6
With what population(s) is/was the instrument used? (e.g. seniors, children, adults with developmental disabilities)
7
a) What was the number of people in your study?
b) Will you be using the instrument with more people?
yes
no
If yes, how many?
8
How many studies, projects, etc is/was the instrument used in?
one study/ evaluation
more than one study/evaluation
repeated use in study/evaluation over time (e.g. longitudinal study)
9
Who administered the instrument?
(Check all that apply)
Self-administered
Interviewer
Care-giver
Other, please specify:
10
a) Overall, how easy or difficult was the instrument to administer?
b) Please comment on your experience.
11
a) Did you use a translated version of the instrument?
yes
no
b) If yes, what language?
12
Did you have it back-translated?
yes
no
13
a) Other than translations, did you modify the instrument in any way?
If Yes, please answer questions (13b -13d).
If No, please go to question 14
yes
no
b) What was the reason or purpose for modifying the instrument? Please specify
c) How did you modify the instrument? Please specify
d) Did you psychometrically evaluate the modified instrument?
yes
no
If so, please describe how:
14
How effective was the instrument for your purpose?
Please comment
15
Did you use/are you using the instrument along with other assessment tools, instruments, questionnaires?
Yes
No
If yes, please state which ones:
16
a) Did you write a report/article on the results of your study?
Yes
No
b) If you published your report/article, please indicate the type of publication:
(Check all that apply)
Report
Peer-review article
Peer-review book chapter
Dissertation/Thesis
Newsletter
Other, please specify:
17
What do you like most about the instrument?
Please describe:
18
How satisfied are you with the instrument?
19
If you are/were not completely satisfied with the instrument, how would you recommend that the instrument be improved?
20
a) Would you recommend the instrument(s) to others?
Yes
No
b) Why or why not?
21
Please add any other comments you would like to make about the instrument.
Sharing Data and Information
The Quality of Life Research Unit would like to hear more about the work you are doing, or have done, using our Quality of Life instruments. If you are you interested in sharing information and/or data, and perhaps posting some of the results of your work on the QOL website, please answer the following questions.
22.
If you do wish to share information or data, please provide your email address.
23.
Would you be interested in sharing data in the future?
Yes
No
24.
Would you like to make your report/article available for download on the QOL
website?
Yes
No
25.
If you have written a report, or published an article in relation to the work carried out using the Quality of Life instruments, we would appreciate if you would provide us with the citation.