{"slug": "questionnaire-in-english", "title": "Questionnaire in English", "pdfUrl": "https://dhir.gov.mt/wp-content/uploads/2024/04/Questionnaire_in_English.pdf", "sourcePage": "https://dhir.gov.mt/en/surveys/european-health-interview-survey-2019-2020-ehis/", "group": "Survey", "topic": "European Health Interview Survey 2019 2020 Ehis", "tables": [{"caption": "Table 1: Name Of Individual", "header": ["NAME OF INDIVIDUAL", "", "", "", "", "", "", "", "", ""], "rows": [["1. REFERENCE NUMBER", "", "", "", "", "", "", "", "", ""], ["2. ID NUMBER", "", "", "", "", "", "", "", "", ""], ["3. Telephone number", "", "", "", "", "", "", "", "", ""], ["4. Mobile number", "", "", "", "", "", "", "", "", ""], ["5. E-mail", "", "", "", "", "", "", "", "", ""], ["6. Respondent\u2019s signature", "", "", "", "", "", "", "", "", ""]]}, {"caption": "Table 2: European Health Interview Survey", "header": ["FOR OFFICIAL USE ONLY", "", "", ""], "rows": [["", "Initials", "Name and Surname", "Date"], ["Interviewer", "", "", ""], ["Vetter", "", "", ""], ["Data Entry Operator", "", "", ""]]}, {"caption": "Table 3: Section A: Core Social Variables", "header": ["CS.1", "What is your gender? (Tick one box ONLY)", ""], "rows": [["CS.1", "Male", "o\u2081"], ["CS.1", "Female", "o\u2082"], ["CS.1", "Transgender Male", "o\u2083"], ["CS.1", "Transgender Female", "o\u2084"], ["CS.1", "Gender-queer/Non-binary", "o\u2085"], ["CS.1", "Other (specify) ______________________________________________________", "o\u2086"]]}, {"caption": "Table 4: CS.3 by Which is your country of birth? (Tick one box ONLY) Malta United Kingdom Italy Germany Serbia Russia Canada Unit", "header": ["CS.3", "Which is your country of birth? (Tick one box ONLY) Malta United Kingdom Italy Germany Serbia Russia Canada United States of America Australia Philippines Other (specify) ______________________________________________________", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], "rows": [["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081 o\u2082 o\u2083 o\u2084 o\u2085 o\u2086 o\u2087 o\u2088 o\u2089 o\u2081\u2080"], ["CS.3", "", "o\u2081\u2081"], ["CS.4", "What is your main citizenship? (Tick one box ONLY)", ""], ["CS.4", "Maltese", "o\u2081"], ["CS.4", "British", "o\u2082"], ["CS.4", "Italian", "o\u2083"], ["CS.4", "German", "o\u2084"], ["CS.4", "Serbian", "o\u2085"], ["CS.4", "Russian", "o\u2086"], ["CS.4", "Canadian", "o\u2087"], ["CS.4", "American", "o\u2088"], ["CS.4", "Australian", "o\u2089"], ["CS.4", "Philippine", "o\u2081\u2080"], ["CS.4", "Other (specify) ______________________________________________________", "o\u2081\u2081"], ["CS.4", "Stateless", "o\u2081\u2082"]]}, {"caption": "Table 5: CS.11 Insert your current main job titleE.g. Primary School Teacher, Carpenter, Clerk, etc.CS.12 Describe your main job", "header": ["CS.11 Insert your current main job titleE.g. Primary School Teacher, Carpenter, Clerk, etc.CS.12 Describe your main job:E.g. Teaching in a primary school, Making furniture, Work in an office, etc."], "rows": [["CS.13 What is the economic activity of the establishment that you work for in your main job?E.g. Primary school, Kitchen making, Manufacture of toys, etc."], ["CS.14 What is your legal marital status? (Tick one box ONLY)Single (never married or never in a registered partnership)                 o\u2081Married (or in a registered partnership)                          o\u2082Legally separated                                      o\u2083Widowed (or persons whose registered partnership ended with the death of thepartner)                                           o\u2084Divorced (or persons whose registered partnership was legally dissolved)         o\u2085Annulled                                          o\u2086"], ["CS.15 Do you currently live with a partner in the same household? (Tick one box ONLY)\u2018Partner\u2019 includes husband, wife, civil partner or de facto partner (partner/cohabitant)Yes                                             o\u2081No                                             o\u2082"], ["CS.16 How many persons reside in this household (including selected individual)?"], ["CS.17 How many persons aged 13 years or less reside in the household?"], ["CS.18 What type of household do you live in? (Tick one box ONLY)Every household differs \u2013 Some households may consist of a couple with children or a couple withoutchildren. Other households may contain a single parent with children or consist of a group of friendsliving together.One-person household                                   o\u2081Lone parent with at least one resident child aged less than 25               o\u2082Lone parent with all resident children aged 25 or more                  o\u2083Couple without resident children                             o\u2084Couple with at least one resident child aged less than 25                 o\u2085Couple with all resident children aged 25 or more                     o\u2086Other (specify)______________________________________________________    o\u2087"]]}, {"caption": "Table 6: Section B: European Health Status Module", "header": ["If questionnaire is answered by a proxy, go to question HS.2HS.1  How is your health in general? (Tick one box ONLY)Very good                                                        o\u2081Good                                                           o\u2082Fair                                                            o\u2083Bad                                                            o\u2084Very bad                                                         o\u2085"], "rows": [["HS.2  Do you have any longstanding illness or longstanding health problem? (By longstanding Imean illness or health problems which have lasted or are expected to last for six months ormore). (Tick one box ONLY)E.g. asthma, diabetes, heart diseaseYes                                                             o\u2081No                                                             o\u2082"], ["HS.3  Are you limited because of a health problem in activities people usually do? (Tick one box ONLY)Yes, severely limited                                                 o\u2081Yes, limited but not severely                                            o\u2082No, not limited at all                                                 o3\u2192 CD.1"], ["HS.4  Have you been limited at least for the past 6 months? (Tick one box ONLY)Yes                                                             o\u2081No                                                             o\u2082"]]}, {"caption": "Table 7: DH.1 by How would you describe the state of your teeth and gums? (Tick one box ONLY)", "header": ["DH.1", "How would you describe the state of your teeth and gums? (Tick one box ONLY)", ""], "rows": [["DH.1", "Very good", "o\u2081"], ["DH.1", "Good", "o\u2082"], ["DH.1", "Fair", "o\u2083"], ["DH.1", "Poor", "o\u2084"], ["DH.1", "Very poor", "o\u2085"]]}, {"caption": "Table 7: DH.1 by How would you describe the state of your teeth and gums? (Tick one box ONLY) (cont. 2)", "header": ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2081"], "rows": [["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", ""], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", ""], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2082 o\u2083 o\u2084 o\u2085"], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2082 o\u2083 o\u2084 o\u2085"], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2082 o\u2083 o\u2084 o\u2085"], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2082 o\u2083 o\u2084 o\u2085"], ["DH.2", "Adults can have up to 32 natural teeth. Which of the following best describes you? (Tick one box ONLY) \u2022 Consider filled teeth as \u2018normal\u2019 own teeth I have all my own teeth \u2013 none missing I have my own teeth, no dentures/implants \u2013 but some teeth are missing I have dentures/implants as well as some of my own teeth I only have dentures/implants I have no teeth/dentures/implants", "o\u2082 o\u2083 o\u2084 o\u2085"], ["DH.3", "During the past 12 months, did you experience any difficulty when it came to eating or speaking as a result of dental and/or other mouth problems? (Tick one box ONLY)", ""], ["DH.3", "Not at all", "o\u2081"], ["DH.3", "A little", "o\u2082"], ["DH.3", "A fair amount", "o\u2083"], ["DH.3", "A lot", "o\u2084"], ["DH.4", "How often do you brush your teeth? (Tick one box ONLY)", ""], ["DH.4", "Never", "o\u2081"], ["DH.4", "Less than once a day", "o\u2082"], ["DH.4", "Once a day", "o\u2083"], ["DH.4", "Twice a day", "o\u2084"], ["DH.4", "More than two times a day", "o 5"], ["DH.4", "", ""], ["ACCIDENTS AND INJURIES", "", ""], ["ACCIDENTS AND INJURIES", "", ""], ["AC.1", "During the past 12 months, have you had a road traffic accident that resulted in injury (external or internal)? (Tick one box ONLY)", ""], ["", "Yes", "o\u2081"], ["", "No", "o \u2192 AC.3 2"], ["AC.2", "Did you visit a doctor, a nurse or an emergency department of a hospital as a result of this accident? (Tick one box ONLY)", ""], ["", "Admission to the emergency department", "o\u2081"], ["", "Visit to a doctor or nurse", "o\u2082"], ["", "No intervention was needed", "o 3"], ["AC.3", "During the past 12 months, have you had an accident at home that resulted in injury (external or internal)? (Tick one box ONLY)", ""], ["AC.3", "Yes", "o\u2081"], ["AC.3", "No", "o \u2192 AC.5 2"], ["AC.4", "Did you visit a doctor, a nurse or an emergency department of a hospital as a result of this accident? (Tick one box ONLY)", ""], ["AC.4", "Admission to the emergency department", "o\u2081"], ["AC.4", "Visit to a doctor or nurse", "o\u2082"], ["AC.4", "No intervention was needed", "o 3"], ["AC.5", "During the past 12 months, have you had an accident while conducting a leisure activity that resulted in injury (external or internal)? (Tick one box ONLY)", ""], ["AC.5", "Yes", "o\u2081"], ["AC.5", "No", "o \u2192 AW.1 2"]]}, {"caption": "Table 9: PL.4 by Do you use a hearing aid? (Tick one box ONLY) If respondent is deaf, do not ask this question and tick option 3", "header": ["PL.4", "Do you use a hearing aid? (Tick one box ONLY) If respondent is deaf, do not ask this question and tick option 3 and go to PL.9 Yes No I am profoundly deaf", "", "", ""], "rows": [["PL.4", "Do you use a hearing aid? (Tick one box ONLY) If respondent is deaf, do not ask this question and tick option 3 and go to PL.9 Yes No I am profoundly deaf", "", "o\u2081", ""], ["PL.4", "Do you use a hearing aid? (Tick one box ONLY) If respondent is deaf, do not ask this question and tick option 3 and go to PL.9 Yes No I am profoundly deaf", "", "o\u2082 \u2192 PL.6 o\u2083", ""], ["PL.4", "Do you use a hearing aid? (Tick one box ONLY) If respondent is deaf, do not ask this question and tick option 3 and go to PL.9 Yes No I am profoundly deaf", "", "\u2192 PL.9", ""], ["PL.5", "Do you have difficulty hearing what is said in a conversation with another person in a quiet room, even when using your hearing aid? (Tick one box ONLY) No difficulty", "", "o\u2081", ""], ["PL.5", "", "", "", ""], ["PL.5", "Some difficulty", "", "o\u2082", "\u2192 PL.7"], ["PL.5", "A lot of difficulty", "", "o\u2083", ""], ["PL.5", "Cannot do at all/Unable to do", "", "o 4", ""], ["PL.6 Do you have difficulty hearing what is said in a conversation with another person in a quiet room? (Tick one box ONLY)", "", "", "", ""], ["", "No difficulty", "", "o\u2081", "\u2192 PL.8"], ["", "Some difficulty", "", "o\u2082", "\u2192 PL.8"], ["", "A lot of difficulty", "", "o\u2083", "\u2192 PL.8"], ["", "Cannot do at all/Unable to do", "", "o 4", "\u2192 PL.8"], ["PL.7 Do you have difficulty hearing what is said in a conversation with another person in a noisier room, even", "", "", "", ""], ["", "No difficulty", "", "o\u2082 \u2192 PL.9 o\u2083 o", ""], ["", "Some difficulty", "", "o\u2082 \u2192 PL.9 o\u2083 o", ""], ["", "A lot of difficulty", "", "o\u2082 \u2192 PL.9 o\u2083 o", ""], ["", "", "", "o\u2082 \u2192 PL.9 o\u2083 o", ""], ["", "Cannot do at all/Unable to do", "", "o\u2082 \u2192 PL.9 o\u2083 o", ""], ["PL.8", "Do you have difficulty hearing what is said in a conversation with another person in a noisier room? (Tick", "", "4", ""], ["PL.8", "one box ONLY)", "", "", ""], ["PL.8", "No difficulty", "", "o\u2081", ""], ["PL.8", "", "", "", ""], ["PL.8", "", "", "o\u2082 o\u2083", ""], ["PL.8", "Some difficulty", "", "o\u2082 o\u2083", ""], ["PL.8", "", "", "o\u2082 o\u2083", ""], ["PL.8", "A lot of difficulty", "", "o\u2082 o\u2083", ""], ["PL.8", "Cannot do at all/Unable to do", "", "o", ""], ["PL.8", "", "4", "", ""], ["PL.9", "Do you have difficulty walking 500 metres on flat terrain without a stick or other walking aid/assistance?", "4", "", ""], ["(Tick one box ONLY)", "", "", "", ""], ["(Tick one box ONLY)", "", "", "", ""], ["", "Some difficulty", "", "o\u2082", ""], ["", "A lot of difficulty", "", "o\u2083", ""], ["", "Cannot do at all/Unable to do", "", "o 4", ""], ["PL.10", "Do you have difficulty walking up or down a flight of 12 steps without a stick or other walking aid/assistance? (Tick one box ONLY)", "", "", ""], ["No difficulty o\u2081", "", "", "", ""], ["", "Some difficulty", "", "o\u2082", ""], ["", "A lot of difficulty", "", "o\u2083", ""], ["", "Cannot do at all/Unable to do", "", "o 4", ""], ["PL.11 Do you have difficulty remembering or concentrating? (Tick one box ONLY)", "", "", "", ""], ["", "o\u2081", "", "", ""], ["", "Some difficulty", "", "o\u2082", ""], ["", "A lot of difficulty", "", "o\u2083", ""], ["", "Cannot do at all/Unable to do", "", "o 4", ""]]}, {"caption": "Table 10: If respondent is aged less than 55 years, go to PN.1", "header": ["", "", "If respondent is aged less than 55 years, go to PN.1", ""], "rows": [["PL.12", "", "Do you have difficulty biting and chewing on hard foods such as a firm apple? (Tick one box ONLY)", ""], ["PL.12", "", "No difficulty", "o\u2081"], ["PL.12", "", "Some difficulty", "o\u2082"], ["PL.12", "", "A lot of difficulty", "o\u2083"], ["PL.12", "", "Cannot do at all/Unable to do", "o 4"]]}, {"caption": "Table 11: Personal Care Activities", "header": ["", "", "", "", "", ""], "rows": [["PC.1", "Indicate the level of difficulty usually experienced when doing the following without help/assistance: (Tick one box PER ROW)", "", "", "", ""], ["", "Feed myself", "o\u2081", "Difficulty o\u2082", "Difficulty o\u2083", "do it alone o\u2084"], ["", "Get in and out of bed/chair", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["", "Dress and undress myself", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["", "Use the toilet", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["", "Bathing/showering myself", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["If \u2018No Difficulty\u2019 is chosen for all options of PC.1, go to question HA.1.", "", "", "", "", ""], ["PC.2 Do you usually get help/assistance when carrying out any such personal care activities? (Tick one box ONLY)", "", "", "", "", ""], ["", "Yes, with at least one activity o\u2081", "", "", "", ""], ["", "Yes, with at least one activity o\u2081", "", "", "", ""], ["", "No", "", "", "", "o \u2192 PC.4 2"], ["If questionnaire is answered by a proxy, go to HA.1.", "", "", "", "", ""], ["PC.3", "Would you require more help/assistance when carrying out such personal care activities? (Tick one box ONLY)", "", "", "", ""], ["PC.3", "Yes, with at least one activity o\u2081 \u2192 HA.1", "", "", "", ""], ["PC.3", "o 2", "", "", "", ""], ["PC.4", "Would you need  help/assistance to carry out any such personal care activities? (Tick one box ONLY) This question is about your opinion about whether or not you feel the need for help or assitance.", "", "", "", ""], ["PC.4", "Yes, with at least one activity o\u2081", "", "", "", ""], ["PC.4", "No o 2", "", "", "", ""]]}, {"caption": "Table 12: HA.1 by Indicate the level of difficulty usually experienced when doing the following without help/assistance: (Tick", "header": ["HA.1", "Indicate the level of difficulty usually experienced when doing the following without help/assistance: (Tick", "", "", "", "", ""], "rows": [["HA.1", "", "No Difficulty", "Some Difficulty", "A lot of Difficulty", "Not able to do it alone", "Not Applicable"], ["", "Preparing meals", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Using the telephone", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Shopping", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Managing medication", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Light housework", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Occasional heavy housework", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["", "Managing finances and everyday administrative tasks", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["If \u2018No Difficulty\u2019 is chosen for all options of HA.1, go to question PN.1.", "", "", "", "", "", ""], ["HA.2", "", "Do you usually get help/assistance when carrying out any such household activities?", "", "", "", ""], ["", "(Tick one box ONLY) Yes, with at least one activity o\u2081", "", "", "", "", ""], ["", "(Tick one box ONLY) Yes, with at least one activity o\u2081", "", "", "", "", ""], ["", "", "2", "", "", "", ""], ["If questionnaire is answered by a proxy, go to Section C: European Health Care Module", "", "", "", "", "", ""], ["If questionnaire is answered by a proxy, go to Section C: European Health Care Module", "", "", "", "", "", ""], ["If questionnaire is answered by a proxy, go to Section C: European Health Care Module", "", "", "", "", "", ""], ["HA.3", "Would you require more help/assistance? (Tick one box ONLY)", "", "", "", "", ""], ["", "Yes, with at least one activity o\u2081 No o", "", "", "", "", ""], ["", "Yes, with at least one activity o\u2081 No o", "", "", "", "", ""], ["", "Yes, with at least one activity o\u2081 No o", "", "", "", "", ""], ["", "", "", "", "", "", "2"], ["HA.4", "Would you need help/assistance to carry out any such household activities? (Tick one box ONLY) This question is about about the participants opinion on whether or not he or she feels the need for help or assitance which is already being provided or can be provided.", "", "", "", "", ""], ["HA.4", "No o 2", "", "", "", "", ""], ["HA.4", "No o 2", "", "", "", "", ""], ["PAIN", "", "", "", "", "", ""], ["PN.1 Overall how much physical pain have you had during the pas t 4 weeks? (Tick one box ONLY)", "", "", "", "", "", ""], ["", "o\u2081 \u2192 MH.1", "", "", "", "", ""], ["", "Very mild o\u2082", "", "", "", "", ""], ["", "Mild o\u2083", "", "", "", "", ""], ["", "Moderate o\u2084", "", "", "", "", ""], ["", "Severe o\u2085", "", "", "", "", ""], ["", "Very severe o 6", "", "", "", "", ""]]}, {"caption": "Table 13: PN.2 by During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home", "header": ["PN.2", "During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? (Tick one box ONLY)", ""], "rows": [["PN.2", "Not at all", "o\u2081"], ["PN.2", "A little", "o\u2082"], ["PN.2", "Moderately", "o\u2083"], ["PN.2", "Quite a bit", "o\u2084"], ["PN.2", "Extremely", "o 5"]]}, {"caption": "Table 14: MH.1 by During the past 2 weeks did you \u2026? (Tick one box PER ROW) Not at all Several days, More than half the days, Near", "header": ["MH.1", "During the past 2 weeks did you \u2026? (Tick one box PER ROW) Not at all Several days", "", "", "More than half the days", "Nearly every day"], "rows": [["MH.1", "Have  little  interest  or  pleasure  in doing things", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Feel down, depressed or hopeless", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Have trouble falling or staying asleep, or sleeping too much", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Feel tired or have little energy", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Have a poor appetite or overate", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Feel bad about yourself or feel like a failure", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Have trouble concentrating on things, such  as  reading  the  newspaper  or watching television", "o\u2081", "o\u2082", "o\u2083", "o\u2084"], ["MH.1", "Move or speak slowly/restlessly, that other people took notice", "o\u2081", "o\u2082", "o\u2083", "o\u2084"]]}, {"caption": "Table 14: MH.1 by During the past 2 weeks did you \u2026? (Tick one box PER ROW) Not at all Several days, More than half the days, Near (cont. 2)", "header": ["last 2 weeks.", "", "", "", "", "", "", ""], "rows": [["last 2 weeks.", "", "", "", "", "", "", ""], ["MH.2 During the past 2 weeks did you \u2026? (Tick one box PER ROW)", "", "", "", "", "", "", ""], ["", "", "All of the time", "Most of the time", "More than half of the time", "Less than half of the time", "Some of the time", "At no time"], ["", "Feel cheerful and in good spirits", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Feel calm and relaxed", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Feel active and vigorous", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Wake up feeling fresh and rested", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Feel your daily life was filled with things of interest to you", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"]]}, {"caption": "Table 16: Section C: European Health Care Module", "header": ["\u2022 In this section all types of hospitals are to be included.\u2022 A \u2018day-patient\u2019 is a patient who is formally admitted to a hospital for treatment and/or care but stays for less than 24 hoursand does not stay overnight.\u2022 An \u2018in-patient\u2019 is a patient who is formally admitted to a hospital for treatment and/or care and stays for aminimum of one night or more.\u2022 Both \u2018day-patient\u2019 and \u2018in-patient\u2019 care exclude emergency visits with no admission and exclude out-patient visits.\u2022 The time spent in hospital for giving birth (without complications) should not be included in the number ofhospital days in inpatient care.\u2022 Time spent in hospital as an inpatient for reasons related to antenatal and postnatal period (e.g. complicationsduring pregnancy, miscarriages and complications after giving birth) should be included."], "rows": [["HC.1 During the past 12 months, have you been in hospital as an inpatient?  (Tick one box ONLY)Yes                                            o\u2081No                                            o\u2082\u2192 HC.4"], ["HC.2 How many separate stays in hospital as an inpatient have you had during the past 12 months?Only state number of stays which have come to an end during this period."], ["HC.3 How many nights in total did you spend in hospital as an inpatient, during the past 12 months?"], ["HC.4 During the past 12 months, have you been admitted to hospital for diagnostic treatment or other types ofhealth care as a day-patient, but were not required to stay overnight?  (Tick one box ONLY)Examples of diagnostic treatments are; colonoscopy, gastroscopy, operation for cataract and varicose veins, operation forD&C in females, dialysis, etc.Yes                                            o\u2081No                                            o\u2082\u2192 HC.6"], ["HC.5 How many times have you been admitted as a day patient during the past 12 months?"], ["\u2022   The next set of questions are about visits to orthodontists and dentists."], ["HC.6 When was the last time you visited an orthodontist on your own behalf(that is, not while onlyaccompanying a child, spouse, etc.)? (Tick one box ONLY)Less than 6 months ago                                  o\u20816 months ago or before, but less than 12 months ago                    o\u208212 months ago, or before                                 o\u2083Never                                           o\u2084"], ["HC.7 When did you last visit a dentist on your own behalf? (that is, not while accompanying a child, spouse, etc.)?(Tick one box ONLY)Less than 6 months ago                                  o\u20816 months ago or before, but less than 12 months ago                    o\u208212 months ago, or before                                 o\u2083Never                                           o\u2084\u2192 HC.9"]]}, {"caption": "Table 16: Section C: European Health Care Module (cont. 2)", "header": ["HC.8", "What was the reason for your last visit to the dentist? (Tick one box ONLY) Pain/trouble with teeth, gums or mouth Treatment/follow-up treatment Routine check-up Do not know/do not remember", "", "", "", "", "o\u2081", ""], "rows": [["HC.8", "What was the reason for your last visit to the dentist? (Tick one box ONLY) Pain/trouble with teeth, gums or mouth Treatment/follow-up treatment Routine check-up Do not know/do not remember", "Specify  __________________________________________________________", "", "", "", "o\u2082 o\u2083 o\u2084 o\u2085", ""], ["\u2022 The next set of questions are about consultations with your general practitioner or family doctor (private or public). Please include visits to your doctor\u2019s practice as well as home visits and consultations by telephone.", "", "", "", "", "", "", ""], ["HC.9 When was the last time you consulted a private general pra ctitioner (GP)/private family doctor, on your own behalf?  (Tick one box ONLY)", "", "", "", "", "", "", ""], ["", "Less than 12 months ago o\u2081", "", "", "", "", "", ""], ["", "12 months ago, or before o\u2082", "", "", "", "", "", ""], ["", "\u2192 HC.11 o\u2083", "", "", "", "", "", ""], ["HC.10", "behalf? If none, write 0", "During the past 4 weeks, how many times did you consult a private GP/private family doctor on your own", "", "", "", "", ""], ["HC.11 When was the last time you consulted a government GP /health centre doctor on your own behalf? (Tick one box ONLY)", "", "", "", "", "", "", ""], ["Less than 12 months ago o\u2081", "", "", "", "", "", "", ""], ["", "12 months ago, or before o\u2082", "", "", "", "", "", ""], ["", "\u2192 HC.18 Never o\u2083", "", "", "", "", "", ""], ["", "\u2192 HC.18 Never o\u2083", "", "", "", "", "", ""], ["HC.12", "During the past 4 weeks (up until yesterday), how many times did you consult a government GP/health centre doctor on your own behalf? If none, write 0", "", "", "", "", "", ""], ["", "During the past 4 weeks (up until yesterday), how many times did you consult a government GP/health centre doctor on your own behalf? If none, write 0", "", "", "", "", "", ""], ["", "During the past 4 weeks (up until yesterday), how many times did you consult a government GP/health centre doctor on your own behalf? If none, write 0", "", "", "", "", "", ""], ["", "During the past 4 weeks (up until yesterday), how many times did you consult a government GP/health centre doctor on your own behalf? If none, write 0", "", "", "", "", "", ""], ["All respondents who visited private or public GP in the last 12 months are to answer questions HC13 \u2013 HC17", "", "", "", "", "", "", ""], ["All respondents who visited private or public GP in the last 12 months are to answer questions HC13 \u2013 HC17", "", "", "", "", "", "", ""], ["HC.13", "", "During your last visit, did the GP or family doctor spend enough time with you? (Tick one box PER ROW) Yes, definitely", "Yes, to some", "", "No, not really", "No, definitely", "Do not know"], ["HC.13", "Government GP/Health Centre doctor", "o\u2081", "extent o\u2082", "", "o\u2083", "not o\u2084", "o\u2085"], ["HC.13", "Private Family doctor", "o\u2081", "o\u2082", "", "o\u2083", "o\u2084", "o\u2085"], ["HC.14 During your last visit, did the GP or family doctor explain things in a way that was easy to understand? (Tick one box PER ROW)", "", "", "", "", "", "", ""], ["", "Government GP/Health Centre", "Yes, definitely", "Yes, to some extent", "No, not really", "No, definitely not", "No need to explain things", "Do not know"], ["", "doctor", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Private Family doctor", "o 1", "o 2", "o 3", "o 4", "o 5", "o 6"]]}, {"caption": "Table 16: Section C: European Health Care Module (cont. 3)", "header": ["HC.15", "about the recommended treatment? (Tick one box PER ROW)", "Yes, definitely", "During your last visit, did the GP or family doctor give you an opportunity to ask questions or raise concerns Yes, to some extent", "No, not really", "No, definitely not", "No need to ask question or raise concerns about recommended treatment", "Do not know"], "rows": [["", "Centre doctor", "", "", "", "", "", ""], ["", "Private Family doctor", "o 1", "o 2", "o 3", "o 4", "o 5", "o 6"]]}, {"caption": "Table 19: Yes, definitely by Yes, to some extent, No, not really, No, definitely not", "header": ["", "Yes, definitely", "Yes, to some extent", "No, not really", "", "No, definitely not", "Did not want to be involved", "No decisions about care and treatment were made", "Do not know"], "rows": [["Government GP/Health Centre doctor", "o\u2081", "o\u2082", "o\u2083", "", "o\u2084", "o\u2085", "o\u2086", "o\u2087"], ["Private Family doctor", "o\u2081", "o\u2082", "o\u2083", "", "o\u2084", "o\u2085", "o\u2086", "o\u2087"]]}, {"caption": "Table 20: If none, write 0", "header": ["All respondents who visited private or public medical or surgical specialist in the last 12 months are to answer questions HC22-HC26", "", "", "", "", "", "", "", ""], "rows": [["All respondents who visited private or public medical or surgical specialist in the last 12 months are to answer questions HC22-HC26", "", "", "", "", "", "", "", ""], ["HC.22 During your last visit, did the specialist spend enough time with you? (Tick one box PER ROW) Yes, Yes, to No,", "", "", "", "", "", "", "", ""], ["", "Government specialist", "", "definitely o\u2081", "", "some extent o\u2082", "really o\u2083", "definitely not o\u2084", "Do not know o\u2085"], ["", "Private specialist", "", "o\u2081", "", "o\u2082", "o\u2083", "o\u2084", "o\u2085"], ["HC.23 During your last visit, did this specialist explain things in a way that was easy to understand? (Tick one box PER ROW) Yes, Yes, to No,", "", "", "", "", "", "", "", ""], ["", "Government specialist", "", "o\u2081", "extent o\u2082", "really o\u2083", "not o\u2084", "explain things o\u2085", "know o\u2086"], ["", "Private specialist", "", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["HC.24", "recommended treatment? (Tick one box PER ROW)", "", "", "During your last visit, did this specialist give you an opportunity to ask questions or raise concerns about", "", "", "", ""], ["", "recommended treatment? (Tick one box PER ROW)", "", "", "", "", "", "No need to ask question", ""], ["", "recommended treatment? (Tick one box PER ROW)", "", "Yes, definitely", "Yes, to some extent", "No, not really", "No, definitely not", "or raise concerns about recommended treatment", "Do not know"], ["", "recommended treatment? (Tick one box PER ROW)", "", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "recommended treatment? (Tick one box PER ROW)", "", "", "", "", "", "", ""], ["", "Government specialist Private specialist", "", "", "", "", "", "", ""], ["HC.25 During your last visit did this specialist involve you as much as you wanted to when it came to making", "", "", "", "", "", "", "", ""], ["decisions about your care and treatment? (Tick one box PER ROW) No decisions", "", "", "", "", "", "", "", ""], ["decisions about your care and treatment? (Tick one box PER ROW) No decisions", "", "", "", "", "", "", "", ""], ["", "Government", "Yes, definitely", "Yes, to some extent", "No, not really", "No, definitely not", "Did not want to be involved", "about care and treatment were made", "Do not know"], ["", "specialist", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086", "o\u2087"], ["HC.26", "", "", "Very", "Overall, how would you rate the quality of the consultation during your last visit? (Tick one box PER ROW)", "", "", "", "Do not"], ["", "", "", "Good", "Good", "Fair", "Bad", "Very Bad", "know"], ["", "Government specialist", "", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"], ["", "Private specialist", "", "o\u2081", "o\u2082", "o\u2083", "o\u2084", "o\u2085", "o\u2086"]]}, {"caption": "Table 20: If none, write 0 (cont. 2)", "header": ["HC.27 During the past 12 months, which of the following have you visited on your own behalf? (Tick ALL that apply)The option \u2018None\u2019 can only be chosen on its own.Physiotherapist                                          o\u2081Chiropractor/Osteopath                                     o\u2082Dietician/Nutritionist                                       o\u2083Optometrist/Ophthalmic nurse                                 o\u2084Psychologist or psychotherapist                                 o\u2085Psychiatrist                                            o\u2086Podiatrist/podologist                                       o\u2087Acupuncturist                                           o\u2088Other (specify)  ____________________________________________________     o\u2089None                                               o\u2081\u2080"], "rows": [["HC.28 During the past 12 months, have you yourself used or received any home care services? (Tick one box ONLY)Yes                                                 o\u2081No                                                 o2\u2192 MD.1"], ["HC.29 During the past 12 months, have you yourself used any of the following home care services provided by theprivate and/or public sector? (Tick ALL that apply)Private            PublicYes No Yes NoHome care service provided by a nurse         o\u2081     o\u2082     o\u2081     o\u2082Home help by a carer (non-nursing services)      o\u2081     o\u2082     o\u2081     o\u2082\u201cMeals on wheels\u201d                    o\u2081     o\u2082     o\u2081     o\u2082Handyman service                    o\u2081     o\u2082     o\u2081     o\u2082Telecare                          o\u2081     o\u2082     o\u2081     o\u2082Other (specify)  _________________________    o\u2081     o\u2082     o\u2081     o\u2082"], ["MD.1 During the past two weeks, have you used any medicines that were prescribed to you by a doctor?(Tick one box ONLY)Exclude contraceptives pills/hormones used solely for contraception.Yes                                                 o\u2081"]]}, {"caption": "Table 22: PA.1 When was the last time you were vaccinated against influenza? (Tick one box ONLY)", "header": ["PA.1 When was the last time you were vaccinated against influenza? (Tick one box ONLY)", "", "", "", "", ""], "rows": [["Specify month", "", "", "", "", ""], ["Specify year", "", "", "", "", ""], ["Too long ago (before 31st December 2017)", "", "", "", "", ""], ["Never", "", "", "", "", ""], ["$\\textcircled{3}$\u2192PA.3", "", "", "", "", ""], ["PA.2 Did you buy the vaccine yourself or did you get the free one supplied by the Ministry for Health? (Tick one box ONLY)", "", "", "", "", ""], ["Bought it", "", "", "", "", ""], ["Got it for free", "", "", "", "", ""], ["PA.3 When was the last time a health professional ...? (Tick one box PER ROW)", "", "", "", "", ""], ["", "Within the past 12 months", "12 months or more, but less than 3 years ago", "3 years or more, but less than 5 years ago", "5 years ago or more", "Never"], ["Measured your blood pressure", "$\\textcircled{1}$", "$\\textcircled{2}$", "$\\textcircled{3}$", "$\\textcircled{4}$", "$\\textcircled{5}$"], ["Measured your blood cholesterol", "$\\textcircled{1}$", "$\\textcircled{2}$", "$\\textcircled{3}$", "$\\textcircled{4}$", "$\\textcircled{5}$"], ["Measured your blood glucose", "$\\textcircled{1}$", "$\\textcircled{2}$", "$\\textcircled{3}$", "$\\textcircled{4}$", "$\\textcircled{5}$"], ["PA.4 When was the last time you had a stool sample tested for blood (faecal occult blood test)? (Tick one box ONLY)", "", "", "", "", ""], ["Within the past 12 months", "", "", "", "", ""], ["12 months or more, but less than 2 years ago", "", "", "", "", ""], ["2 years or more, but less than 3 years ago", "", "", "", "", ""], ["3 years or more", "", "", "", "", ""], ["Never", "", "", "", "", ""], ["$\\textcircled{5}$\u2192PA.6", "", "", "", "", ""], ["PA.5 Where did you have the latest stool sample (FOB) tested for blood? (Tick one box ONLY)", "", "", "", "", ""], ["National Screening Centre", "", "", "", "", ""], ["Mater Dei Hospital/Gozo General Hospital", "", "", "", "", ""], ["Private Hospital/Private Clinic", "", "", "", "", ""], ["PA.6 When was the last time you had a colonoscopy? (Tick one box ONLY)", "", "", "", "", ""], ["Within the past 12 months", "", "", "", "", ""], ["12 months or more, but less than 5 years ago", "", "", "", "", ""], ["5 years or more, but less than 10 years ago", "", "", "", "", ""], ["10 years ago or more", "", "", "", "", ""], ["Never", "", "", "", "", ""]]}, {"caption": "Table 23: UN.1 UN.2 by All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits", "header": ["UN.1 UN.2", "All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits as well as private and public consultations and hospitals should all be included. Yes No During the past 12 months, have you experienced delay in getting health care /because of any of the following reasons? (Tick one box PER ROW)", "", "", "", ""], "rows": [["UN.1 UN.2", "All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits as well as private and public consultations and hospitals should all be included. Yes No During the past 12 months, have you experienced delay in getting health care /because of any of the following reasons? (Tick one box PER ROW)", "", "o\u2081 o \u2192 SA.1 2", "", ""], ["UN.1 UN.2", "All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits as well as private and public consultations and hospitals should all be included. Yes No During the past 12 months, have you experienced delay in getting health care /because of any of the following reasons? (Tick one box PER ROW)", "", "o\u2081 o \u2192 SA.1 2", "", ""], ["UN.1 UN.2", "All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits as well as private and public consultations and hospitals should all be included. Yes No During the past 12 months, have you experienced delay in getting health care /because of any of the following reasons? (Tick one box PER ROW)", "", "", "", ""], ["", "All forms of healthcare including in-patient, outpatient, day-patients, emergency, specialist and GP visits as well as private and public consultations and hospitals should all be included. Yes No During the past 12 months, have you experienced delay in getting health care /because of any of the following reasons? (Tick one box PER ROW)", "", "", "Yes o\u2081", "No o\u2082"], ["", "Distance/transporting problems", "", "", "o\u2081", "o\u2082"], ["", "Family related commitments", "", "o\u2081 o\u2082", "", ""], ["Work related commitments o o\u2082 1 UN.3 During the past 12 months, did you find yourself needing any of the following health care services, but could", "", "", "", "", ""], ["", "not afford to get them? (Tick one box PER ROW)", "No need for this type of Yes No", "", "", ""], ["", "Medical examination or treatment", "o\u2081", "o\u2082", "care in past 12 months o\u2083", ""], ["", "Dental examination or treatment", "o\u2081", "o\u2082", "o\u2083", ""], ["", "Prescribed medicines", "o\u2081", "o\u2082", "o\u2083", ""], ["", "Mental health care (e.g. psychologist or psychiatrist)", "o", "o\u2082", "o\u2083", ""], ["", "", "1", "", "", ""], ["HEALTH INSURANCE", "", "", "", "", ""], ["SA.1", "Are you covered by a private health insurance? (Tick one box ONLY)", "", "", "o\u2081", ""], ["", "Yes", "", "", "o\u2081", ""], ["No", "", "", "", "", "o \u2192 BMI.1 2"], ["", "Myself", "", "", "", "o\u2081"], ["", "Employer", "", "", "o\u2082", ""], ["", "Both (myself and the employer)", "", "", "", "o\u2083"], ["", "Do not know", "", "", "", "o\u2084"], ["", "Other (specify) ________________________________________________________", "o 5", "", "", ""], ["SA.3 What does this insurance cover? (Tick ALL that apply)", "", "", "", "", ""], ["", "Consultations/outpatient", "", "", "o\u2081", ""], ["", "Hospital treatment, local", "", "", "", "o\u2082"], ["", "Hospital treatment, abroad", "", "", "o 3", ""]]}, {"caption": "Table 24: Section D: European Health Determinants Module", "header": ["If questionnaire is being answered by proxy , go to FV.1", "", "", ""], "rows": [["BMI.1", "How tall are you without shoes?  (Tick one box ONLY) Specify _______________________________________________________________ cm", "", "o\u2081"], ["BMI.1", "Do not know", "", "o\u2082"], ["BMI.2", "How much do you weigh without clothes and shoes?  (Tick one box ONLY) Specify _______________________________________________________________ kg Do not know", "", "o\u2081 o\u2082"], ["BMI.2", "", "", ""], ["BMI.2", "", "", ""]]}, {"caption": "Table 25: \u2022 Please answer these questions even if you do not consider yourself to be a physically active person", "header": ["PE.1", "When you are working, which of the following best describes what you do?  (Tick one box ONLY)", ""], "rows": [["PE.1", "Mostly sitting or standing", "o\u2081"], ["PE.1", "Mostly walking or tasks of moderate physical effort", "o\u2082"], ["PE.1", "Mostly heavy labour or physically demanding work", "o\u2083"], ["PE.1", "Not performing any working tasks", "o\u2084"]]}, {"caption": "Table 26: PE.2 by During a typical week, on how many days do you walk for at least 10 minutes continuously to get to and from plac", "header": ["PE.2", "During a typical week, on how many days do you walk for at least 10 minutes continuously to get to and from places?  (Tick one box ONLY) Specify _______________________________________________________________ days I never carry out such physical activities", "", "", "o\u2081 o\u2082 \u2192 PE.4"], "rows": [["PE.2", "During a typical week, on how many days do you walk for at least 10 minutes continuously to get to and from places?  (Tick one box ONLY) Specify _______________________________________________________________ days I never carry out such physical activities", "", "", "o\u2081 o\u2082 \u2192 PE.4"], ["PE.3", "How much time do you spend walking in a continuous manner in order to get to and from places on a typical day?  (Tick one box ONLY)", "", "", ""], ["PE.3", "10 minutes or more but less than 30 minutes per day", "", "", "o\u2081"], ["PE.3", "30 minutes or more but less than 1 hour per day", "", "", "o\u2082"], ["PE.3", "1 hour or more, but less than 2 hours per day", "", "", "o\u2083"], ["PE.3", "2 hours or more, but less than 3 hours per day", "", "", "o\u2084"], ["PE.3", "3 hours or more per day", "", "", "o\u2085"], ["PE.4", "During a typical week, on how many days do you ride a bicycle for at least 10 minutes continuously to get to and from places?  (Tick one box ONLY)", "", "", ""], ["PE.4", "Specify _______________________________________________________________ days", "", "", "o\u2081"], ["PE.4", "I never carry out such physical activities", "", "", "o\u2082 \u2192 PE.6"]]}, {"caption": "Table 27: Places and brisk walking and focus only on leisure (non-brisk) walks", "header": ["places and brisk walking and focus only on leisure (non-brisk) walks."], "rows": [["PE.11 In a typical week, on how many days do you go for leisure walks (not brisk) for at least 10 minutescontinuously for fitness or recreation (leisure)?  (Tick one box ONLY)Specify ______________________________________________________________ days  o\u2081I never carry out such physical activities                          o\u2082\u2192 PE.13"], ["PE.12 How much time in total do you spend walking (not brisk) for recreation (leisure) during a typical week?(Tick one box ONLY)Indicate in hours or minutesIf exact number of days is not known, give an approximationSpecify ____________________________________________________________ hours  o\u2081Specify ____________________________________________________________ minutes o\u2082"], ["PE.13 How much time do you spend sitting and reclining on a typical day (exclude time spent sleeping)?(Tick one box ONLY)Indicate in hours or minutesSpecify ____________________________________________________________ hours  o\u2081Specify ____________________________________________________________ minutes o\u2082"], ["NUTRITION"], ["FV.1 How often do you eat fruit, excluding juice squeezed from fresh fruit or made from concentrate?(Tick one box ONLY)Frozen, dried, canned, etc. fruits should beincludedAny fruit juices should beexcludedDaily                                           o\u20814 to 6 times a week                                   o\u20821 to 3 times a week                                   o\u2083\u2192 FV.3Less than once a week                                  o\u2084Never                                          o\u2085"], ["FV.2 How many portions of fruit of any sort, excluding juice, do you eat per day?Hand respondent show card 4To answer in number of portions"], ["FV.3 How often do you eat vegetables or salad, excluding potatoes and fresh soup/juice or soup/juice made fromconcentrate?  (Tick one box ONLY)Frozen, dried, canned, etc. vegetables should beincludedAny kind of vegetable juices or soups (warm and cold) should beexcludedDaily                                           o\u20814 to 6 times a week                                   o\u20821 to 3 times a week                                   o\u2083\u2192 FV.5Less than once a week                                  o\u2084Never                                          o\u2085"], ["FV.4 How many portions of vegetables or salad, of any sort excluding soup/juice and potatoes do you eat eachday?Hand respondent show card 4To answer in number of portions"]]}, {"caption": "Table 27: Places and brisk walking and focus only on leisure (non-brisk) walks (cont. 2)", "header": ["FV.5 How often do you drink 100% pure fruit, vegetable juice or freshly made vegetable soup?Excluding soup/juice made from concentrate or sweetened juice?(Tick one box ONLY)Daily                                           o\u20814 to 6 times a week                                   o\u20821 to 3 times a week                                   o\u2083Less than once a week                                  o\u2084Never                                          o\u2085"], "rows": [["NU.1 Is salt added to your meals during cooking (excluding cubes)?  (Tick one box ONLY)Almost always                                      o\u2081Occasionally                                       o\u2082Never (or low salt alternative)                              o\u2083Do not know                                       o\u2084"], ["NU.2 Do you add salt to your meals whilst eating?  (Tick one box ONLY)Almost always                                      o\u2081Occasionally                                       o\u2082Never (or low salt alternative)                              o\u2083"], ["NU.3 How often do you drink sugar free soft drinks?  (Tick one box ONLY)Daily                                           o\u20814 to 6 times a week                                   o\u20821 to 3 times a week                                   o\u2083\u2192 NU.5Less than once a week                                  o\u2084Never                                          o\u2085"], ["NU.4 How many glasses do you drink each day?  (Tick one box ONLY)Hand respondent show card 5"], ["NU.5 How often do you drink regular soft drinks?  (Tick one box ONLY)Daily                                           o\u20814 to 6 times a week                                   o\u20821 to 3 times a week                                   o\u2083\u2192 NU.7Less than once a week                                  o\u2084Never                                          o\u2085"], ["NU.6 How many glasses do you drink each day?  (Tick one box ONLY)Hand respondent show card 5"], ["NU.7 On how many days during the last week (7-day period) have you consumed the following foods?(Tick one box PER ROW)Never  1-2 days  3-5 days  6-7 daysChicken/rabbit                      o\u2081    o\u2082    o\u2083    o\u2084Fish                           o\u2081    o\u2082    o\u2083    o\u2084Meat                           o\u2081    o\u2082    o\u2083    o\u2084Meat products                      o\u2081    o\u2082    o\u2083    o\u2084Sweet pastries                      o\u2081    o\u2082    o\u2083    o\u2084(Including biscuits, cakes, fancy cakes, gateaux etc.)Sweets                          o\u2081    o\u2082    o\u2083    o\u2084(Including chocolates etc.)"]]}, {"caption": "Table 27: Places and brisk walking and focus only on leisure (non-brisk) walks (cont. 3)", "header": ["NU.8", "Do you have children aged between 0 and 3 years?  (Tick one box ONLY) Yes No", "", "o\u2081 o\u2082 \u2192 EN.1", ""], "rows": [["NU.8", "Do you have children aged between 0 and 3 years?  (Tick one box ONLY) Yes No", "", "o\u2081 o\u2082 \u2192 EN.1", ""], ["NU.8", "Do you have children aged between 0 and 3 years?  (Tick one box ONLY) Yes No", "", "o\u2081 o\u2082 \u2192 EN.1", ""], ["NU.9 Was your child breastfed?  (Tick one box ONLY) If more than one child is aged 0 to 3 years, these questions should be answered in relation to the eldest", "", "", "", ""], ["", "child Yes, child is still breast feeding Including partial breastfeeding", "", "o\u2081", ""], ["", "Yes, child was breastfed", "", "", ""], ["", "Including partial breastfeeding", "", "o 2", "\u2192 NU.11"], ["", "No, never breastfed", "", "o\u2083", ""], ["", "Do not know", "", "o\u2084", "\u2192 EN.1"], ["NU.10", "How old is your child? Age in number of weeks", "", "", ""], ["NU.11", "__________________________________________________________________ weeks For how many weeks was your child breastfed?", "", "\u2192 NU.12", ""], ["NU.12", "At what age did your child start to consume foods or liquids other than breast milk?  (Tick one box ONLY)", "", "", ""], ["NU.12", "To be answered in number of weeks E.g. of liquids; water, herbal teas, juices, animal milk etc. __________________________________________________________________ weeks", "", "o\u2081", ""], ["ENVIRONMENT WHERE YOU LIVE", "", "", "", ""], ["ENVIRONMENT WHERE YOU LIVE", "", "", "", ""], ["EN.1", "State whether you have any of the following problems/issues in your current accommodation: (Tick one box PER ROW)", "", "Yes", "No"], ["EN.1", "Overcrowding", "", "o\u2081", "o\u2082"], ["EN.1", "Leaking roof, damp floors/walls/foundation, or rot in window frames/floor", "", "o\u2081", "o\u2082"], ["EN.1", "Too dark/not enough light", "", "o\u2081", "o\u2082"], ["EN.1", "Noise from neighbours or noise from outside E.g. Traffic, business, factories, etc.", "", "o\u2081", "o\u2082"], ["EN.1", "Pollution, grime or other environmental problems in the area", "", "o\u2081", "o\u2082"], ["EN.1", "Crime, violence or vandalism in the area", "", "o\u2081", "o\u2082"], ["EN.1", "Insufficient ventilation", "", "o\u2081", "o\u2082"], ["EN.1", "Insufficient privacy", "", "o\u2081", "o\u2082"], ["", "If questionnaire is being answered by a proxy the Interviewer is to go to Section E and the proxy is to go to the self-completion questionnaire", "", "", ""]]}, {"caption": "Table 30: TS.1 Date of interview", "header": ["", "D", "D", "M", "M", "Y", "Y", "Y", "Y"], "rows": [["TS.2 Language used to complete questionnaire: (Tick one box ONLY)English                                                  o\u2081Maltese                                                 o\u2082", "", "", "", "", "", "", "", ""], ["TS.3 The questionnaire was answered by: (Tick one box ONLY)Selected Individual                                           o\u2081\u2192 TS.5Proxy \u2013 another member of the selected individual\u2019s household                 o\u2082Proxy \u2013 someone not from the same household as the selected individual           o\u2083", "", "", "", "", "", "", "", ""], ["TS.4 What is the reason for having a proxy respondent answer this questionnaire? (Tick ALL that apply)Sample person has a cognitive impairment                             o\u2081Sample person is physically debilitated                               o\u2082Sample person has a hearing/speech problem                           o\u2083Sample person cannot speak English or Maltese                          o\u2084Other (specify) ____________________________________________________________ o\u2085", "", "", "", "", "", "", "", ""], ["TS.5 Indicate the amount of time it took to complete the questionnaire.Specify in hours and minutes.TS.6 Locality of residence of respondent:", "", "", "", "", "", "", "", ""], ["TS.7 Name and Surname of interviewer:TS.8 Interviewer ID Card:TS.9 Questionnaire Number:", "", "", "", "", "", "", "", ""], ["TS.10 The self-completion form is answered via  (Tick one box ONLY):Printed questionnaire                                         o\u2081Tablet                                                  o\u2082", "", "", "", "", "", "", "", ""]]}]}