46 Recalling I will now ask Yesterday, Day 1: NOTE: taking pill about taking pills 1. Yes Repeat in the past 7 2. No going days, not 98. Don’t remember backwards including today. I 7 days Day 2: will ask about starting 1. Yes each of the past with 2. No seven days, yesterday. 98. Don’t remember starting with yesterday (x-day). Day 3 1. Yes We are most 2. No interested in 98. Don’t remember knowing on how many days you Day 4 took the pill. 1. Yes Soif you cannot 2. No remember which 98. Don’t remember day(s) exactly you did or did not Day 5 take the pill, 1. Yes please guess. If 2. No you missed 98. Don’t remember days, we some prefer that you Day 6 indicate this even 1. Yes if you cannot 2. No remember 98. Don’t remember exactly which days you missed. Day 7 1. Yes Yesterday (x-day) 2. No did you take a 98. Don’t remember pill? 47 Pill Does taking 1. Yes interfere with any 2. No with of your regular regular daily activities? activities 48 Time of In the past month, 1. Morning pill what time of day 2. Afternoon do you typically 3. Evening take your pill? 96. Other, specify____________ 49 In the past Always of pill month, how often Sometimes did you take your Never pill at about the same time each day?
46 Recalling taking pill I will now ask about taking pills in the past 7 days, not including today. I will ask about each of the past seven days, starting with yesterday (x-day). We are most interested in knowing on how many days you took the pill. Soif you cannot remember which day(s) exactly you did or did not take the pill, please guess. If you missed some days, we prefer that you indicate this even if you cannot remember exactly which days you missed. Yesterday (x-day) did you take a pill? Yesterday, Day 1: 1. Yes 2. No 98. Don’t remember Day 2: 1. Yes 2. No 98. Don’t remember Day 3 1. Yes 2. No 98. Don’t remember Day 4 1. Yes 2. No 98. Don’t remember Day 5 1. Yes 2. No 98. Don’t remember Day 6 1. Yes 2. No 98. Don’t remember Day 7 1. Yes 2. No 98. Don’t remember NOTE: Repeat going backwards 7 days starting with yesterday. 47 Pill with regular activities Does taking interfere with any of your regular daily activities? 1. Yes 2. No 48 Time of pill In the past month, what time of day do you typically take your pill? 1. Morning 2. Afternoon 3. Evening 96. Other, specify____________ 49 of pill In the past month, how often did you take your pill at about the same time each day? Always Sometimes Never
Ashodaya_follow-up-_questionnaire.docx