Specially designed questionnaire used in the study
| 1 | To what extent do you feel physically impaired by the implanted device (pacemaker, defibrillator)? | ||||
| □ No impairment | □ Limited impairment | □ Considerable impairment | □ Disabling impairment | ||
| 2 | How often do you think about the implanted device? | ||||
| □ Never | □ Sometimes | □ Several days a week | □ Every day | ||
| 3 | Did you feel depressed when you were informed about the necessity of a device implantation? | ||||
| □ No | □ Yes, to some degree | □ Yes, considerably | □ Yes, very much | ||
| 4 | Since implantation, to what extent are you preoccupied with your heart condition? | ||||
| □ None | □ To some degree | □ Considerably | □ Very much | ||
| 5 | Did the implanted device change your image of your body? | ||||
| □ Yes | □ No | ||||
| 6 | To what extent do the visible changes at the implantation site disturb you? | ||||
| □ Does not disturb | □ To some degree | □ Considerably | □ Very much | ||
| 7 | Does the implanted device disturb you in daily life? | ||||
| □ No | □ Yes, a little | □ Yes, considerably | □ Yes, very much | ||
| 8 | Does the implanted device disturb you in your leisure activities? | ||||
| □ No | □ Yes, a little | □ Yes, considerably | □ Yes, very much | ||
| 9 | Do you have anxiety about premature battery depletion? | ||||
| □ No | □ Yes, a little | □ Yes, considerably | □ Yes, very much | ||
| 10 | Do you have anxiety about malfunction of the implanted device? | ||||
| □ No | □ Yes, a little | □ Yes, considerably | □ Yes, very much | ||
| 11 | How well are you informed about the implanted device? | ||||
| □ Badly | □ Moderately | □ Well | □ Very well | ||
| 12 | How well are you informed about your heart disease? | ||||
| □ Badly | □ Moderately | □ Well | □ Very well | ||
| 13 | Is the implanted device a source of security for you? | ||||
| □ No | □ A little | □ Considerably | □ Very much | ||
| 14 | Is the implanted device a life extender for you? | ||||
| □ No | □ A little | □ Considerably | □ Very much | ||
| 15 | Is the implanted device a source of anxiety for you? | ||||
| □ No | □ A little | □ Considerably | □ Very much | ||
| 16 | Would you rather have more frequent appointments with your physician? | ||||
| □ Yes | □ No | ||||
| 17 | Would you rather have longer appointments with your physician? | ||||
| □ Yes | □ No | ||||
| 18 | Would you also consider having psychological or psychotherapeutic support? | ||||
| □ Yes | □ No | ||||
| 19 | Would you also consider being involved in a support group? | ||||
| □ Yes | □ No | ||||
| 20 | Do you believe that the public should be better informed about the implantable devices for heart diseases? | ||||
| □ Yes | □ No | ||||
| 21 | How do you feel now as compared to your status before the implantation? | ||||
| □ Worse | □ Same | □ Better | |||
| 22 | How long did it take you to adjust the implanted device? | ||||
| □ Less than 1 month | □ Up to 6 months | □ Up to 1 year | □ Up to 2 years | □ Not yet | |
| 23 | Overall, was it worthwhile having the device implanted? | ||||
| □ No | □ Probably | □ Yes | |||