> ![](media/image1.png){width="1.5in" height="0.4in"}
>
> *Research Directorate*
>
> *Demographic Census Committee Coordinating Entity*

Report on the Cognitive Test and Field Test

Individuals with Disabilities

Brazil

> April 2006
>
> **Introduction**
>
> This report is about the Cognitive Test and Field Test conducted in
> Brazil to test the questions on the topic of Individuals with
> Disabilities. The report includes an executive summary, a discussion
> of the methodology employed, the operational aspects and the analysis
> of the results obtained.
>
> **Demographic Census Committee**

**Table of Contents**

1.  Executive summary

> Introduction
>
> Methodology
>
> Interviewers
>
> Respondents
>
> Questionnaires
>
> Translation
>
> Data quality
>
> Findings
>
> 2\. Methodology and Operational Aspects
>
> Fieldwork
>
> Team
>
> Training
>
> Sample
>
> 3\. Analysis
>
> Structure and general aspects of the questionnaires
>
> Question by question
>
> Analysis comparing each basic question with a corresponding additional
> questions
>
> Informant bias
>
> False negatives
>
> Analysis of open questions
>
> **1. Executive Summary**
>
> **Introduction**
>
> The Cognitive Test on Individuals with Disabilities in Brazil was
> fielded in April 2006 in the southeast, northeast and southern regions
> in which specific areas were selected in the municipalities of Rio de
> Janeiro (Rio de Janeiro), Olinda
>
> (Pernambuco) and Curitiba (Paraná).
>
> The Team of the Demographic Census Committee was involved in the
> conceptual design and questionnaire design, drafting of the
> instructions manual and other training materials, the analysis plan,
> and the selection of sectors.
>
> The Team of the Demographic Census Committee administered the training
> for the technicians of the aforementioned State Units who were
> assigned as survey interviewers. In addition, it conducted
> observations and supervision of the data collection of the Cognitive
> Test on Individuals with Disabilities in the selected areas.
>
> **Methodology**
>
> **a. Interviewers**
>
> Interviewers were selected among IBGE professionals, both permanent
> and contract employees, taking into account their previous experience
> with censuses and/or other household surveys. With the exception of an
> interviewer with just one year of experience in household surveys, all
> had over 10 years of experience in either household surveys or the
> census. None of the interviewers were students, but 30% have higher
> education, 47% middle level (over 10 years of education) and 23% basic
> education level. Of the total of 15 interviewers, 9 are females \--
> one in her 20s and the rest between the ages of 45 and 55. Among the
> men, one is in his 20s and the others between 45 and 54 years old. All
> interviewers speak Portuguese.
>
> **b. Respondents**
>
> A total of 406 people were interviewed. Among them, 227 indicated they
> have at least one of the difficulties being investigated. Since all
> the people with at least one of the difficulties being investigated
> answered all the questions in the Self-report Questionnaire, a total
> of 641 cases of disabilities were recorded, that is, each person with
> a disability, on the average, gave a positive answer in more than two
> modules. The socio-demographic profile of the respondents can be seen
> below.
>
> First, a list of addresses was prepared, of individuals with the
> disabilities researched in Census 2000; it was developed on the basis
> of data from the Census. Due to sample loss mainly associated with
> change of address of people with disabilities, it was necessary to
> complement the list. This was done on the basis of information
> obtained from the field, through indications of previously selected
> informants and visits to institutions serving people with
> disabilities.
>
> The quota sample was stratified by type of disability researched in
> Census 2000, trying to include both genders and the following age
> groups: 0-14, 15-64, 65 and over.
>
> **Respondents, by age group -- Cognitive Test - Brazil 2006**
>
> 45
>
> 40
>
> 35
>
> 30
>
> 52
>
> Men
>
> Women
>
> 02
>
> 15
>
> 10
>
> 5
>
> 0
>
> 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59
> 60+
>
> **Age groups**
>
> Source: IBGE, Demographic Census Committee. Cognitive Test and Field
> Test on Individuals with Disabilities. 2006

> **Total number of respondents by gender and age groups, by years of
> education**
>
> Gender and age groups
>
> Respondents
>
> Years of Education

Never

Attended

School

> Total Missing

0 to 4 5 to 8 9 to 11 12 or more

> Total 406 28 49 148 83 70 28
>
> Age 0-14 111 10 28 52 20 1 0
>
> Age 15-64 243 15 12 71 54 67 24
>
> 65 and over 50 1 9 25 9 2 4
>
> Unknown 2 2 0 0 0 0 0
>
> Source: IBGE, Demographic Census Committee. Cognitive Test and Field
> Test on Individuals with Disabilities. 2006
>
> **Total number of respondents, by gender and age group, by activity
> condition in the reference week and by earnings from all jobs.**
>
> Gender and age groups
>
> Respondents

Work Earnings from jobs (R\$)

Total Missing

Paid Work

Working,

Not for pay

Not

Working Total Missing

Does

Not have

300.00 And under

> \>300.00 and =\<
>
> 1500.00
>
> \>1500.00 and =\<
>
> 3000.00
>
> \>3000.00
>
> Total 406 57 101 6 242 406 291 5 40 62 5 3
>
> Age 0-14 111 30 0 0 81 111 109 2 0 0 0 0
>
> Age 15-64 243 24 97 6 116 243 137 3 38 57 5 3
>
> 65 and over 50 1 4 0 45 50 43 0 2 5 0 0
>
> Unknown 2 2 0 0 0 2 2 0 0 0 0 0
>
> Source: IBGE, Demographic Census Committee. Cognitive Test and Field
> Test on Individuals with Disabilities. 2006
>
> **c. Questionnaires**
>
> Four questions were added that had been used in the 2000 Demographic
> Census. Also, a thematic module was augmented: Body Structures and
> Functions, since this topic was requested by the National Coordinating
> Body for the Integration of Individuals with Disabilities -- CORDE. In
> addition the response categories of some probes and functional
> questions were modified, however the basic questions and their
> response categories were preserved.
>
> **d. Translation**
>
> All interviews were conducted in Portuguese. A translation of the
> questionnaire was carried out by technicians involved in the project,
> taking into consideration the cultural characteristics of the country,
> so that some terms were not translated literally.
>
> The questionnaire was tested among IBGE staff, with relatives and
> friends of the technical staff involved in the project. There were no
> problems related to the translation, so it was not necessary to make
> modifications to the questionnaire due to translation difficulties.
>
> **e. Data Quality**
>
> Because of the length of the questionnaire, respondents' cooperation
> declined in the questions of the final modules. Therefore, there is
> some concern that these data are not of the same quality as those
> related to the questions in the initial sections of the questionnaire.
>
> Interviewers reported problems related to the sample list: addresses
> not found and potential informants that moved away; excessive
> questionnaire length, and problems related to interview administration
> training such as the fact that reading all questions exactly as worded
> made the interviews tiresome.
>
> Generally speaking, few inconsistencies were identified. There was
> only partial non-response, with no loss of information in the core
> questions. In some cases the respondent did not wish to continue with
> the interview, in others it was not possible to complete the interview
> because the respondent was not available during the field period.
>
> **f. Results**
>
> The six core questions recommended in the Washington Group protocol
> for the cognitive test: 1) Do you have difficulty seeing, even with
> glasses or contact lenses?; 2) Do you have difficulty hearing, even
> with a hearing aid?; 3) Do you have difficulty remembering something
> or concentrating?; 4) Do you have difficulty walking or climbing
> steps?; 5) Do you have difficulty caring for yourself, such as
> dressing or bathing?; 6) Because o a physical, visual, auditory,
> mental or emotional condition, do you have any difficulty
> communicating, for example understanding others or being understood by
> others?
>
> In addition to those questions, an additional module of questions was
> added to research aspects related to body structure and functions, in
> which the basic question was: Do you have any of the following
> physical impairments: (record only the first response), the body
> functions and structures with response options that include different
> types of paralysis or a missing limb or body part.
>
> Considering the wording of the questions, in most cases the questions
> recommended by the Washington Group were easily understood. Frequently
> respondents gave their answer before hearing all the response
> categories, given the clarity and simplicity of the questions, which
> made them easy to understand by people with different levels of
> education. In many cases, it was necessary to wait for the respondent
> to finish answering, to then read the categories and ask him/her to
> choose that which best described his/her situation. However, some
> problems were observed regarding strictly following the objectives of
> the questions.
>
> Generally speaking, the questions about vision and hearing did not
> present comprehension problems. These questions were well understood
> during the interviews. On the other hand, the questions did not make
> clear that the objective is to investigate the difficulties that imply
> impairment or limitation of activities and therefore all types of
> difficulties were captured. Thus, the question overestimates the
> population with difficulties as it includes persons who are suffering
> from temporary limitations.
>
> The question about cognitive limitations did not present problems in
> terms of formulation; however it presented many problems regarding the
> goal of capturing serious limitations. It is a very inclusive question
> and for that reason it captured all types of difficulties related to
> memory and concentration. On the other hand, the question did not
> capture some cases of mental deficiencies such as Down's syndrome,
> which were captured by the question used in the 2000 Demographic
> Census.
>
> The question in the mobility module was also easily understood by
> respondents. Nevertheless, the question does not mention that the
> degree of difficulty needs to be evaluated without the use of
> equipment or assisting device. Therefore, individuals who normally use
> some type of aid to move around will remain in doubt as to whether or
> not to take such aid into consideration.
>
> Generally speaking, the question about self-care was easily
> understood, although in some cases respondents found the example of
> bathing odd. Some people quickly answered that they have no
> difficulties to bathe and that no, they do not have difficulties
> caring for themselves, giving the impression that they wanted to show
> they had good hygiene habits. As in other questions, this one does not
> make it clear that the goal is to research permanent difficulties, and
> therefore it also included persons with temporary difficulties.
>
> The question about communication did not present comprehension
> problems. Nevertheless it was hard to administer because of its
> length. As other questions, it does not make it clear that it is about
> communication difficulties that make it hard to carry out daily
> activities, and therefore it also captured all types of difficulties.
> Considering that it is administered together with the questions about
> vision, hearing and cognitive difficulties, this question duplicates
> the efforts to identify persons with difficulties, because it also
> included conditions previously investigated by the abovementioned
> questions.
>
> **2. Methodology and Operational Aspects**
>
> For the Cognitive Test and Fieldwork, 142 addresses were visited, in
> which 406 direct interviews were conducted in the period between April
> 10 and 20, 2006. Respondents had the following characteristics:
>
> Gender and
>
> Age groups

Persons interviewed according to their characteristics

> Years of education
>
> Never
>
> Total Missing

Attended School

0 to 4 5 to 8 9 or more

> Total 406 28 49 148 83 98
>
> 0 to 14 111 10 28 52 20 1
>
> 15 to 64 243 15 12 71 54 91
>
> 65 and over 50 1 9 25 9 6
>
> Unknown 2 2 0 0 0 0
>
> Men 182 11 19 66 40 46
>
> 0 to 14 56 4 14 29 9 0
>
> 15 to 64 112 7 5 29 27 44
>
> 65 and over 14 0 0 8 4 2
>
> Women 224 17 30 82 43 52
>
> 0 to 14 55 6 14 23 11 1
>
> 15 to 64 131 8 7 42 27 47
>
> 65 and over 36 1 9 17 5 4
>
> Unknown 2 2 0 0 0 0

<table style="width:100%;">
<colgroup>
<col style="width: 15%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 9%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 3%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td rowspan="3">Gender and age groups</td>
<td colspan="12">Characteristics of persons interviewed</td>
</tr>
<tr class="even">
<td colspan="5">Employment Status</td>
<td colspan="7">Work earnings (R$)</td>
</tr>
<tr class="odd">
<td>Total</td>
<td>Missing</td>
<td>Working for pay</td>
<td>Working – not for pay</td>
<td>Not work-ing</td>
<td>Total</td>
<td>Miss-ing</td>
<td>None</td>
<td><blockquote>
<p>Under</p>
</blockquote>
<p>300.00</p></td>
<td><blockquote>
<p>&gt;=300.00</p>
<p>&amp; up to 1500.00</p>
</blockquote></td>
<td>&gt;1500.00 &amp; up to 3000.00</td>
<td>Over 3000.00</td>
</tr>
</tbody>
</table>

> Total 406 57 101 6 242 406 291 5 40 62 5 3
>
> 0 to 14 111 30 0 0 81 111 109 2 0 0 0 0
>
> 15 to 64 243 24 97 6 116 243 137 3 38 57 5 3
>
> 65 and over 50 1 4 0 45 50 43 0 2 5 0 0
>
> Unknown 2 2 0 0 0 2 2 0 0 0 0 0
>
> Men 182 25 52 3 102 182 122 2 17 35 4 2
>
> 0 to 14 56 16 0 0 40 56 54 2 0 0 0 0
>
> 15 to 64 112 9 50 3 50 112 57 0 17 32 4 2
>
> 65 and over 14 0 2 0 12 14 11 0 0 3 0 0
>
> Women 224 32 49 3 140 224 169 3 23 27 1 1
>
> 0 to 14 55 14 0 0 41 55 55 0 0 0 0 0
>
> 15 to 64 131 15 47 3 66 131 80 3 21 25 1 1
>
> 65 and over 36 1 2 0 33 36 32 0 2 2 0 0
>
> Unknown 2 2 0 0 0 2 2 0 0 0 0 0

**Fieldwork**

Given that this work is quite different from the other surveys done by
IBGE, there was a need for interviewers to get used to the structure of
the cognitive test, as well as familiarizing themselves with the
questions,. In the first few days it was necessary to hold meetings to
remember the goal of the study, the reasons why it is necessary to ask
similar questions, the importance of having more than one questionnaire
about the same person (Proxy and Self) and mainly the importance of this
work for the next Census. To a certain extent, the interviewers are used
to quantitative research and this cognitive test does not seem to them
to be very practical. Because the interviews are lengthy, there is the
feeling of lack of progress in the work, which caused them some
distress.

Once the adaptation phase was over, the work was conducted as planned
and, understanding the goals of the cognitive test, the interviewers
were able to do their work independently.

There were two supervisors/observers per Unit of the Federation. Each of
them accompanied different interviewers so that each interviewer was
observed at some point during the field period.

On the first day of fieldwork it was observed that the mean interview
time with each respondent was about 40 minutes. Therefore, in a
household of four people and only one person with a disability, the
total interview time would be over three hours.

The interview length was due to the following factors: first, the fact
that according to the instructions, in each residential address
selected, an Informant Questionnaire needed to be pre-filled with the
information about each household resident and the Self Questionnaire
with the information provided by the person with disability his/herself;
but also due to the size of the questionnaire that, in eight modules,
includes more than 100 questions. Moreover, the topic requires certain
sensibility and disposition to listen to the respondents. In some cases
the respondent wanted to think before responding, in other s/he wanted
to tell his/ her family history and talk about the motives that led to
the person's impairment. In other situations, they wanted to speak about
their experiences living with the disability. There were also cases in
which the respondent did not want to complete the interview because s/he
got tired and bored with so many questions. Two interviews were not
completed because the respondent did not want to continue providing
information, asking the interviewer to return the following day.

The time taken was too long for the interviews to be completed on the
same day, which made it necessary in several cases to return to an
address. Once this was determined, and the estimated time for data
collection, the decision was made to conduct the complete interview, in
the Informant Questionnaire, only with some of the household residents
including one person with a disability, and to pre-fill some
characteristics such as gender, age, and others for all residents.

Reading all the questions with their corresponding response categories
exactly as worded made the interviews tiresome, both for the interviewer
and for the respondent. The requirement that the questionnaire be read
to the respondent made the interview seem like a mechanical act,
preventing good interaction between interviewer and respondent. Even in
cases in which the respondent attempted to chat about the topic, rather
than simply responding to the questions, the requirement to read the
questions made it difficult to create an environment where both,
interviewer and respondent, could feel more relaxed, with the cordiality
required of an interview.

The requirement to read the questions in sequence (see, for example, in
questions 4.08 through 4.14, 5.11 through 5.15, among others) which were
initially identically worded, with the exception of the question ending
(type of difficulty about which the question is asking), took too long
and bored the respondents. In some cases it was noted that he
interviewer asked only the first question in the sequence, asking in the
remaining items just the ending of the question, as for instance in: "Do
you have difficulty remembering names of persons or places?"... "and
remembering appointments?" ... "and taking medications?" ... Although it
greatly facilitated the interview, the adoption of this procedure was an
individual decision, since the general instruction given was that all
questions had to be read.

In a majority of the cases, the respondents were patient and helped with
the interviews. Only in two cases the respondents refused to continue
the interview. One of them was too tired and, after almost 3 hours of
interview requested that the interviewer return another day. Another one
said he did not wish to answer questions any longer because they were
personal and repetitive. Many respondents mentioned that the interview
is very long and the questions are repetitive and boring. In some of the
cases observed, the interviewer abbreviated the interview, asking
general questions instead of reading the questions exactly as worded,
when they perceived that they were taking too much of the respondent's
time and that s/he was getting impatient.

The questionnaire is too long to be administered to one single person.
Perhaps it would be more productive to only apply one or two modules to
each person with a disability. This might be a strategy to spare the
respondent and gain in interview quality. We observed, for instance, a
person with a physical disability who had to answer the whole
questionnaire before getting to the module that best captures his
disability, got tired and abbreviated his answers regarding Body
Structures and Functions.

The interview conducted with the person with disability him/herself
seems to have worked well for most questions, although we observed two
cases in which a person with mental impairment denied having such
impairment. In both cases, the impairment was apparent and was confirmed
by an informant.

**Equipment**

To conduct the cognitive and field test three work teams were organized,
one for each unit of the federation. In Rio de Janeirio and in Olinda,
each team was composed of two experts based in the Research Directorate
and four interviewers based in the local agencies. In Curitiba the team
was integrated by two experts based in the Research Directorate and
seven interviewers based in the local agencies.

The experts, with experience in different stages of implementation of
demographic censuses and other surveys were responsible for training the
interviewers as well as escorting and supervising the interviews. The
interviewers, all with prior experience in data collection in surveys or
in the demographic census, were responsible for conducting the
interviews.

The coordination was done by the Census Committee Coordinating Entity.

**Training**

Training was conducted over a two day period and covered concepts and
definitions about persons with disabilities, methodology of the
cognitive test, presentation of two different types of questions (core,
probes, functional and additional) and different types of questionnaire
(Proxy/Informant and Self), as well as the presentation of the
questionnaire, question by question with the respective goals and
formulation of each question.

**Sample**

In each of the Units of the Federation, a limited number of addresses
was selected in which it was expected that persons would be found who
would answer each module/question, of the Proxy and Self Questionnaires,
thus reaching pre-established quotas of persons with disabilities and
persons without any of the researched disabilities as specified below:

> ° 14 interviews with persons with visual disability (module 2/Vision
> -- Self Questionnaire) prioritizing 'great difficulty" or "unable" to
> see.
>
> ° 14 interviews with persons with auditory disability (module
> 3/Hearing -- Self Questionnaire) prioritizing "much difficulty" or
> unable to hear.
>
> ° 14 interviews with persons with mental disability (question 4.15 in
> module 4/Cognitive -- Self Questionnaire)
>
> ° 10 interviews with persons with difficulty walking/climbing steps
> (module 5/Movility -- Self Questionnaire), prioritizing "much
> difficulty" or "unable" to walk/climb steps)
>
> ° 10 interviews with persons with difficulty to care for themselves
> (module 5/Self Care -- Self Questionnaire)
>
> ° 10 interviews with persons with difficulty to communicate (module
> 6/Communication -- Self Questionnaire)
>
> ° 14 interviews with people with physical disabilities (module 7/Body
> structures and functions -- Self Questionnaire)
>
> ° 14 persons without any of the disabilities being investigated

In total, considering the quotas of each of the three Units of the
Federation where the interviews would be carried out, it was expected
that 100 interviews would be obtained in each Unit of the Federation,
for a total of 300 interviews.

Taking into account that the database for the selection of the sample
was Census 2000, it was expected that there would be some sample
attrition due to respondents having moved in the intervening six years
or even died. Yet the possibility was considered of having made some
classification mistake in the Census, though minimal. Therefore, 276
addresses were selected in which it was expected to find 460 persons
with a disability and 671 without. In interviewing persons with a
disability it was expected that 711 cases of disability would be
identified since some persons had more than one of the types of
disabilities researched in Census 2000.

The difficulty in carrying out the fieldwork on the basis of the
information from Census 2000, due to loss of addresses and consequently
of respondents was larger than anticipated. Nearly 45% of the addresses
could not be visited due to the fact that they could not be found
(change of street numbers, demolitions, or incomplete addresses in the
Census 2000 listings), due to being locked or vacant, or due to
refusals. In about 60% of the addresses visited we were unable to find
at least one of the persons with a disability sought, due to respondents
having moved or died. In some cases it was possible to interview a
different person with a disability at the same address but in other
cases there was not even one person with a disability. It is worth
noting that in only one case there was a person identified as having a
disability in the Census 2000 database who had had surgery since and
therefore no longer had the disability reported on.

Given the difficulties to conduct the work on the basis of the
previously built list, strategies were adopted for the construction of
complementary lists. Such lists were built in the field and had as basis
the information provided by the interviewers who, given their extensive
knowledge of the area, were able to identify institutions or
associations of persons with disabilities, through which it was possible
to find individuals, and also on the basis of the information provided
by the persons with disabilities themselves who provided referrals to
find other persons.

At the conclusion of the fieldwork, 227 persons had been interviewed
with at least one of the difficulties researched, therefore the
effective sample were 406 interviews. As all the persons with at least
one of the difficulties under research answered all the questions in the
Self Questionnaire, in total 641 cases of disability were recorded, that
is, each person with a disability had an average of 3 disabilities.

**3. Analysis**

The qualitative analysis was based on the observations in the cognitive
and field test interviews. Therefore, the report presented in this
section takes into consideration basically the perception of the
interviewers and observers regarding the reactions of the respondents,
as well as the additional comments and suggestions made by respondents
during the interviews.

**Structure and General Aspects of the Questionnaires**

Skip Instructions

The skip instructions formulated as a headline were difficult to grasp
for the interviewers. In some of the interviews that were observed, the
interviewer needed to read the headline, even if to him or herself, so
as not to ask questions inappropriately.

It was also observed that the interviewers' need to use critical
thinking, and should have freedom to introduce skips according to
specific situations. This is the case of prefilling of the module on
mobility in the interview to persons with physical disabilities. Even if
this module comes earlier than the module where the physical disability
is detected, already in the core mobility question the respondents
mentioned that the difficulties reported are the result of a physical
disability. According to the instructions, the questions that inquire
whether the person can walk short or long distances, for example, must
be done for everyone. However, this question does not apply to a person
who always uses a wheelchair to move around or even for the persons who
do not have both legs (we did not run into any such case; thus, this is
just an example). In some situations, the respondent provided the
information in advance, already in the core question, telling a long
story, covering what s/he is able and unable to do, which made the
reading of some of the questions to cause distress.

Open-ended Question

In most of the cases observed the question was confusing for the
respondent. It was observed that when choosing the response category of
the core question, the respondent explained the reason for the choice,
as for example: "I have much difficulty seeing because I have myopia and
I don't wear glasses", or "I have much difficulty walking and climbing
steps because I have arthritis". However, when we asked "why did you
answer that way?" the majority of persons did not understand the
question. At first, they did not understand that it was related to the
core question and when we explained it, the person was surprised because
s/he knew that s/he had already answered why when they provided an
answer to the core question. Some persons were not able to grasp the
goal of the question, not even after the interviewer's explanation and
said that they had answered that way because "it's the right answer",
"just because", "because I live with this person", or "because I see
what goes on".

In specific situations, such as those found in module 7, Body structures
and functions, it is very restrictive to ask this question. In the
interview of persons with some physical disability, whether it is
paralysis or a missing limb, it is very unpleasant to ask why did the
person reported s/he is paralyzed or is missing a limb. There is a
subtle different between persons with a physical disability and the
other types of difficulties. Generally speaking, when they are talking
about vision, hearing, mobility or some other difficulty, the
individuals spontaneously tell that something happened and therefore
they have such difficulty, but when it is physical, it seems that the
disability is obvious in general or the respondent tells what caused the
disability and not because they answered that way.

To obtain information that in fact complement the answer provided to the
core question, it was necessary to be at the given response.

**Question by Question of the Topic Modules for Vision, Hearing,
Cognitive, Mobility, Self-Care, Communication, and Body structures and
functions**

This section presents comments about the fulfillment of the goals of the
core questions in each module, as well as about the adaptation and
understanding of the other questions, in the context of the cognitive
test. The questions not mentioned did not present comprehension problems
and attended to the objectives of the cognitive test; therefore they
were not included in this section.

Vision Module

Core Question

Taking into consideration the goal of the core question "**Do you have
difficulty seeing, even if using glasses or contact lenses?"**, that is,
"to identify persons who have some visual impairment or some type of
difficulty seeing, that contributes to make difficult his daily
activities" in a majority of the cases observed, the question did not
facilitate the total comprehension that it aimed to identify the cases
in which the persons had difficulty to carry out daily tasks due to the
loss or limitation of vision. In a general way, the question captured
all types of difficulties with vision, including the cases in which the
difficulty does not imply impairment or limitation of activities.

For this reason, the question overestimates the population with visual
difficulties that impede the realization of daily activities.

Since the question does not make explicit the type of visual difficulty
that is of interest to the investigation, that is, only those that imply
limitation of activities, the response category "Yes, some difficulty",
frequently added false positives. Many persons with a little difficulty
seeing that did not impede or make harder to carry out daily activities,
chose this response option, which would not have happened if the
question were more complete, as for example, "**Do you have any
difficulty seeing, even using glasses or contact lenses, that impedes
carrying out daily activities?**

If on one hand the recommended wording prevents the overestimation of
the group that in fact has limitations due to visual difficulty, on the
other hand it still includes those persons with temporary difficulties
which in fact prevent them from carrying out daily activities, such as
those who have suffered accidents, had surgery or emotional shock at the
time of the survey. In this case, a formulation even more complete could
be utilized as, for instance, "**Do you have any permanent difficulty
seeing, even using glasses or contact lenses, that prevents you from
carrying out daily activities?".** Despite its length, the question
would be more clear and in agreement with its goal.

Considering only the wording, in most of the interviews the question
recommended by the Washington Group was easily understood. Given the
clarity and simplicity of the question, which made it easy to understand
by people with different levels of education, respondents frequently
answered before the response categories were read. In many cases it was
necessary to first wait for the respondents to finish answering, to then
read the categories and ask the respondent to choose the one that best
described his/her situation.

Other Questions

The question "**Is there any activity that you are unable/incapable of
doing because of your difficulty seeing?"** proved to be excellent to
help distinguish between the difficulty due to injury or loss, and that
one which affects the majority of persons, such as small difficulties
with their vision, but which do not impede the carrying out of daily
activities. In a majority of the cases observed, when the person
reported having some difficulty due to injury or loss, s/he also
reported that there is some activity s/he is unable to do because of
this lesion or loss. Nevertheless, in some cases it was observed that
even when people had a more serious injury which prevented them from
doing some activity, they mentioned it because of the personal or social
context in which they live. Some persons are not used to reading the
newspaper, for example, and therefore they did not mention the
difficulty reading due to the loss or reduction in their ability to see.

The question "**How do you rate your degree of concern with your
vision?**" seemed difficult to understand. Even when the response
categories were read right after the question, the respondent showed
difficulty understanding the question. In the majority of the interviews
observed it was necessary to ask a different way, formulating the
question including the response categories, as for example "are you very
concerned or a little concerned with your vision?" Generally speaking,
to ask the respondent to "rate his degree of concern" does not seem like
the best way to research the concern of the respondents regarding his
vision, especially if we consider that it is a question to be formulated
for persons with different levels of education and of vocabulary
capability. In any case, this question seems to reveal more the cultural
context of the respondent than the situation of his vision per se, since
many people without vision problems reported concern about their vision,
while others, with serious vision problems, reported that they had no
preoccupation at all, adding comments such as: "there's nothing that can
be done about it, so why worry."

In the questions about **the "difficulty seeing an illustration in a
map, newspaper or book",** many respondents replied that it depends on
the size of the figure. A respondent recommended changing this question
to read: "are you able to read the Bible?" because it is printed in
standard font size.

Regarding **recognizing an object at arm's length**, some respondents
had difficulty understanding if it was about the shape of a bottle, for
instance, or the reading of the label. If we take into consideration the
autonomy to pick out the right medication in a cabinet with several
medication bottles, the ability to read the label may be crucial.

The additional question **"How do you rate your ability to see? \[if you
use glasses or contact lenses, please answer about when you are using
them\]",** which has the same goal as the core question (WG), and which
was also tested, it was not as well understood as the core question in
this module. The expression "rate your ability" did not appear to be
easily understood or comprehended by respondents. Nevertheless, the
response categories appeared more appropriate once the term "permanent"
was added, which prevented the inclusion in the group of persons with
difficulty seeing of those with temporary difficulties and impairments
due to surgery, accidents or emotional shocks.

Hearing Module

Core Question

Considering the goal of the core question "**Do you have difficulty
hearing, even using a hearing aid?"**, that is "to identify persons who
have some hearing limitation or some type of difficulty to hear that
contributes to make difficult to carry out their daily activities, in
the majority of cases observed, the question did not facilitate the
total comprehension that it aimed to identify the cases in which people
had difficulty doing daily activities due to the loss or limitation of
hearing. Generally speaking, the question captured all types of
difficulties with hearing, including the cases in which the difficulty
does not imply an impairment or limitation of activities. Thus, the
question overestimates the population with hearing difficulties that
prevent them from doing daily activities.

Since the question does not specify the type of auditory difficulty that
we intend to research, that is, only those which imply limitation of
activities, the response category "Yes, some difficulty", it frequently
added false positives. Many persons with a little difficulty hearing
which in no way prevents or makes harder to carry out daily activities,
they chose this response option, which would not happen if the question
were more complete as in, for example, "**Do you have any difficulty
hearing, even using a hearing aid, that prevents you from doing daily
activities?".**

If on one hand the recommended wording prevents the overestimation of
the group that in fact has limitations due to auditory difficulty, on
the other hand it still includes those persons with temporary
difficulties which in fact prevent them from carrying out daily
activities, such as those who have suffered accidents, had surgery or
emotional shock at the time of the survey. In this case, a formulation
even more complete could be utilized as, for instance, "**Do you have
any permanent difficulty hearing, even using a hearing aid, that
prevents you from carrying out daily activities?".** Despite its length,
the question would be more clear and in agreement with its goal.

Considering only the wording, in most of the interviews the question
recommended by the Washington Group was easily understood. Given the
clarity and simplicity of the question, which made it easy to understand
by people with different levels of education, respondents frequently
answered before the response categories were read. In many cases it was
necessary to first wait for the respondents to finish answering, to then
read the categories and ask the respondent to choose the one that best
described his/her situation.

Other Questions

The question "**Is there any activity that you are unable/incapable of
doing because of your difficulty hearing?"** proved to be excellent to
help distinguish between the difficulty due to injury or loss, and that
one which affects the majority of persons, such as small difficulties
with their hearing, but which do not impede carrying out daily
activities. In a majority of the cases observed, when the person
reported having some difficulty due to injury or loss, s/he also
reported that there is some activity s/he is unable to do because of
this injury or loss. Nevertheless, in some cases it was observed that
even when people had a more serious injury which prevented them from
doing some activity, they mentioned it because of the personal or social
context in which they live. Some persons who reported not having any
tasks they cannot carry out because of their difficulty hearing, simply
increase the volume of the TV or radio and live with people who have
gotten used to speaking louder to be heard; thus, despite the reduction
in their ability to hear they do not perceive that in a "normal"
situation they would be unable to carry out some activities such as, for
example, to communicate or to watch television.

The question "**How do you rate your degree of concern with your
hearing?**" seemed difficult to understand. Even when the response
categories were read right after the question, the respondent showed
difficulty understanding the question. In the majority of the interviews
observed it was necessary to ask a different way, formulating the
question including the response categories, as for example "are you very
concerned or a little concerned with your hearing?" Generally speaking,
to ask the respondent to "rate his degree of concern" does not seem like
the best way to research the concern of the respondents regarding his
hearing, especially if we consider that it is a question to be
formulated for persons with different levels of education and of
vocabulary capability. In any case, this question seems to reveal more
the cultural context of the respondent than the situation of his hearing
per se, since many people without hearing problems reported concern
about their hearing, while others, with serious problems, reported that
they had no preoccupation at all, adding comments such as: "there's
nothing that can be done about it, so why worry."

In the questions about **the "difficulty hearing someone speaking in a
normal tone of voice,"** some respondents with limitations in their
ability to hear had difficulties perceiving or admitting that they are
unable to hear under those conditions. Some rated a normal volume of
voice as 'low.' When the information provided by the person itself was
contrasted with the information provided by someone s/he lives with, it
was clear that the difficulty is not felt due to the habit of increasing
the volume of the television or radio and because the persons they live
with speak louder than normal to be heard.

The additional question **"How do you rate your ability to hear? \[if
you use a hearing aid, please answer about when you are using it\]",**
which has the same goal as the core question (WG), and which was also
tested, was not as well understood as the core question in this module.
The expression "rate your ability" did not appear to be easily
understood or comprehended by respondents. Nevertheless, the response
categories appeared more appropriate once the term "permanent" was
added, which prevented the inclusion in the group of persons with
difficulty hearing of those with temporary difficulties and impairments
due to surgery, accidents or emotional shocks.

Cognitive Module

Core Question

Considering the goal of the core question "**Do you have difficulty
remembering something or concentrating?"**, that is "to identify persons
who have some limitation or some type of difficulty to remember or
concentrate that contributes to make difficult to carry out their daily
activities, in the majority of cases observed, the question did not
facilitate the total comprehension that it aimed to identify the cases
in which people had difficulty doing daily activities due to the serious
limitation to remember something or concentrate. Generally speaking, the
question captured all types of difficulties with remembering or
concentrating, including the cases in which the difficulty does not
imply an impairment or limitation of activities. Thus, the question
overestimates the population with difficulties remembering or
concentrating that prevent them from doing daily activities.

Since the question does not specify the type of difficulty with memory
or concentration that we intend to research, that is, only those which
imply limitation of activities, the response category "Yes, some
difficulty" frequently added false positives. Many persons with a little
difficulty remembering or concentrating which in no way prevents or
makes harder to carry out daily activities, chose this response option,
which would certainly not happen if the question were more complete as
in, for example, "**Do you have any difficulty remembering something or
concentrating that prevents you from doing daily activities?".**

If on one hand the recommended wording prevents the overestimation of
the group that in fact has limitations due to memory or concentration
difficulty, on the other hand it still includes those persons with
temporary difficulties which in fact prevent them from carrying out
daily activities, such as those who have suffered accidents, had surgery
or emotional shock at the time of the survey. In this case, a
formulation even more complete could be utilized as, for instance, "**Do
you have any permanent difficulty remembering things or concentrating,
that prevents you from carrying out daily activities?".** Despite its
length, the question would be more clear and in agreement with its goal.

Considering only the wording, in most cases the question recommended by
the Washington Group was easily understood. Given the clarity and
simplicity of the question, which made it easy to understand by people
with different levels of education, respondents frequently answered
before the response categories were read. In many cases it was necessary
to first wait for the respondents to finish answering, to then read the
categories and ask the respondent to choose the one that best described
his/her situation.

Other Questions

The question "**Is there any activity that you are unable/incapable of
doing because of your difficulty remembering or concentrating?"** proved
to be excellent in helping to distinguish between serious difficulties
and those which affect the majority of persons, such as difficulties
remembering names or dates, or even to concentrate when the task is not
interesting or the environment is noisy, but which do not impede
carrying out daily activities even if they make them somewhat harder. In
a majority of the cases observed, when the difficulty remembering or
concentrating was serious, the respondent also reported that there is
some activity s/he is unable to do because of this difficulty.
Nevertheless, in some cases it was observed that even when people had a
serious difficulty which prevented them from doing some activity, they
did not mention it because of the personal or social context in which
they live. Some of the respondents, for instance, did not mention that
are neither studying nor working as a result of the difficulty in memory
or concentration.

The question "**How do you rate your degree of concern with your ability
to remember something or concentrate?**" seemed difficult to understand.
Even when the response categories were read right after the question,
the respondent showed difficulty understanding the question. In the
majority of the interviews observed it was necessary to ask a different
way, formulating the question including the response categories, as for
example "are you very concerned or a little concerned with your memory
or concentration?" Generally speaking, to ask the respondent to "rate
his degree of concern" does not seem like the best way to research the
concern of the respondent regarding his ability to remember or
concentrate, especially if we consider that it is a question to be
formulated for persons with different levels of education and vocabulary
capability. In any case, this question seems to reveal more the cultural
context of the respondent than the situation of his memory or
concentration per se, since many people without memory or concentration
problems reported being concerned, while others, with serious problems,
reported that they had no preoccupation at all, adding comments such as:
"there's nothing that can be done about it, so why worry."

In the questions about **the "difficulty remembering something"** like
names of persons or places; appointments; how to get to known places;
and important tasks, were perfectly understood. Nevertheless, they are
also able to distinguish the cases in which the difficulty is serious
and implies a negative impact to their quality of life from those which
are common to the majority of people. Therefore, these questions
identify all types of difficulties and not only those stemming from
disabilities. Moreover, people with some difficulty remembering names or
places after a first contact, are considered the same way than those who
are incapable of doing it. In the majority of the interviews observed,
the respondents mentioned occasional difficulties such as "sometimes I
cannot remember something" or "sometimes I forget to do something".

The question "**Do you have difficulty concentrating for 10 minutes on
what you are doing?"** did not help the identification of the level of
difficulty as well as the distinctions between chronic difficulty and
occasional difficulty associated with the environment. Some persons with
difficulty concentrating, for example, when they are in a busy and noisy
environment, use the category "yes, some difficulty" to express that
sometimes they have concentration difficulties, instead of using it to
identify the level of difficulty.

> This question should be investigated in two stages. The first one
> about the frequency with which they have difficulty and the second one
> \-- beginning with the expression "when you have difficulty..."\--
> about the level of difficulty, as exemplified in the initial questions
> in this same module.

The additional question "**Do you have any mental impairment that limits
your usual activities (such as working, going to school, playing,
etc.)?** which, as well as in the core question, was being tested, it
was very easily understood. Despite having a different objective than
the core question in the module, because it aims to identify objectively
the cases of mental impairment that imply a limitation of activities, it
fulfilled an important role, since some cases with impairments that
implied a limitation in activities were not captured by the other
questions in the module, but only by this question.

Mobility Module

Core Question

Considering the goal of the core question "**Do you have difficulty
walking or climbing steps?"** that is "*to identify persons who have
some hearing limitation or some type of difficulty to move around on
foot. Such difficulties **may or may not contribute to make it difficult
to carry out their daily activities...**, to walk some distance without
stopping to rest or even walk **without using any aids or equipment such
as a cane, walker or crutch.** It may be entirely impossible to stay on
one's feet for one or two minutes, needing a wheelchair"*, in the
majority of cases, the question did not facilitate the comprehension
that it aimed to identify any locomotion difficulties without using
auxiliary equipment.

Generally speaking, the question captured all types of difficulties for
walking or climbing steps, including the cases in which the difficulty
does not imply an impairment or limitation of activities, thus partially
fulfilling its objective. Still, it is not clear in the sense that the
evaluation should be done without the use of devices or equipment, as is
the case in the questions in the modules on vision and hearing,
therefore it did not capture those cases in which people are able to
walk or climb steps although with the aid of or use of equipment. Thus,
the question promotes the underestimation of the population with
difficulties walking or climbing steps without the use of equipment. To
promote a better identification of the population with locomotion
problems, in the sense of the established objective, the question should
be more complete, as in for example, "**Do you have any difficulty
walking or climbing steps without the aid or use of equipment such as a
cane, crutch or walker?"**

On the other hand, the question is also addressed to those persons with
temporary difficulties, such as those who have suffered accidents, had
surgery or emotional shock at the time of the survey. In this case, to
prevent overestimation of the persons who in fact have a permanent
limitation, a formulation even more complete could be utilized as, for
instance, "**Do you have any permanent difficulty walking or climbing
steps, without the aid or use of equipment such as a cane, crutch or
walker?"** Despite its length, the question would be more clear and in
agreement with its goal.

Other Questions

The question "**Do you use any type of equipment or assistive device,
such as a prosthesis, wheelchair, walker or cane to move around?"** did
not present any comprehension problem, although it generated internal
discussion about the need to distinguish internal from external
prosthesis. Since the population that uses prosthesis is rare, there was
no case found in the sample that implied the need to distinguish,
however, thinking that the question will be used in a census, it could
be useful to discuss this question in advance.

The question "**Is there any activity that you are unable to do because
of a problem in your legs?"** is restricted if we consider the objective
of the core question to investigate the locomotion difficulties in a
general way, since it associates the difficulty to problems in the legs.
In that way, the question does not make it possible to record the
difficulties due to problems in the feet or even in the spine, which
depending on its degree can prevent locomotion. To probe the core
question, these could be more useful if reformulated as in, for
instance, "**Is there any activity that you are unable to do because of
difficulties walking or climbing steps?"**

The question "**How do you rate your degree of concern with your ability
to walk or climb stairs?"** seems difficult to understand. Even when the
response categories were read right after the question, the respondent
showed difficulty understanding the question. In the majority of the
interviews observed it was necessary to ask a different way, formulating
the question including the response categories, as for example "are you
very concerned or a little concerned with your ability to walk or climb
steps?" Generally speaking, to ask the respondent to "rate his degree of
concern" does not seem like the best way to research the concern of the
respondent regarding his locomotion abilities, especially if we consider
that it is a question to be formulated for persons with different levels
of education and of vocabulary use. In any case, this question seems to
reveal more the cultural context of the respondent than to confirm the
respondents' mobility. People without mobility problems reported being
concerned, while others, with serious problems, reported that they had
no preoccupation at all because they are paraplegic, for instance, and
not have any possibilities for improvement or worsening of their ability
to walk or climb steps.

The questions about the **"locomotion difficulties inside or outside the
home"** did not present comprehension difficulties, but there is a need
for a "not applicable" option and an instruction that the questions
should not be read to, for example, people with total paralysis. In the
same fashion, the questions about "**difficulties walking or being on
your feet"** there is a "not applicable" option missing as well as the
instruction that the questions should not be read to persons with, for
instance, total paralysis, paraplegic or quadriplegic. Both question
sets caused a certain distress, once the interviewers were instructed to
read all the questions in the questionnaire.

The additional question **"How do you rate your ability to walk/climb
stairs? \[if you use a prosthesis, cane, or assistive device, please
answer about when you are using them\]",** which has the same goal as
the core question (WG), and which was also tested, was not as well
understood in this module as it was in the core question. The expression
"rate your ability" did not appear to be easily understood or
comprehended by respondents. Moreover, the expression to climb stairs is
more restrictive than to climb steps, since, in the common sense, it
does not include climbing onto the sidewalk, for instance. However, the
question is more complete than the core question since it establishes
the conditions (such as the use of equipment...) in which the evaluation
should be done, without leaving any doubts regarding its objective.
Moreover, the response categories seemed to be more appropriate, since
the addition of the term "permanent" prevented the inclusion in the
group of persons with locomotion difficulties of persons with temporary
difficulties and impairments due to surgery, accidents, or emotional
shocks.

Self-Care Module

Core Question

Considering the goal of the core question "**Do you have difficulty
caring for yourself, such as bathing or dressing?"**, that is "to
identify persons who have some limitation to take care of themselves",
in a majority of the interviews the question was easily understood. The
wording made it easy to understand that it sought to identify persons
with any difficulty with regard to personal care. Nevertheless, in some
cases it was observed that the example "to bathe" caused surprise and
that some people quickly answered that they had no difficulties to
bathe, giving the impression that they did not think about the question
because they were concerned to appear as persons with good hygiene
habits.

On the other hand, the question included those persons with temporary
difficulties, such as those who have suffered accidents, had surgery or
emotional shock at the time of the survey. In this case, a formulation
even more complete could be utilized as, for instance, "**Do you have
any permanent difficulty caring for yourself, as, for instance bathing
or dressing?"** The question would then be more clear and in agreement
with its goal.

The question "**Do you use any type of equipment or assistive device,
such as a prosthesis, wheelchair, walker, or cane to move around?"** did
not present any comprehension problem, although it generated internal
discussion about the need to distinguish internal from external
prosthesis. Since the population that uses prosthesis is rare, there was
no case found in the sample that implied the need to distinguish,
however, thinking that the question will be used in a census, it could
be useful to discuss this question in advance.

Within the context of the thematic module, the question "**How often do
you wish you could take better care of yourself?"** was easily
understood. Nevertheless it would be necessary to have one more response
category to identify the cases in which the question was "always". In
any case, this question seems to reveal more about the cultural context
than to actually confirm the autonomy of the respondent to take care of
him/herself.

The questions about the "**difficulties reaching up over your head and
reaching out to shake someone's hand"** did not present comprehension
problems; still it caused certain issues since it was not possible to
establish a relationship between the questions and the objective of the
self-care module. An attempt was made to associate the act of raising
the arms with that of washing or combing the hair, but that question is
asked later. In any case, it was not possible to establish any
relationship between greeting another person and self-care, therefore
such questions would not belong in this module, but rather in the
mobility module if the concept were not restricted to lower limb
mobility.

The questions about "**difficulties buttoning clothing, putting on
socks, tying shoelaces, combing hair and eating"** did not present any
comprehension difficulties; on the contrary they are objective and
clear. Furthermore, mainly because they began with "By yourself and
without any aids..." they delimit better than the core question the
universe under investigation.

Regarding the wording, the question "**Do you have difficulty staying by
yourself for a few days?"** it was easy to understand. Still, in some
cases the type of difficulty under research was confusing, and some
persons who do not like to stay alone answered that they do have
difficulty, eluding the objective of the question.

Communication Module

Core question

Considering the objective of the core question "**Because of a physical,
visual, auditory, mental or emotional condition, do you have difficulty
communicating, for example understanding or being understood by
others?"**, that is, "to identify persons with difficulties speaking,
hearing or understanding someone speaking, in such way that that
contributes to make harder to do daily activities", in the majority of
cases the question did not help realize that it sought to identify the
cases in which people had difficulty doing daily activities due to
difficulties speaking, hearing or understanding someone speaking.
Generally speaking, the question captured all types of difficulties with
communication, including the cases in which the difficulty does not
imply impairment or limitation of activities. Thus, the question
overestimates the population with communication difficulties that make
it harder to do daily activities.

Since the question does not specify the type of communication
difficulties that are under investigation, that is, only those which
imply a limitation of activities, the response category "Yes, some
difficulty" often led to adding cases that could be considered false
positives. Many people with a little difficulty hearing or expressing
themselves which in no way prevents or makes harder carrying out daily
activities, chose this response option, which would certainly not happen
if the question were more complete as in, for example, "**Because of a
physical, visual, auditory, mental or emotional condition, do you have
any difficulty communicating, such as, for example understanding others
or being understood by others, which makes it difficult to do your daily
activities?"**

If on one hand the recommended wording prevents overestimating the group
that in fact has limitations stemming from visual difficulty, on the
other hand it still includes those persons with temporary difficulties
which in fact prevent them from carrying out daily activities, such as
those who have suffered accidents, had surgery or emotional shock at the
time of the survey. In this case, a formulation even more complete could
be utilized as, for instance, "**Because of a physical, visual,
auditory, mental or emotional condition,** **do you have any permanent
difficulty communicating, such as, for example understanding others or
being understood by others, which makes it difficult to do your daily
activities?"** This way the question would be more clear and in
agreement with its goal.

Considering the original wording recommended by the Washington Group the
question is very long, which made it difficult to fluidly read for the
respondent. The introduction "Because of a physical, visual, auditory,
mental or emotional condition" made it hard to understand the central
issue of the question which is the communication difficulty. Since this
introduction presents an exhaustive list of the reasons why people can
report having difficulty communicating, it could be replaced by "Because
of any reason..." or even be excluded, since not mentioning the reasons
is generally understood as meaning "regardless of the reason". Thus,
taking into account the prior concerns with fulfilling the question
objectives and given also the need to reduce the text, the question
could, for example, read: "**Do you have any difficulty communicating,
such as, for example understanding others or being understood by others,
which makes it difficult to do your daily activities?"**

Other Questions

The question "**How do you rate your degree of concern with your ability
to understand or be understood?**" seemed difficult to understand. Even
when the response categories were read right after the question, the
respondent showed difficulty understanding the question. In the majority
of the interviews observed it was necessary to ask a different way,
formulating the question including the response categories, as for
example "are you very concerned or a little concerned with your ability
to understand or be understood?" Generally speaking, to ask the
respondent to "rate his degree of concern" does not seem like the best
way to research the concern of the respondent regarding his/her ability
to understand or be understood, especially if we consider that it is a
question to be formulated for persons with different levels of education
and of vocabulary use. In any case, this question seems to reveal more
the cultural context of the respondent than the situation of his/her
ability to understand or be understood, per se.

The questions "**Do you have difficulty making new friends?"** and "**Do
you feel shy in group or social situations?**", were easily understood;
however, in a more strict context of limitation of activities, the
questions would not contribute much to the analysis of communication
abilities. On the other hand, difficulty to make friends and shyness are
also associated to the cultural context and the type of education
received in the family, therefore they are not always associated to the
physical, mental or emotional conditions as mentioned in the question.
Thus, some persons without any communication difficulty due to their
physical, mental or emotional condition feel shy or have difficulty
making friends.

Body structures and functions Module

Core Question

Taking into consideration the goal of the core question "**Do you have
any of the following disabilities**: (**record only the first
response)",** that is, "to identify persons who have some physical
deficiency," the majority respondents easily understood the question,
given its objectivity and clarity. Still, given the instruction to
record only one disability, the question does not favor the
identification of all the disability that the population under
investigation has. Thus, for a person who does not have both arms and
therefore cannot take care of himself without help, but also has
paralysis of the legs, only the legs' paralysis will be captured, which
does not necessarily imply a limitation for self-care or locomotion.
Therefore, the universe of physical disabilities will not be complete.
In this way, the question underestimates not the number of people with
disabilities but the number of persons with the disabilities presented
in the last positions in the order of presentation, especially those who
are missing a leg, arm, hand, foot or thumb.

Considering that the question did not present any comprehension problem,
and it won't restrict the universe of the disabilities under study, the
instruction for assigning the type of disability should be reformulated.
Thus, the question could read, for example: **"Do you have any of the
following disabilities (assign more than one if applicable)".**

Other Questions

The question "Is there any activity that you cannot do because of a
physical problem?" turned out to be excellent to help evaluate the
degree to which the physical disability affects the ability to do daily
activities but, mainly, it provides some information to help identify
other disabilities not enumerated in the core question.

The question "**Has any health professional told you that you have an
injury or illness (such as paralysis) that affects your ability to use
the your hands or feet?"** caused some doubts, because it does not make
it clear if the term injury can also include physical disabilities such
as loss of limbs or parts of them. The question also presents a
conceptual problem, since "paralysis" is not an illness, but rather the
consequence, and therefore should not be used as an example.

The quantitative analysis was done based on the questions and answers
recorded on the questionnaires of the cognitive and field test
interviews. Therefore, in the next section we will present the
comparisons of the answers provided by the persons with disabilities
themselves against those provided by an informant/proxy (informant
bias), analysis of false positive and false negatives according to the
answers to the core, additional and probe questions, analysis of the
open-ended questions and...

**Analysis Comparing the Core and Additional Questions**

Vision

Of the total of 406 interviews, in 221 of them a response was elicited
both for the core question "Do you have difficulty seeing, even using
glasses or contact lenses?", as well as for the additional question "How
do you rate your ability to see? \[If you use glasses or contact lenses,
rate your ability while using them\]". In 165 cases, that is in about
75% of the cases for which both responses were elicited, the same degree
of difficulty seeing was reported. In the remaining interviews, the
great majority of the response categories obtained are contiguous and
vary between "none" to "some" or "a lot" to "some" difficulty.

The responses obtained for each degree of severity appear in the
following table.

  -------------------------- ----------- ------------- ------------ -------------- -------------- --------------
  **Answers obtained for the **Answers                                                            
  question "Do you have      obtained                                                             
  difficulty seeing, even    for the                                                              
  using glasses or contact   question                                                             
  lenses?**                  "How do you                                                          
                             rate your                                                            
                             ability to                                                           
                             see? \[if                                                            
                             you use                                                              
                             glasses or                                                           
                             contact                                                              
                             lenses,                                                              
                             rate your                                                            
                             ability to                                                           
                             se while                                                             
                             using                                                                
                             them\]"**                                                            

                             **Total**   **Missing**   **Unable**   **Much         **Some         **No
                                                                    permanent      permanent      difficulty**
                                                                    difficulty**   difficulty**   

  **Total**                  **406**     **183**       **8**        **27**         **61**         **127**

                                                                                                  

  **Missing**                **47**      **47**        **-**        **-**          **-**          **-**

  **No, no difficulty**      **245**     **125**       **-**        **2**          **12**         **106**

  **Yes, some difficulty**   **61**      **6**         **-**        **5**          **34**         **16**

  **Yes, much difficulty**   **43**      **2**         **3**        **20**         **14**         **4**

  **Cannot see at all**      **8**       **3**         **5**        **-**          **-**          **-**

  **Don't know/No answer**   **2**       **-**         **-**        **-**          **1**          **1**
  -------------------------- ----------- ------------- ------------ -------------- -------------- --------------

Hearing

Of the total of 406 interviews, in 187 of them a response was elicited
both for the core question "Do you have difficulty hearing, even using a
hearing aid?", as well as for the additional question "How do you rate
your ability to hear? \[if you use hearing aids, rate your ability while
using them\]". In 172 cases, that is in nearly 92% of the cases for
which both responses were elicited, the same degree of difficulty
hearing was reported. In the remaining interviews, the great majority of
the response categories obtained are contiguous and vary between "none"
to "some" or "some" to "much" difficulty.

The responses obtained for each degree of severity appear in the
following table.

  -------------------------- ----------- ------------- ------------ -------------- -------------- --------------
  **Answers obtained for the **Answers                                                            
  question "Do you have      obtained                                                             
  difficulty hearing, even   for the                                                              
  using hearing aids?**      question                                                             
                             "How do you                                                          
                             rate your                                                            
                             ability to                                                           
                             hear? \[if                                                           
                             you use                                                              
                             hearing                                                              
                             aids, rate                                                           
                             your                                                                 
                             ability to                                                           
                             se while                                                             
                             using                                                                
                             them\]"**                                                            

                             **Total**   **Missing**   **Unable**   **Much         **Some         **No
                                                                    permanent      permanent      difficulty**
                                                                    difficulty**   difficulty**   

  **Total**                  **406**     **217**       **6**        **18**         **34**         **131**

                                                                                                  

  **Missing**                **49**      **48**        **-**        **-**          **-**          **-**

  **No, no difficulty**      **295**     **159**       **2**        **1**          **4**          **129**

  **Yes, some difficulty**   **36**      **3**         **-**        **5**          **28**         **-**

  **Yes, much difficulty**   **20**      **5**         **1**        **12**         **2**          **-**

  **Cannot see at all**      **5**       **2**         **3**        **-**          **-**          **-**

  **Don't know/No answer**   **1**       **-**         **-**        **-**          **-**          **1**
  -------------------------- ----------- ------------- ------------ -------------- -------------- --------------

Cognitive

Of the total of 406 interviews, in 243 of them a response was elicited
both for the core question "Do you have difficulty remembering something
or concentrating?", as well as for the additional question "Do you have
any permanent mental deficiency that limits your usual activities (such
as working, going to school, playing, etc.)?". Taking into consideration
the fact that, in contrast with the other questions compared, the
universe for investigating the two questions that constitute this module
is not the same, there is no inconsistency in the fact that 185 persons
who reported to have some difficulty to remember something or to
concentrate had also reported they did not have any mental disability.
Still, analyzing the universe of persons with mental disability, some 60
interviews, 6 cases were found, that is 10% of the persons with mental
disability who reported they did not have any difficulty remembering or
concentrating. In two other interviews, the respondent knew to report
that s/he had difficulty remembering or concentrating. Taking into
account both situations, in 8 interviews the core question in the module
did not capture the mental disability; which was captured only by the
more direct (additional) question.

The responses obtained for each degree of severity appear in the
following table.

  ----------------------------- ------------ ------------- --------- ---------
  **Answers obtained for the    **Answers                            
  question "Do you have         obtained for                         
  difficulty remembering or     the question                         
  concentrating?**              "Do you have                         
                                any                                  
                                permanent                            
                                mental                               
                                disability                           
                                that limits                          
                                your usual                           
                                activities                           
                                (such as                             
                                working,                             
                                going to                             
                                school,                              
                                playing,                             
                                etc.)?"**                            

                                **Total**    **Missing**   **Yes**   **No**

  **Total**                     **406**      **160**       **60**    **186**

                                                                     

  **Missing**                   **53**       **52**        **-**     **1**

  **No, no difficulty**         **209**      **97**        **6**     **106**

  **Yes, some difficulty**      **73**       **1**         **12**    **60**

  **Yes, much difficulty**      **38**       **1**         **21**    **16**

  **Cannot remember or          **22**       **-**         **19**    **3**
  concentrate at all**                                               

  **Don't know/No answer**      **11**       **9**         **2**     **-**
  ----------------------------- ------------ ------------- --------- ---------

> Motor

Of the total of 406 interviews, in 233 of them a response was elicited
both for the core question "Do you have difficulty walking or climbing
steps?", as well as for the additional question "How do you rate your
ability to walk/climb stairs? \[if you use a prosthesis, cane or
assisting device, rate your ability while using them\]". In 192 cases,
that is in about 82% of the cases for which both responses were
elicited, the same degree of difficulty walking or climbing steps was
reported. In the remaining interviews, the great majority of the
response categories obtained are contiguous and vary between "none" to
"some" or "some" to "much" difficulty.

The responses obtained for each degree of severity appear in the
following table.

  -------------------------- ------------- ------------- ------------ -------------- -------------- --------------
  **Answers obtained for the **Answers                                                              
  question "Do you have      obtained for                                                           
  difficulty walking or      the question                                                           
  climbing steps?**          "How do you                                                            
                             rate your                                                              
                             ability to                                                             
                             walk/climb                                                             
                             stairs? \[if                                                           
                             you use a                                                              
                             prosthesis,                                                            
                             cane or                                                                
                             assisting                                                              
                             device, rate                                                           
                             your ability                                                           
                             to while                                                               
                             using                                                                  
                             them\]"**                                                              

                             **Total**     **Missing**   **Unable**   **Much         **Some         **No
                                                                      permanent      permanent      difficulty**
                                                                      difficulty**   difficulty**   

  **Total**                  **406**       **173**       **35**       **43**         **31**         **124**

                                                                                                    

  **Missing**                **52**        **52**        **-**        **-**          **-**          **-**

  **No, no difficulty**      **232**       **101**       **1**        **3**          **8**          **119**

  **Yes, some difficulty**   **32**        **5**         **-**        **7**          **17**         **3**

  **Yes, much difficulty**   **52**        **4**         **9**        **31**         **6**          **2**

  **Cannot see at all**      **37**        **10**        **25**       **2**          **-**          **-**

  **Don't know/No answer**   **1**         **1**         **-**        **-**          **-**          **-**
  -------------------------- ------------- ------------- ------------ -------------- -------------- --------------

> **Respondent Bias**
>
> Of the total 406 interviews, 178 were conducted directly with the
> person who had at least one of the disabilities under study. In 20
> cases, or about 11%, in addition to the interview with the person with
> a disability, an interview was also conducted with a family or
> household member who provided proxy information about the person, thus
> making it possible to evaluate if there is a difference between the
> information provided by the person him/herself and that provided by an
> informant.
>
> In all cases in which the two interviews were conducted, a different
> was found it at least one of the answers provided by the person and
> the information provided by the informant. Still, the number of
> disagreeing answers found was small. The great majority of the answers
> provided by the informant coincided with those from the person
> him/herself. In the following table the number of same and different
> answers found is shown, according to the thematic modules and the type
> of question, whether core or additional (Census 2000).

+-------------------------+-----+-------+---+------+---+------+------+------+
| **Thematic Module**     |     |       |   | **   |   |      | **Ad |      |
|                         |     |       |   | Core |   |      | diti |      |
|                         |     |       |   | Qu   |   |      | onal |      |
|                         |     |       |   | esti |   |      | Qu   |      |
|                         |     |       |   | on** |   |      | esti |      |
|                         |     |       |   |      |   |      | on** |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
|                         | *   |       | * |      | * |      | **P  | **P  |
|                         | *To |       | * |      | * |      | roxy | roxy |
|                         | tal |       | P |      | P |      | resp | resp |
|                         | \#  |       | r |      | r |      | onse | onse |
|                         | o   |       | o |      | o |      | same | d    |
|                         | f** |       | x |      | x |      | as   | iffe |
|                         |     |       | y |      | y |      | se   | rent |
|                         | **  |       | r |      | r |      | lf** | from |
|                         | Int |       | e |      | e |      |      | se   |
|                         | erv |       | s |      | s |      |      | lf** |
|                         | iew |       | p |      | p |      |      |      |
|                         | s** |       | o |      | o |      |      |      |
|                         |     |       | n |      | n |      |      |      |
|                         |     |       | s |      | s |      |      |      |
|                         |     |       | e |      | e |      |      |      |
|                         |     |       | s |      | d |      |      |      |
|                         |     |       | a |      | i |      |      |      |
|                         |     |       | m |      | f |      |      |      |
|                         |     |       | e |      | f |      |      |      |
|                         |     |       | a |      | e |      |      |      |
|                         |     |       | s |      | r |      |      |      |
|                         |     |       | s |      | e |      |      |      |
|                         |     |       | e |      | n |      |      |      |
|                         |     |       | l |      | t |      |      |      |
|                         |     |       | f |      | f |      |      |      |
|                         |     |       | * |      | r |      |      |      |
|                         |     |       | * |      | o |      |      |      |
|                         |     |       |   |      | m |      |      |      |
|                         |     |       |   |      | s |      |      |      |
|                         |     |       |   |      | e |      |      |      |
|                         |     |       |   |      | l |      |      |      |
|                         |     |       |   |      | f |      |      |      |
|                         |     |       |   |      | * |      |      |      |
|                         |     |       |   |      | * |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
|                         |     |       |   |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Vision**              | **2 | *     | * |      |   | **   | *    |      |
|                         | 0** | *18** | * |      |   | 13** | *7** |      |
|                         |     |       | 2 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Hearing**             | **2 | *     | * |      |   | **   | *    |      |
|                         | 0** | *15** | * |      |   | 15** | *5** |      |
|                         |     |       | 5 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Cognitive**           | **2 | *     | * |      |   | **   | *    |      |
|                         | 0** | *17** | * |      |   | 17** | *3** |      |
|                         |     |       | 3 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Mobility**            | **2 | *     | * |      |   | **   | *    |      |
|                         | 0** | *17** | * |      |   | 15** | *5** |      |
|                         |     |       | 3 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Self-care**           | **2 | *     | * |      |   |      |      |      |
|                         | 0** | *17** | * |      |   |      |      |      |
|                         |     |       | 3 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Communication**       | **2 | *     | * |      |   |      |      |      |
|                         | 0** | *18** | * |      |   |      |      |      |
|                         |     |       | 2 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+
| **Body Structures and   | **2 | *     | * |      |   |      |      |      |
| Functions**             | 0** | *16** | * |      |   |      |      |      |
|                         |     |       | 4 |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
|                         |     |       | * |      |   |      |      |      |
+-------------------------+-----+-------+---+------+---+------+------+------+

Of the total of 140 answers provided by the person to the 7 **core**
questions in the different thematic modules, in 22 (16%) the information
provided by the proxy informant was different. In five interviews the
difference was due to the fact that no answer was elicited from the self
reporter to the core question in the Cognitive (1) and Body Structure
and Functions (4). For the other 17 cases, in 10 of them the informant
reported a more severe degree of difficulty than the person. In 7 cases
the opposite was true, the more severe degree of difficulty was self
reported. In a majority of the cases, the response categories chosen by
the person and those chosen by the proxy informant were contiguous as,
for example, when the person reported "no difficulty" and the informant
reported "some", or when the informant reported "some" difficulty and
the person answered "much difficulty". The answers elicited with the
core questions in the interviews appear on the following table.

+---------------------+------------+-------------+--------------------+
| **Thematic Module** | **Core     |             |                    |
|                     | Question** |             |                    |
|                     |            |             |                    |
|                     | **         |             |                    |
|                     | Additional |             |                    |
|                     | Question** |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **Total \# | **Response  |                    |
|                     | of**       | c           |                    |
|                     |            | ategories** |                    |
|                     | **In       |             |                    |
|                     | terviews** |             |                    |
+---------------------+------------+-------------+--------------------+
|                     |            | **Self**    | **Proxy            |
|                     |            |             | Informant**        |
+---------------------+------------+-------------+--------------------+
| **Total**           | **22**     |             |                    |
+---------------------+------------+-------------+--------------------+
| **Vision**          | **2**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Much      | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Some      | **Much             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
| **Hearing**         | **5**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **No        | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **2**      |             |                    |
+---------------------+------------+-------------+--------------------+
| **Cognitive**       | **3**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
| **Mobility**        | **3**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
| **Self care**       | **3**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
| **Communication**   | **2**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      |             |                    |
+---------------------+------------+-------------+--------------------+

> In 20 (25%) of the total of 80 responses provided by the person
> him/herself to the 4 **additional** questions of the different
> thematic modules, the information provided by the informant was
> different. In nine interviews, the difference was due to not having
> obtained an answer from the person him/herself to the additional
> question (6) or to the informant (3). Of the remaining 11 cases, in 7
> the informant reported a more serious degree of difficulty than was
> self-reported. In 4 cases the opposite was true: the more severe
> difficulty was reported by the person him/herself. In the majority of
> the cases, the response categories chosen by the person reporting
> about self and those chosen by the informant are contiguous as, for
> example, when the person self-reported "no difficulty" and the
> informant reported "some", or when the informant reported "some
> difficulty" and the person reporting about him/herself reported "much
> difficulty". The answers to the additional questions collected in the
> interviews appear in the following table.

+---------------------+------------+-------------+--------------------+
| **Thematic Module** | **         |             |                    |
|                     | Additional |             |                    |
|                     | Question** |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **Total \# | **Response  |                    |
|                     | of**       | c           |                    |
|                     |            | ategories** |                    |
|                     | **r        |             |                    |
|                     | esponses** |             |                    |
+---------------------+------------+-------------+--------------------+
|                     |            | **Self**    | **Proxy            |
|                     |            |             | Informant**        |
+---------------------+------------+-------------+--------------------+
| **Total**           | **20**     |             |                    |
+---------------------+------------+-------------+--------------------+
| **Vision**          | **7**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Some      | **No difficulty**  |
|                     |            | d           |                    |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **3**      | **No        | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Unknown** | **Much             |
|                     |            |             | difficulty**       |
+---------------------+------------+-------------+--------------------+
|                     | **2**      | **Much      | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
| **Hearing**         | **5**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **2**      | **Much      | **Unknown**        |
|                     |            | d           |                    |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Unknown** | **Some             |
|                     |            |             | difficulty**       |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **No        | **Much             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **No        | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
| **Cognitive**       | **3**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Unknown** | **Yes**            |
+---------------------+------------+-------------+--------------------+
|                     | **2**      | **Unknown** | **No**             |
+---------------------+------------+-------------+--------------------+
| **Mobility**        | **5**      |             |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Unknown** | **Much             |
|                     |            |             | difficulty**       |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Some      | **Much             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **Some      | **No difficulty**  |
|                     |            | d           |                    |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **No        | **Some             |
|                     |            | d           | difficulty**       |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+
|                     | **1**      | **No        | **Unknown**        |
|                     |            | d           |                    |
|                     |            | ifficulty** |                    |
+---------------------+------------+-------------+--------------------+

Of the total of 220 responses obtained to the 7 core and 4 additional
questions, in 28 cases -- nearly 13% -- the answer provided by the
informant was different from the self-report. If we consider that only
the cases in which the response provided by the informant modify the
person's status, that is, when the person reports having a disability,
independently of the degree of severity, and the informant reports there
is no difficulty, or vice versa, this number decreases to 22 cases, that
is, 10% of the cases.

**False Negatives**

The following analysis was done comparing the responses to the core
questions in each of the first six thematic modules with those obtained
in selected questions of the same module. Therefore, the responses to
the core questions were compared to those obtained in some of the
functional questions, probe questions and the additional questions in
the modules.

In selecting for which questions to compare the answers to those to the
core question, a potential contradiction between their answers was
considered, for example if a respondent reported not to have any vision
problem but later reported he could not see an illustration in print,
this was considered a false negative.

The following tables show the questions considered potentially
contradictory, as well as the response categories considered for testing
for false negatives.

+--------------------------------------------------+-------------------+
| > **Questions in the Vision Module**             | **Response        |
|                                                  | Categories**      |
+--------------------------------------------------+-------------------+
| > **Do you have difficulty seeing, even using    | No, no difficulty |
| > glasses or contact lenses?**                   |                   |
+--------------------------------------------------+-------------------+
| > Is there any activity that you cannot do       | Yes               |
| > because of difficulty seeing?                  |                   |
+--------------------------------------------------+-------------------+
| > How do you rate your ability to see? \[if you  | Unable **or**     |
| > use glasses or contact lenses, rate your       | with much         |
| > ability while using them\]                     | permanent         |
|                                                  | difficulty **or   |
|                                                  | some** permanent  |
|                                                  | difficulty        |
+--------------------------------------------------+-------------------+
| > With your glasses or contact lenses, do you    | Yes, unable       |
| > have difficulty seeing a printed figure in a   | **or** yes, much  |
| > map, newspaper or book?                        | difficulty **or** |
|                                                  | yes, some         |
|                                                  | difficulty        |
+--------------------------------------------------+-------------------+
| > With your glasses or contact lenses, do you    | Yes, unable       |
| > have difficulty seeing and recognizing someone | **or** yes, much  |
| > on the other side of the street (approximately | difficulty **or** |
| > 7 meters away)?                                | yes, some         |
|                                                  | difficulty        |
+--------------------------------------------------+-------------------+
| > With your glasses or contact lenses, do you    | Yes, unable       |
| > have difficulty seeing and recognizing an      | **or** yes, much  |
| > object at a distance of about one meter (a     | difficulty **or** |
| > stretched arm)?                                | yes, some         |
|                                                  | difficulty        |
+--------------------------------------------------+-------------------+

> **Hearing Module Questions Response Categories Do you have difficulty
> hearing, even using a hearing aid? No, no difficulty**

Is there any activity you cannot do because of difficulty hearing? Yes

> How do you rate your ability to hear? \[if you use a hearing aid, rate
> your ability while using it\]
>
> When using your hearing aid, do you have difficulty hearing someone
> speaking in a normal voice on the other side of a room?

Unable **or** much permanent difficulty **or some** permanent difficulty

Yes, unable **or** yes, much difficulty **or** yes, some difficulty

> When using your hearing aid, do you have difficulty hearing what is
> said when you are Yes, unable **or** yes, much
>
> talking in a crowded room?
>
> When using your hearing aid, do you have difficulty hearing what is
> said in a conversation in a quiet room?

Yes, unable **or** yes, much difficulty, **or** yes, some difficulty

Yes, unable **or** yes, much difficulty **or** yes, some difficulty

> **Cognitive Module Questions Response Categories**
>
> **Do you have difficulty remembering something or concentrating? No,
> no difficulty**
>
> Is there any activity you cannot do because of difficulty remembering
> or concentrating?

Yes

> Do you have difficulty remembering names of persons or places? Yes Do
> you have difficulty remembering appointments? Yes Do you have
> difficulty remembering how to go to places you know? Yes
>
> Do you have difficulty remembering important tasks, such as taking
> medicines or paying bills?

Yes

> Do you have difficulty concentrating on what you are doing for 10
> minutes? Yes, unable **or** yes, much difficulty **or yes**, some
> difficulty
>
> Do you have difficulty learning a new task, for example, how to get to
> a new place?

Yes, unable **or yes**, much difficulty **or yes**, some difficulty

> Do you have difficulty solving daily problems? Yes, unable **or yes**,
> much difficulty **or yes**, some difficulty
>
> Do you have any permanent mental disability that limits your usual
> activities (such as Yes
>
> working, going to school, playing, etc.)?
>
> **Mobility Module Questions Response Categories Do you have difficulty
> walking or climbing steps? No, no difficulty**

Is there any activity you cannot do because of a problem with your legs?
Yes

> Do you have difficulty moving around inside your home? Yes, unable
> **or yes**, much difficulty **or yes**, some difficulty
>
> Do you have difficulty going outside of your home? Yes, unable **or
> yes**, much difficulty **or yes**, some difficulty
>
> Do you have difficulty walking a long distance such as 1 km? Yes,
> unable **or yes**, much difficulty **or yes**, some difficulty
>
> By yourself and not using equipment or assistive devices, do you have
> difficulty walking 2
>
> or 3 blocks?

Yes

> By yourself and not using equipment or assistive devices, do you have
> difficulty walking up ten steps without resting?

Yes

> By yourself and not using equipment or assistive devices, do you have
> difficulty standing on your feet for about 2 (two) hours?

Yes

> By yourself and not using equipment or assistive devices, do you have
> difficulty sitting for about 2 (two) hours?

Yes

> By yourself and not using equipment or assistive devices, do you have
> difficulty stooping, crouching, or kneeling?

Yes

> **Self-Care Module Questions Response Categories**
>
> **Do you have difficulty caring for yourself, such as, for example,
> bathing or dressing?**

**No, no difficulty**

> How often do you wish you could take better care of yourself?
> Frequently
>
> By yourself and without any type of aid, do you have any difficulty
> reaching up over your head?

Yes

> By yourself and without any type of aid, do you have any difficulty
> reaching out to greet Yes
>
> someone?
>
> By yourself and without any type of aid, do you have any difficulty
> using your fingers to button a shirt or dress?

Yes

> By yourself and without any type of aid, do you have any difficulty
> putting on socks or stockings?

Yes

> By yourself and without any type of aid, do you have any difficulty
> tying your shoelaces?
>
> By yourself and without any type of aid, do you have any difficulty
> combing your hair?

Yes

Yes

> By yourself and without any type of aid, do you have any difficulty
> feeding yourself? Yes
>
> Do you frequently need someone to help you with everyday activities
> such as eating, showering, dressing or toileting?

Yes

> Do you have difficulty, using your hands and fingers, to pick up small
> objects or open or close containers?

Yes

> Do you feel too tired or sad to dress or bathe? Yes
>
> **Communication Module Questions Response Categories**

**Because of some physical, visual, hearing, mental or emotional
condition, do No, no difficulty**

**you have any difficulty communicating, such as understanding others
or**

**being understood by others?**

Do you have difficulty in generally understanding what people say? Yes,
unable **or yes**, much difficulty **or yes**, some difficulty

Do you have difficulty in starting and maintaining a conversation? Yes,
unable **or yes**, much difficulty **or yes**, some difficulty

Do other people have difficulty understanding you? Yes

The number of "false negative" cases was found in each thematic module
was found using the criterion described above, that is, a negative
response about difficulty in the core question and an affirmative
response about difficulty in at least one of the selected questions in
the same thematic module, as the following table shows.

+--------------------+------------+----------------+-------+----------+
| **Thematic         | **Number   |                |       |          |
| Module**           | of         |                |       |          |
|                    | interviews |                |       |          |
|                    | with       |                |       |          |
|                    | negative   |                |       |          |
|                    | response   |                |       |          |
|                    | about the  |                |       |          |
|                    | di         |                |       |          |
|                    | fficulty** |                |       |          |
|                    |            |                |       |          |
|                    | **asked    |                |       |          |
|                    | about**    |                |       |          |
+--------------------+------------+----------------+-------+----------+
|                    | **Total**  | **Other        | **    | **%      |
|                    |            | Questions      | False | False    |
|                    |            | Answered (2)** | N     | neg      |
|                    |            |                | egati | atives** |
|                    |            |                | ves** |          |
+--------------------+------------+----------------+-------+----------+
| Vision             | 245        | 138            | 17    | 12.3     |
+--------------------+------------+----------------+-------+----------+
| Hearing            | 295        | 170            | 20    | 11.8     |
+--------------------+------------+----------------+-------+----------+
| Cognitive          | 209        | 118            | 32    | 27.1     |
+--------------------+------------+----------------+-------+----------+
| Mobility           | 232        | 134            | 27    | 20.1     |
+--------------------+------------+----------------+-------+----------+
| Self care          | 281        | 173            | 47    | 27.2     |
+--------------------+------------+----------------+-------+----------+
| Communication      | 267        | 164            | 15    | 9.1      |
+--------------------+------------+----------------+-------+----------+
| \(2\) At least one |            |                |       |          |
| of the questions   |            |                |       |          |
| selected to test   |            |                |       |          |
| for false          |            |                |       |          |
| negatives          |            |                |       |          |
+--------------------+------------+----------------+-------+----------+

The table shows that of the 245 persons who reported **No** difficulty
seeing, 138 also answered at least one of the other questions in the
module, selected to test for false negatives. Of that total, in 17
interviews at least one question was found for which the answer
conflicts with the response to the core question. This represents about
12% of the total number of interviews in which a negative response to
the core question was obtained and also an affirmative response was
elicited in at least one of the selected questions. This same analysis
could be done for the other thematic modules, referring to the
corresponding table, although it is worth mentioning that the
Communication thematic module was the module with the lowest proportion
of false negatives -- nearly 9% -- as well as the modules with the
highest proportion of false negatives which were Cognitive and
Self-Care, with approximately 27%.

For some of the questions selected to test for false negatives no answer
was elicited that contradicted the response given to the core question,
while for others there was a significant number of cases with
inconsistent answers. The questions that contributed most to the number
of false negatives in each thematic module can be seen in the following
table.

+-------------------------------------------------+------------+-------+
| **Thematic Modules and Corresponding Questions  | **Total \# | **    |
| for which Answers conflict with answers given   | of false   | Total |
| to the core questions**                         | n          | \# of |
|                                                 | egatives** | in    |
|                                                 |            | tervi |
|                                                 |            | ews** |
+-------------------------------------------------+------------+-------+
| **Vision**                                      | **17**     | 14    |
|                                                 |            |       |
| 2.12 -- How do you rate your ability to see?    |            |       |
| (if you use glasses or contact lenses, rate     |            |       |
| your ability while using them)                  |            |       |
+-------------------------------------------------+------------+-------+
| **Hearing**                                     | **20**     | 7     |
|                                                 |            |       |
| 3.12 -- How do you rate your ability to hear?   |            | 11    |
| (if you use hearing aids, rate your ability     |            |       |
| while using them)                               |            |       |
|                                                 |            |       |
| 3.17 - ¿Does any family or household member     |            |       |
| frequently say that this person has difficulty  |            |       |
| hearing?                                        |            |       |
+-------------------------------------------------+------------+-------+
| **Cognitive**                                   | **32**     | 12    |
|                                                 |            |       |
| 4.08 -- Do you have difficulty remembering      |            | 9     |
| names of persons or places?                     |            |       |
|                                                 |            | 10    |
| 4.11 -- Do you have difficulty doing important  |            |       |
| tasks such as taking medicines or paying bills? |            |       |
|                                                 |            |       |
| 4.13 -- Do you have difficulty learning a new   |            |       |
| task such as going to a new place?              |            |       |
+-------------------------------------------------+------------+-------+
| **Mobility**                                    | **27**     | 10    |
|                                                 |            |       |
| 5.10 -- Do you have difficulty walking a long   |            | 14    |
| distance such as 1 km?                          |            |       |
|                                                 |            | 10    |
| 5.13 -- By yourself and without any equipment   |            |       |
| or assisting device, do you have difficulty     |            | 9     |
| being on your feet for 2 hours?                 |            |       |
|                                                 |            |       |
| 5.14 -- By yourself and without any equipment   |            |       |
| or assisting device, do you have difficulty     |            |       |
| sitting for 2 hours?                            |            |       |
|                                                 |            |       |
| 5.15 -- By yourself and without any equipment   |            |       |
| or assisting device, do you have difficulty     |            |       |
| stooping, crouching, or kneeling?               |            |       |
+-------------------------------------------------+------------+-------+
| **Self-care**                                   | **47**     | 18    |
|                                                 |            |       |
| 6.09 - By yourself and without any aid, do you  |            | 19    |
| have difficulty tying your shoelaces?           |            |       |
|                                                 |            |       |
| 6.15 -- Do you have difficulty staying alone    |            |       |
| for a few days?                                 |            |       |
+-------------------------------------------------+------------+-------+
| **Communication**                               | **15**     | 11    |
|                                                 |            |       |
| 7.06 -- Do you have difficulty communicating    |            |       |
| and maintaining a conversation?                 |            |       |
+-------------------------------------------------+------------+-------+

**Analysis of the Open-Ended Question**

Vision

In 49 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
230 of the 357 interviews with an answer to the core question, an answer
was elicited for the open-ended question. Therefore, the following
comments are based in those answers.

In the great majority of the interviews, that is in about 200, the
answer provided to the open-ended question confirmed the information
provided in the core question. In only 7 interviews, the answers
provided were not specific, such as "just because" or "because that is
the right answer", "because I live with the person", "because it's how I
understood it", among others. Instances of inconsistency between the
answer to the core question and the open-ended question were also rare.
In just two interviews there was a contradiction between the core
question and the open-ended question. The respondents reported not
having difficulties seeing, however, in the answer to the open-ended
question, they indicated they have difficulty seeing even when wearing
their glasses or have difficulty reading.

In 64 interviews the verb 'to see' was mentioned in the answer, whether
to confirm the answer given to the core question -- as in, for example,
"because I see/don't see well" or "because I see/don't see well with my
glasses on" -- or explaining/complementing the answer given to the core
question -- as for example in "because I don't have any problem seeing"
or "because I don't see well up close or at a distance". On the other
hand, in just 11 cases the respondent associated his/her visual
abilities to the act of reading, manifesting s/he had or did not have
visual problems because s/he could or could not read. This suggests that
the prevailing understanding was that the question aimed to investigate
visual difficulties in the widest sense, such as in seeing, is not
restricted to the act of reading.

In 42 interviews the respondent consistently mentioned the use of
glasses or contact lenses, whether explaining s/he can't see because
s/he needs to have a stronger prescription or that s/he does not have a
problem when using glasses, making it evident that the respondent is
clear about the fact that the question refers to difficulties even when
using glasses or contact lenses.

In about 100 of the 134 interviews in which the respondent reported not
having a vision problem and also answered the open-ended question, the
answer provided to the open-ended question only confirmed the answer to
the core question. Only one respondent said s/he did not know how to
answer and another provided an inconsistent response saying that,
"despite using glasses" he did not see well. In the other cases, the
respondents added information to the answer as, for example, in "I see
near and far", "I see small and large letters", "I don't have any
problems leaving the house or watching TV".

Nineteen of the 56 respondents who reported having "some difficulty" in
their vision and who answered the open-ended question, mentioned facts
as basis for the response they had provided, such as "because I use
glasses", "because I had an accident", "because I had a stroke",
"because I fell a lot". Nevertheless, the great majority of respondents
based their answers on the degree of difficulty they experience, using
expressions such as: "sometimes I cannot see," "I can't see well," "I
have difficulty reading."

In just 4 of the 34 interviews in which the respondent reported "great
difficulty" and also answered the open-ended question, the respondent
indicated having much, great or serious difficulty seeing. One
respondent said s/he only has 10% visual capacity and another one said
s/he cannot read magazines or newspapers. Most answers followed the
pattern of the answers given in the cases in which the respondents
reported having some difficulty seeing. However, although they confirmed
the difficulty reported in the core question, they did not contribute
much to the differentiation of the degree of difficulty, since many
answers are similar to those observed among persons who have some
difficulty seeing, as for instance in "sometimes I can't see well".

Of the eight persons who cannot see at all, only two said they were
blind. Two of them did not answer the open-ended question and the others
mentioned that they cannot see or that they have a serious problem such
as glaucoma.

Hearing

In 50 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
216 of the 356 interviews with an answer to the core question, an answer
was elicited for the open-ended question. Therefore, the following
comments are based in those answers.

In the great majority of the interviews, that is in about 210, the
answer provided to the open-ended question confirmed the information
provided in the core question. In only 3 interviews, the answers
provided were not specific. In those interviews the respondent answered
"because it is true". There were no cases of inconsistency between the
answer to the core question and the open-ended question. In just one
interview the respondent mentioned he had found the question "strange
because it mentions the use of equipment", although not making any
additional comments.

> In 148 of the 164 interviews in which the respondent reported not
> having a hearing problem and also answered the open-ended question,
> the answer provided to the open-ended question only confirmed the
> answer to the core question, without adding additional information
> such as, for example, "because he can hear/listen well" or "because he
> does not have difficulty".

Seven of the 336 respondents who reported having "some difficulty" in
their hearing and who answered the open-ended question, mentioned that
"sometimes I have difficulties" or that they suffer minor difficulties.
Six respondents said that they have to "yell" or "speak loud". The
others gave different answers such as for instance, "because I went to
the doctor", "because he works in a noisy environment", "because he does
not hear him/her". In just one case, the respondent indicated that the
person "is always distracted", revealing some sort of confusion about
the aim of the question to capture a physical hearing problem.

In 17 interviews in which the respondent reported "much difficulty" and
also answered the open-ended question, in just 4 of the responses to the
core question there was a mention of the fact that the respondent
"almost cannot hear". In the remaining interviews the answer does not
permit to evaluate the degree to which the hearing is compromised, but
simply confirms that there is a problem.

Such responses would fall in a different degree of hearing loss since
they barely mention that there is an auditory problem, that the person
cannot hear, that they have to speak loud, among other responses,
however not specifying how much difficulty the person feels they have.

Of the five persons that cannot see at all, only two answered the
open-ended question. These people reported being deaf since birth.

Cognitive

> In 64 of the 406 interviews, the respondent did not answer the core
> question, and therefore the open-ended question was not asked. In 225
> of the 342 interviews with an answer to the core question, an answer
> was obtained for the open-ended question. Therefore, the following
> comments are based in those responses.
>
> In the great majority of the interviews -- 210 -- the answer given to
> the open-ended question confirmed the information provided in the core
> question. In most cases, the answers to the open-ended question were
> very rich in examples and descriptive comments about the difficulty
> experienced. In just one interview there was a contradictory response.
> The respondent reported having difficulty but, in the open-ended
> question, he said he did not know how to evaluate it. In 4 other
> interviews, the respondent indicated that "I don't have difficulty;
> it's just because of my age". This reveals that the respondent
> actually has some difficulty with his memory or concentration, but
> that nevertheless he considers it "normal". In the other interviews
> the responses obtained were not specific, for instance, "just
> because".
>
> Among the 113 interviews in which the respondent reported not having
> difficulty to remember o concentrate and also answered the open-ended
> question, in just about 35 of them the answer given to the open-ended
> question simply confirmed the answer to the core question, as for
> example "because I don't have any difficulty" or "because I remember
> things", without however adding any additional information. In the
> great majority of cases, respondents mentioned they had no
> difficulties for specific reasons such as, for example, "because he
> knows all the relatives' phone numbers", "because he always finds the
> objects he hides", "because he remembers things that happened when he
> was a child". In three interviews the respondent referred to the age
> of the child he was proxy respondent for as the reason for the answer
> provided.

Of the 62 respondents who reported having "some difficulty" remembering
or concentrating and who answered the open-ended question, 28 mentioned
difficulties remembering something or easily forgetting, while only 3
reported difficulty concentrating. Several respondents justified the
answer provided based on attitudes or external factors such as "is
anxious and is always joking", "has no patience to do things", "gets
easily distracted", "is old", "it's a consequence of the stroke", but in
a more general way, the majority confirmed the answer given in the core
question. There was only one case in which the respondent could not tell
why he answered as he did.

In 3 interviews in which "much difficulty" remembering or concentrating
was reported and the core question was also answered, the majority of
respondents mentioned difficulties related to remembering names of
persons, remembering to give messages or where they put something. In
three cases, the respondent mentioned difficulty learning and, in two
others, problems related to the use of drugs/alcohol. In four interviews
there was a report of a mental disability.

> Of the 22 persons who cannot remember things or concentrate at all,
> five did not answer the open-ended question. Among the answers
> provided, about half mentioned reasons why they have difficulty such
> as, for example, "because I have cerebral palsy", "because he is
> mentally disabled," "because she suffered an accident." The other half
> simply reinforced their answer to the core question, mentioning they
> had problems concentrating or remembering something.

> Mobility

In 53 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
232 of the 353 interviews with an answer to the core question, an answer
was elicited for the open-ended question. Therefore, the following
comments are based in those answers.

In the great majority of the interviews, that is in about 221, the
answer provided to the open-ended question confirmed the information
provided in the core question. In only 6 interviews, the answers
provided were not specific. In those interviews the respondent answered
"because that's the truth" and "that's it". In 3 interviews there were
cases of inconsistency between the answer to the core question and the
open-ended question.

> In 126 of the 131 interviews in which the respondent reported not
> having difficulty walking or climbing steps and also answered the
> open-ended question, the answer provided to the open-ended question
> only confirmed the answer to the core question, without adding
> additional information such as, for example, "because I have no
> difficulty". In 3 interviews the following responses were obtained:
> "because of obesity", "holding a hand" and "suffered an accident",
> which suggests inconsistency between both answers.

One of the 27 respondents who reported having "some difficulty" walking
or climbing steps and who answered the open-ended question mentioned
that "does not run, because he's epileptic, but he has no difficulty
walking". One respondent said he has "some difficulty" but when
answering the open-ended question he said that "he walks aimlessly and
in a semiconscious state because of drugs", showing confusion about the
aim of the question to capture difficulties regarding locomotion.

In only 1 of the 46 interviews in which respondents reported "much
difficulty" walking or climbing steps and also answered the open-ended
question, the respondent mentioned that s/he "is somewhat sick", which
does not help figure out if the difficulty is permanent or temporary. In
the remaining interviews the response to the open-ended question only
confirmed the answer provided to the core question.

> Of the 36 respondents who reported they cannot walk or climb steps at
> all, 13 are quadriplegic, 3 are unable cannot walk or climb steps
> since birth because of cerebral palsy and 5 are paraplegic. Only 1
> reported missing lower limbs. Eight respondents did not answer the
> open-ended question.
>
> Self-Care

In 53 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
213 of the 353 interviews with an answer to the core question, an answer
was elicited for the open-ended question. Therefore, the following
comments are based in those answers.

In the great majority of the interviews, that is in about 198, the
answer provided to the open-ended question confirmed the information
provided in the core question. In only 7 interviews, the answers
provided were not specific. In those interviews the respondent answered
"because that's the truth" and "that's it". In 1 interview there was an
indication of inconsistency between the answer to the core question and
the open-ended question.

> In 158 of the 160 interviews in which the respondent reported not
> having difficulty caring for him/herself and also answered the
> open-ended question, the answer provided to the open-ended question
> only confirmed the answer to the core question, without adding
> additional information such as, for example, "because I have no
> difficulty", "a good persons does not have any problem", "thank God I
> can do it". In the case of 1 interview in which it was said that the
> respondent "did not have difficulty", in the answer to the probing of
> the open-ended question the following response was elicited: "he does
> not bathe by himself because of his age", showing an inconsistency in
> the answers to the two questions. In only 1 case the respondent
> reported that: "life has taught me to be careful with problems", thus
> revealing confusion regarding the goal of the question.

Among the 16 respondents who reported having "some difficulty" in this
topic and who answered the open-ended question, no inconsistencies were
found; only one respondent said he had "some difficulty", but when
answering the open-ended question he said that "sometimes he does not
like to bathe", showing confusion regarding the objective of the
question, aimed at capturing physical problems that limit a person's
ability to take care of him/herself.

In 10 interviews in which "much difficulty" was reported and the core
question was also answered, only 1 answer to the core question mentioned
that the respondent "is schizophrenic and cannot always care for
himself". In the other interviews the answer to the open-ended question
only confirmed the answer to the core question.

Two of the 38 respondents who answered in the core question "that they
cannot take care of themselves at all" reported in the open-ended
question that they are quadriplegic and the others have limitations due
to the most varied reasons, the main ones being advanced age or serious
illness, such as stroke and cerebral palsy. Eleven respondents did not
answer the open-ended question.

> Communication

In 57 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
216 of the 349 interviews with an answer to the core question, some
response to the open-ended question was obtained. Therefore, the
following comments were based in those responses.

> In the great majority of the interviews, that is in about 200, the
> answer provided to the open-ended question confirmed the information
> provided in the core question. In a few cases the answer obtained was
> not specific, however the number of questions such as "that's it" and
> "because that's the truth" was larger than in the previous questions.
> In one interview the respondent said he was tired of answering the
> same questions. In some case the respondent associated the difficulty
> communicating with shyness, dislike for conversation or being grumpy,
> but the majority associated it with physical, emotional or mental
> problems, or simply mentioned being able to understand (or not) or
> being understood.
>
> In about 50 of the 154 interviews in which the respondent reported not
> having difficulty communicating and also answered the open-ended
> question, the answers were such as "I don't have it" or "None",
> without adding additional information that would help understand the
> reasons for the answer. In the majority of the remaining interviews,
> the respondents made comments that illustrated their ability to
> communicate, resorting often to expressions such as "I am
> communicative" and "I am articulate". In only one interview the
> respondent reported being used to his problem, which suggests there is
> a communication problem even if it was not reported in the core
> question.

Five of the 21 respondents who reported "some difficulty" communicating
and who answered the open-ended question reported physical problems with
speech or hearing. The majority of the other respondents only mentioned
difficulty understanding without, however, adding other information.

In 25 interviews in which "much difficulty" communicating was reported
and the core question was also answered, the great majority of
respondents reported physical, mental or emotional problems such as
difficulty talking or hearing, Down's syndrome, schizophrenia or
depression. In only one interview the respondent reported a dislike for
conversation, suggesting that the question may not have been well
understood.

Ten of the 26 persons who cannot communicate at all did not answer the
open ended question. Among the answers given, the great majority
justifies the inability to communicate due to the difficulty with speech
and/or hearing. In several interviews the respondent reported that
communication only takes place through crying, smiles or looks, which in
a certain way is contradictory because it reveals that the person is
capable of communication, albeit very basic.

Body Structures and Functions

In 56 of the total of 406 interviews, the respondent did not answer the
core question, and therefore the open-ended question was not asked. In
201 of the 350 interviews with an answer to the core question, some
response to the open-ended question was obtained. Therefore, the
following comments were based in those responses.

In the great majority of the interviews, the answer provided to the
open-ended question confirmed the information provided in the core
question. It was rare to obtain a non-specific answer such as "that's
it" or "because it's true". Compared to the other modules, this had the
lowest percentage of non-specific answers.

The majority of respondents in the 162 interviews in which they reported
not having any of the disabilities mentioned and answered the open-ended
question confirmed the answer given to the core question. However, in
about 15 cases the respondent explicitly mentioned "not having
paralysis" or "having the limbs in perfect shape", which suggests that
they focused their understanding on just one part of the question. Some
respondents reported having "paralysis in one arm", "partial cerebral
palsy", aside from other impairments such as visual or mental problems,
spine problems, arthritis, among others, which are not included in the
response categories presented in this thematic module. In some
interviews the response suggests that there is a problem, however there
is not enough information to identify the problem because the answers
are such as 'I cannot do everything", "is better after the surgery",
"had a stroke...", "makes movements with limitations", "can feel the leg
but have no strength to walk", among others.

The great majority of the 14 respondents who reported permanent total
paralysis and who answered the open-ended question mentioned that they
were completely disabled or quadriplegic. In the remaining cases, the
reason why the person is paralyzed was mentioned, for example, "was in a
car accident". In only one case the respondent mentioned his complete
inability to walk, which could be due to paralyzed legs or missing
limbs, although no additional information is available.

Of the 17 respondents who reported having permanent paralysis of the
legs and who answered the open-ended question, the great majority of the
answers to the open-ended question confirm the existence of difficulty,
but only in four the answer confirms the type of disability reported. In
the remaining answers the respondent mentioned problems walking or being
on their feet, that the person is sick or has dystrophy, difficulties
that can be associated to other disabilities. In two interviews the
response category selected is not correct, since the respondents
reported being quadriplegic or having paralysis in one side of the body.

In four of the 5 interviews in which respondents reported having
permanent paralysis in one side of the body and who answered the
open-ended question, the respondent barely provided the reason why they
have the difficulty: "because of a stroke".

Of the 3 respondents who reported a missing leg, arm, hand, foot or
thumb, and who answered the open-ended question, all described the type
of disability.