WBOT Individual Health Status Assessment (HSA)
Version 1, 30 September 2013
Revised 24 February 2014
Revised October 2014
Revision 05 February 2015
The structure of the individual health status assessment
Item number / Item type / Content / Item / Page1 / Individual registration / 6
[S] / [Surname, Name, DOB, ID/BC,{Age}, Gender, Relation, Vulnerability] / - / 6
[S/C] / Edit information / - / 6
[C] / Communication / 1 / 6
[C] / Reason for communication difficulty / (1) / 6
[C] / Interview assistance / (1) / 7
[Q] / Consent / 3 / 9
[Q] / Residence status / 1 / 9
[Q] / Education / 1 / 9
[Q] / Studying / 1 / 9
[Q] / School / 1 / 8
[Q] / Occupational status / 1 / 9
[Q] / Individual income / 1(-2) / 10
[Q] / Grant (MC) / 1-3 / 11
[Q] / Applicatin for Grant / 1 / 12
Individual “triage” / 11
[Q] / Health problem / 1 / 11
Individual assessment / 14
2 / Life style / 14
[C] / Body mass - Stunkard card / 1 / 14
[M] / Height / 1 / 14
[M] / Weight + Readiness for change / 2 / 14
[Q] / Physical activity + Readiness for change / 2 / 15
[Q] / Active smoking + Readiness for change / 2 / 16
[Q] / Snuff use / 1 / 16
[Q] / Passive smoking / 1 / 16
[Q] / Alcohol QF / 2 / 17
[Q] / Alcohol RAPS4 / (4) / 18
[Q] / Drugs ever / 11 / 20
[Q] / Drugs present / (11) / 20
3 / General health (Sensory and Performance/Activity) / 22
[Q] / Vision Screening / 1 / 23
[Q] / Vision Care / (1) / 23
[Q] / Hearing Screening / 1 / 23
[Q] / Hearing Care / (1) / 23
[C] / Hearing Test / (1) / 23
[Q] / Performance status / 2 / 24
[Q] / Bedridden / 1 / 24
[Q] / Home Based Care / 1 / 25
4 / Oral health / 26
[Q] / Teeth brushing / 1 / 26
[Q] / Oral health assessment / 5 / 26
5 / Chronic/Non-communicable Diseases / 28
Hypertension / 29
[Q] / Current diagnosis and care / 1(-2) / 29
[C] / BP screen / 1(-2) / 29
Diabetes mellitus / 30
[Q] / Current diagnosis and care / 1(-2) / 30
[S] / Risk assessment / Age / 30
[S] / BMI/Stunkardt / 31
[M] / Waist circumference / 31
[S] / Physical activity / 31
[Q] / Nutrition/Vegetables / 1 / 31
[S/Q] / BP treatment / (1) / 31
[Q] / High glucose ever / 1 / 31
[Q] / Family history / 1 / 31
[Q/M] / Glucose measurement / 2 / 32
Coronary heart disease/heart attack / 33
[Q] / Current diagnosis and care / 1(-2) / 33
[Q] / Diagnostic screen / 2 / 33
[S] / Risk assessment / 33
Peripheral arterial vascular disease / 38
[Q] / Current diagnosis and care / 1 / 38
[Q] / Diagnostic screen / 2 / 38
Cerebro-vascular disease / 38
[Q] / Current diagnosis and care / 1 / 38
[Q] / Diagnostic screen / 5 / 38
Chronic lung disease / 39
[Q] / Current diagnosis and care / 1(-2) / 39
[Q] / Diagnostic screen / 3 / 39
Epilepsy/Cerebral fit / 39
[Q] / Current diagnosis and care / 1(-2) / 39
[Q] / Diagnostic screen / 1 / 40
Chronic joint disease / 40
[Q] / Current diagnosis and care / 1(-2) / 40
Chronic pain / 40
[Q] / Chronic pain / 40
[Q] / Location of pain / MC(7) / 41
Sleeping problems / 41
[Q] / Sleeping problem / 1 / 41
Mental health (screening) / 41
[Q] / Depression - Diagnostic screening / 2(-10) / 42
[Q] / Dementia/Cognitive disorder – Diagnostic screening / 1(-5) / 44
Other chronic diseases/conditions / 45
[Q] / Other chronic diseases/conditions / 1 / 45
6 / TB algorithm / 44
[Q] / Currently taking TB treatment / 1 / 49
[Q] / Green Card / (1) / 49
[Q] / optional: Documentation TB treatment / (x) / 49
[Q] / Ever taken TB treatment before / 1 / 50
[Q] / optional: Documentation TB history / (x) / 50
[Q] / TB treatment in the past 12 months / (1) / 51
[Q] / Currently diagnosed with TB but not taking treatment / 1 / 51
[Q] / optional: Documentation date of diagnosis / (1) / 51
[Q] / Symptoms of TB / 5 / 51
[Q] / optional: Documentation TB symptoms / (x) / 52
[Q] / Tested for TB / (1) / 52
[Q] / Test outcome / (1) / 53
[Q] / optional: Documentation TB tests / (x) / 53
7 / Reproductive Health algorithm / 25
[Q] / Attitude on contraception / 1 / 28
[Q] / Sexual activity / 1 / 28
[Q] / Current contraception use / F 10 / 28
[Q] / Reasons for not using contraception currently / F 1 / 29
[Q] / History (children, pregnancies) / F 2 / 29
[Q] / Pregnancy / F 1 / 30
[Q] / ANC attendance / F (1) / 31
[Q] / EDD / F (1) / 31
[Q] / Intention of pregnancy / F 1 / 31
[Q] / Previous contraception use / (F {10}) / 31
[Q] / Reasons for not using contraception previously / (F {9}) / 32
[Q] / Intention of TOP / F (1) / 32
[Q] / Previous complications / F (1) / 33
[Q] / Documentation prompt / F (5) / 33
[Q] / Duration of trying to becoming pregnant / (F {1}) / 34
[Q] / Knowledge of emergency contraception / 1 / 34
[Q] / Condom usage / 1 / 35
[Q] / Reasons for not using condoms / F 1 / 35
[Q] / STI screen / 1 / 35
[Q] / Circumcision / M 1 / 36
[Q] / “Men’s health” / M 5 / 37
8 / HIV algorithm / 39
[Q] / Ever tested / 1 / 42
[Q] / Outcome / 1 / 42
[Q] / Age of test / ART / 1 / 42
[Q] / Last CD4 / (1) / 42
[Q] / CD4 value / (1) / 42
[S/Q] / PMTCT / F 1 / 42
9 / Cancer / 70
Breast cancer / 70
[Q] / Diagnosis and Care / F 1(-2) / 70
[Q] / Risk/prevention / F 2(-3) / 71
Cervix cancer / 72
[Q] / Diagnosis and Care / F 1(-2) / 72
[Q] / Pap screen / F 3(-4) / 72
10 / Violence/sexual assault/accidents/injury / 74
[Q] / Experience/Exposure to violence/sexual assault / 1 / 74
[Q] / Experience and exposure to accidents/injury / 1 / 16
[C] / Documentation prompt / (5) / 17
11 / Indigent information / 76
[Q] / Skills / 39+39 / 76
[Q] / Driver’s licence / 1 / 78
[Q] / Availability / 1 / 78
1
Individual registration - Individual information
[applicable to persons: ≥15 years – compulsory schooling]
Item / Comment/Rationale / ReferenceS: [System displays surname, name, DOB, ID/RN/PP, gender, DOB etc. which was captured already when HH is registered] / Mezzanine to advise
S: [Prompt to edit/complete information if any fields are blank] / Mezzanine to advise
Communication
C: Do you (CHW) and the person have difficulty understanding and/or communicatingwith each other?
A: No difficulty, Some difficulty, A lot of difficulty, Unable to understand and/or communicate with each other / Proper communication is a prerequisite to conduct the interview. Communication is understood as the ability to speak and the mental abilities required to follow and/or keep up a conversation. There needs tobesufficentabiity to communicate in order to complete the interview. Should this not be possible, th CHW will have to establish who the primary carer of the individual is and interview him or her.
Reason for communication difficulties
If: “Some difficulty, A lot of Difficulty, Unable to understand and/or communicate”:
C: Please specify the reasons (multiple choice):
Reason
o / Language
o / Speaking
o / Hearing
o / Understanding/Mental issues
o / Other
/ FLAG: Communication difficulty if Reason Speaking, Hearing or Understanding/Mental issues
Conduct of the interview
[only asked if Some difficulty, A lot of difficulty, Unable to understand and/or communicate”]
C: Is the interview conducted with assistance?
A: Yes, No
If yes:
Continue
If no and “some difficulty”:
Continue
If no and “a lot of difficulty” or “unable to understand...]:
Show prompt: Please get assistance to conduct the health status assessment.
A: Continue with assistance, Exit
If Exit, exit (to be defined)
If Continue with assistance, repeat question / Training issue! Ethcially, the interview can only be conducted if CHW and the person can communicate properly/understand each other. Otherwise, what value would the consent have?
If language is the communication hurdle a translator should be assisting or the interview should be conducted by a person who is knowledgeable in the language of the interviewee.
If hearing/speaking ability is a problem the CHW should explore appropriate ways for communication and seek assistance accordingly (e.g. hearing aid, pen and paper, family member who can better understand the person and can “translate” etc.)
If the person is mentally unable to communicate a primary carer or family member who is familiar with the person should assist with the interview.
S: [Prompt consent, part 1: I have been told about the purpose of the HSA...{data storage}] / Mezzanine to advise
S: [Prompt consent, part 2: {research}] / Mezzanine to advise
Residency status
Q: In South Africa everybody is entitled toaccess public health care services. However your access to social services is conditional on your nationality or residency status. What is your residency status?
A: South African citizen, Non-South African - Permanent resident, Non-South African - Temporary resident, Non-South African – Refugee, Non-South African – Unknown/undetermined residency status, Refuse to answer / Aim 1) to get residency status clarified to allow for access of social services, 2) condition for Indigent labour programme, 3) conditional for grant qualification
Educational status
Q: What is your highest level of education?
A: [system displays table] / Educational status enables us to distinguish between illiteracy and the degrees of functional literacy. It is a useful indicator for both descriptive and analytical purposes in respect of health and social status. Furthermore the level of qualification informs service delivery iro the indigent programme.
Level[1]/ FET / Designation / General and Further Education and Training Qualifications Sub-Framework / Occupational Qualifications Sub-Framework
o / - / No schooling / - / -
o / - / Grade 1 – 6 (Incomplete primary) / - / -
o / - / Grade 7 - 8 / - / -
o / 1 / Grade 9 / General Certificate / Occ. certificate (level 1)
o / 2 / Grade 10 and National (vocational) certificate level 2 / Elementary Certificate / Occ. certificate (level 2)
o / 3 / Grade 11 and N(V)C level 3 / Intermediate Certificate / Occ. certificate (level 3)
o / 4 / Grade 12 (National Senior Certificate) and N(V)C level 4 / National Certificate / Occ. certificate (level 4)
o / 5 / Higher Certificates and Advanced N(V)C / Higher Certificate / Occ. certificate (level 5)
o / 6 / Diploma and Advanced Certificates / Diploma, Advanced Certificate / Occ. certificate (level 6)
o / 7 / Bachelor’s degree and Advanced Diploma / Bachelor’s degree,
Advanced Diploma / -
O / 8 / Honours degree, Post-graduate Diploma and Professional Qualifications / Honours degree,
Post-graduate Diploma / -
O / 9 / Master’s degree / Master’s degree / -
O / 10 / Doctor’s degree / Doctor’s degree / -
Studying
Q: Are you currently enrolled at a school, college or university?
A:
Studying
o / Yes, School
o / Yes, College
o / Yes, University
o / No
School name
If “Studying – school”:
Q: Please provide the name of the school
A: [enter school name] / Requirement by NDOH
Occupational status
Q: Are you currently working?
A:
Occupation/work
o / Yes - Self employed
o / Yes - full time
o / Yes - part time
o / No - Unable to work because of illness or disability
o / No - Unemployed – looking for work
o / No - Staying at home – not looking for work
o / No - Retired/Pensioner
/ Working categories focus on the class of activity as they relate to livelihood/occupation rather than the sector (as in the census). The question is useful for descriptive (informing strategy, how to reach people who are working) and analytical purposes (attributed risks).
Definition “working” (census): work for pay (in cash or kind), profit or family gain
“studying” – enrolled at an educational institution or in an educaitonal programme (school, college, university, course)
Individual income
Q: How much money do you earn from work (income only)
A: [week]
A: [month]
Refuse to answer / The individual needs to provide either monthly or weekly earnings, but should be allowed to provide both (monthly and weekly).
Grants
Q: Do you receive any of the following grants?
A: [table, system displays only what is applicable according to age]
Grant / Y / N / DK / R
Old age grant / o / o / o / o
Disability Grant / o / o / o / o
War Veteran’s Grant / o / o / o / o
Care Dependency Grant / o / o / o / o
Foster Child Grant / o / o / o / o
Child Support Grant / o / o / o / o
/ This provides information on individual grant income, with the exception of grants for children, who are the indirect beneficiaries of such awards. Grants in South Africa:
Grant / National / Age / Criteria / Single income / Couple income
Old age / SA/PR / ≥60 years / 47.400 / <94.800
Disability / SA/PR / 18-59 / Disability (medical) report / 47.400 / <94.800
War Veteran / SA/PR / (≥60 years) / WWI+II, Korean war / 47.400 / <94.800
Care Dependency / SA/PR / no age restriction (can also apply to adults who depend on care) / Disability
(medical)
report / <144.000 / 288.000
Foster Child / SA/PR/Ref / <18 years / Court order foster parent / - / -
Child Support / SA/PR / Child DOB <01.01.1993 / Primary care giver / <33.600 / <67.000
Eample:
<18: does not show anything
18-59 years shows: Disability, Care Dependency, Foster child, Child >=60 shows: War veteran, care dependency, Foster child, child support
Grant application
[If not receiving any grant]:
Q: Do you want to apply for a grant?
A: Yes, No / If Yes: FLAG: Grant application
Individual “triage”:
Item / Comment/Rationale / ReferenceTriage
Q: Now I am going to ask you about your health. Is there anything you want to tell me about your health?
A: Yes, No, DK, R
If No, DK, R:
[Skip documentation questions]
If Yes:
Q: Please provide details
A: [freetext] / This question is meant to identify any condition that requires immediate action (“triage”), whatever it is. The question is intentionally open ended to allow the person to mention any health issue that he/she wants to address, be it an acute problem, any health worry, a known diseases, or relevant medical history.
With regards to interview strategy the question invites the respondent to verbalise any health concerns they have immediately and it supports the building of rapport between the CHW and the respondent.
In taking this approach we are aware that the CHW will not be able to make a clinical judgement from information provided by the person. However, acting within scope of practice, a CHW will be able to identify and “triage” a person who presents an acute problem and send for referral or seek advice on how to proceed.
The CHW should be taught how to document a case:
What problem was reported?
How long does the problem exist?/When last did the problem occur?
How severe is the problem? (mild, moderate, severe)
What has been done so far about it?
If Yes: FLAG: Health problem
Individual assessment - Lifestyle
Body massC: Please assess the person’s body shape using the Stunkard card
A: [enter number]
Example:
/ Body mass is an important health measure. Underweight can be a sign of a consuming disease (e.g. cancer, TB, worm infestation) as well as under-nutrition and malnutrition. Overweight is important risk factor for cardiovascular and skeletal diseases. CHWs can act on all these issues through referrals or health education.
In data analyses weight can be used as a predictor for certain health and social conditions.
Assessing BMI is a bit more challenging to operationalisein a COPC context both in terms ofgetting the measurement itself (scale/height) as well as regarding the interpretation of results.
Other measures (such as waist circumference, or waist to height ratios) have been found to be unacceptaple at community or not validated for adults or to assess obesity (MUAC).
The comparison of the person against Stunkard cards aims to eliminate investigator bias regarding what is considered as under-/normal-/overweight/obesity. The mobile device only displays shapes and not their interpretation like “obesity” etc.
Based on observations, the CHWassesss readiness for change and/or refers to person observed for nutritional assessment and can support dietary changes.
Height
C: Please measure the person’s height
A: [enter number], refused, skip / After discussions we decided to add this question in order to be able to assess BMI. The question should be understood as optional, conditional to the availability of a leangth measurement tool.
Weight
C: Please measure the person’s weight
A: [enter number], refused, skip / See comment to previous questions.
The system should display the BMI based on the following calculation:
BMI = weight in kg / (heigth in meter)2
The display should prompt the following statements depending on the BMI
<18.5 / 18.5 - 24.99 / 25 - 29.99 / ≥ 30
“The BMI indicates that the person is underweight” / “The weight of the person is normal” / “The BMI indicates that the person is overweight” / “The BMI indicates that the person is obese”
Referral prompt / (no action) / Assess readiness for change (see next questions)
FLAG If Stunkard <=2, or BMI <18.5: Underweight
If obese (Stunkard >=7 or BMI >=25):
Assess readiness for change
Q: How important is it for you to reduce your weight?
A: important, unsure, not important, R, DK
If important:
suggest referral for nutritional assessment
[referral prompt] / FLAG If important: Obese - ready to change
There should be a nutritional support programm available!
If unsure: provide more information but don’t necessarily prompt for action
Physical activity
Q: Do you do physical activity (walk fast, run, dosport or physical labour)for at least half an hour on five days a week or for at least two and a half hours per week?
A: Yes, No, DK, R / Physical activity contributes to physical health and mental wellbeing. Its absence is a risk factor for cardiovascular disease. It is recommended that an individual should be involved in sustained physical activity for 150 minutes in a week
If No to physical activity:
Assess readiness for change
Q: How important is it for you to become more physically active?
A: Important, unsure, No, R, DK
If important:
provide further information/schedule follow-up visist/refer
Tobacco exposure
Active smoking
Q: How many cigarettes, cigars or pipes do you usually smoke a day?
A: [enter number], Refuse to answer / Identifying active smokers and quantifying the health hazard of active smoking. Will also support CHWs to engage actively in health promotion and disease prevention.
The fagerstrøm test was suggested. The test includes about 6 questions assessing nicotine dependency and heaviness of smoking. We believe that the screening here should just identify smokers and assess whether they are prepared for change with as few questions as possible and then go into more detail with an assessment test separately. / The short fagerstrom test for nicotine dependence might be worth a look in the ichange4health material?
If >= 10 cigarettes per day:
Assess readiness for change
Q: How important is it for you to reduce smoking?
A: Important, unsure, not important, R, DK / There should be a special programme for smokers, otherwise this question may not be asked
FLAG: Smoker - ready for change
Q: Do you use snuff?
A: Yes/No/R
Passive smoking
Q:How many cigarettes do people smoke in your presence a day (in your home or personal car, at work/school/college or during recreation/leisure outside your home)?
A: [enter number], R, DK / This questions aims to identifying people exposed to tobacco smoke (passive smoker)
It is especially important in respect of managing environmental pollution in the home, reducing health problems in children, the aged, pregnant womenas well as limiting generational reproduction of high risk lifestyle habits.
A review of recent literature highlights general difficulties in assessing secondhand smoking. However, asking about the the number of cigarettes smoked per day (CPD) in the presence of the exposed individual was found to be most reliable reliable. / Avila-Tang et al. Assessing secondhand smoke exposure with reported measures. Tobaccor Control, 2013; 22: 156-163
Alcohol
Identify risky drinking (abuse/dependency)
Q: How often do you drink alcohol? (F Frequency)
A: Never or less than once a month, once a month, once a week, several days of the week, daily
If Never or less than once a month:
Skip following questions and continue with next complex of questions (drugs) / Alcohol has major implications on individual health. Drinkers are at risk of liver damage, brain damage, depression, nerve damage, accidents, and financial/work place consequences. Drinkers also affect the health of others e.g. birth defects, aggression, violence, injury, accidents. It is therefore both an individual and a public health concern to identify hazardous drinking in order to get individuals to reduce or stop alcohol consumption. The ICD-10 distinguished between Alcohol abuse and Alcohol dependency.
Alcohol abuse is defined as drinking related trouble with friends, police, work, physical health or psychological health.
Alcohol dependency is defined as being positive in three or more of the following domains: (i) craving, (ii) impaired capacity to control use, (iii) withdrawal, (iv) tolerance, (v) neglect of interests, (vi) continued use despite problems, (vii) spending a great deal of time in drinking activities.
The difficulty of controlling alcohol consumption through behaviour change is that alcohol consumption is socially acceptable, individuals are rarely socially sanctioned for excessive alcohol consumption and their sequelae, and equally, they are reluctant to acknowledge their responsibility in regulating their own drinking.In respect of alcohol dependency various drinking patterns each carry specific hazards and challenges (e.g. routine drinking, binge drinking, social drinking etc...).