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Non-Communicable Diseases: Risk Factors and other Health Problems 337 49 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia CQ15 … menilai bagaimana keadaan tempat tinggal anda (contoh: komuniti, kawasan perumahan) mempengaruhi kesihatan dan kesejahteraan anda? CQ16 … menilai bagaimana keadaan rumah anda membantu anda kekal sihat? CQ17 … membuat keputusan untuk memperbaiki kesihatan anda? CQ18 … menyertai aktiviti yang boleh menambah baik kesihatan dan kesejahteraan dalam komuniti anda? Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 338 50 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia MODULE CQ: HEALTH LITERACY ELIGIBILITY CRITERIA : ALL MEMBERS OF THE HOUSEHOLD ID Negeri (2 Digit) DP (2 Digit) & DB (3 Digit) BP (4 Digit) UB (3 Digit) TK (3 Digit) Strata (1 Digit) Isi Rumah & Individu (2 Digit) (2 Digit) ITEM LIST OF HEALTH LITERACY INTRUMENTS HLS-M-Q18 Please tick (√) in the appropriate box. On a scale from “very difficult” to “very easy”, evaluate how easy it is for you: Very difficult Fairly difficult Fairly easy Very easy CQ01 … understand the guidance that comes with a medicine? CQ02 … understand what to do in a medical emergency? CQ03 … judge how information from your doctor applies to you? CQ04 … judge when you may need to get a second opinion from another doctor? CQ05 … call an ambulance in an emergency? CQ06 … follows instructions from your doctor or pharmacist? CQ07 … find information on how to manage mental health problems like stress or depression? CQ08 … understand health warnings about behaviour such as smoking, insufficient physical activity, unhealthy eating and drinking too much alcohol? CQ09 … find information about vaccinations / immunisation and health screening (such breast exam, blood glucose test, blood pressure, cholesterol levels) that you should have? CQ10 … understand why do you need health screening (example: breast examination, blood glucose test, blood pressure and cholesterol test)? CQ11 … judge which health screenings (such as breast exam, blood glucose test, blood pressure and cholesterol test) you should have? CQ12 … judge when you need to go to a doctor for a check-up? CQ13 … understand advice on health from family members or friends? CQ14 … understand information in the media (such as Internet, newspapers, magazines) on how to get healthier? CQ15 … judge how where you live (such as your community, neighbourhood) affects your health and well-being? CQ16 … judge how your housing conditions help you to stay healthy? CQ17 … make decisions to improve your health? CQ18 … take part in activities that improve health and well- being in your community? Appendix 7 Non-Communicable Diseases: Risk Factors and other Health Problems 339 51 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia MODULE CR: HIPERPLASIA PROSTAT BENIGNA / BENIGN PROSTATIC HYPERPLASIA KRITERIA KELAYAKAN: AHLI ISIRUMAH BERUMUR 40 TAHUN DAN KE ATAS ID Negeri (2 Digit) DP (2 Digit) & DB (3 Digit) BP (4 Digit) UB (3 Digit) TK (3 Digit) Strata (1 Digit) Isi Rumah & Individu (2 Digit) (2 Digit) Soal Selidik Permarkahan Simptom Prostat Antarabangsa / International Prostate Symptom Score (IPSS) Questionnaire SILA BACA DENGAN CERMAT / PLEASE READ THIS CAREFULLY: Kami ingin mengetahui pengalaman pembuangan air kecil anda di dalam satu bulan yang lepas. Sila bulatkan jawapan yang paling sesuai dari pandangan anda. We would like to know your experience of urinary for the last 1 month. Please circle the designated box for which you think most nearly applies to you. Dalam tempoh 1 bulan yang lepas In the past 1 month Langsung tidak pernah
Not at all Kurang dari 1 dalam 5 kali Less than 1 in 5 times Kurang dari separuh sepanjang sesi pem- buangan air kecil Less than half the times Lebih kurang separuh sepanjang sesi pem- buangan air kecil About half the times Lebih dari separuh sepanjang sesi pem- buangan air kecil More than half the times Hampir selalu sepanjang sesi pem- buangan air kecil Almost always CR01 Berapa kerapkah anda merasakan ketidakpuasan untuk mengosongkan / menyahtinjakan sepenuhnya pundi kencing? How often have you had the sensation of not emptying your bladder? 0 1 2 3 4 5 CR02 Berapa kerapkah anda terpaksa membuang air kecil dalam masa kurang setiap 2 jam? How often have you had to urinate less than every two hours? 0 1 2 3 4 5 CR03 Berapa kerapkah anda mengetahui untuk anda berhenti dan mulakan balik beberapa kali apabila anda membuang air kecil? How often have you found you stopped and started again several times when you urinated? 0 1 2 3 4 5 CR04 Berapa kerapkah anda mengetahui yang anda mengalami kesukaran untuk menundakan/menangguhkan pembuangan air kecil? How often have you found it difficult to postpone urination? 0 1 2 3 4 5 Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 340 52 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia Dalam tempoh 1 bulan yang lepas In the past 1 month Langsung tidak pernah
Not at all Kurang dari 1 dalam 5 kali Less than 1 in 5 times Kurang dari separuh sepanjang sesi pem- buangan air kecil Less than half the times Lebih kurang separuh sepanjang sesi pem- buangan air kecil About half the times Lebih dari separuh sepanjang sesi pem- buangan air kecil More than half the times Hampir selalu sepanjang sesi pem- buangan air kecil Almost always CR05 Berapa kerapkah anda mengalami aliran pembuangan air kecil yang lemah? How often have you had a weak urinary
stream? 0 1 2 3 4 5 CR06 Berapa kerapkah anda terpaksa berikhtiar/menekankan/berusaha untuk memulakan pembuangan air kecil? How often have you had to strain to start urination? 0 1 2 3 4 5 Tidak pernah None 1 kali 1 Time 2 kali 2 Times 3 kali 3 Times 4 kali 4 Times 5 kali 5 Times CR07 Berapa kerapkah anda bangun untuk membuang air kecil di waktu malam? How many times did you typically get up at night to urinate? 0 1 2 3 4 5 Kualiti hidup disebabkan oleh simptom pembuangan air kecil Quality of life due to Urinary Symptoms Berasa gembira
Delighted Berpuas hati Pleased Keban- yak- kannya puas hati
Mostly Satisfied Bercampur perasaan Mixed Keban- yakkannya tidak puas
Mostly Dis- satisfied Tidak gembira Unhappy Berasa sangat teruk Terrible CR08 Jika anda melalui kehidupan anda dengan keadaan pembuangan air kecil seperti sekarang, bagaimana perasaan anda terhadap perkara tersebut? If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? 0 1 2 3 4 5 6 Terima kasih diatas segala kerjasama yang diberikan. Thank you very much for your co-operation. Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 341 53 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia MODUL CS: MATI PUCUK / ERECTILE DYSFUNCTION KRITERIA KELAYAKAN: AHLI ISIRUMAH BERUMUR 18 TAHUN DAN KE ATAS SAHAJA DAN AKTIF SECARA SEKSUAL. ID Negeri (2 Digit) DP (2 Digit) & DB (3 Digit) BP (4 Digit) UB (3 Digit) TK (3 Digit) Strata (1 Digit) Isi Rumah & Individu (2 Digit) (2 Digit) Soal Selidik Indeks Keupayaan Ereksi Antarabangsa / International Index of Erectile Function Questionnaire Di sepanjang enam bulan yang lalu, Over the past 6 months, Sila tandakan (√) pada kotak yang bersesuaian. Please tick (√) in the appropriate box. CS01 Pada penilaian anda, sejauh manakah tahap keyakinan anda, yang anda boleh mencapai serta mengekalkan ketegangan zakar (kemaluan atau batang keras)? How did you rate your confidence that you could get & keep an erection? a. Sangat rendah / Very low b. Rendah / Low c. Sederhana / Moderate d. Tinggi / High e. Sangat Tinggi / Very high CS02 Apabila anda mengalami ketegangan zakar (kemaluan atau batang keras) menerusi rangsangan seks, berapa kerap ketegangan itu cukup keras untuk persetubuhan? When you had erections with sexual stimulation, how often were your erections hard enough for penetration?
a. Tidak pernah atau hampir tidak pernah / Almost never or never b. Beberapa kali / A few times c. Kadang-kadang / Sometimes d. Sering kali / Most times e. Setiap kali atau hampir setiap kali / Always CS03 Sewaktu bersetubuh, berapa kerap anda dapat mengekalkan ketegangan zakar (kemaluan atau batang keras)? During sexual intercourse, how often were you able to maintain your erection after you had penetrated your partner? a. Tidak pernah atau hampir tidak pernah / Almost never or never b. Beberapa kali / A few times c. Kadang-kadang / Sometimes d. Sering kali / Most times e. Setiap kali atau hampir setiap kali / Always CS04 Sewaktu bersetubuh, berapa sukarkah untuk mengekalkan ketegangan sehingga selesai persetubuhan? During sexual intercourse, how difficult was it to maintain your erection to completion of intercourse? a. Tersangat sukar / Extremely difficult b. Sangat sukar / Very difficult c. Sukar / Difficult d. Sukar sedikit / Slightly difficult e. Tidak sukar / No difficult Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 342 54 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia CS05 Apabila anda cuba melakukan persetubuhan, berapa kerap anda berasa puas hati? When you attempted sexual intercourse, how often was it satisfactory to you? a. Tidak pernah atau hampir tidak pernah / Almost never or never b. Beberapa kali / A few times c. Kadang-kadang / Sometimes d. Sering kali / Most times e. Setiap kali atau hampir setiap kali / Always Appendix 7

Non-Communicable Diseases: Risk Factors and other Health Problems 343 55 QUESTIONNAIRE National Health And Morbidity Survey 2019 Institute for Public Health Ministry of Health Malaysia MODUL CU1: ANTROPOMETRI / ANTHROPOMETRIC Keseluruhan Modul ini perlu dijalankan dan diisi oleh Jururawat ARAHAN: Bagi responden Kanak-kanak < 18 tahun tidak perlu menjawab soalan CU101 & CU102. Adakah penghuni mempunyai “kriteria pengecualian”? Does respondent have “exclusion criteria”? CU101 Wanita mengandung Pregnant women

  1. Ya / Yes
  2. Tidak / No CU102 Wanita yang baru melahirkan anak (<60 hari dari tarikh lawatan) Post-natal (less than 60 days at the same time of visit)
  3. Ya / Yes
  4. Tidak / No CU103 Terlantar - akibat sakit teruk/berpanjangan, kecederaan/kemalangan Bed ridden - due to chronic /prolonged illness, injury /accident
  5. Ya / Yes
  6. Tidak / No CU104 Mengalami ketidakupayaan fizikal yang menghadkan kebolehan untuk berdiri dengan tegak termasuk yang memakai kerusi roda. Having physical disabilities which can affect the normal standing including on wheel chair.
  7. Ya / Yes
  8. Tidak / No CU105 Cacat anggota badan seperti tiada tangan atau tiada kaki, spondylosis (bengkok tulang belakang) kecuali buta, bisu dan pekak. Body deformities such as no hand and leg, spondylosis except blind, mute and deaf.
  9. Ya / Yes
  10. Tidak / No Jika ‘Ya’ kepada salah satu Pilihan di atas, terus ke Modul CU2 CU106 Tarikh Pengukuran Antropometri / Anthropometric Measurement Date: Hari / Day Bulan / Month Tahun / Year Berat Badan / Body Weight CU107 Ukuran 1 / 1st Measurement . kg CU108 Ukuran 2 / 2nd Measurement . kg (-6) Tidak berkaitan / Not applicable (-9) Enggan diukur / Refuse to be measured Tinggi / Height Panjang / Length CU109 Ukuran 1 / 1st Measurement . cm CU110 Ukuran 2 / 2nd Measurement . cm (-6) Tidak berkaitan / Not applicable (-9) Enggan diukur / Refuse to be measured JURURAWAT: Ukuran panjang hanya untuk kanak-kanak di bawah umur 2 tahun Bagi responden berumur ≥ 60 tahun ke atas yang tidak boleh berdiri dengan tegak guna kaedah setengah depa lengan. Use Half-arm span method for respondents aged 60 years and above if they cannot stand straight. Questionnaire

National Health and Morbidity Survey 2019 Technical Report − Volume I 344 56 BORANG SOAL SELIDIK Tinjauan Kebangsaan Kesihatan Dan Morbiditi 2019 Institut Kesihatan Umum Kementerian Kesihatan Malaysia Setengah depa lengan / Half-arm span CU111 Ukuran 1 / 1st Measurement . cm CU112 Ukuran 2 / 2nd Measurement . cm (-6) Tidak berkaitan / Not applicable (-9) Enggan diukur / Refuse to be measured Ukuran lilit pinggang untuk responden berumur 18 tahun dan ke atas. Waist circumference for respondents aged 18 years and above. Ukur lilit pinggang / Waist circumference CU113 Ukuran 1 / 1st Measurement . cm CU114 Ukuran 2 / 2nd Measurement . cm (-6) Tidak berkaitan / Not applicable (-9) Enggan diukur / Refuse to be measured MODUL CU2: PEMERIKSAAN TEKANAN DARAH KRITERIA KELAYAKAN: RESPONDEN BERUMUR 18 TAHUN DAN KE ATAS ELIGIBILITY CRITERIA: RESPONDENTS AGED 18 YEARS AND ABOVE Bacaan tekanan darah / Blood pressure reading CU201 Sistolik / Systolic 1 Bacaan pertama / First reading CU202 Diastolik / Diastolic 1 Bacaan pertama / First reading CU203 Sistolik / Systolic 2 Bacaan kedua / Second reading CU204 Diastolik / Diastolic 2 Bacaan kedua / Second reading CU205 Sistolik / Systolic 3 Bacaan ketiga / Third reading CU206 Diastolik / Diastolic 3 Bacaan ketiga / Third reading (-9) Enggan diperiksa / Refuse to be examined ** Bagi Modul berikutnya, jika wanita mengandung hanya perlu lakukan Modul CU4 sahaja. Jika tidak mengandung, perlu lakukan Modul CU3 & CU4. Appendix 7

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