |

SECTION G: HEALTH AND CARE

Now we’d like to talk to you about health and health care in this household:

|G1 |G2 |G3 |G4 |G5 |G6 |What would you estimate to be the total cost of any medical treatment or care that X has received, over |

| | | | | | |the last 3 months? I am going to ask you about different types of medical and care services |

|All |Sick, injured or disabled |Sick, injured |Sick, injured or |Sick, injured or |Sick, injured or |Sick, injured or disabled |

| | |or disabled |disabled |disabled and |disabled and | |

| | | | |needing care |needing care | |

|Has |What is the nature of the sickness or injury? |How long has X been sick, injured or disabled? |Does x require |

|any |(If more than one, code the most important) | |special care or |

|member| | |support from other|

|of |1. lifelong disability (since birth) |Enter Months, code 0 if less than one month |household members |

|this |2. infection | |because of a |

|househ|3. mental disorder | |long-term illness |

|old |4. other chronic disease | |or disability? |

|been |5. accident or injury | | |

|sick, |6. other | |0 = No |

|injure| | |1 = Yes |

|d or | | |If 0=No, skip to |

|disabl| | |G7 |

|ed, | | | |

|and/ | | | |

|or | | | |

|receiv| | | |

|ing | | | |

|any | | | |

|treatm| | | |

|ent or| | | |

|care | | | |

|for a | | | |

|health| | | |

|condit| | | |

|ion | | | |

|over | | | |

|the | | | |

|past | | | |

|three | | | |

|months| | | |

|? | | | |

| | | | |

|IVW: | | | |

|Includ| | | |

|e all | | | |

|those | | | |

|with | | | |

|an | | | |

|acute | | | |

|or | | | |

|chroni| | | |

|c | | | |

|illnes| | | |

|s, | | | |

|and/ | | | |

|or | | | |

|disabi| | | |

|lity | | | |

|arisin| | | |

|g from| | | |

|a | | | |

|health| | | |

|condit| | | |

|ion | | | |

| | | | |

|Enter | | | |

|person| | | |

|code | | | |

|If | | | |

|none, | | | |

|skip | | | |

|to | | | |

|sectio| | | |

|n G | | | |

|H2 |How would you rate the financial situation of |1= Very good | |

| |this household AT PRESENT? Is it very good, |2= Good | |

| |good, average, bad or very bad? |3= Average | |

| | |4= Bad | |

| | |5= Very bad | |

|H3 |How would you rate the financial situation of |1= Better | |

| |the household compared to three years ago? Is |2= Same | |

| |it better, the same or worse than three years |3= Worse | |

| |ago? |IF 2 go to G5. | |

|H4 |What would you say is the MAIN reason for the | | |

| |change in the financial situation of the | | |

| |household? (Write exact words and only ONE | | |

| |reason)) | | |

|H5 |How do you expect life will be like for this |1= Better | |

| |household in five years time? |2= Same | |

| | |3= Worse | |

I. SIGNIFICANT CHANGES SINCE THE INCIDENCE WAVE INTERVIEW IN 200X

I am now going to ask you about significant changes that have happened to this household since 200X

|I1 |Have any breadwinners moved into the household? |0 = No | |

| |If 0, go to I3 |1 = Yes | |

|I2 |Has this resulted in an increase in household income? If yes, by how much per |Code increase in income in local | |

| |month? |currency, per month, If no increase | |

| | |code ‘0’ | |

|I3 |Have any breadwinners moved out of the household, or died? |0 = No | |

| |If 0, go to I5 |1 = Yes | |

|I4 |Has this resulted in a loss of household income? If yes, by how much per month? |Code loss of income in local currency, | |

| | |per month, If no loss code ‘0’ | |

|I5 |Do you think that, on the whole relations between household members are the same, |1 = The same | |

| |better or worse than they were in 200x? |2 = Better | |

| |If 1 0r 2, skip to Section AA |3 = Worse | |

|I6 |Which of the following factors, in your opinion, might have contributed to the | | |

| |worsening relations? | | |

|I6.1 |Insufficient income to meet the household’s needs |0 = No | |

| | |1 = Yes | |

|I6.2 |Conflicts over money |0 = No | |

| | |1 = Yes | |

|I6.3 |Overcrowding |0 = No | |

| | |1 = Yes | |

|I6.4 |Other housing problems, for example unsuitable housing, insecure tenancy, problems|0 = No | |

| |with landlord |1 = Yes | |

|I6.5 |Interpersonal difficulties |0 = No | |

| | |1 = Yes | |

|I6.6 |Stress in meeting the needs for care and supervision for children in the household|0 = No | |

| | |1 = Yes | |

|I6.7 |Conflict over care arrangements for children |0 = No | |

| | |1 = Yes | |

|I6.8 |Stress in meeting the needs for care and supervision for older people in the |0 = No | |

| |household |1 = Yes | |

|I6.9 |Conflict over care arrangements for older adults |0 = No | |

| | |1 = Yes | |

|16.10 |Could you tell me about any positive changes or happy events that have affected |0= none identified | |

| |the household since 200x? |1= one positive event described | |

| | |2= two or more positive events | |

| | |described | |

THANK YOU FOR YOUR TIME

SECTION AA: OLDER ADULT INFORMANT INTERVIEW

I would now like to ask you some more questions specifically about X (IVW – that is the index older person)

IVW - First establish if the older person needs care because of an underlying health condition and/ or disability

| |HOUSEHOLD IDENTIFIER |HOUSEID | |

| |PARTICIPANT IDENTIFIER |PARTICID | |

|AA.1 |Does X require extra help, support or supervision, because of a health |0 = No | |

| |condition or disability? |1 = Yes | |

|AA.2 |What do you think would be the longest period of time that X could manage by |0= They could not be| |

| |themselves, without help from others, supposing that they were living on their|left on their own | |

| |own? |1= A few hours | |

| | |2= A morning or | |

| |If AA1 = 0 and AA2 = 6 skip to Section BB |afternoon | |

| | |3= A whole day | |

| | |4= A whole day and a| |

| | |night | |

| | |5= Two to three days| |

| | |6= Longer than that | |

|Open ended |What kind of help does/ would X need inside of the home? | |

|questions |What kind of help does/ would X need inside of the home? | |

| |Who, in the family, is available to care for x? | |

| |What help do you provide? | |

| |Do you help to organise care and support for your xxxx? | |

| |Is there anyone else in the family who is also involved in helping? | |

| |What help do they provide? | |

| |What about friends and neighbours? | |

| |What help do they provide? | |

|AA.3 |IVW coding – based upon the answers to these questions, use you judgment to |1 = needs care much of the time | |

| |make the coding; does the older person need care much of the time, |2 = needs care occasionally | |

| |occasionally, or does not need care |3 = does not need care; they are able | |

| | |to do everything for themselves | |

|AA.4 |Communicating with the person |Code time in HOURS | |

| |Please consider the following examples of activities | | |

| |- Answering the same question again and again | | |

| |- Trying to make sense of what the person says | | |

| |- Leaving reminders for the person | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.5 |Using transport |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Organising transport or reminding the person about means of transport |2 = 1 to 2 hours | |

| |- Taking the person to various places(other than shopping)by car, public |3 = more than two hours | |

| |transport, taxi or any other means of transport | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.6 |C2.3 Dressing |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Reminding the person to dress |2 = 1 to 2 hours | |

| |- Choosing what to wear |3 = more than two hours | |

| |- Laying out clothes | | |

| |- Helping the person to dress or undress | | |

| |- Supervising the person dressing | | |

| |- Keeping the person from undressing at the wrong time | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.7 |Eating |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Reminding the person to eat |2 = 1 to 2 hours | |

| |- Setting up utensils and food |3 = more than two hours | |

| |- Cutting or arranging food on the plate | | |

| |- Supervising or encouraging the person to eat | | |

| |- Cleaning the person after eating | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.8 |Looking after one’s appearance |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Reminding the person to brush their teeth, brush their hair, apply |2 = 1 to 2 hours | |

| |cosmetics, shave or care for nails |3 = more than two hours | |

| |- Helping the person to groom | | |

| |- Setting out items for grooming activities | | |

| |- Supervising grooming activities | | |

| |- Maintaining the person’s appearance over the course of the day | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.9 |Supervising the person |Code time in HOURS | |

| |Please consider the following examples of activities: | | |

| |- Keeping an eye on the person to be sure that they do not wander off or get | | |

| |into some kind of difficulty | | |

| |- Looking out for the person | | |

| |- Preventing the person from getting lost | | |

| |- Finding the person if they get lost | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.10 |TOILETTING |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Reminding, encouraging or persuading the person to use the toilet |2 = 1 to 2 hours | |

| |Helping the person to the toilet, and on and off the toilet |3 = more than two hours | |

| |- Dealing with incontinence, e.g. washing the person, cleaning clothes | | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

|AA.11 |HELPING WITH bathing |0 = no time | |

| |Please consider the following examples of activities: |1 = less than 1 hour | |

| |- Reminding, encouraging or persuading the person to wash or bathe |2 = 1 to 2 hours | |

| |- Helping the person to wash or bathe |3 = more than two hours | |

| | | | |

| |Thinking back over the past day, how much time did you spend in the last 24 | | |

| |hours (day and night) doing these types of activities? | | |

AA12. Household care arrangements for the index older person

|AA12. I am now going to ask you about the different household members, INCLUDING YOURSELF who are now, or have ever been involved in providing care for X, and the impact that this has had on them |

|NOTE FOR IVW – ENQUIRE ABOUT ALL HOUSEHOLD MEMBERS, BUT ONLY ENTER DETAILS OF THOSE WHO HAVE EVER BEEN INVOLVED IN PROVIDING CARE |

| |AA12.1 |AA12.2 |AA12.3 |

| |THIS QUESTIONNAIRE ASKS ABOUT DIFFICULTIES DUE TO HEALTH CONDITIONS. Health conditions include disease or illnesses, | |

| |other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with | |

| |alcohol or drugs. | |

| |Think about the last 30 days and answer these questions thinking about how much difficulty you had doing the | |

| |following activities. | |

|BB.2 |How much difficulty did you have in standing for long |0 = None | |

| |periods such as 30 minutes? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.3 |How much difficulty did you have in taking care of your |0 = None | |

| |household responsibilities? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.4 |How much difficulty did you have in learning a new task, for|0 = None | |

| |example, learning how to get to a new place? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.5 |How much of a problem did you have joining in community |0 = None | |

| |activities (for example, festivities, religious or other |1 = Mild difficulty | |

| |activities) in the same way as anyone else can? |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.6 |How much have you emotionally affected by your health |0 = Not at all | |

| |problems? |1 = Mildly | |

| | |2 = Moderately | |

| | |3 = Severely | |

| | |4 = Extremely | |

|BB.7 |How much difficulty did you have in concentrating on doing |0 = None | |

| |something for ten minutes? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.8 |How much difficulty did you have in walking a long distance,|0 = None | |

| |such as a kilometer [or equivalent]? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.9 |How much difficulty did you have in washing your whole body?|0 = None | |

| | |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.10 |How much difficulty did you have in getting dressed? |0 = None | |

| | |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.11 |How much difficulty did you have in dealing with people you |0 = None | |

| |do not know? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.12 |How much difficulty did you have in maintaining a |0 = None | |

| |friendship? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.13 |How much difficulty did you have in carrying out your day to|0 = None | |

| |day work and usual activities? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|BB.14 |In the past 30 days, for how many days were you totally |Code number of days (BB.14 + BB.15 should not exceed | |

| |unable to carry out your usual activities or work because of|30) | |

| |any health condition? | | |

|BB.15 |In the past 30 days, not counting the days that you were |Code number of days (BB.14 + BB.15 should not exceed | |

| |totally unable, for how many days did you cut back or reduce|30) | |

| |your usual activities or work because of any health | | |

| |condition? | | |

|BB.16 |Do you personally receive any income from old age pension, |0 = No | |

| |disability benefit, gifts from family or others not living |1 = Yes | |

| |in this household, rent or other sources? | | |

| |If 0 = No, Skip to BB.19 | | |

|BB.17 |Do you mind if I ask approximately how much you receive each|code monthly income in local currency | |

| |month? | | |

|BB.17.1 |Income from pensions |code monthly income in local currency | |

|BB.17.2 |Disability benefits |code monthly income in local currency | |

|BB.17.3 |Rent |code monthly income in local currency | |

|BB.17.4 |Gifts |code average monthly income in local currency | |

|BB.17.5 |Other |code average monthly income in local currency | |

|BB.18 |Do you tend to keep this money, or share it with others in |1 = keeps it all | |

| |the household |2 = keeps most, but shares some with household | |

| | |3 = shares most with household but keeps some | |

| | |4 = shares all with household | |

|BB.19 |Do you regularly give money to family members who live |0 = No | |

| |elsewhere? |1 = Yes | |

| |If 0 = No, skip to BB.21 | | |

|BB.20 |How much, on average, do you give each month? (code in local| | |

| |currency) | | |

|BB.21 |Have you ever taken a loan from a money-lender or a |0 = No | |

| |micro-loan for pensioners? |1 = Yes | |

|BB.22 |Would you say that family members consult you about |1= always | |

| |important decisions affecting you; always, usually, |2= usually | |

| |sometimes or never? |3= sometimes | |

| | |4= never | |

|BB.23 |Would you say that family members consult you about |1= always | |

| |important decisions affecting the household as a whole; |2= usually | |

| |always, usually, sometimes or never? |3= sometimes | |

| | |4= never | |

|BB.24 |Who decides what to do if you need to consult with a doctor,|1 = I decide for myself | |

| |or buy medicines? |2 = I need to ask others in the family or household | |

| | |3 = others in the family or household decide | |

|BB.25 |Who decides what to do if you need to buy clothes, shoes, |1 = I decide for myself | |

| |toiletries or other necessities of daily life? |2 = I need to ask others in the family or household | |

| | |3 = others in the family or household decide | |

|BB.27 |To what extent are your needs met for…. | | |

|BB. 27.1a |Comfort and shelter |1 = Completely. met, I have everything I need | |

| | |2 = partly met, I have some but not all of the things I| |

| | |need | |

| | |3 = not met, I lack basic necessities | |

|BB. 27.1b |In your opinion, Could more be done to meet your needs for |0 = no | |

| |comfort and shelter, given the economic situation of your |1 = yes | |

| |household and family? | | |

|BB. 27.2a |Food |1 = Completely. met, I have everything I need | |

| | |2 = partly met, I have some but not all of the things I| |

| | |need | |

| | |3 = not met, I lack basic necessities | |

|BB. 27.2b |In your opinion, Could more be done to meet your needs for |0 = no | |

| |food, given the economic situation of your household and |1 = yes | |

| |family? | | |

|BB. 27.3a |Medical care |1 = Completely. met, I have everything I need | |

| | |2 = partly met, I have some but not all of the things I| |

| | |need | |

| | |3 = not met, I lack basic necessities | |

|BB. 27.3b |In your opinion, Could more be done to meet your needs for |0 = no | |

| |medical care, given the economic situation of your household|1 = yes | |

| |and family? | | |

|BB. 27.4a |Clothes and other necessities of daily life |1 = Completely. met, I have everything I need | |

| | |2 = partly met, I have some but not all of the things I| |

| | |need | |

| | |3 = not met, I lack basic necessities | |

|BB. 27.4b |In your opinion, Could more be done to meet your needs for |0 = no | |

| |clothes and the necessities of life, given the economic |1 = yes | |

| |situation of your household and family? | | |

|BB. 27.5a |Transport; that is getting around to everywhere you need and|1 = Completely. met, I have everything I need | |

| |want to go? |2 = partly met, I have some but not all of the things I| |

| | |need | |

| | |3 = not met, I lack basic necessities | |

|BB. 27.5b |In your opinion, Could more be done to meet your needs for |0 = no | |

| |transport, given the economic situation of your household |1 = yes | |

| |and family? | | |

|BB.28 |Are you currently involved in providing care or supervision |0 = no | |

| |(baby-sitting/ childminding) to children under the age of 16|1 = yes, taking sole responsibility | |

| |in your household |2 = yes, assisting others | |

|BB.29 |How many hours per week, on average, do you provide care or |Code average number of hours per week | |

| |supervision (baby-sitting/ childminding) to children under | | |

| |the age of 16 in your household | | |

|BB.30 |In the last YEAR, how much money in total have you given to |Code total amount of money given in last year, in local| |

| |help pay for schooling of children in your household or |currency | |

| |family? | | |

|BB.31 |In the last YEAR, how much money in total have you given to |Code total amount of money given in last year, in local| |

| |help pay for medical care of children in your household or |currency | |

| |family? | | |

|BB.32 |Taking everything into consideration how would you describe |0 = good | |

| |your satisfaction with life in general at the present time; |1 = fair | |

| |good, fair or poor? |2 = poor | |

|BB.33 |In general, how happy would you say you are: very happy, |0 = very happy | |

| |fairly happy, not very happy, or not happy at all?: |1 = fairly happy | |

| | |2 = not very happy | |

| | |3 = not very happy at all | |

SECTION CC: INDEX OLDER PERSON INTERVIEW BY PROXY

Note for IVW. This section should only be completed if the index older person does not have or may not have the capacity to understand these questions and provide meaningful responses. Under these circumstances, we are asking a person who knows the older person well to provide the answers to the best of their ability. This would probably be the same person who completed the informant interview about the older person (Section X).

| |Thank you for agreeing to answer some questions about X. We | | |

| |understand that you may not know the answers to some of | | |

| |these questions | | |

|CC.1 |How do you rate X’s overall health in the past 30 days? |0 = Very good | |

| | |1 = Good | |

| | |2 = Moderate | |

| | |3 = Bad | |

| | |4 = Very bad | |

| |THIS QUESTIONNAIRE ASKS ABOUT DIFFICULTIES DUE TO HEALTH CONDITIONS. Health conditions include disease or illnesses, | |

| |other health problems that may be short or long lasting, injuries, mental or emotional problems, and problems with | |

| |alcohol or drugs. | |

| |Think about the last 30 days and answer these questions thinking about how much difficulty X had doing the following | |

| |activities. | |

|CC.2 |How much difficulty did X have in standing for long periods |0 = None | |

| |such as 30 minutes? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.3 |How much difficulty did X have in taking care of household |0 = None | |

| |responsibilities? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.4 |How much difficulty did X have in learning a new task, for |0 = None | |

| |example, learning how to get to a new place? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.5 |How much of a problem did X have joining in community |0 = None | |

| |activities (for example, festivities, religious or other |1 = Mild difficulty | |

| |activities) in the same way as anyone else can? |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.6 |How much do you think X has been emotionally affected by |0 = Not at all | |

| |their health problems? |1 = Mildly | |

| | |2 = Moderately | |

| | |3 = Severely | |

| | |4 = Extremely | |

|CC.7 |How much difficulty did X have in concentrating on doing |0 = None | |

| |something for ten minutes? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.8 |How much difficulty did X have in walking a long distance, |0 = None | |

| |such as a kilometer [or equivalent]? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.9 |How much difficulty did X have in washing their whole body? |0 = None | |

| | |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.10 |How much difficulty did X have in getting dressed? |0 = None | |

| | |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.11 |How much difficulty did X have in dealing with people they |0 = None | |

| |do not know? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.12 |How much difficulty did X have in maintaining a friendship? |0 = None | |

| | |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.13 |How much difficulty did X have in carrying out your day to |0 = None | |

| |day work and usual activities? |1 = Mild difficulty | |

| | |2 = Moderate difficulty | |

| | |3 = Severe difficulty | |

| | |4 = Extreme difficulty/ cannot do | |

|CC.14 |In the past 30 days, for how many days was X totally unable|Code number of days (CC.14 + CC.15 should not exceed | |

| |to carry out their usual activities or work because of any |30) | |

| |health condition? | | |

|CC.15 |In the past 30 days, not counting the days that X was |Code number of days (CC.14 + CC.15 should not exceed | |

| |totally unable, for how many days did X cut back or reduce |30) | |

| |their usual activities or work because of any health | | |

| |condition? | | |

|CC.16 |Does X personally receive any income from old age pension, |0 = No | |

| |disability benefit, gifts from family or others not living |1 = Yes | |

| |in this household, rent or other sources? | | |

| |If 0 = No, Skip to CC.19 | | |

|CC.17 |Do you mind if I ask approximately how much X receives each |code monthly income in local currency | |

| |month? | | |

|CC.17.1 |Income from pensions |code monthly income in local currency | |

|CC.17.2 |Disability benefits |code monthly income in local currency | |

|CC.17.3 |Rent |code monthly income in local currency | |

|CC.17.4 |Gifts |code average monthly income in local currency | |

|CC.17.5 |Other |code average monthly income in local currency | |

|CC.18 |Does X tend to keep this money, or share it with others in |1 = keeps it all | |

| |the household? |2 = keeps most, but shares some with household | |

| | |3 = shares most with household but keeps some | |

| | |4 = shares all with household | |

|CC.19 |Does X regularly give money to family members who live |0 = No | |

| |elsewhere? |1 = Yes | |

| |If 0 = No, skip to CC.21 | | |

|CC.20 |How much, on average, does X give each month? (code in local| | |

| |currency) | | |

|CC.21 |Has X ever taken a loan from a money-lender or a micro-loan |0 = No | |

| |for pensioners? |1 = Yes | |

|CC.22 |Would you say that family members consult X about important |1= always | |

| |decisions affecting them; always, usually, sometimes or |2= usually | |

| |never? |3= sometimes | |

| | |4= never | |

|CC.23 |Would you say that family members consult X about important |1= always | |

| |decisions affecting the household as a whole; always, |2= usually | |

| |usually, sometimes or never? |3= sometimes | |

| | |4= never | |

|CC.27 |To what extent are X’s needs met for…. | | |

|CC. 27.1a |Comfort and shelter |1 = Completely. met, X has everything they need | |

| | |2 = partly met, X has some but not all of the things | |

| | |they need | |

| | |3 = not met, X lacks basic necessities | |

|CC. 27.2a |Food |1 = Completely. met, X has everything they need | |

| | |2 = partly met, X has some but not all of the things | |

| | |they need | |

| | |3 = not met, X lacks basic necessities | |

|CC. 27.3a |Medical care |1 = Completely. met, X has everything they need | |

| | |2 = partly met, X has some but not all of the things | |

| | |they need | |

| | |3 = not met, X lacks basic necessities | |

|CC. 27.4a |Clothes and other necessities of daily life |1 = Completely. met, X has everything they need | |

| | |2 = partly met, X has some but not all of the things | |

| | |they need | |

| | |3 = not met, X lacks basic necessities | |

|CC. 27.5a |Transport; that is getting around to everywhere that X needs|1 = Completely. met, X has everything they need | |

| |and want to go? |2 = partly met, X has some but not all of the things | |

| | |they need | |

| | |3 = not met, X lacks basic necessities | |

|CC.28 |Is X currently involved in providing care or supervision |0 = no | |

| |(baby-sitting/ childminding) to children under the age of 16|1 = yes, taking sole responsibility | |

| |in your household |2 = yes, assisting others | |

|CC.29 |How many hours per week, on average, does X provide care or |Code average number of hours per week | |

| |supervision (baby-sitting/ childminding) to children under | | |

| |the age of 16 in your household | | |

|CC.30 |In the last YEAR, how much money in total has X given to |Code total amount of money given in last year, in local| |

| |help pay for schooling of children in their household or |currency | |

| |family? | | |

|CC.31 |In the last YEAR, how much money in total has X given to |Code total amount of money given in last year, in local| |

| |help pay for medical care of children in their household or |currency | |

| |family? | | |

SECTION H: QUESTIONNAIRE EVALUATION

Note for IVW: Please provide here as rich as possible a description, in your own words of the household situation. Please describe any noteworthy or unusual aspects of the care arrangements for the index older person (if they need care). Remembering that the focus of the study is upon the impact of caring for a dependent older person on the wider household, please also mention any impressions that you have gleaned. We are particularly interested in how and why households may have experienced economic strain. We will not be analysing these data, but they may be very helpful, later, in identifying households for more detailed ‘case studies’.

Please also note down here any difficulties you experienced in the conduct of the interview; for example problems with the interview environment, and any difficulties with asking questions, or getting a codeable response, or deciding what the correct code should be. These could then be discussed with your research coordinator

|H1 |Duration of Interview | |

| | |minutes |

|H2.1 |Personal observations of the | |

| |respondents | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

|H2.2 |Personal observations of the | |

| |interview | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

|H2.3 |Personal observations of the | |

| |household situation | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

|H3 |Other observations or comments | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

| | | |

-----------------------

Chronic and incident dependent , or control group

Care exit group (IOP has died)

Approach household and identify index older person

IOP has died

IOP has moved away

IOP traced

Approach household and identify head of household

No connection with HH when IOP was resident

Exclude household

At least one household member from time when IOP was resident

Introduce study to IOP. Leave them with info sheets for IOP and HOH

Introduce study to HOH. Leave info sheets for household IV when IOP has died

Revisit to seek consent 24 hours later

Given

Declined

Exclude household

Complete section BB or CC (proxy)

Declined

Given

Declined

Complete household IV (section A-I) only

Revisit to seek consent 24 hours later

Consent given to approach KIs for household IV and IOP informant IV?

Declined

Given

Conclude

Introduce study to KI(s). Leave them with info sheets for household IV and IOP informant IV

Revisit to seek consent KIs 24 hours later

Given

Declined

Complete household IV (sections A-I ) and informant IV (Section AA)

No capacity

Seek assent from NoK

Given

Trace to new address

Conclude

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download