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پیوست

پیوست شماره ۱

پرسشنامه کیفیت زندگی سازمان بهداشت جهانی

سؤالات زیر در پی یافتن احساس شما درباره کیفیت زندگی، سلامتی و یا سایر حیطه‌های زندگیتان است

۱ – کیفیت زندگی خود را چگونه ارزیابی می‌کنید؟

۱

۲

۳

۴

۵

بسیار بد

بد

نه خوب، نه بد

خوب

بسیار خوب

۲ – چقدر از سلامتی خود رضایت دارید؟

۱

۲

۳

۴

۵

بسیار ناراضی

ناراضی

نه راضی، نه ناراضی

راضی

بسیار راضی

سؤالات زیر ‌در مورد این است که هر یک از موارد را در چهار هفته گذشته چقدر تجربه کرده‌اید.

۳ – تا چه حدی احساس می‌کنید که درد بدنی، شما را از انجام کارهایی که لازم است انجام دهید باز می‌دارد؟

۱

۲

۳

۴

۵

بسیار زیاد

زیاد

به میزان متوسط

کمی

اصلاً

۴ – برای کارکرد عادی در زندگی روزمره، چقدر به معالجه و درمان پزشکی نیاز دارید؟

۱

۲

۳

۴

۵

بسیار زیاد

زیاد

به میزان متوسط

کمی

اصلاً