Items:

First of all, do you think you have had the same opportunities as other people to participate in and take advantage of?

1. Education
2. Employment
3. Recreationleisure

Tell me how often each of the following has been a barrier to your own participation in the activities that matter to you.

1. In the past 12 months, how often has the availability of transportation been a problem for you? When this problem occurs has it been a big problem or a little problem?
2. In the past 12 months, how often have 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 big problem or a little problem?
3. In the past 12 months, how often have the design and layout of buildings and places you use at school or work made it difficult to do what you want or need to do? When this problem occurs has it been a big problem or a little problem?
4. In the past 12 months, how often have the design and layout of buildings and places you use in your community made it difficult to do what you want or need to do? When this problem occurs has it been a big problem or a little problem?
5. In the past 12 months, how often has the natural environment- temperature, terrain, climate – made it difficult to do what you want or need to do? When this problem occurs has it been a big problem or a little problem?
6. In the past 12 months, how often have other aspects of your surrounding – lighting, noise, crowds, etc- made it difficult to do what you want or need to do? When this problem occurs has it been a big problem or a little problem?
7. In the past 12 months, how often has the information you wanted or needed not been available in a format you can use or understand? When this problem occurs has it been a big problem or a little problem?
8. In the past 12 months, how often has the availability of education and training you needed been a problem for you? When this problem occurs has it been a big problem or a little problem?
9. In the past 12 months, 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 big problem or a little problem?
10. In the past 12 months, how often has the lack of personal equipment or special adapted devices been a problem for you? When this problem occurs has it been a big problem or a little problem?
11. In the past 12 months, how often has the lack of computer technology been a problem for you? When this problem occurs has it been a big problem or a little problem?
12. In the past 12 months, how often did you need someone else's help in your home and could not get it easily? When this problem occurs has it been a big problem or a little problem?
13. In the past 12 months, how often did you need someone else's help in your community and could not get it easily? When this problem occurs has it been a big problem or a little problem?
14. In the past 12 months, how often did you need someone else's help in your community and could not get it easily? When this problem occurs has it been a big problem or a little problem?
15. In the past 12 months, how often have other people's attitudes toward you been a problem at home? When this problem occurs has it been a big problem or a little problem?
16. In the past 12 months, how often have other people's attitudes toward you been a problem at school or work? When this problem occurs has it been a big problem or a little problem?
17. In the past 12 months, how often have other people's attitudes toward you been a problem in the community? When this problem occurs has it been a big problem or a little problem?
18. In the past 12 months, how often has lack of support and encouragement from others in your home been a problem? When this problem occurs has it been a big problem or a little problem?
19. In the past 12 months, how often has lack of support and encouragement from others at school or work been a problem? When this problem occurs has it been a big problem or a little problem?
20. In the past 12 months, how often has lack of support and encouragement from others in your community been a problem? When this problem occurs has it been a big problem or a little problem?
21. In the past 12 months, how often did you experience prejudice or discrimination? When this problem occurs has it been a big problem or a little problem?
22. In the past 12 months, how often has the lack of programs and services in the community been a problem? When this problem occurs has it been a big problem or a little problem?
23. In the past 12 months, how often did the policies and rules of businesses and organizations make problems for you? When this problem occurs has it been a big problem or a little problem?
24. In the past 12 months, how often did education and employment policies make it difficult to do what you want or need to do? When this problem occurs has it been a big problem or a little problem?
25. In the past 12 months, 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 big problem or a little problem?

Response options
A frequency score on a 5-point Likert scale

Never – 0
Less than monthly – 1
Monthly- 2
Weekly- 3
Daily- 4

Magnitude score on a 3-point Likert scale
No problem- 0
A little problem – 1
A big problem – 2