Items if Problems Identified 1. I had pain or discomfort... Word problem, conceptual 2. My treatment (transfusion, pills, needles) prevented me from doing the things that I wanted to do… Word problem, conceptual 3. I put off my treatment (transfusion, pills, needles)… Word problem, conceptual 4. Thalassemia negatively (bad) affected my family… Word problem, conceptual 5. Thalassemia positively (good) affected my family… Word problem, conceptual

Table 2: Items rated as difficult to understand by 3 or more children with thalassemia