Manual Short Form- Health and Labour Questionnaire (SF-HLQ)

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“All rights reserved. Nothing in this publication may be changed or reproduced without theauthors’ permission. Such permission may be obtained under the conditions stated in the UsersConditions.”1
User conditionsThis questionnaire was developed by the Institute for Medical Technology Assessment (iMTA),Erasmus University Rotterdam. The questionnaire may be used on the following conditions.Permission for usePermission to use the questionnaire and manual must be obtained in advance. To apply for suchpermission, contact the address provided at the bottom of the page, or complete and submit theenclosed registration form to the same. In principle, permission for use will be granted. There areno financial conditions attached to use of the questionnaire. However, the following conditionsmust be observed when using the questionnaire, whether such use is for commercial or scientificpurposes.Conditions for use• The copyright notice on the title page must be reproduced in cases where thequestionnaire is largely or wholly used as is. If an altered version of the questionnaire isused, this version should be stated as source material.• The source is required to be explicitly stated in all publications as follows: Hakkaart-vanRoijen L, Short Form- Health and Labour Questionnaire. Institute for Medical TechnologyAssessment, Erasmus University Rotterdam.• The liability notice printed on the title page must always be included when using themanual and questionnaire.• Changes are permitted to be made to the questionnaire without prior consent. However, itshould be very clear that these changes were made by the user.• The user shall indemnify the Institute for Medical Technology Assessment, ErasmusUniversity Rotterdam and the author of this edition against claims from third partiesarising from and/or related to the use of this edition by the user, in the event of changesand or translation, or due to errors, omissions and misinterpretations or anyconsequences of this.• To assess the use of the questionnaire and the purpose to which this is used, please fillin the registration form as fully as possible (see appendix III).• A copy of all manuscripts, articles or other publications featuring this questionnaire orcontaining results obtained with the help of this instrument shall be made available to theauthor.• For the purpose of further (validation) studies, we may request the user – in consultation– to place part of the research at the disposal of the authors, specifically the scores forthe individual questions in the questionnaire, as (if gathered) those for the questions onsex, age, diagnosis, living situation, educational attainment and work status. The datamade available on the basis of the three preceding items will be treated confidentially bythe authors.For questions and comments, please Consultation:Dr. L. Hakkaart-van RoijenInstitute for Medical Technology AssessmentErasmus University RotterdamPostbox 17383000 DR RotterdamTel: +31 10 4088555E-mail: hakkaart@bmg.eur.nl2
Page 1: ManualShort Form- Health and Labour
Page 5 and 6: 1. IntroductionBackgroundIn economi
Page 7 and 8: Random sample size, effect size and
Page 9 and 10: Valuation module 1There are two met
Page 11 and 12: Individuals with health problems ar
Page 13 and 14: without absenteeism may also be val
Page 15 and 16: followed by the question of whether
Page 17 and 18: ‘unpaid help’ (what is known as
Page 19 and 20: 4. References1. Nederlandse richtli
Page 21 and 22: This questionnaire concerns the con
Page 23 and 24: 9. Which of the following situation
Page 25 and 26: General questions1. Sex:malefemaleD
Page 27 and 28: Overstressed, depression, severe ne
Page 29 and 30: -3 = have paid work, nohindrance (H
Page 31 and 32: ecause of health problems4. Did not
Page 33 and 34: ALG3O Thyroid disease 1=YESALG3PPer

Manual Short Form- Health and Labour Questionnaire (SF-HLQ)

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