General Information: *Note: The Dari and Arabic translation of the items were tested. These are English translations of the original German source items.*
Question Text: How many times in the last four weeks did it happen that you...
[Wie oft kam es in den letzten vier Wochen vor, dass Sie...]
Answer Categories
never [nie]

rarely [selten]

sometimes [manchmal]

often [oft]

always [immer]

not specified [keine Angabe]
- Findings for Answer Categories
- Recommendations for Answer Categories

Findings/Recommendations for Multi-Item Scale:
- Findings for Multi-Item Scale
- Recommendations for Multi-Item Scale
Findings for Multi-Item Scale: The items 2, 3 and 5were systematically tested. For the other items, only spontaneous responses of the test persons were available, if at all.

Other findings

Two Dari-speaking test persons left out the temporal frame of reference and asked whether the question was about whether they were currently suffering from these troubles or whether they were suffering from them in general (DA03, DA05). In addition, one test person asked whether the temporal frame of reference also applied to the last two items in this question, which were on a separate page (IR01).

One test person noted that she lacked the appropriate response option for item 3 ("...felt down and gloomy?") (IR04). She suffers from depression and would want to answer the question with "almost always" or "most of the time." The options given were not specific enough for her. She finally selected the option "often." None of the other test person had comments on the answer categories.

One test person initially misunderstood the sentence structure of item 5 ("...because of mental or emotional problems in your work or your daily activities you have achieved less than you wanted?") and then misinterpreted the scale (SY04). She chose "always" to express that she always gets her work done. When asked or pointed out by the translator, she corrected her answer to "never".
Recommendations for Multi-Item Scale: Introduction: We recommend emphasizing the temporal frame of reference. This can be done, for example, by underlining the corresponding words or by bringing them forward in an introductory sentence:
“Now please think about the last four weeks:”
Response format: No changes recommended.

Cognitive Techniques: General Probing, Comprehension Probing, Emergent Probing

Items

Item Text	Item Tested
1. ... felt rushed or under time pressure?[... sich gehetzt oder unter Zeitdruck fühlten?]	No
2. ... had severe physical pain?[... starke körperliche Schmerzen hatten?] Tested Item and Recommendations Findings Topic and Construct Item Text: 2. ... had severe physical pain?[... starke körperliche Schmerzen hatten?] Recommendations: No changes recommended. Findings: What do test persons mean by "severe physical pain"? The question posed no difficulties for the test persons, who had a homogeneous understanding of severe physical pain. Moreover, no differences by language or country of origin were apparent. Five test persons explained that severe pain was often caused by injuries, especially accidents or sports (IR05, IR06, DA01, DA03, DA06). Four test persons defined severe pain as a physical impairment (DA04) experienced by not being able to walk (SY01, SY04), stand (SY01), or stand up (IR02). Likewise, four test persons explained when pain, in their understanding, should be considered "severe". This was the case when one could not sleep (SY02, IR02), one fainted from it (IR03) or one could not stand the pain without medication (DA05). Most of the test persons mentioned typical site-specific pain in their explanations. These included headaches or migraines (SY03, IR01, DA02, DA03), back pain or problems with the intervertebral disc (IR01, IR02, IR03), pain in the hip, legs, joints, bones (e.g., due to a fracture) or chest (SY04, IR01, IR05, IR06, DA01), pain in internal organs, abdomen, or muscles (SY02, SY03, DA03), and dental pain (SY03) and pain after surgery (SY06). Two test persons also mentioned emotional pain. One of the Iranian test persons even referred exclusively to psychological pain, which was an important topic for the test person for personal reasons at the time of the interview (IR04). A Dari-speaking test person, on the other hand, seemed to have over-read the word "physical" and first explained that there was external, internal, and psychological pain, all of which needed to be considered (DA03). When asked if all forms were meant, she noticed this mistake and focused exclusively on physical pain. Question Topic: Public health/ Health impairments Construct: Problems in the last four weeks	Yes
3. … felt down and gloomy?[... sich niedergeschlagen und trübsinnig fühlten?] Tested Item and Recommendations Findings Topic and Construct Item Text: 3. … felt down and gloomy?[... sich niedergeschlagen und trübsinnig fühlten?] Recommendations: No changes recommended. Findings: What do the test persons mean by feeling "down" or "gloomy"? Of the Arabic-speaking test persons, six stated that the feelings of dejection and gloom were pressures that were felt (SY04, SY05, SY06, IR01, IR03, IR05). They explained in more detail that this pressure was internal (SY04, IR03) or general (IR01) or a pressure in everyday life (SY06). Four Arabic-speaking test persons equated the words with depression or feeling depressed (SY03, SY04, SY05, IR04). Other explanations included mental stress (IR02), psychological or emotional problems (IR01, IR04), feeling stressed (SY03), or not having peace of mind (IR05). There were no differences in understanding between Arabic-speaking test persons from Syria and Iraq. The Dari-speaking test persons did not name any synonyms for these emotional states, with the exception of DA01, who also spoke German and spoke of depressive. Instead, the Dari-speaking test persons increasingly mentioned (as did a few Arabic-speaking test persons) effects of dejection and gloom. These effects were characterized by either withdrawal or inner turmoil. One test person stated that when she felt this way, she had no desire to exercise or work (SY01). Another said that one did not feel pleasure or was even deprived of pleasure (DA05). Another test person tried to withdraw in such cases and was then not very talkative (DA02). Another explained that she sometimes had so much to do that she no longer knew what to do first. In the end, when she didn't accomplish anything because she had so much on her mind, she felt down. In the case of gloom, it felt like someone was sitting next to her and holding her down in such a way that she couldn't do anything (IR02). Lastly, one test person stated that for her, feeling down or gloomy was feeling angry and that this mood did not go away throughout the day (DA01). The most frequently cited triggers for these problems were homesickness for the country of origin, longing for and concern about the well-being of the family, and fear of whether they would see them again (SY03, SY06, IR03, DA02, DA05). Also frequently mentioned was frustration at not making progress, not achieving goals, or experiencing other obstacles (SY02, SY03, DA01, DA04). In addition, the test persons mentioned work-related problems or the problem of not having a job or having lost their job (SY01, IR04, DA02). Two test persons mentioned physical pain as the only trigger for feeling down and depressed (IR06, DA06). Possibly this is due to the directly preceding item on the topic of pain. Question Topic: Public health/ Health impairments Construct: Problems in the last four weeks	Yes
4. …felt lots of energy?[... jede Menge Energie verspürten?]	No
5. …because of mental or emotional problems in your work or your daily activities you have achieved less than you wanted?[... wegen seelischer oder emotionaler Probleme in Ihrer Arbeit oder Ihren alltäglichen Beschäftigungen weniger geschafft haben, als Sie wollten?] Tested Item and Recommendations Findings Topic and Construct Item Text: 5. …because of mental or emotional problems in your work or your daily activities you have achieved less than you wanted?[... wegen seelischer oder emotionaler Probleme in Ihrer Arbeit oder Ihren alltäglichen Beschäftigungen weniger geschafft haben, als Sie wollten?] Recommendations: No changes recommended. Findings: What do the test persons understand by "mental and emotional problems"? Four test persons (across both languages and all three countries of origin) explicitly distinguished between mental or psychological problems on the one hand and emotional problems on the other (SY03, SY06, IR03, DA06). They related emotional problems to family ties, family life, or personal relationships. Two of these test persons explained that they were happily married and therefore had no emotional problems (SY03, SY06). Another explained that she was currently suffering from emotional problems because her spouse was ill (IR03). They defined emotional or psychological problems somewhat more heterogeneously. One respondent spoke of psychological problems due to experiences in the home country that led to flight (SY03). Another remained vague but seemed to refer to mental illnesses (IR03). One test person each mentioned homesickness (SY06) and discrimination or lack of attention (DA06) as psychological problems. The explanations indicate that the question was perceived as a double stimulus at least by individual test persons; however, none of the test persons mentioned having had problems with the question. A total of four other test persons mentioned physical problems that impaired their work or everyday activities. Of these, one test person, even when asked, defined mental problems exclusively as physical problems (SY05). It should be noted that this test person generally showed reading difficulties and comprehension problems throughout the interview. Another test person, when filling out the question, stated that she had health problems that affected her work and that she therefore answered "always" (IR03). However, when asked, she explained what she meant by mental and emotional problems, suggesting that she had rather skimmed over the orientation of the item when first reading and answering. The third test person stated that she understood emotional problems to mean both physical and psychological stress, although in her case the psychological stress also had physical effects such as abdominal pain due to her family situation (IR02). The fourth test person first mentioned psychological problems and then wanted to talk about physical problems (SY03). The interpreter intervened, however, and pointed out to the test person that it was about psychological problems. One test person did not answer the question because she did not currently have a job and felt that the question therefore did not apply to her (DA03). Even the interviewer's inquiry as to whether she had seen the addition of "everyday occupations" did not convince the test person that she could complete this question. For her, work was clearly related to occupation. In addition, she had not experienced any impairment due to mental or emotional problems in the last four weeks, although she attested to suffering from such problems. Another test person, on the other hand, explained that she was currently a housewife and that her daily occupation was therefore her children, even though this did not constitute work (DA05). She had no problems understanding the question or applying it to her circumstances. None of the test persons understood the word "psychic" in a religious context. Question Topic: Public health/ Health impairments Construct: Problems in the last four weeks	Yes