miwish_id

csr_prescreener

textPrescreener IDy miwish_st_id

csr_prescreener

sqlSite IDselect record as value, concat(record, ' - ', value) as label from redcap_data where project_id = 90 and field_name = 'miwish_st_nm' order by recordy csr_intv_id

csr_prescreener

radioInterviewer1, 1 | 2, 2 | 3, 3 | 4, 4 J | 6, 6 | 7, 7 | 8, 8 | 9, 9 | 10, 10 | 11, 11 | 12, 12 | 13, 13 | 14, 14 | 15, 15 | 16, 16 y csr_zip

csr_prescreener

textZip code csr_stnd_wlk

csr_prescreener

radioCan you stand/walk independently, without the help of another person? (use of canes/walkers OK, wheelchairs NO)0, (0) No | 1, (1) YesNeed only ask if P is in wheelchair or using scooter at contacty csr_fsc_yr

csr_prescreener

radioDo you expect to live in your current housing facility for at least one year?0, (0) No | 1, (1) Yes | 8, (8) Unsure/Do not knowy csr_eng_abil

csr_prescreener

radioEnglish ability1, (1) Speaks well | 2, (2) A bit Limited | 3, (3) Very Limited (ineligible) | 4, (4) Does not speak English (ineligible)y csr_hm_lang_spk

csr_prescreener

textHome Language (Language spoken in the home)yRH csr_lang_oth

csr_prescreener

radioOther languages?0, (0) No | 1, (1) Yesy csr_oth_lang_spec

csr_prescreener

textSpecify other Languages[csr_lang_oth] = '1' csr_cogn_abil

csr_prescreener

radioCognitive ability1, (1) Sufficient | 2, (2) Questionable | 3, (3) Insufficient (Ineligible)(If able to provide answers to questions above, mark sufficient)y csr_hear_abil

csr_prescreener

radioHearing ability1, (1) Hears well | 2, (2) A bit limited | 3, (3) Very limited (Ineligible)(If able to provide answers to questions above, mark sufficient)y csr_prx_avl

csr_prescreener

radioProxy available?0, (0) No | 1, (1) Yes csr_prx_rel

csr_prescreener

radioWhat is his/her relationship to you? 1, (1) Spouse or partner | 2, (2) Daughter or son | 3, (3) Other relative | 4, (4) Friend | 5, (5) Neighbor | 6, (6) Other[csr_prx_avl] = '1' csr_prescreener_complete

csr_prescreener

radioComplete?0, (0) Incomplete | 1, (1) Unverified | 2, (2) Complete dem_brth_dt_avl

csr_prescreener_demographics

DEMOGRAPHICS

radioDate of birth available?0, (0) No | 1, (1) Yesy dem_age

csr_prescreener_demographics

textAgeType 999 (DK) if age is unknownnumbery dem_gdr

csr_prescreener_demographics

radioGender1, (1) Male | 2, (2) Femaleask only if necessaryy dem_mrtl_st

csr_prescreener_demographics

radioMarital status1, (1) Single | 2, (2) Married | 3, (3) Divorced | 4, (4) Separated | 5, (5) Widowed | 6, (6) Living with partner | 8, (8) Refusedy dem_hisp

csr_prescreener_demographics

radioEthnicity: Do you consider yourself Hispanic or Latino?0, (0) No | 1, (1) Yes | 8, (8) Refused | 9, (9) Don't know / Non-valid responsey dem_rc

csr_prescreener_demographics

radioRace1, (1) American Indian or Alaska native | 2, (2) Asian | 3, (3) Black or African American | 4, (4) Native Hawaiian or other Pacific Islander | 5, (5) White | 6, (6) More than one race | 7, (7) Other | 8, (8) Refusedy dem_race_othr_spec

csr_prescreener_demographics

textIf Other, Please specify[dem_rc] = '7' dem_sts_chk

csr_prescreener_demographics

radioStatus check: Prescreen Eligible?0, (0) Not eligible | 1, (1) Yes: Eligible | 2, (2) Unsure/ Not determined | 8, (8) RefusedParticipant eligible?y dem_sts_ne

csr_prescreener_demographics

STOP! THE FOLLOWING QUESTION SHOULD ONLY BE ANSWERED IF THE REASON FOR NOT BEING ELIGIBLE FOR THE STUDY IS OTHER THAN: The participant: - Is unable to stand/walk independently - Does not expect to live in the facility for at least a year - Is not able to speak English - Has insufficient cognitive ability - Has limited hearing ability

radioReasons for not eligible?1, (1) Health | 7, (7) Other[dem_sts_chk] = '0' dem_sts_ne_oth

csr_prescreener_demographics

notesSpecify Other[dem_sts_chk] = '0' and [dem_sts_ne] = '7' dem_reas_ref

csr_prescreener_demographics

Refused

radioReason refused0, (0) Not interested | 1, (1) Length of Study | 2, (2) Too busy | 3, (3) Other[dem_sts_chk] = '8' dem_reas_ref_sp

csr_prescreener_demographics

textIf other, Please Specify[dem_reas_ref] = '3' csr_prescreener_demographics_complete

csr_prescreener_demographics

radioComplete?0, (0) Incomplete | 1, (1) Unverified | 2, (2) Complete