| The following questionnaire is designed to find out how CF affects your life. Read each statement, and then indicate which response is closest to how you feel, by ticking (✔) one of the boxes after each statement. Please try to answerALL the questions, as honestly as you can.
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SECTION ONE: |
| How often, over the last two weeks, do you feel that your CF has affected the following aspects of your physical functioning/mobility? |
| 1. Because of my CF, During the last two weeks, I have had difficulty doing heavy physical jobs. For example, digging, moving furniture, washing the car, vacuuming etc. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 2.During the last two weeks, my CF has prevented me from getting out of the house to run errands. For example, paying bills, posting a letter, doing light shopping etc. |
| 3. Because of my CF, over the last two weeks, it has been difficult for me to do light tasks around the house. For example, preparing a light snack, washing up, picking up the mail etc. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 4.Over the last two weeks, getting around the house has been difficult because of my CF. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 5. For the last two weeks, CF has made it difficult to move from my bed or my chair. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 6. Despite CF,over the last two weeks I have got around and done what I like. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 7. During the last two weeks, there are places that I would like to have gone but didn't because of my CF. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 8. My CF has limited the type of sports and exercise I have been able to doover the last two weeks.
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 9.During the last two weeks, my CF has made me feel lacking in energy. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 10.Over the last two weeks, I have found that my physical functioning and mobility have affected my quality of life by making life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
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SECTION TWO:
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| Over thepast two weeks, has CF affected your social life in any of the following ways? |
| 11. When I have been out socialising, over the last two weeks, I have behaved more cautiously than I would like to because of my CF. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 12. Because of my CF, during the last two weeks, I have tended to avoid visiting friends. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 13.For the last two weeks, I have avoided going out and socialising because of my CF. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 14. I find that the way in which CF affects my socialising interferes with my overall enjoyment of life. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
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SECTION THREE:
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| The following questions ask you about symptom and treatment aspects of your CF.How have the following factors affected you over the last two weeks?
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| 15. Over the last two weeks, I have found my treatments (ie physio, enzymes etc) very time consuming. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 16.During the last two weeks, my treatments have interfered with other things that I have wanted to do. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 17.Over the last two weeks, I have found that my treatments have interfered with my enjoyment of life. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 18. I have found my breathlessness troublesome, during the last two weeks. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 19.Over the last two weeks, I have found my coughing troublesome. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 20. I have found my coughing embarrassing over the last two weeks. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 21. For me,over the past two weeks, breathlessness / coughing have made life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
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SECTION FOUR:
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Over the past two weeks, I have found that my CF has made me feel: |
| 22.Resentful:
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 23.Angry:
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 24.Embarrassed:
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 25.Irritable:
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 26. Sofed up that nothing can cheer me up: |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 27. Anxious:
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| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
| 28.Frustrated:
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| □ | □ | □ | □ | □ | □ |
| All of the time. | most of the time | good bit of the time | sometimes | occasionally | never |
| 29. The way that my CF makes me feel emotionally interferes with my quality of life. |
| □ | □ | □ | □ | □ | □ |
| All of the time | most of the time | good bit of the time | sometimes | occasionally | never |
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PLEASE NOTE, the remaining sections have a slightly different response scale, which asks you to indicate to what extent you either agree or disagree with each statement. Again, indicate which response is the closest to how you feel by ticking (√) one of the boxes after each statement. Please try to answerALL questions as honestly as possible. |
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SECTION FIVE:
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| The next section asks you about any concerns that you may have for the future because of your CF: |
| 30. It concerns me that I may not be able to have any/have more children. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 31. I have concerns about being assessed for a heart-lung transplant. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 32. The possibility of needing a heart-lung transplant worries me. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 33. I worry about CF shortening my life. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 34. In general thinking about the future makes me feel concerned / worried. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 35. The worries that I have about the future make life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
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SECTION SIX:
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In general , do you agree or disagree that your CF has affected your relationships with other people in any of the following ways? |
| 36. Establishing new relationships / friendships is difficult because of my CF. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 37. I find that my friends don't always understand the limits that my CF places on me. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 38. My CF makes it difficult for me to establish intimate relationships. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 39. My CF makes it difficult for me to maintain intimate relationships. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 40. I find that my CF interferes with me having a satisfactory sex life. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 41. I find that CF makes me feel different from other people my own age. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 42. My CF makes me feel isolated from other people. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 43. I am concerned that my CF is stressful for those who are close to me. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 44. I worry that, because of my CF, I will never be able to lead an independent life. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 45. The way in which CF affects my relationships with other people interferes with my quality of life by making life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
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SECTION SEVEN:
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| CF can affect your height/weight, in general how has this made you feel? |
| 46. I believe that my CF has made me too small. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 47. I feel that because of my CF I am too thin. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 48. The way that my CF has made me look because of my height / weight makes life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
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SECTION EIGHT:
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| The next section asks you about problems you may experience at college, work OR school as a result of your CF. If you are no longer working or at college, please answer the questions in relation to your past experiences. |
| 49. CF makes/has made, finding a suitable college course/job difficult. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 50. Holding down a job / college course is / has been difficult because of my CF. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 51. I am now unable to work / go to college because of my CF. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
| 52. I find that CF interferes with my career / college OR school life to such an extent that it makes life less enjoyable. |
| □ | □ | □ | □ | □ | □ |
| Strongly agree | Agree | Slightly agree | Slightly disagree | Disagree | Strongly disagree |
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Thank you for completing the questionnaire
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