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Table 2 Adaptation to the Dutch Impact of Vision Impairment Profile

From: Translation and content validity of the Dutch Impact of Vision Impairment questionnaire assessed by Three-Step Test-Interviewing

Original IVI Dutch-IVI (final version)
  General changes:
▪ Inclusion of the ‘presentence’ in several items (see item 1 and 16 for example)
▪ Frequently repeating the instructions
▪ Clarifying n/a response option
INSTRUCTIONS
Please read each question carefully and circle the answer that BEST applies to you.
Put one circle on each row.
If you use GLASSES, CONTACT LENSES OR MAGNIFIERS for some activities please answer according to how you can see when using them.
INSTRUCTIONS
Please read each question carefully and circle the answer that BEST applies to you.
Put one circle in each row. If you use GLASSES, CONTACT LENSES OR MAGNIFIERS for some activities please give your answer according to how you see when using them.
Choose the answer ‘never’ if you can perform the task without being hindered by your vision. Choose ‘not applicable’ if you do not perform the task for reasons other than your vision.
PRESENTENCE: In the PAST MONTH, how much has YOUR EYESIGHT INTERFERED with the following activities:  
1. Your ability to see and enjoy T.V? 1. In the past month, how much has your eyesight interfered with your ability to see and enjoy T.V.?
2. Taking part in recreational activities such as bowling, walking or golf? 2. [presentence] taking part in recreational activities such as cycling, walking or other activities?
3. Shopping? (finding what you want and paying for it) 3. [presentence] shopping (for example for groceries) (finding what you want and paying for it)?
4. Visiting friends or family? 4. [presentence] visiting friends or family?
5. Recognizing or meeting people? 5a. [presentence] meeting people?
  5b. [presentence] recognizing people?
6. Generally looking after your appearance? (face, hair, clothing etc.) 6. [presentence] generally looking after your appearance? (face, hair, clothing etc.)
7. Opening packaging? (for example, around food, medicines) 7. [presentence] opening packaging? (for example around food, medicines)
  SHORT REPEAT INSTRUCTIONS: Please answer the following questions about YOUR eyesight with GLASSES, CONTACT LENSES or MAGNIFIERS, if you use them.
8. Reading labels or instructions on medicines? 8. [presentence] reading labels or instructions? (for example, on medicines)
9. Operating household appliances and the telephone? 9a. [presentence] operating household appliances? (for example, the washing machine, oven, microwave or thermostat)
  9b. [presentence] operating your (mobile) phone?
10. How much has your eyesight interfered with getting about outdoors? (on the pavement or crossing the street) No changes to item
11. In the past month, how often has your eyesight made you go carefully to avoid falling or tripping? No changes to item
12. In general, how much has your eyesight interfered with travelling or using transport? (bus & train) 12. In general, how much has your eyesight interfered with travelling or using transport? (bus or train)
13. Going down steps, stairs, or curbs? 13. [presentence] going down step, stairs, or curbs?
  SHORT REPEAT INSTRUCTIONS: Please answer the following questions about YOUR eyesight with GLASSES, CONTACT LENSES or MAGNIFIERS, if you use them.
PRESENTENCE: In the PAST MONTH, how much has YOUR EYESIGHT INTERFERED with the following activities  
14. Reading ordinary size print? (for example, newspapers) 14. [presentence] reading ordinary size print? (for example, newspapers)
15. Getting information that you need? 15. [presentence] getting information that you need?
SHORT REPEAT INSTRUCTIONS: Please answer about YOUR eyesight with GLASSES, CONTACT LENSES or MAGNIFIERS, if you use them. Same instructions added
PRESENTENCE: In the PAST MONTH, how often has YOUR EYESIGHT MADE YOU CONCERNED OR WORRIED about the following:  
16. Your general safety at home? 16. In the past month, how much has your eyesight made you concerned or worried about your general safety at home?
17. Spilling or breaking things? 17. [presentence] spilling or breaking things?
18. Your general safety when out of your home? 18. [presentence] your general safety when out of your home?
19. In the past month, how often has your eyesight stopped you doing the things you want to do? No changes to item
20. In the past month, how often have you needed help from other people because of your eyesight? No changes to item
SHORT REPEAT INSTUCTIONS: Please answer about YOUR eyesight with GLASSES, CONTACT LENSES or MAGNIFIERS, if you use them. DELETE instructions because of domain: emotional well being
INSTRUCTIONS: Think about how YOUR eyesight has made you FEEL in the PAST MONTH. Same instructions added
21. Have you felt embarrassed because of your eyesight? No changes to item
22. Have you felt frustrated or annoyed because of your eyesight? No changes to item
23. Have you felt lonely or isolated because of your eyesight? No changes to item
24. Have you felt sad or low because of your eyesight? No changes to item
25. In the past month, how often have you worried about your eyesight getting worse? No changes to item
26. In the past month how often has your eyesight made you concerned or worried about coping with everyday life? No changes to item
27. Have you felt like a nuisance or a burden because of your eyesight? No changes to item
28. In the past month, how much has your eyesight interfered with your life in general? No changes to item