9. RNZFB Costs Of Blindness Survey
- 1. Introductory Demographics
- 2. Daily Living
- 3. Equipment
- 4. Accommodation and Home Alterations
- 5. Education and Training
- 6. Employment
- 7. Transport
- 8. Medical and Health Services
- 9. Social, Recreation, Leisure
- 11. Things Don't Have/Not Accessible
- 12. Other Costs of Blindness
- 13. Demographics
- Thanks and Close
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Good afternoon/evening, this is ....from Gravitas. Is......available?
I am calling to interview you as part of the Costs of Blindness research being undertaken by the Royal New Zealand Foundation of the Blind. Is this still a good time to do the interview?
If Yes: Proceed
If No: Reschedule as appropriate
Thank you for taking part. Your participation will help ensure that the Costs of Blindness research succeeds in identifying the range of costs associated with being blind or vision impaired.
Please remember that we are interested in the extra costs you or others have on a day-to-day basis as a direct result of your vision impairment. It is useful to consider extra costs as those you do not have a choice about paying or experiencing because of your vision impairment.
Please also remember that the extra costs of blindness can include financial costs to you and others, they can also include things you have had to give up, things you have to do differently, or things you are prevented or restricted from doing because of your vision impairment.
You may also experience costs as a result of any other impairments you may have. However, for this research, we would like you to focus on those costs specifically related to your vision impairment.
Please remember that your participation in this research is voluntary and totally confidential. You do not have to answer all the questions if you do not wish to.
The interview will take approximately 30 to 45 minutes. If at any stage, you need a break, please let me know and we can decide how we will complete the interview (e.g. ring back after your break, re-schedule another time and day to complete).
I'd like to start with some questions about you. These will help determine some of the questions I will ask you during our interview.
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1. Introductory Demographics
1.1. Visual Status
Q1. Can you see ordinary newspaper print, with glasses or contact lenses, if you usually wear them: easily, with difficulty or not at all?
Read out. Single response.
1. Easily
2. With Difficulty
3. Not at all
4. (Don't read) Don't Know/ Refused
Q1a. Can you clearly see the face of someone across a room (that is from 4 meters or 12 feet away), with glasses or contact lens if you usually wear them: easily, with difficulty or not at all?
Read out. Single response
1. Easily
2. With Difficulty
3. Not at all
4. (Don't read) Don't know/ Refused
1.2 Employment Status
Q2. Which statement or statements describe you? Are you...?
Read out. Multiple responses possible.
1. In full time paid employment (includes self-employed)
2. In part time paid employment (less than 30 hours a week; includes self-employed)
3. A student (includes full time and part time)
4. Unemployed
5. Beneficiary
6. Retired
7. Or would you say something else (please specify)
[INTERVIEWER NOTE: It is possible to be on the Invalid's Benefit (blindness) and still work]
If employed at Q2:
Q2a. Are you.....
Read out. Single response.
1a. In full time paid employment (includes self-employed)....and what is your occupation? (specify)
1b. In part time paid employment (less than 30 hours a week; includes self-employed)...and what is your occupation? (specify)
1c. Self employed...and what is your occupation (specify)
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If a student:
Q2b. Can I check that in the last 12 months, were you enrolled in any type of formal education or training, for example, a school, polytech, or any other training provider?
(Note: includes training provided by RNZFB).
Don't read. Single Response
1. Yes
2. No
3. (Don't read) Other (please specify)
4. (Don't read) Don't Know/ Refused
If Yes at Q2b:
Q2c. Were you studying full time or part time?
Don't read. Single Response
1. Full Time
2. Part Time
3. (Don't read) Other (please specify)
2. Daily Living
I would like to start by talking about any additional costs associated with day-to-day living. These first questions are about daily tasks around the home.
2.1 Domestic Tasks
Q3. Which of the following tasks do you personally spend time on - with or without the help of other people?
(To all answer either Yes or No)
[Interviewer Note: If undertaken by someone else for other reasons= No]
Read out. Single response
1. Preparing food and drink and clearing up after meals [time spent per day]
2. Indoor cleaning, laundry and other care of clothing [time spent per week]
3. Home maintenance, repairs, and upkeep of heating and water systems and vehicles [time spent per week]
4. Looking after the grounds (e.g. gardening and mowing lawns) [time spent per week]
5. Looking after pets and other domestic animals [ time spent per day]
6. Household administration such as paying bills [time spent per week]
For each 'Yes' in Q3:
Q3a. How long (in hours/mins) on average would you personally spend
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doing [task] each [relevant period]?
1. Insert minutes/hours
2. (Don't read) Not sure/ Don't Know
2.2 Personal Tasks
Q4. And with or without help from others, how long on average would you spend each day... [insert task below]?
Read out. Single response
1. ...getting dressed, attending to personal hygiene and grooming
2. ...eating and drinking in your home
2.3 Support and Assistance
Q5. Still thinking about daily tasks around the home, does anyone do any of the following, or help you with the following, because of your vision impairment? Helpers may include family, friends, volunteers and paid helpers.
[INTERVIEWER NOTE: "Not my responsibility" for reasons other than vision impairment = NO]
1. Do you require help preparing food and drink and clearing up after meals? (Yes/No)
2. Do you require help doing indoor cleaning, your laundry and other care of clothing? (Yes/No)
3. Do you require help with looking after your grounds (e.g. gardening and mowing lawns)? (Yes/No)
4. Do you require help with home maintenance, repairs, and upkeep of heating and water systems and vehicles? (Yes/No)
5. Do you require help with household administration such as banking and paying bills? (Yes/No)
6. Do you require help with personal care such as getting dressed, personal hygiene and grooming (Yes/No)
7. Looking after pets and other domestic animals (Yes/No)
If none, skip to Q9
For all tasks identified in Q4.
For each ask Q6-Q8b
Q6. Who usually helps you with [task]?
[If "varies", ask for person who helps most often]
Don't read. Single response
1. Husband/wife/partner
2. Family/whanau member
3. Helper employed by government agency
4. Helper employed/provided by private agency
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5. Helper employed by respondent or family
6. Flatmate
7. Friend or neighbor
8. Volunteer or volunteer organisation
9. Other (please specify)
For helper identified in Q6: Ask Q7- Q8b
Q7. How often does [helper] help with [task]: Would you say everyday, at least twice a week, once a week, or less than once a week?
[If "varies", ask for usual/ typical frequency]
Read out if necessary. Single response
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q7
Q7a. Approximately how much time does [helper] spend helping you each week with [task]?
1. Insert minutes/hours
2. Not sure
If 4 in Q7
Q7b. Approximately how much time does [helper] spend helping you each month with [task]?
1. Insert minutes/hours
2. Not sure
Q8. Does [helper] receive any payment for helping you with [task]?
Don't read out. Single response.
1. Yes
2. No (Skip to Q9)
3. Not sure (Skip to Q9)
Q8a. Who pays them?
Don't read out. Multiple responses possible.
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Other private agency
4. Part respondent/family and part government/other private agency
5. Other (please specify)
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6. Not sure
If 1 or 4 in Q8a:
Q8b. What would be the approximate monthly cost to you or your family for this help?
1. Insert cost
2. Not sure
2.4 Shopping
These next questions are about any additional costs associated with going shopping.
Q9. Do you go shopping, with or without help, for household goods such as groceries?
[INTERVIEWER NOTE: Excludes shopping for personal items]
1. Yes
2. No (Skip to Q14)
Q10. And on average, how many hours per week do you spend shopping for household goods? This includes getting to and from the shops, doing your shopping and putting your shopping away.
1. Insert hours
2. Not sure
Q11. Do you require any help with your household goods shopping? This could include getting to and from the shops, doing, doing your shopping and putting your shopping away.
1. Yes
2. No (Skip to Q18)
Q11a. And who usually helps you?
Don't read. Single response
[If varies, ask for person who helps most often]
1. Husband/wife/partner
2. Family/whanau member
3. Helper employed by government agency
4. Helper employed/provided by private agency
5. Helper employed by respondent or family
6. Flat mate
7. Friend or neighbor
8. Volunteer or volunteer organisation
9. Employee at supermarket/shops
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10. Taxi Driver
11. Driver- Public Transport
12. Other (please specify)
If 10 or 11, taxi driver or driver of public transport:
Q11b. Does anyone else usually help you?
1. Yes (please specify) (go to Q12)
2. No (skip to Q18)
For helper identified in Q11a or 11b:
Q12. How often does [helper] help with the shopping?: Would it be everyday, at least twice a week, once a week, or less than once a week?
Read out if necessary. Single response.
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q12:
Q12a. Approximately how much time does [helper] spend helping you each week with the shopping?
1. Insert minutes/hours
2. (Don't read) Not sure
If 4 in Q12:
Q12b. Approximately how much time does [helper] spend helping you each month with the shopping?
1. Insert minutes/hours
2. (Don't read) Not sure
Q13. Does [helper] receive any payment for helping you with your shopping?
1. Yes
2. No (Skip to Q18)
3. Not sure (Skip to Q18)
Q13a. Who pays them?
Don't read out. Multiple response possible.
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Other private agency
4. Part respondent/family and part government/other private agency
5. Other (please specify)
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6. Not sure
If 1 or 4 in Q13a:
Q13b. What would be the approximate monthly cost to you or your family for the help you receive with your household goods shopping?
1. Insert cost (skip to Q18)
2. Not sure (skip to Q18)
If No in Q9:
Q14. Is it because of your vision impairment that you do not do this shopping or is there some other reason?
Don't read. Single response
1. Do not go shopping because of vision impairment
2. Do not go shopping because of some other reason (please specify) (Skip to Q17)
3. Not sure (Skip to Q17)
Q15. Does someone else do this shopping for you?
1. Yes
2. No (Skip to Q17)
Q15a. And who usually does this?
[If "varies", ask for person who helps most often]
Don't read. Single response only
1. Husband/wife/partner
2. Family/whanau member
3. Helper employed by government agency
4. Helper employed/provided by private agency
5. Helper employed by respondent or family
6. Flat mate
7. Friend or neighbor
8. Volunteer or volunteer organisation
9. Other (please specify)
For helper identified in Q15a
Q16. How often does [helper] do your shopping?: Would it be everyday, at least twice a week, once a week, or less than once a week?
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
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If 1, 2, 3 or 5 in Q16
Q16a. Approximately how much time does [helper] spend doing your shopping each week?
1. Insert minutes/hours
2. Not sure (Skip to Q17 )
If 4 in Q16
Q16b. Approximately how much time does [helper] spend doing your shopping each month?
1. Insert minutes/hours
2. Not sure (Skip to Q17)
Q17. Does [helper] receive any payment for doing your shopping?
1. Yes
2. No (Skip to Q18)
3. Not sure (Skip to Q18 )
Q17a. Who pays them?
Don't read. Single response
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Other private agency
4. Part respondent/family and part government/other private agency
5. Other (please specify)
6. Not sure
If 1 or 4 in Q17a :
Q17b. What would be the approximate monthly cost to you or your family for getting your household good shopping done?
1. Insert cost
2. Not sure
Q18. What other additional financial, time or other costs do you have related to shopping because of your vision impairment? These could include things you miss out on, things you have to do differently or things you are restricted or prevented from doing.
Don't read. Multiple responses possible
After each identified: "Are there any others?"
1. Pay more for goods because less able to take advantage of sales/specials
2. Pay more for goods because less able to shop at supermarkets and other discount stores
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3. Unable to shop at certain times or places (e.g. avoid shops at busy times)
4. Pay more for goods because shop over the internet more often
5. Unable to 'just go out and get something'; unable to shop spontaneously
6. Other (please specify)
7. (Don't read) None
8. (Don't read) Not sure
Q18a. Do you have any of the following additional costs related to shopping because of your vision impairment?
Read out Multiple responses possible
After each identified: "Are there any others?"
1. Do you pay more for goods because you are less able to take advantage of sales/specials
2. Do you pay more for goods because you are less able to shop at supermarkets and other discount stores
3. Are you unable to shop at certain times or places (e.g. do you avoid shops at busy times)
4. Do you pay more for goods because you shop over the internet more often
5. Are you unable to 'just go out and get something' or unable to shop spontaneously
3. Equipment
These next questions are about any special equipment you need to use because of your vision impairment. This includes any equipment you use during daily living, for communication or for work, education or training.
3.1 Communication Equipment
Q19. Do you use any of the following equipment specifically because of your vision impairment?
Read Out. Multiple Responses possible
1. Personal computer
2. Closed Circuit Television (CCTV)
3. OCR Scanner (scanner for reading)
4. 19" Monitor
5. Printer
6. Braille equipment (e.g. Braille note)
7. Talking book player
8. Tape recording equipment
9. Magnifying equipment
10. (Don't read) Other [Interviewer Note: Use to specify any double ups in equipment]
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11. (Don't read) None (Skip to Q26 )
For those identified as working and/or in education:
For each equipment item identified as used in Q19:
19a. Is your use of the [equipment] for personal or work purposes or both?
Read out if necessary. Multiple response
1. Personal
2. Work
3. Education purposes
4. (Don't read) Don't know
For equipment specified as having dual/multiple use at 19a:
19b. Do you use the same or a different [equipment] for [personal/work/education] purposes?
1. Yes
2. No
3. (Don't read) Don't Know
If different equipment used, re-code to show dual/multiple equipment
For all identified in Q19. Ask Q20-Q23 (acquisition questions)
Exclude Braille equipment from the selection
Q20. How did you acquire or gain access to [equipment]? Did
Read out. Single response
1. ...you buy it, personally or with someone else helping pay for it?
2. ...you or someone else loan or lease it?
3. ...someone buy it for you or give it to you?
4. ...or, did you acquire it or gain access to it through some other way? (please specify)
5. (Don't read) Don't know
If 1 in Q20:
Q21. Did you receive any financial assistance or subsidy in acquiring [equipment]?
1. Yes
2. No (Skip to next identified equipment item- return to Q20)
3. Not sure (Skip to next identified equipment item- return to Q20)
Q21a. From whom did you receive this assistance?
Don't Read. Multiple responses possible
1. Government (general)
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2. ACC
3. WINZ
4. Ministry of Health
5. Ministry of Education
6. Workbridge
7. Homia School
8. RNZFB (e.g. Pearson fund)
9. Employer
10. Family member
11. Employer
12. Friend or neighbour
13. Other (please specify)
14. Not sure
Q21b. Can you recall what proportion of the total cost of [equipment] you or your family paid for?
1. Enter proportion or $ value if given
2. (Don't read) Not sure
If 2 in Q20:
Q22. What is the approximate monthly cost of loaning or leasing [equipment]?
1. Insert cost ($)
2. Nothing (Skip to next identified equipment item- return to Q20)
3. Not sure (Skip to next identified equipment item- return to Q20)
Q22a. And who pays the cost of loaning or leasing [equipment]?
Don't read. Multiple responses possible
1. Government (general)
2. ACC
3. WINZ
4. Ministry of Health
5. Ministry of Education
6. Workbridge
7. Homai School
8. RNZFB
9. Employer
10. Respondent or family
11. Employer
12. Other (specify)
13. Not sure
If 3 in Q20:
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Q23. Who brought or gave [equipment] to you?
Don't read. Multiple responses possible
1. Government (general)
2. ACC
3. WINZ
4. Ministry of Health
5. Ministry of Education
6. Workbridge
7. Homai School
8. RNZFB
9. Employer
10. Family member
11. Employer
12. Friend or neighbour
13. Other (specify)
14. Not sure
3.2 Computer Software
If Yes to "personal computer" in Q19:
All others skip to Q25
Q24. Do you use any of the following computer software packages?
Read Out. Multiple responses possible.
1. Screen reader software (e.g. JAWS)
2. Screen magnification software (e.g. Zoomtext)
3. Voice/ Speech recognition software
4. Print reading software (e.g. K1000, OpenBook)
5. (Don't read) None used (Skip to Q25 )
For each software item identified in Q24: Ask Questions Q20- 23(Acquisition questions)
3.3 Braille Equipment
If "Braille equipment" identified in Q19:
All others skip to Q26
Q25. Which of the following Braille equipment do you use?
Read out if necessary. Multiple responses possible.
1. Braille Writer (e.g. Perkins Brailler; Mountbatten Braille Writer)
2. Braille embosser
3. Electronic Notetaker (e.g. BrailleLite, BrailleNote)
4. Computer Braille Display (refreshable Braille display)
For each of 1, 2, 3, 4 identified above
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Q25a. Can you please specify the brand of the Braille Writer/ Braille Embosser/ Electronic Notetaker/ Computer Braille Display?
1. Yes (please specify)
2. No/ Don't know
For each Braille equipment identified in Q25: Ask Questions Q20 - Q23 (Acquisition questions)
3.4 Other Equipment
Q26. Do youuse any of the following other equipment specifically because of your vision impairment?
Read Out. Multiple response possible.
1. Special glasses (e.g. prescription glasses, anti-glare glasses)
2. Walking/ mobility canes
3. Talking appliances (e.g. microwave)
4. Adaptive telephone equipment (e.g. large number buttons)
5. Adaptive or special kitchen utensils
6. Voice activated remote for TV, VCR or DVD
7. Special lights and lighting equipment
8. Talking or special clocks, watches or alarms
9. Talking Day Organiser
10. (Don't read) None (Skip to Q27)
For each equipment item identified in Q26 ask Q20-Q23 (Acquisition questions)
If no equipment identified at all in Q19 and Q26, Skip to Q33
3.5 Equipment Training
Q27. Have you ever been required to undertake special training in the use of any of the equipment you have identified? Please exclude any training not specifically required for, or tailored to, your vision impairment.
1. Yes
2. No (skip to Q31)
3. (Don't read) Don't know (skip to Q31)
Q27b. For what equipment was this training required?
Don't read. Multiple response possible
After each identified: "Have you received any other training?"
1. Personal computer
2. Scanner software
3. Screen reader software
4. Screen magnification software
5. Voice recognition software
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6. Braille equipment
7. Cane/ mobility training
8. Other (specify)
Have not been required to undertake specific training (Skip to Q31)
Not sure (Skip to Q31)
For each equipment training identified in Q27b: Ask Q28- Q30b
Q28. Approximately, how much time was spent training you in the use of [equipment item]?
1. Insert hours, days, or weeks
2. Not sure
Q29. And who provided or paid for this training?
Don't Read. Multiple response possible
1. Government (general)
2. ACC
3. WINZ
4. Ministry of Health
5. Ministry of Education
6. Workbridge
7. Homia School
8. RNZFB
9. Husband/wife/partner
10. Other family member
11. Employer
12. Friend or neighbour
13. Respondent
14. Other (specify)
15. Not sure
If 9, 10 or 13 identified above
Q29a. Approximately what was the cost of your training to you or your family?
1. Other (please specify)
2. Don't Know
Q30. What other financial, time or other costs did you or anyone else have as a result of this training?
Don't Read. Multiple response possible
After each identified: "What other costs?"
1. Cost of travel to and from training
2. Time spent traveling to and from training
3. Accommodation while undertaking training
4. Lost productivity while training (employer cost)
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5. Time not working/ earning (if employed)
6. Time potentially working but training instead
7. Loss of personal income while training
8. Other (specify)
9. No other costs (Skip to Q31)
10. Not sure (Skip to Q31)
For each not identified above at question 30:
Q30a. Did you or anyone else face the following costs as a result of this training?
Read out. Multiple response possible
1. Cost of travel to and from training
2. Time spent traveling to and from training
3. Accommodation while undertaking training
4. Lost productivity while training
5. Loss of personal income while training
6. No other costs
For each cost identified in Q30 and 30a: Ask Q30b - Q30c
Q30b. Approximately, what was the total cost of [other cost]?
[INTERVIEWER NOTE: May be financial or time costs]
1. Insert total financial cost ($)
2. Insert total time cost (hours/mins)
3. Not sure (Skip to Q30)
Q30c. And who paid for or who experienced this cost?
Don't read. Single response only
1. Respondent or family
2. Government agency
3. Other private agency
4. Employer
5. Part respondent/family and part government/other private agency
6. Part respondent/family and part employer
7. Other (Specify)
8. Not sure
3.6 Equipment Repairs and Maintenance
Q31. In the last 12 months, has any of the equipment you require because of your vision impairment needed repair or maintenance?
1. Yes
2. No (skip to Q33)
3. (Don't read) Don't know
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If Yes at Q31:
Q31a. What equipment has required repair or maintenance?
Don't read. Multiple responses possible
After each identified: "Was there anything else"?
1. Personal computer
2. Scanner software
3. Screen reader software
4. Screen magnification software
5. Voice/ Speech recognition software
6. Braille equipment
7. Talking appliances (e.g. microwave)
8. Adaptive or special kitchen utensils
9. Voice activated remote for TV/VCR/DVD
10. Special lights and lighting equipment
11. Talking or special clocks, watches or alarms
12. Other (please specify)
13. No (Skip to Q33)
14. Not sure (Skip to Q33)
For each item of repair/maintenance identified in Q31a: Ask Q32-32b:
Q32. Approximately, what was the total cost of the repair or maintenance to your [equipment item]?
1. Insert total cost
2. Not sure
Q32a. And who paid this cost?
Don't read. Single response only
1. Respondent or family
2. RNZFB
3. Government agency
4. Other private agency
5. Employer
6. Part respondent/family and part government/other private agency
7. Part respondent/family and part employer
8. Other (Specify)
If 6 or 7 in Q32a:
Q32b. Approximately, what was the total cost to you or your family for the repairs or maintenance undertaken?
1. Insert cost ($)
2. Don't know
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4. Accommodation and Home Alterations
These next questions are about your home.
4.1 Home Alterations
Q33. Have you ever been required to make any of the following alterations or additions to your home because of your vision impairment?
Read out. Yes/No response
1. Additional safety features such as rails or guards
2. Structural changes to the layout of the house
3. Additional or special lighting
4. Added contrasting features such as strips on steps or contrasts between walls and floors
5. Additional security measures such as burglar alarms or smoke alarms
6. Erected fencing (e.g. for safety reasons or because you have a guide dog)
7. Or any other alteration or addition (please specify)
8. (Don't read) No alterations or additions (Skip to Q37)
For each alteration/addition identified in Q33: Ask Q34 - Q36a
Q34. Who paid for the cost of [alteration/addition]?
Don't read. Multiple responses possible
1. Respondent or family (full cost)
2. Respondent or family (partial cost)
3. Government (general)
4. ACC
5. WINZ
6. Ministry of Health
7. RNZFB
8. Other private agency
9. Other (please specify)
10. Not sure
If 1 or 2 at Q34:
Q35. What would you estimate the total costs of [alteration] to you or your family have been?
1. Insert cost
2. Not sure (Skip to Q36)
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If 2 in Q34
Q35a. Approximately, what proportion of this cost did you or your family pay?
1. Insert proportion (%)
2. Not sure
Q35b. Who paid the remaining cost of [alteration]?
Don't read. Multiple response possible.
1. Government (general)
2. ACC
3. WINZ
4. Ministry of Health
5. RNZFB
6. Other private agency
7. Other (please specify)
8. Not sure
Q36. Did you receive any unpaid assistance in completing [alteration], for example, from family members, friends or neighbors?
1. Yes
2. No (Skip to Q37)
3. Not sure (Skip to Q37)
Q36a. Approximately how many hours of unpaid assistance did you receive?
1. Insert hours
2. Not sure
5. Education and Training
Questions only for those identified as students (3 in Q2)
All others Skip to Q45 if employed or Q52 if not employed.
I now have some questions relating to the study or training you have been undertaking.
Q37. Where have you been studying or training?
Don't read. Multiple Responses possible
After each identified: "Is there anywhere else?"
1. Secondary School
2. University
3. Polytechnic
4. RNZFB
5. Extramural
6. Private Training Establishment
7. Apprenticeship
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8. Other (please specify)
5.1 Education Support and Assistance
Q38. Because of your vision impairment, do you require any help from others to complete the requirements of your education/ training?
1. Yes
2. No (Skip to Q42)
3. (Don't read) Don't Know (Skip to Q42)
Q39. Who helps you?
Don't read. Multiple responses possible
Follow each identified with "Is there anyone else?"
1. Husband/Wife/Partner
2. Family/whanau member
3. Support person employed by education institution (e.g. note taker)
4. Support person employed by government agency (e.g. WINZ, ACC)
5. Support person employed by respondent or family
6. Fellow Student
7. Flatmate
8. Friend or neighbor
9. Volunteer or volunteer organisation
10. Private organisation
11. Other (specify)
Randomly select maximum 3 helpers identified in Q 39
For each helper ask Q40 - Q41b
Q40. In a typical week, how often would [helper] spend helping you with your study or training? Would it be everyday, at least twice a week, once a week, or less than once a week?
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q40
Q40a. And approximately how much time would [helper] spend helping you each week?
1. Insert minutes/hours
2. (Don't read) Not sure
If 4 in Q40:
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Q40b. And approximately how much time would [helper] spend helping you each month?
1. Insert minutes/hours
2. (Don't read) Not sure
Q41. Does [helper] receive any payment for the time they spend helping you?
1. Yes
2. No (Skip to Q42)
3. (Don't read) Not sure (Skip to Q42)
Q41a. Who pays them?
Don't read. Multiple response possible
1. Respondent or family
2. Education institution (e.g. university/polytechnic)
3. Government agency (e.g. WINZ, ACC, Ministry of Education)
4. Other (please specify)
5. (Don't read) Not sure
If 1 in Q41a:
Q41b. What would be the approximate monthly cost to you or your family for the help you receive?
1. Insert cost
2. (Don't read) Not sure
5.2 Time Spent Studying
Q42. In total, how much time do you typically spend studying each week, both in lectures/classes and in private study?
1. Record in hours per week
2. (Don't read) Not sure (Skip to Q44)
Q43. Of the total time you spend studying each week, how much of this time do you consider to be taken by additional tasks related to your vision impairment? (e.g. planning, organizing accessible format documents and text, organizing assistance etc).
[If Needed: By this I mean, tasks that a fully sighted student would not have to undertake]
1. Record time
2. (Don't read) Not sure
5.3 Other Education/Training Related Costs
Q44. What other extra costs do you or others face because of your vision impairment in relation to education and training?
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Don't read. Multiple response possible.
After each: Is there is anything else?
1. Cost of getting accessible format text books (books converted to Braille, audio or large print either by RNZFB or the University)
2. Other (specify)
3. (Don't read) No other costs
4. (Don't read) None
5. (Don't read) Don't Know
Q44a. Which of the following costs do you or others face because of your vision impairment in relation to education and training?
Read out. Multiple response possible
After each: Is there is anything else?
1. Cost of getting accessible format text books (books converted to Braille, audio or large print either by RNZFB or the University)
2. Other (specify)
3. (Don't read) No other costs
4. (Don't read) None
5. (Don't read) Don't Know
6. Employment
Only for those identified as employed (1, 2 in Q2)
All others Skip to Q52
These next questions focus on your employment and your workplace.
6.1 Workplace Modifications
Q45. Have any modifications or other changes been made to your workplace because of your vision impairment?
1. Yes
2. No (Skip to Q48)
3. Not sure (Skip to Q48)
Q46. What modifications or other changes have been made?
Don't read. Multiple response possible
After each identified: "Is there anything else?"
1. Modifications to layout of work area
2. Additional or special lighting
3. Over sized desk to accommodate additional equipment used
4. Other (specify)
5. (Don't read) Don't Know
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For each workplace modifications identified in Q46: Ask Q47-Q47a
Q47. Who paid for the cost of [modification/change]?
Don't read. Multiple responses possible
After each identified: "Did anyone else contribute?"
[INTERVIEWER NOTE: If partially paid for, ensure you record who paid for the rest]
1. Fully paid for by respondent or family
2. Part paid for respondent or family
3. Fully paid for by employer
4. Part paid for by employer
5. Fully paid for by government agency (e.g. ACC, WINZ, Workbridge, Ministry of Education)
6. Part paid for by government agency e.g. ACC, WINZ, Workbridge, Ministry of Education
7. Fully paid for by other agency (please specify)
8. Part paid for by other agency (please specify)
9. Other (please specify)
10. No cost
11. Not sure
If 1 or 2 in Q47:
Q47a. What was the approximate cost of [workplace modification] to you or your family?
1. Insert cost ($)
2. (Don't read) Not sure
6.2 Employment Support and Assistance
Q48. Because of your vision impairment, do you require help from others to complete the requirements of your job?
1. Yes
2. No (Skip to Q51)
3. Not sure (Skip to Q51)
Q49. What help do you receive?
Don't read. Multiple responses possible
Follow each identified: "Do you receive any other help?"
1. Additional administration/secretarial support within the workplace
2. A reader provided within the workplace
3. Additional support/assistance provided by family/friends outside of the workplace
4. Other (specify)
5. None identified (Skip to Q51)
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For each type of help identified in Q49: Ask Q50-Q50d
Q50. In a typical working week, how often do you require [type of help]? Would you say everyday, at least twice a week, once a week, or less than once a week?
Read out if necessary. Single response
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q50:
Q50a. Approximately how much time would be spent each week providing you with [type of help]?
1. Insert minutes/hours
2. (Don't read) Not sure
If 4 in Q50:
Q50b. Approximately how much time would be spent each month providing you with [type of help]?
1. Insert minutes/hours
2. (Don't read) Not sure
Q50c. Is this time specifically allocated or paid for to provide you with the help you require?
[INTERVIEWER NOTE: That is, is not just provided through someone's existing job or through some existing activity]
Don't read out. Single response
1. Yes
2. No (Skip to Q51)
3. Not Sure (Skip to Q51)
If Yes in Q50c:
Q50d. Who pays for the cost of providing [type of help]?
Don't read. Multiple responses possible
1. Respondent or family
2. Employer
3. ACC
4. Other government agency
5. Other private agency
6. Other (please specify)
7. There is no cost
8. (Don't read) Not sure
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6.3 Other Workplace Changes
Q51. Have there been any other changes made in your job, for example, the duties you undertake or the hours that you work?
1. Yes
2. No (Skip to Q51)
3. Not sure (Skip to Q51)
If Yes in Q51:
Q51a. What other changes have been made?
Don't read. Multiple responses possible
Follow each identified: "Is there anything else?"
1. Modified duties or different duties
2. Modified hours or days worked
3. Other (specify)
7. Transport
7.1 Short Distance Travel
These next questions are about the transport you use to travel short distances. By short distances, I mean trips which are less than 80 kms (or about 50 miles).
For those employed and/or students (1,2 or 3 in Q2) At this stage, please exclude any forms of transport you use for traveling to and from your work or place of study or training as well as any travel you do as part of your job.
Q52. Have you traveled short distances at all in the last 12 months?
Don't read out. Single response.
1. Yes (Skip to Q54)
2. No
3. (Don't read) Don't Know (Skip to Q54)
Q53. Does your vision impairment completely stop you traveling short distances?
1. Yes (Skip to Q59)
2. No
3. No- for other reasons (e.g. other impairments) (please specify) (Skip to Q59)
Q54. Which of the following forms of transport do you use to travel short distances.
Read out. Multiple responses possible
1. Taxis
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2. Public transport (e.g. Buses, Trains, or Ferries)
3. Your own car
4. Someone else's car
5. Walking
6. Any other form of transport (please specify)
7. (Don't read) Don't Know
If Taxis identified in Q54: Ask Q55- Q56b
Q55. Over the last 12 months, how often have you used a taxi to travel short distances? For employed/Students: Remember to exclude travel to and from your work or place of study or training.
Don't read out. Single response only
1. Everyday or almost everyday
2. Once a week or more
3. Once a month or more
4. Less than once a month
5. (Don't read) Not sure
Q56. And ina typical week and including any subsidies you may receive, how much in total would your taxi travel cost?
1. Insert cost
2. Not sure (Skip to Q57)
Q56a. Of [cost] how much of this would be covered by subsidies for taxi travel? (e.g. Total Mobility Scheme)
1. Insert subsidy amount (dollars/subsidy)
2. Not sure (Skip to Q57 )
Q56b. Check question: So that means you are personally spending about [total cost - subsidy] dollars on taxis in a typical week?
1. Yes
2. No - modify
For all respondents (adjust question appropriately for whether taxis identified or not in Q54)
Q57. What is the MAIN reason you have [not used taxis at all/not used taxis more often] over the last 12 months?
Don't read out. Single response only
1. Don't need to
2. Too expensive
3. Need to book in advance
4. Other (please specify)
5. No reason
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6. Not sure
If own car/someone else's car identified in Q54
Q58. Who usually drives you?
[If "varies", ask for person who drives most often]
1. Husband/Wife/Partner
2. Family/whanau member
3. Flat mate
4. Friend or neighbor
5. Other (specify)
6. Not sure (skip to Q59)
For driver identified in Q58
Q58a. And how much time would [driver] spend driving you in a typical week?
1. Insert time (minutes/hours)
2. Not sure
7.2 Long Distance Travel
These next questions are about traveling long distances. By long distances, I mean trips that are 80 kms or more. That is about 50 miles or one hour traveling on the open road.
Q59. In the last 12 months, have you been on a trip that was 80kms or more?
1. Yes
2. No (skip to Q63)
3. (Don't read) Don't Know
Q60. Does your vision impairment completely stop you traveling long distances?
1. Yes (Skip to Q64 if employed/student, otherwise Skip to Q71)
2. No
3. No- for other reasons (e.g. other impairments) (please specify) (skip to Q71)
Q61. Do you need someone to help you on such trips?
1. Yes
2. No
Q62. Over the last 12 months, have you traveled 80 kms or more by:
Read Out. Multiple response possible
1. Plane
2. Train
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3. Bus
For each transport type NOT identified in Q62:
Q63. Over the last 12 months, has your vision impairment stopped you from traveling long distances in a:
1. Plane
2. Train
3. Bus
4. (Don't read) None (skip to Q64 if employed/ student, otherwise skip to Q72)
Q63a What difficulties do you have traveling [that way/those ways]?
Don't read. Multiple responses possible
After each identified: Would you face any other difficulties?
1. Lack someone to help
2. Lack of accessible transport to and from station/terminal
3. Moving around the station/terminal
4. Lack of accessible toilets in the station/terminal
5. Boarding and getting off the bus/train/plane
6. Seeing signs and notices
7. Unsupportive staff
8. Other (please specify)
7.3 Travel To and From Work/Place of Study
If employed and/or studying (1,2,3 in Q2) ask Q64 - Q67
If employed and studying repeat Q64 - Q67 for both employed situation and student situation
These next questions are specifically about your travel to and from your place of work or study.
Q64. What form of transport do you usually use to travel to and from your work/place of study?
[Note: form of transport = that form used to travel the greatest distance] If "Varies" - ask: "What form of transport do you use most often?"
Don't read. Single response
1. Taxis
2. Public transport (e.g. Buses, Trains, Ferries)
3. Your own car
4. Someone else's car
5. Walk
6. Other (specify)
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If "Taxis" in Q64: Ask Q65-Q65b
Q65. In a typical week and including any subsidies you may receive, how much in total would your taxi travel to and from your work/place of study cost?
1. Insert cost
2. Not sure (skip to Q66)
Q65a. Of [cost] how much of this would be covered by subsidises for taxi travel? (e.g. Total Mobility Scheme)
1. Insert subsidy amount ($) (if given in percentage, convert to $)
2. Not sure (skip to Q66)
Q65b. Check question: So that means you are personally spending about [total cost minus subsidy] dollars on taxis to travel to and from your work/place of study in a typical week?
1. Yes
2. No - modify
If "Own car/Someone else's car" in Q64: Ask Q66-Q66b
Q66. Who usually drives you to and from work/place of study?
Don't read out. Multiple response possible
[If "varies", ask for person who drives most often]
1. Husband/Wife/Partner
2. Family/whanau member
3. Friend or neighbor
4. Flat mate
5. Work colleague
6. Other (specify)
7. Not sure
For driver identified in Q66
Q66a. Does [driver] make a special trip to drive you to and from your work/place of study?
[INTERVIEWER NOTE: That is, is not dropping the respondent off to work/place of study as part of some other travel usually undertaken]
1. Yes
2. No (skip to Q67)
Q66b. And how much time would [driver] spend driving you to and from
work/place of study in a typical week?
1. Insert time (minutes/hours)
2. Not sure
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For all employed/students:
Q67. And, how much time in total would you spend traveling to and from your work/place of study each week? Please think about the total time taken, not just the time you are actually traveling (e.g. if you take the bus, include the time it takes you to walk to the bus and change buses if you need to)
1. Insert Time
2. Not sure
7.4 Employment Related Travel
For employed only (1 or 2 in Q1)
Q68. Are you required to travel as part of your job? This includes short and long distance travel.
1. Yes
2. No (Skip to Q71)
Q69. What form of transport do you usually use for your work related travel?
[If "Varies" - ask: "What form of transport do you use most often?"]
Don't read. Single response
1. Taxis
2. Public transport (e.g. Buses, Trains)
3. Plane
4. Own car
5. Someone else's car
6. Walk
7. Other (please specify)
If "Taxis" in Q69:
Q70. In a typical working week, how often would you use taxis for your work-related travel? Would it be everyday, at least twice a week, once a week, or less than once a week?
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week?
5. (Don't read) Not Sure
Q70a. And ina typical working week, how much would be spent in total on taxis for your work-related travel?
1. Insert spend
2. Not sure
Page 75
Q70b. And who pays for the cost of the taxis?
Don't read out. Multiple response
1. Respondent or family
2. Employer
3. ACC
4. Other government agency
5. Other private agency
6. Other (please specify)
7. Not sure
If 2,3,4,5, 6, or 7 in Q69:
Q71. Do you require help in order to travel by [form of transport]?
1. Yes
2. No (Skip to Q72)
3. Not sure (Skip to Q72)
Q71a. What help do you require?
Don't read. Multiple responses possible
Follow each identified: "Do you require any other help?"
1. Work colleagues drive
2. Other drivers made available to drive
3. Sighted guide to accompany on travel
4. Other (specify)
For each helper identified in Q71a: Ask Q71b - Q71f
Q71b. In a typical working week, how often would you require [type of help]?: Would it be everyday, at least twice a week, once a week, or less than once a week?
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q71b:
Q71c. Approximately how much time would be spent each week providing you [type of help]?
1. Insert minutes/hours
2. Not sure
If 4 in Q71b:
Q71d. Approximately how much time would be spent each month providing you with [type of help]?
1. Insert minutes/hours
Page 76
2. Not sure
Q71e. Is this time specifically allocated or paid for to provide you with the help you require?
[INTERVIEWER NOTE: That is, is not just provided through someone's existing job or through some existing activity]
1. Yes
2. No (Skip to Q72)
3. Not Sure (Skip to Q72)
Q71f. Who pays for the cost of providing [type of help]?
Don't read. Multiple responses possible
1. Respondent or family
2. Employer
3. ACC
4. Other government agency
5. Other private agency
6. Other (please specify)
7. There is no cost
8. Not sure
8. Medical and Health Services
The following questions are about your use of health services and products required for your vision impairment.
8.1 Medical and Health Consultations
Q72. In the last 12 months which of the following have you had a consultation with, or received treatment from, because of your vision impairment?
Read out. Multiple Response
[Interviewers note: "Eye specialist" code as Ophthalmologist or eye surgeon]
1. GP or family doctor
2. A nurse, without seeing a doctor
3. Ophthalmologist or eye surgeon
4. Optician or optometrist
5. Chemist or pharmacist
6. Occupational therapist
7. Counselor, social worker or psychologist
8. Podiatrist or chiropodist
9. Any other health professional, therapist or healer (please specify)
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10. (Don't read) None (Skip to Q78)
Randomly select maximum of 4 medical/health professionals identified in Q72: For each ask Q73-Q77c:
Q73. How often have you seen [medical/health professional] in the last 12 months? Would you say:
Read out. Single response only
1. 1 or 2 times
2. 3 to 5 times
3. 6 to 10 times
4. more than 10 times
5. (Don't read) Don't know
Q74. In the last 12 months, have you had to pay for your consultations or treatment from [medical/health professional] without getting all the money back from a government agency or medical insurance?
1. Yes
2. No (Skip to Q75)
Q74a. Approximately, how much would you have personally paid for these consultations or treatments in the last 12 months?
1. Insert spend
2. Not sure
Q75. How long does it typically take you to travel to and from your consultations or treatment from [medical/health professional]?
Don't read. Single response
1. Less than 30mins
2. 30mins- 1 hour
3. 1-2 hours
4. 2-3 hours
5. 3 hours +
6. Varies too much to say
7. Not sure
Q76. Excluding drivers of taxis or pubic transport, do you receive any other help getting to, and attending these consultations of treatments?
1. Yes
2. No (skip to Q78)
Q76a. Who usually provides this help?
[If "varies", ask for person who helps most often]
Page 78
Don't read Out. Single response
1. Husband/Wife/Partner
2. Family/whanau member
3. Flatmate
4. Helper employed by government agency
5. Helper employed/provided by private agency
6. Helper employed by respondent or family
7. Friend or neighbor
8. Volunteer or volunteer organisation
9. Other (please specify)
For helper identified in Q76a:
Q77. On average, how long (hours/mins) would [helper] spend helping you to attend each consultation or treatment with [medical/health professional]?
1. Insert time
2. Not sure
Q77a. Does [helper] receive any payment for the time they spend helping you?
1. Yes
2. No (Skip to Q78)
3. Not sure (Skip to Q78)
Q77b. Who pays them?
Don't read out. Multiple Response
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Other private agency
4. Part respondent/family and part government/other private agency
5. Medical insurer
6. Other (please specify)
7. Not sure
If 1 or 4 in Q77b:
Q77c. On average, how much do you or your family pay [helper] each time they help you attend each consultation or treatment?
1. Insert spend
2. Other (specify)
3. Not sure
8.2 Medication and Drugs
Q78. In the last 12 months have you taken any medication, prescription or
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non-prescription drugs, herbal remedies, or vitamins for your vision impairment?
1. Yes
2. No (Skip to Q85)
Q79. Do you take any prescription drugs for your vision impairment...
Read Out. Single response
1. Daily
2. Once a week or more
3. Less than once a week
4. As needed
5. Not at all (Skip to Q81)
Q80. In the last 12 months, have you or your family had to pay for prescription drugs needed for your vision impairment without getting all the money back from a government agency or medical insurance?
1. Yes
2. No (skip to Q81)
Q80a. Approximately, how much would you or your family have paid for prescription drugs in the last 12 months?
1. Insert spend
2. Not sure
Q81. Do you take any non-prescription drugs for your vision impairment?
Read Out. Single response
1. Daily
2. Once a week or more
3. Less than once a week
4. As needed
5. Not at all (Skip to Q84)
Q82. In the last 12 months, have you or your family had to pay for non-prescription drugs for your vision impairment without getting all the money back from a government agency or medical insurance?
1. Yes
2. No (Skip to Q84)
Q82a. Approximately, how much would you or your family have paid for non-prescription drugs in the last 12 months?
1. Insert spend
2. Not sure
Page 80
Q83. Do you take any herbal remedies or vitamins for your vision impairment?
Read Out. Single response only
1. Daily
2. Once a week or more
3. Less than once a week
4. As needed
5. Not at all (Skip to Q85)
Q84. In the last 12 months, have you or your family had to pay for herbal remedies or vitamins for your vision impairment without getting all the money back from a government agency or medical insurance?
1. Yes
2. No (Skip to Q85)
Q84a. Approximately, how much would you or your family have paid for herbal remedies or vitamins in the last 12 months?
1. Insert spend
2. Not sure
8.3 Other Related Health Conditions
Q85. In the last 12 months, have you experienced any other health conditions or problems which you consider to be related to your vision impairment? This includes any health conditions or problems resulting from any accidents caused by your vision impairment.
1. Yes
2. No (Skip to Q89)
Q86. What other health conditions or problems have you experienced?
Don't read. Multiple responses possible
After each identified: "Are there any others?"
1. Broken bones
2. Sprains/strains
3. Grazes, bruises, cuts
4. Psychological problems (e.g. depression)
5. Other (please specify)
For each health condition identified in Q85:
Q87. What time, financial or other costs have there been to you or others as a result of [condition/accident]? Remember this could include things you have had to give up, do differently or been restricted in doing.
Don't read out. Multiple responses possible
After each identified: "Have there been any other costs?"
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1. Consultations, treatment or surgery from medical professionals
2. Consultations and treatment from other health professionals
3. Time spent traveling to and attending consultation, treatment or surgery appointments
4. Rehabilitation (e.g. occupational therapy, physiotherapist treatments)
5. Prescribed drugs
6. Non-prescribed drugs
7. Lost productivity (employer cost)
8. Time off work/loss of personal income
9. Loss of quality of life
10. Other (please specify)
11. No costs (Skip to Q89)
12. Not sure (Skip to Q89)
Q87a. Have you or others incurred any of the following time, financial or other costs as a result of [condition/accident]? Remember this could include things you have had to give up, do differently or been restricted in doing.
Don't read out. Multiple responses possible
After each identified: "Have there been any other costs?"
1. Consultations, treatment or surgery from medical professionals
2. Consultations and treatment from other health professionals
3. Time spent traveling to and attending consultation, treatment or surgery appointments
4. Rehabilitation (e.g. occupational therapy, physiotherapist treatments)
5. Prescribed drugs
6. Non-prescribed drugs
7. Lost productivity (employer cost)
8. Time off work/loss of personal income
9. Loss of quality of life
10. Other (please specify)
11. No costs (Skip to Q88)
12. Not sure (Skip to Q88)
For each cost identified in Q87:
Q88. Who paid for or who experienced the costs of [cost]?
Don't read out. Multiple response.
1. Respondent or family (full cost)
2. Respondent or family (partial cost)
3. Medical insurer
4. Government (general)
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5. ACC
6. WINZ
7. Ministry of Health
8. RNZFB
9. Other private agency
10. Other (please specify)
11. Not sure
9. Social, Recreation, Leisure
These next questions are about the things you do in your leisure or free time and any additional costs associated with these activities.
9.1 Activities Undertaken
Q89. What types of activities do you undertake in your leisure or free time?
Don't read. Multiple response possible
After each identified: "Is there anything else?
1. Garden
2. Craft activities, knitting
3. Cooking
4. Read
5. Listen to talking books
6. Listen to music at home
7. Sing, play musical instruments
8. Go to music concerts
9. Listen to/watch television
10. Play with pets
11. Go shopping
12. Attend social groups and clubs
13. Attend church
14. Play sport (e.g. blind bowls, golf, cricket)
15. Visit family/friends
16. Talk with family/friends
17. Go out for coffee, lunch or dinner
18. Walking/tramping
19. Go to the gym
20. Drives/trips with friends
21. Drives/trips using public transport
22. Other (please specify)
23. None (Skip to Q97 )
9.2 Equipment and Aids
Q90. Because of your vision impairment, do you require any special equipment or aids to take part in any of your leisure activities?
Page 83
[If required: "Beyond that or different to what a sighted person would require to take part in the same activity]
1. Yes
2. No (Skip to Q92)
Q91. What equipment or aids do you require?
Don't read. Multiple responses possible
After each identified: "Is there anything else?"
1. Modified sports equipment
2. Walking Cane
3. Antiglare glasses
4. Talking Book Player
5. Other (please specify)
6. None identified
9.3 Support and Assistance
Q92. Do you require help from others so that you can take part in any of the leisure activities you have identified?
1. Yes
2. No (Skip to Q97)
Q93. What type of help do you require?
Don't read. Multiple responses possible
After each identified: "Do you require any other help?"
1. Transport to and from activity
2. Directions/assistance getting to activity (e.g. crossing the road, catching the right bus)
3. Guiding/assistance during leisure activity
4. Specific or special training or instruction
5. Other (please specify)
Q94. Who helps you?
Don't read. Multiple responses possible
Follow each with "Is there anyone else?"
1. Husband/Wife/Partner
2. Family/whanau member
3. Member of social club
4. Member of sports club
5. Flatmate
6. Friend or neighbor
7. Volunteer or volunteer organisation
8. Private organisation
9. General public/person on the street
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10. Other (please specify)
For each helper identified in Q93, Ask Q95 - Q95b:
Q95. How often would you receive help from [helper]? Would you say everyday, at least twice a week, once a week, or less than once a week?
Read out. Single response
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week
5. (Don't read) Not Sure
If 1, 2, 3 or 5 in Q95:
Q95a. Approximately how much time would [helper] spend each week helping you?
1. Insert minutes/hours
2. (Don't read) Not sure
If 4 in Q95:
Q95b. Approximately how much time would [helper] spend each month helping you?
1. Insert minutes/hours
2. (Don't read) Not sure
Q96. Does [helper] receive any payment for the time they spend helping you?
1. Yes
2. No (Skip to Q97)
3. Not sure (Skip to Q97)
Q96a. Who pays them?
Don't read. Multiple responses possible
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Social club
4. Sports clubs
5. Other (please specify)
6. Not sure
If 1 in Q96a:
Q96b. What would be the approximate monthly cost to you or your family for the help you receive?
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Insert cost
(Don't read) Not sure
9.4 Other Activities and Pursuits
Q97. I'd like you to think widely now about recreation and leisure, sport, social activities, holidays and holiday type activities. Thinking of these areas, what, if any, activities or pursuits would you like to participate in or do more often, but are unable or restricted from doing so. This could be because of your vision impairment or because of the cost, equipment, time or assistance that you would require to participate.
Record all identified. Multiple responses possible
After each identified "Is there anything else?"
1. Other (please specify)
2. None (skip to Q 98)
Random select up to 3 activities/pursuits identified in Q97. For each:
Q97a. What prevents or restricts you from participating or participating more often in [x]?
Don't read out. Multiple responses possible
After each identified "Does anything else prevent or restrict your participation?"
1. Cannot physically undertake because of blindness/vision impairment
2. Cannot afford to participate (e.g. cost of equipment, cost of transport, cost of support)
3. Necessary equipment is not available
4. Lack access to necessary support and assistance
5. Lack access to necessary transport/transportation difficulties
6. Necessary support/assistance is not provided by the activity
7. The time taken to undertake the activity (e.g. plan, organize, participate)
8. Feel embarrassed/lack confidence in participating because of needs/impairment
9. Don't know if activity is available
10. Other (specify)
10. Unpaid/Voluntary Work
Q98. Do you do any voluntary work?
1. Yes
2. No (Skip to Q105)
Q99. And how often would you do voluntary work? Would it be everyday, at least twice a week, once a week, or less than once a week?
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Read out. Single response.
1. Daily
2. Weekly
3. Monthly
4. Less than monthly
5. (Don't read) Not Sure
If 1 or 2 in Q99:
Q99a. Approximately how much time each week would you spend doing voluntary work?
1. Insert minutes/hours
2. Not sure
If 3 in Q99:
Q99b. Approximately how much time each month would you spend doing voluntary work?
1. Insert minutes/hours
2. Not sure
If 4 in Q99:
Q99c. Approximately how much time each year would you spend doing voluntary work?
1. Insert minutes/hours
2. Not sure
10.1 Support and Assistance
Q100. Do you require help from others so that you can undertake your voluntary work?
1. Yes
2. No (Skip to Q105)
Q101. What type of help do you require?
Don't read. Multiple responses possible
After each identified: "Do you require any other help?"
1. Transport to and from voluntary work commitments
2. Other (please specify)
Q102. Who helps you?
Don't read. Multiple responses possible
Follow each with "Is there anyone else?"
1. Husband/Wife/Partner
2. Family/whanau member
3. Member of social club
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4. Member of sports club
5. Flatmate
6. Friend or neighbor
7. Volunteer or volunteer organisation
8. Private organisation
9. Other (please specify)
For each helper identified in Q102: Ask Q103 - Q104b
Q103. How often does [helper] help you undertake your voluntary work?: Would you say everyday, at least twice a week, once a week, less than once a week or less than once a month?
Read out if necessary. Single Response
1. Everyday
2. At least twice a week
3. Once a week
4. Less than once a week?
5. Less than once a month?
6. (Don't read) Not Sure
If 1, 2, 3 or in Q103:
Q103a. Approximately how much time would [helper] spend each week
helping you to undertake your voluntary work?
1. Insert minutes/hours
2. Not sure
If 4 in Q103:
Q103b. Approximately how much time would [helper] spend each month helping you to undertake your voluntary work?
1. Insert minutes/hours
2. Not sure
If 5 in 102
Q103c. Approximately how much time would [helper] spend each year helping you to undertake your voluntary work?
1. Insert minutes/hours
2. Not sure
Q104. Does [helper] receive any payment for the time they spend helping you?
1. Yes
2. No (Skip to Q105)
3. Not sure (Skip to Q105)
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Q104a. Who pays them?
Don't read. Multiple responses possible
1. Respondent or family
2. Government agency (e.g. ACC, Ministry of Health services)
3. Other private agency
4. RNZFB
5. Social club
6. Sports clubs
7. Other (please specify)
8. Not sure
If 1 in Q104a:
Q104b. What would be the approximate monthly cost to you or your family for the help you receive?
1. Insert cost ($)
2. Not sure
11. Things Don't Have/Not Accessible
We are almost at the end of our interview.
Q105. Is there any equipment, service or other support that you need because of your vision impairment but are unable to get?
Don't read out. Multiple response.
1. Yes (please specify)
2. No (Skip to Q107)
3. Not sure (Skip to Q107)
For each identified in Q105:
Q106. What prevents you from having [insert identified]?
Don't read. Multiple response possible
After each identified: "Are there any other reasons?"
1. Unsure whether equipment/help/service/support exists
2. Equipment/help/service/support is not available in area
3. Equipment/help/service/support is too costly/can't afford it
4. Ineligible for financial help to receive equipment/help/service/support
5. Don't know whether could apply for financial help or where to apply
6. Don't like equipment/help/service/support that is available
7. Feel uncomfortable with equipment/help/service/support available because of cultural differences
8. Other (please specify)
9. Not sure
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12. Other Costs of Blindness
Q107 What other costs do you or others around you experience that would be a cost of blindness which we haven't discussed but which you feel is significant? Remember that costs can include financial and time costs to yourself and others as well as things you may have had to give up, do differently or things you may be prevented or restricted from doing.
Multiple responses possible
After each identified: "Is there anything else?"
1. Record verbatim comments
2. No
13. Demographics
These last questions are about you and will help to ensure that we have an appropriate cross section of the Foundation' membership in the survey. Please remember all the information you provide is confidential and your participation is anonymous.
Q108. Which of the following best describes your living situation?
Read Out. Single response
1. Living alone
2. Living with partner no children
3. Living with partner and children
4. Living with children only
5. Living with friends/ flat mates
6. Living with family/ parents
7. Other (please specify)
Q109. Which of the following best describes your highest education level?
Read Out. Single response
1. Primary School
2. Intermediate (Form 1 & 2)
3. Secondary (Form 3 & 4)
4. School Certificate (NCEA Level One)
5. Sixth Form Certificate (NCEA Level Two)
6. Bursary (NCEA Level Three)
7. Certificate/ Diploma/ NCEA Level 4
8. Degree
9. Postgraduate Qualification
10. Other (specify)
Q110. Which, if any, of the following benefits do you receive?
Read Out. Multiple responses possible
1. Invalids Benefit (blindness)...if Yes: and do you also receive the Blind Subsidy
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2. Invalids Benefit
3. Sickness Benefit
4. Disability Allowance
5. ACC weekly compensation
6. NZ Superannuation
7. Accommodation Supplement
8. Or any other benefit (please specify)
Q111. Which of the following best describes your household annual income before tax?
Read out. Single response
1. Less than $10,000 a year
2. $10,000 to $29,999
3. $30,000 to $59,999
4. $60,000 to $79,999
5. $80,000 to $99,999
6. $100,000 to $119,999
7. $120,000 or more
8. (Don't read) Varies
9. (Don't read) Don't know/Refused
Q112. Can you tell me your present best-corrected visual acuity?
1. Yes (please specify)
2. (Don't read) Don't Know/ Refused.
Thanks and Close
That is the end of our interview. Thank you very much for your time and thoughts today. We very much appreciate your assistance with this important research.
The findings will be made widely available to all members of the RNZFB once the research has been completed.
If you have any queries about the research, you can contact either:
Hilary Boyd at the Foundation for the Blind on 0800 24 33 33
Or Michael Blewden at Gravitas Research on 0508 RESEARCH
If you would like to talk further about any other issues arising from our interview. I can provide you with some other contact details. Would you like to take some details now? If Yes: Provide names of contact people from/closest to the respondent's location.
If no- Thank you again and Good Afternoon/Good Evening.