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In the following questionnaire, I am going to ask you a variety of
questions. Some are concerned with the problems you faced and some
are general.
There are EIGHT options of every single answer. Please tick
mark only one answer for your each question.
I am simply interested in knowing your interests and perception
of your life.
Please complete all the questions carefully as possible. All your
answers in the questionnaire will be treated as confidential. May I
thank you very much for your co-operation.
SHAILA GAFFAR
PGDRP Student
Name: .
Age: Sex:
Education: . (Illiterate/ Literate)
Occupation:
Monthly Income:
Family Status: (Nuclear/Joint) .
Address: .
Rural / Urban:..
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1. How often has the availability of transportation been a problem foryou?
When this problem occurs has it been
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. monthly
g. Week. h. Daily
2. How often has the design and layout of your home made it difficult to
do what you want or need to do?
When this problem occurs has it been
a. Little problem b. Big problemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weeklyh. Daily
3. How often has the design and layout of buildings and places youuse in your community made it difficult to do what you want or
need to do?
When this problem occurs has it been
a. Little problem b.Big problem
c.Not applicable d.Never
e.Lose than monthly f.Monthly
g.Weekly h.Daily
4. How often has the natural environmenttemperature, terrain, climate
made it difficult to do what you want or need to do?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
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5. How often has the design and layout of buildings and places you use
in your at school at work made it difficult to do what you want or
need to do?
When this problem occurs has it been a
a. Little problem b. Big problemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
6. How often have other aspects of your surroundings lighting, noise,
crowds, etc - made it difficult to do what you want or need to do?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
7. How often has the information you wanted or ne eded not beenavailable in a format you can use or understand?
When this problem occurs has it been a
a. Little problem b. Big problemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
8. Howoften has the availability of the education and training you
needed been a problem for you?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
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9. How often has the availability of health care services and medical
care been a problem for you?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
10. How often has the lack of personal equip mentor special devices
been a problem for you? Examples might include hearing aids,
eyeglasses or wheelchairs?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
11. How often has the lack of computer technology been a problem for
you?
When this problem occurs has it been a
a. Little problem b. Big problemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
12. How often did you need someone elses help in your home and could
not get it easily?
When this problem occurs has it been a
a. Little problem b. Bigproblemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
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13. How often did you need someone elses help at school work and
could not get it easily?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
14. How often did you need someone elses help in your
communityand could not get it easily?
When it problem occurs has it been a
a. Little problem b. Big problemc. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
15. How often have other peoples attitude towards you been a problem
at home?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
16.How often have other peoples attitude towards you been a problem
at school or work?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
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17.How often have other peoples attitudes towards you been a problem
in the community?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
18. How often has a lack of support and encouragement from others in
your home been a problem?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
19. How often has a lack of support and encouragement from others in
.. Or won been a problem?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f . Monthly
g. Weekly h. Daily
20. How often has a lack of support and encouragement from others inyour community been a problem?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
21. How often did you experience prejudice or discrimination?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
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22. How often has the lack of programs and services in the community
been a problem?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthlyg. Weekly h. Daily
23. How often did the policies and rules of businesses and organizations
take problem for you?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
24. How often did education and employmentprograms and policies make
it difficult to do what you want or need to do?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily
25. How often did government programs and policies make it difficult to
do what you want or need to do?
When this problem occurs has it been a
a. Little problem b. Big problem
c. Not applicable d. Never
e. Lose than monthly f. Monthly
g. Weekly h. Daily