# Presentation: 449102

##    ESCAP/WHO Pilot Study Overview

**Wei Liu**
**Statistics Division, ESCAP**
- _[liuw@un.org](mailto:liuw@un.org)_
- Sixth Meeting of the Washington Group on Disability Statistics, Kampala, Oct 10-13, 2006

## 1. Objective2. Background and methodology3. Questions tested4. Analysis and results5. Moving forward 

**Outline **** **

## Objectives

**Comparing the Washington Group 6-question “short set” with a WHO “long set” of questions**
**Studying the relative importance of different domains**
**Considering differences in underlying concepts and phrasings of questions**

## Background

**Pilot countries: **Fiji,  Indonesia, India, Mongolia, Philippines
**Test Design:**
- Study One: Testing sensitivity and specificity
- Study Two: Test-Retest Reliability
- Study Three: Linguistic Evaluation & Cognitive interviewing
**Other Partners:** Australian Bureau of Statistics (ABS)

## Sample Selection

***India:***** Meerut District, Uttar Pradesh State**
***Indonesia:***** Central Jakarta**
***Mongolia*****: Ulaanbaatar**
***Philippines:***** A selection of urban and rural **
**                      ****geographic “clusters”**
***Fiji:***** 2 rural and 8 urban enumeration areas in Central Division (capital city & surrounding areas)**

## Sample Sizes

|  | Fiji | India | Indonesia | Mongolia | Philippines |
| --- | --- | --- | --- | --- | --- |
| Study 1 | 1002 | 1000 | 800 | 1062 | 1057 |
| Study 2 | 100 | 100 | 100 | 100 | 100 |
| Study 3 | 100 | 100 | 100 | 100 | 100 |

## Sample Summary: Age Structure

## Pilot Study Packets

**Study Instructions**
**Questionnaire **
**Version A**
**Version B**
**Cognitive Interview Schedule**

## Support Materials

**Translation**
**Guidelines**
**List of key terms**
**Linguistic evaluation form**
**Interview Guidelines & Q-by-Q specifications**
**Disability Statistics Training Manual - Draft**
**Quality assurance standards & guidelines**
**Data entry program**

## Questions Tested

***Question set 1: ***
**Washington Group’s general disability measures, 6 Qs**
***Question set 2:***** **
**-World Health Survey body structure/functions domains, 17 Qs; **
**-WHO Disability Assessment Schedule II (WHO DAS II), activity and participation domains, 36 Qs; **
**Australian Bureau of Statistics, need-for-assistance domains, 4 Qs**

- _[http://www.unescap.org/stat/meet/widsm4/disabilty_questionnaire_Ver.A.pdf](http://www.unescap.org/stat/meet/widsm4/disabilty_questionnaire_Ver.A.pdf)_

## Study 1: Sensitivity and Specificity of WG Q’s

| n=4512 | Sensitivity  | Specificity  |
| --- | --- | --- |
| “Difficulty...seeing, even if wearing glasses” (W1), compared to:
“...Seeing a person across the road” (B1.6) | 59% | 90% |
| “...Seeing an object at arm's length” (B1.7) | 62% | 90% |
| “Difficulty...hearing, even if using a hearing aid” (W2) , compared to:
“...Hearing someone talking on the other side of the room in a normal voice? ” (B1.8) | 39% | 98% |
| “...Hearing what is said in quiet room” (B1.9) | 38% | 96% |

## Study 1 (cont.)

| Walking or climbing steps (W3) * Walking a long distance >1km (D2.5) | 51% | 91% |
| --- | --- | --- |
| Remembering or concentrating (W4) * Remembering to do important things (D1.2) | 48% | 92% |
| Self care (W5)  * Washing whole body (D3.1) | 50% | 98% |
| Self care (W5)  * Getting dressed (D3.2) | 56% | 98% |
| Self care (W5)  * Need for assistance: Self Care (E1) | 84% | 98% |
| Communicating (W6) * Understanding what people say (D1.5) | 32% | 95% |

## Study 2: Kappa Statistics for Test-retest Reliability

| W1 Seeing | 0.57 |
| --- | --- |
| W2 Hearing | 0.54 |
| W3 Walking & climbing | 0.64 |
| W4 Remembering & concentrating | 0.59 |
| W5 Self Care | 0.71 |
| W6 Communicating | 0.53 |
| B1.1 Pain | 0.60 |
| B1.2 Discomfort | 0.53 |
| B1.5 Using hands & fingers | 0.58 |
| B1.6 Seeing (short sighted) | 0.65 |
| B1.7 Seeing (long sighted) | 0.53 |
| B1.8 Hearing (far) | 0.58 |
| B1.9 Hearing (close) | 0.38 |
| B1.12 Short of breath (rest) | 0.48 |
| B1.13 Short of breath (exercise) | 0.52 |

## Study 2 (cont.)

| B1.14 Coughing | 0.47 |
| --- | --- |
| B1.15 Sleeping | 0.49 |
| B1.17 Worry or anxiety | 0.50 |
| D1.1 Concentrating | 0.55 |
| D1.2 Remembering | 0.55 |
| D1.5 Understanding what people say | 0.42 |
| D1.6 maintaining conversation | 0.42 |
| D2.1 Standing 30min. | 0.60 |
| D2.2 Standing up | 0.58 |
| D2.3 Moving inside | 0.43 |
| D2.4 Getting out  | 0.60 |
| D2.5 Walking >1km | 0.59 |
| D3.1 Washing | 0.55 |
| D3.2 Dressing | 0.62 |

## Study 3: Cognitive Debriefing

**Most questions are understood well**
**95% of the respondents had no difficulties responding to questions**
**Minor difficulties with questions on: **
**Mental disability (i.e. cognition, anxiety, getting along with people, etc.)**
**Need-for-assistance questions **
**W6 communication question**
**Translation**

## Identifying “Core Domains”

**ESCAP/WHO 4****th**** Workshop on Improvement of Disability Statistics and Measurement (Bangkok, June, 2006)**
**Factor analysis research**** **

## Factor Loadings

## Domain Selections 

***Factor Analysis***
**Life Activities**
**Hearing**
**Self Care**
**Participation**
**Mobility**
**Vision**

***4******th****** Bangkok Workshop Recommendation***
**Life Activities **
**Hearing**
**Self Care**
**Communication**
**Mobility**
**Vision**

## Moving Forward

**Further analysis of “core” domains **
**To select/reconsider the phrasings of the questions for the selected domains**
**Follow-up pilot studies for census recommendations and for an “extended” question set for use in surveys **
**Regional training and advisory missions**

## Thank You!

- _www.unescap.org/stat/_