Name of Questionnaire: / CADI
Translation language: / Ukranian
Original language: / English (UK)
Organiser of translation: / Dr Pavel Chernyshov, National Medical University, Kiev
Number of forward-translators: / 2
Number of independent back-translators: / 2
Total number of forward or back-translations before accepted for translation: / 6
Final back-translation confirmed by: / Professor A Y Finlay
Final back-translation attached: / Yes
Date translation confirmed: / February 2006
Relevant publications: attached:
Date this page completed: / 13/2/06

“Dermatitis Family Impact Questionnaire”

Surname and name of a child: Mother/Father/Carer: Date:

Result:

TheaimofthisquestionnaireistoevaluatehowmuchskinproblemsofyourchildinfluencedyouandyourfamilyDURINGLASTWEEK. Please, markonesquareforeveryquestion.

  1. Howmuchyourchild, having eczema, influencedyourhomework (washing, cleaning) during last week?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, havingeczema, affectedyour food preparationand eating during last week?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, having eczema, influencedsleepingofotherfamilymembersduringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuch yourchild, having eczema, influencedrestofotherfamilymembers(eg swimming)duringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuch yourchild, having eczema, influencedtime, thatwasspentforshoppingfor the familyduringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, having eczema, influencedyourspendofmoney (connectedwithtreatment, clothesetc. ) duringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, having eczema,influencedfatigueandtirednessofyourchild’sparents/carersduringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, having eczema,influencedonappearingemotionalstress (depression, frustration, feelingguilty) in yourchild’sparents/carersduringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. Howmuchyourchild, having eczema,influencedrelations between main carer and his partner or betweenmain carer and other childrenin the family duringlastweek?

Very much □

A lot □

A little □

Not at all □

  1. How much effect during last week had help in treatment of your childon chief-tutor’s (parents’) life?

Very much □

A lot □

A little □

Not at all □

Please, checkifyouansweredallquestions. Thank you.

© M.S. Lewis-Jones, A.Y. Finlay 1995.