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Supplemental Items for the CAHPS Health Plan Adult Survey 5.0: People With Mobility Impairments

Population version: Adult

Download these items: English (Word, 30 KB)

Learn more about the CAHPS People With Mobility Impairments Set.

Users of the CAHPS Health Plan Survey are free to incorporate supplemental items in order to meet the needs of their organizations, local markets, and/or audiences. Some items cover events that occur with low frequency in the general population. You should include them only if your sample design is likely to yield a sufficient number of responses to those questions for statistical analysis and reporting.

Questions Placement and Other Instructions
P-IM1. In the last 12 months, did you visit your personal doctor for care?
1__ Yes
2__ No â†’ If No, go to core question 17		 After core question 16

Note: Use P-IM1 if using P-IM2-IM9
P-IM2. In the last 12 months, when you visited your personal doctor's office, how often were you examined on the examination table?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM1

Note: Use with P-IM1
P-IM3. In the last 12 months, when you visited your personal doctor's office, how often did someone weigh you?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM2

Note: Use with P-IM1
P-IM4. In the last 12 months, when you visited your personal doctor's office, did you try to use the restroom?
1__ Yes
2__ No → If No, go to P-IM6		 After P-IM3

Note: Use with P-IM1
P-IM5. In the last 12 months, how often was it easy to move around the restroom at your personal doctor's office?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM4

Note: Use with P-IM4
P-IM6. In the last 12 months, how often did pain limit your ability to do the things you needed to do?
1__ Never → If Never, go to P-IM8
2__ Sometimes
3__ Usually
4__ Always		 After P-IM5

Note: Use with P-IM1
P-IM7. In the last 12 months, did your personal doctor ask about the impact of pain on your life?
1__ Yes
2__ No		 After P-IM6

Note: Use with P-IM6
P-IM8. In the last 12 months, how often did fatigue limit your ability to do the things you needed to do?
1__ Never → If Never, go to core question 17
2__ Sometimes
3__ Usually
4__ Always		 After P-IM7

Note: Use with P-IM1
P-IM9. In the last 12 months, did your personal doctor ask about the impact of fatigue on your life?
1__ Yes
2__ No		 After P-IM8

Note: Use with P-IM8
P-IM10.  In the last 12 months, did you need physical or occupational therapy?
1__ Yes
2__ No → If No, go to P-IM12		 After core question 26
P-IM11. In the last 12 months, how often was it easy to get this kind of therapy?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM10

Note: Use with P-IM10
P-IM12. In the last 12 months, did you need speech therapy?
1__ Yes
2__ No → If No, go to P-IM14		 After P-IM11
P-IM13. In the last 12 months, how often was it easy to get speech therapy?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM12

Note: Use with P-IM12
P-IM14. Mobility equipment includes things like a wheelchair, scooter, walker, or cane. In the last 12 months, have you used any mobility equipment?
1__ Yes
2__ No → If No, go to core question 27		 After P-IM13
P-IM15. In the last 12 months, did you try to get your mobility equipment repaired?
1__ Yes
2__ No → If No, go to P-IM17		 After P-IM14

Note: Use with P-IM14
P-IM16. In the last 12 months, how often was it easy to get your mobility equipment repaired?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM15

Note: Use with P-IM15
P-IM17. In the last 12 months, did you try to get or replace any mobility equipment?
1__ Yes
2__ No → If No, go to core question 27		 After P-IM16

Note: Use with P-IM14
P-IM18. In the last 12 months, how often was it easy to get or replace the mobility equipment that you needed?
1__ Never
2__ Sometimes
3__ Usually
4__ Always		 After P-IM15

Note: Use with P-IM17
P-IM19. A quarter mile is about 5 city blocks or 0.4 kilometers. In the last 12 months, were you able to walk that far?
1__ Yes
2__ No → If No, go to core question 33		 After core question 32
P-IM20. In the last 12 months, did you have difficulty or need assistance walking that far?
1__ Yes
2__ No		 After P-IM19

Note: Use with P-IM19
Page last reviewed February 2021
Page originally created September 2017

Internet Citation: Supplemental Items for the CAHPS Health Plan Adult Survey 5.0: People With Mobility Impairments. Content last reviewed February 2021. ´óÏóÊÓƵ, Rockville, MD.
/cahps/surveys-guidance/item-sets/hp/suppl-PWMI-items-hp-survey50-adult.html

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