6^th^ Meeting of the Washington Group on Disability Statistics

Kampala, Uganda

October 10-13, 2006

**[Summary of pre-test results for WG short set of questions:
COMMUNICATION]{.underline}**

**Introductory phrase:**

The next questions ask about difficulties you may have doing certain
activities because of a HEALTH PROBLEM.

**[Question on communicating]{.underline}**

Because of a physical, mental or emotional health condition, do you have
difficulty communicating, (for example understanding others or others
understanding you)?

a.  No -- no difficulty

b.  Yes -- some difficulty

c.  Yes -- a lot of difficulty

d.  Cannot do at all

[Summary of pre-test results]{.underline}:

In the cognitive tests, only 85 of the cases (out of 1165) fell into the
"problematic" group of response patterns for the communication question.
The majority (n=58) of problematic responses were in pattern "n" where
respondents answered "yes" to the WG question and "no" to all of the
extended questions[^1]. This was interpreted as a problem due to
respondent's focus on the introductory phrase of the WG question
("Because of a physical, mental, or emotional health condition...).
Examination of responses to cognitive probes revealed that respondents
understood the WG question and that for problematic responses,
respondents either focused on the introductory phrase, found the
question ambiguous, or had a second language problem (i.e. had
communication problems because primary language in country was not their
native language). At least one of the extended questions captures a
concept that is somewhat different than the ability to communicate (it
asks whether respondents feel shy in a group or social situations). This
extended question was interpreted in a number of different ways by
respondents and some of the discordance in responses between the WG
question and the extended question was due to this conceptual
difference. It was noted that it is important consider the respondent's
hearing along with communication because some people reported no
communication problem but had hearing problems.

WHO/ESCAP results indicated low sensitivity and high specificity of the
WG question compared to the extended questions. The rates of endorsement
for the extended questions were higher than that of the WG question. It
was reiterated that the results of sensitivity and specificity analyses
need to be interpreted with caution since there is no gold standard.
Since the extended questions have a 5 point response scale and the WG
questions have a 4 point scale, the cut-point was reset and preliminary
analyses were repeated for this question at the time of the annual
meeting. The agreement was better when the cut-points were reset so that
more comparable comparisons could be made. The WG question was
moderately correlated with the two extended questions that were closely
related conceptually to the WG question (difficulty understanding what
people say and difficulty starting and maintaining a conversation). It
was felt that the complicated phrasing (introductory phrase) of the WG
question caused some problems for the respondents which may have
contributed to lower correspondence between the WG question and the
extended questions.

Generally, the WG question was well understood, however the introductory
phrase was found to be misleading. The question was long and
interviewers had to repeat the question to respondents. There were few
(but some) instances where respondents answered affirmatively because of
a second language problem. Concern was expressed that if the
introductory phrase is removed, we might create more false positive
responses because of second language problems. Therefore, it was
recommended to omit the introductory phrase and to move it to the
beginning of the entire question set. It was also recommended to add a
reference to communicating in one's normal language to avoid false
positive responses due to second language problems.

[^1]: Extended questions: (i) *Do you feel shy in a group or social
    situations? Do you have difficulty* (ii*) in making new friends?*
    (iii*) in stating and maintaining a conversation?* (iv) *in
    generally understanding what people say?*