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Asking Questions - The Definitive Guide To Questionnaire Design ...

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Figure 2.4. Household Health Diary.<br />

STAYED HOME FROM WORK OR SCHOOL OR COULD NOT DO USUAL HOUSEHOLD TASKS<br />

List all illnesses during this month to all household members who had to stay home from school, work, or could not do their<br />

usual job.<br />

If the same person starts off a little sick, but goes to work for two days and then stays home for two more days until he is<br />

recovered, you would report the first two days on page 5 and the last two days on page 3.<br />

SAMPLE<br />

Did they stay<br />

in bed all or What medicine or treatment was used?<br />

Date first Who in Why did they stay home? part of the day? (Check one)<br />

stayed Date resumed the family? (Headache, cold, cramps, (Check one) Prescription If other,<br />

home usual activities (First name) sprained ankle, etc.) Yes No None (Name, if known) what?<br />

Oct. 7 Oct. 9 John Flu X Aspirin<br />

Oct. 13 Oct. 14 Mary Stomach cramps X X<br />

Oct. 14 Oct. 19 John Jr. Dislocated shoulder X Plaster cast<br />

Source: Survey Research Laboratory, 1976.

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