4. How do you administer self-care to prevent or relieve Often Always Not symptoms of inflammatory Occasionally applicable bowel disease? Self-care to make sure I sleep well Self-care to manage stress I find out more about inflammatory bowel disease I look for new approaches to living with inflammatory bowel disease I use natural remedies 3. How often do you adapt your Never Occasionally Often Always Not applicable day to problems caused by inflammatory bowel disease? I adapt my diet Other kinds of self-care I various activities _________________________________________________________________________________ I avoid sex I alcohol MEDICATION AND CONTACTING HEALTHCARE PROVIDERS I plan my day so that I am always near a 5. Do you take medication for Never Occasionally Often Always No prescription inflammatory bowel disease as medication prescribed by a doctor? toilet I plan my day in view of the fact that I 6. Do you know whom to No Yes contact if you experience symptoms of inflammatory disease? 7. How familiar are you with the Totally Relatively Relatively Totally familiar unfamiliar unfamiliar familiar symptoms for which you should contact a healthcare provider? have inflammatory disease 8. Tobacco use Do you smoke? Do you use snuff? Yes, every day. Yes, every day Yes, occasionally Yes, occasionally No, I quit in__________(year) No, I quit in __________(year)
3. How often do you adapt your day to problems caused by inflammatory bowel disease? Never Occasionally Often Always Not applicable I adapt my diet I various activities I avoid sex I alcohol I plan my day so that I am always near a toilet I plan my day in view of the fact that I have inflammatory disease 4. How do you administer self-care to prevent or relieve symptoms of inflammatory bowel disease? Occasionally Often Always Not applicable Self-care to make sure I sleep well Self-care to manage stress I find out more about inflammatory bowel disease I look for new approaches to living with inflammatory bowel disease I use natural remedies Other kinds of self-care _________________________________________________________________________________ MEDICATION AND CONTACTING HEALTHCARE PROVIDERS 5. Do you take medication for inflammatory bowel disease as prescribed by a doctor? Never Occasionally Often Always No prescription medication 6. Do you know whom to contact if you experience symptoms of inflammatory disease? No Yes 7. How familiar are you with the symptoms for which you should contact a healthcare provider? Totally unfamiliar Relatively unfamiliar Relatively familiar Totally familiar 8. Tobacco use Do you smoke? Do you use snuff? Yes, every day. Yes, every day Yes, occasionally Yes, occasionally No, I quit in__________(year) No, I quit in __________(year)
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