روانسنجی
اولین سایت تخصصی فارسی تست های روان سنجی ، روان شناسی

Social Functioning Questionnaire
Isobel et al‚ 2003

A. SELF-CARE SKILLS
*1     Personal Appearance 
4 = Maintains a neat and tidy appearance without help or prompting from staff
3 = Maintains neat appearance but needs some supervision
2 = Maintains a neat appearance with close and regular supervision
1 = Does not maintain neat appearance‚ even with supervision. Major problems with this item
2    Appropriate of Clothing
4 = Dresses appropriately without prompting. Wear clothing appropriate to age‚ sex and weather.
3 = Dresses appropriately with occasional supervision or prompting.
2 = Needs close supervision to ensure appropriateness of dress.
1 = Rarely dresses appropriately‚ even with close supervision. Major problems with this item.
3    Changing Clothing
4 = Changes clothing regularly and independently.
3 = Changes clothing with occasional prompting.
2 = Changes clothing with frequent prompting.
1 = Major problems with this item.
4    Washing Hands and Face
4 = Keeps hands and face clean independently.
3 = Needs occasional prompting.
2 = Needs frequent prompting.
1 = Major problems with this item.
5    Sha‎ving
4 = Shaves independently.
3 = Needs occasional prompting or help.  
2 = Needs frequent prompting or help.
1 = Major problems with this item.
6    Menstruation
4 = Manages menstruation adequately and independently.
3 = Manages menstruation with occasional prompting and help.  
2 = Manages menstruation with frequent prompting and help.
1 = Major problems with this item.
7    Bathing/Hair Washing
4 = Does these tasks regularly and independently.
3 = Does these tasks with occasional prompting.  
2 = Does these tasks with frequently prompting.
1 = Major problems with this item.
8    Toileting
4 = Uses toilet appropriately and independently.
3 = Needs occasional help (e.g. not using toilet properly‚ poor cleanliness).  
2 = Frequently needs help (e.g. poor habits in the use of toilet‚ occasional incontinence).
1 = Major problems with this item (e.g. frequent incontinence‚ severe problems with cleanliness).
9    Teeth Cleaning/Dentures
4 = Cleans teeth independently/looks after dentures.
3 = Needs occasional prompting.  
2 = Needs frequent prompting.
1 = Major problems with this item (e.g. no real or false teeth‚ refusal to attend to teeth).
B    DOMESTIC SKILLS
10    Table Manners
4 = Table manners are acceptable to other residents/public.
3 = Table manners are usually acceptable but needs occasional prompting.  
2 = Table manners need frequent prompting.
1 = Major problems with this item.
11    Table Setting and Clearing – E?         YES/NO
4 = Sets and clears table correctly and independently.
3 = Sets and clears table with occasional prompting.  
2 = Sets and clears table with frequent prompting.
1 = Major problems with this item.
12    Washing Up – E?         YES/NO
4 = Washes up correctly and independently.
3 = Washes up with occasional prompting.  
2 = Washes up with frequent prompting.
1 = Major problems with this item.
13    Cooking Simple Foods – E?         YES/NO
4 = Able to prepare a simple snack with little or no supervision.
3 = Able to prepare a snack with close supervision.  
2 = Able to make tea or simple food requiring little cooking e.g. tea‚ sandwiches‚ toast‚ boiled egg.
1 = Unable or resistant to cooking.
14    Preparing Complicated Food Items – E?         YES/NO
4 = Plans and prepares a main cooked meal independently.
3 = Plans and prepares a meal with occasional prompting.  
2 = Prepares a meal with frequent prompting.
1 = Major problems with this item.
*15    Room Cleaning – E?         YES/NO
4 = Able to clean room/bed area well and spontaneously‚ e.g. sweeping‚ tidying etc.
3 = Needs occasional prompting to maintain adequate standard.  
2 = Needs close supervision to maintain adequate standard.
1 = Unable or resistant to cleaning room.
16    Laundry – E?         YES/NO
4 = Does this independently.
3 = Does this with occasional prompting.   
2 = Does this with frequent prompting.
1 = Major problems with this item.
17    Use of Telephone – E?         YES/NO
4 = Does this independently.
3 = Does this with occasional prompting.   
2 = Does this with frequent prompting.
1 = Major problems with this item.
C     COMMUNITY SKILLS
18    Knowledge of Location
4 = Knows complete address of home‚ so could report this if lost.  
3 = Knows name of home and local area.   
2 = Knows name of home.
1 = Does not report any parts of home address correctly.
19    Travelling on Foot – E?         YES/NO
4 = Can walk any distance independently (good traffic sense‚ can find way back etc.).
3 = Can walk a short distance‚ e.g. to a local shop‚ independently.   
2 = Needs accompanying on local outings.
1 = Major problems with this item (e.g. physical inability‚ difficulty leaving place of residence).
*20    Use of Public Transport – E?         YES/NO
4 = Able to use public transport alone and without supervision.
3 = Able to use some form of public transport with minimal guidance.   
2 = Needs to be accompanied on public transport with supervision by staff‚ friends or relatives.
1 = Major problems with use of public transport.
*21    Shopping – E?         YES/NO
4 = Able to purchase major items of clothing (shirt‚ shoes‚ etc.).
3 = Able to purchase minor items (cigarettes‚ sweets‚ etc) from a shop without help.    
2 = Able to use shops with some supervision.
1 = Unable or resistant to using shops.
22    Vocational Activity – E?         YES/NO
(Sheltered work‚ industrial therapy etc.)
4 = Attends regularly with minimal prompting and works acceptably.
3 = Attends regularly with minimal prompting‚ works with little supervision‚ but needs some reminding.    
2 = Attends irregularly and/or needs close supervision.
1 = Major problems with this item (e.g. will not attend‚ work of poor standard‚ leaves after a few minutes etc.).
23    Use of Public Eating/Drinking Facilities – E?         YES/NO
(Cafes‚ Restaurants‚ Public Houses.)
4 = Uses public eating and drinking facilities independently on a regular basis.
3 = Goes to public eating facilities accompanied and needs occasional prompting.    
2 = Goes to public eating facilities accompanied and needs frequent prompting.
1 = Major problems with this item.
24    Use of Public Leisure Facilities – E?         YES/NO
4 = Attends independently.
3 = Attends with guidance given before leaving.    
2 = Attends accompanied by staff.
1 = Major problems with this item.
25    Use of Public Office – E?         YES/NO
(Post Office‚ DHSS‚ Police Station)
4 = Uses one or more of the above regularly and independently (e.g. collect GIRO from Post Office).
3 = Uses one of the above on occasional basis.    
2 = Uses one of the above if accompanied and prompted.
1 = Does not use public offices.
D    SOCIAL SKILLS
26    Speech
4 = Speech is comprehensible to public.
3 = Speech is comprehensible to those who know resident quite well.    
2 = Speech is sometimes comprehensible.
1 = Major problems with this item.
*27    Conversation with Residents    
4 = Can initiate and sustain a conversation with other residents.
3 = Can occasionally initiate and sustain a conversation but rarely involved in more than a brief sequence of exchanges.    
2 = Rarely initiates but responds briefly to prompting (e.g. requests‚ jokes).
1 = Minimal interaction‚ rarely more than single word prompted exchanges.
*28    Conversation with Staff        
4 = Can initiate and sustain a conversation with member of staff.
3 = Can occasionally initiate and sustain a conversation but rarely involved in more than a brief exchange    
2 = Rarely initiates but responds briefly to prompting (e.g. requests‚ jokes).
1 = Minimal interaction‚ rarely more than single word prompted exchanges.
*29    Social Mixing        
4 = Mixes with others and forms friendships or attachments to particular individuals (staff‚ patients or people outside hospital).
3 = Mixes with others but does not seem to form particular attachments.    
2 = Mixes little with groups on the whole but enjoys participating in some social activities (e.g. discussion groups‚ outings).
1 = Minimal interaction‚ rarely more than single word prompted exchanges.
*30    Participation        
4 = Will participate in carrying out programmed activities regularly and with little or no prompting.
3 = Will participate in programme activities fairly regularly‚ but needs some prompting.    
2 = Requires consistent prompting‚ but even so‚ only carries out programmed activities irregularly.
1 = Rarely‚ or never‚ participates in programmed activities.
31    Leisure Activity        
4 = Will engage in leisure activities involving others with or without prompting (e.g. chatting to others‚ card games etc.).
3 = Will engage in organised leisure activities with some prompting.    
2 = Prefers to spend leisure time in activities not involving others‚ e.g. reading‚ watching television.
1 = Prefers to spend leisure time not involved in any activity.
32    Knowledge/Concern for Other Residents       
4 = Demonstrates ha‎ving knowledge of other Residents’ situations‚ and/or shows concern if another Resident has a problem.
3 = Sometimes demonstrates ha‎ving knowledge and/or shows concern for other Residents.    
2 = Has been known to demonstrate ha‎ving knowledge or show concern for other Residents.
1 = Generally does not demonstrate knowledge and/or show concern for other Residents.
33    Sexual Relationships       
4 = Has an established sexual relationship.
3 = Has occasional sexual relationships.    
2 = Enjoys occasional social contact (e.g. discos‚ clubs).
1 = No active interest or engagement in sexual relationships.
E    RESPONSIBILITY
*34    Getting Up in the Morning       
4 = Little or no difficulty in rising. Rises most mornings with no prompting.
3 = Mild difficulty in rising. Wakes and gets out of bed with minimal prompting.    
2 = Moderate difficulty in rising. Needs regular and sometimes frequent prompting to rise.
1 = Severe difficulty in rising. Rises with difficulty only after regular and frequent prompting‚ or requires physical assistance.
35    Meals       
4 = Eats adequate regular meals independently.
3 = Eats adequate regular meals with occasional prompting.    
2 = Eats adequate meals with frequent prompting.
1 = Major problems with this item.
36    Personal Possessions – E?         YES/NO
4 = Is responsible for some items and cares for them independently‚ e.g. toiletries‚ clothes‚ watch.
3 = Is responsible for some items and cares for them but needs occasional prompting.    
2 = Is responsible for some items and cares for them but needs close supervision.
1 = Major problems with this item‚ e.g. loses or gives them away.
37    Managing Weekly Allowance – E?    YES/NO
4 = Can manage weekly allowance independently.
3 = Needs help with budgeting weekly allowance.    
2 = Can use money to buy one item‚ e.g. cigarettes.
1 = Major problems with this item.
38    Personal Finance – E?    YES/NO
4 = Cares for personal finance independently.
3 = Needs some guidance in caring for personal finance.    
2 = Needs to have access to personal finance restricted.
1 = Major problems with this item.
39    Health        
4 = Promptly reports injuries or illness symptoms/attends GP.
3 = Usually reports injuries or illnesses but has been known not to.    
2 = Sometimes fails to report illnesses or injuries.
1 = Does not report injuries or illnesses to staff.
40    Medication – E?    YES/NO           
4 = Is responsible for own medication and administers it independently.
3 = Medication administered by staff. Resident attends and accepts medication regularly.    
2 = Medication administered by staff. Resident attends and accepts medication with prompting.
1 = Major problems in administration‚ e.g. refuses or secretes medication.
41    Returning at Night           
4 = Returns home at night by the set time. (Letting people know).
3 = Occasionally returns home after the set time but is not a problem to staff.    
2 = Frequently returns after the set time and is a problem to staff.
1 = Major problems with this item.

This instrument can be found at: http://www.rcpsych.ac.uk/docs/Social_Functioning_Questionnaire.docx

Clifford‚ P.‚ Isobel‚ M.  (2001). Social functioning questionnaire: A modification of the adaptive functioning scale developed by Tilly Latimer-Sayer and Isobel Morris. International Journal of Social Psychiatry; 51(3): 265-275.
Paul‚ C.‚ Isobel‚ M. (2003). modified Adaptive Functioning Scale developed by Tilly Latimer-Sayer and Isobel Morris 1987. Ann Gen Hosp Psychiatry‚ 2003.
Tyrer‚ P.‚ Nur‚ U.‚ Crawford‚ M.‚ Karlsen‚ S.‚ McLean‚ C.‚ Rao‚ B.‚ & Johnson‚ T. (2005). Social Functioning Questionnaire (SFQ) [Database record]