# Presentation: 305048

## Presentation on Field testsMargie SchneiderDan Mont

- 6th Meeting of the Washington Group
- Kampala, Uganda
- 10 – 13th October 2006

## Why the field tests?

- How does the short set of questions function in different countries?
- Are the questions cross culturally comparable?
- Do the questions capture what the intention of Q is to measure?

## Specific objectives

- Determination of whether the single question per domain is representative of that domain
- Determination of whether the questions produce comparable data across countries
- Determination of how the Washington Group questions work as a set in comparisons with other questions used by the country

## Analysis

- Endorsement rates for single question vs detailed questions for three different definitions of ‘disabled’
- Endorsement rates for composite score on short set vs composite score on detailed set of Qs
- Comparison of WG Qs to specific country Qs used in previous Census/survey

## Analysis - process

- Recoding of data into D1, D2 and D3 and ED1, ED2, ED3
- Frequencies for each question and composite for detailed questions
- Crosstabulations for short question vs individual detailed and composite of detailed Questions
- Comparison of composite scores for WG short set and detailed set

## Countries that did the field test

- Vietnam:
- population based sample in one province; sample size of 3540 individuals;
- WG short set + detailed questions from cognitive test + country specific questions on causes of difficulty
- Gambia:
- Purposive sampling of 302
- Disabled and non-disabled respondents
- WG short set + detailed set from field test (no additional domains) + own country questions

## Countries that did the field test

- South Africa:
- Purposive sample of ‘disabled’, ‘non-disabled’ and ‘unsure’ status – 185 adults and 38 parents of children (disabled and non-disabled)
- WG short set + detailed set (incl additional domains) + Census 2001 question and ‘Are you/is your child disabled?’
- Brazil, Paraguay and ? to do field test in November 2006

## Cognitive test data analysis

- Used responses to the following:
- WG short set questions
- Questions that are included in the field test detailed set of questions
- Sample of 1639 cases from 13 countries
- Not population based sample
- Applied same analysis as for the field test
- Self care – limited because of detailed questions were not included in the Cognitive test

## General comments on results

- Clear progression from low to high endorsement numbers when using different cutoff points (D1 – D3; ED1 – ED3)
- Short set/core single questions seem to be capturing more than the detailed individual questions in most domains
- Use of additional domains increases overall endorsement
- WG short set: more endorsement than Qs with ‘disability’ or ‘disabled’

## Slide 10

## Slide 11

## Slide 12

## Slide 13

## Slide 14

## Slide 15

## South Africa testing process

- Stats SAs needs: Testing a disability schedule for Census 2011
- Process includes:
- Focus group study (2006)
- Household survey (2006/07)
- Further qualitative work (?) (2008)
- Pilot of Census (2009)
- Census (2011)

## Focus group distribution

- 5 focus groups with parents of children (3 with disabled children and 2 with non-disabled children)
- 21 focus groups with adults:
- 9 groups with ‘disabled’
- 6 groups with ‘non-disabled’
- 6 groups with ‘unsure’
- Mixed in terms of urban/rural and language groups
- All completed questionnaire before the group discussion
- Background info including ‘are you disabled?’ and Census 2001 Qs
- Proposed Qs for Census (WG short set)
- Detailed Qs
- Whole questionnaires translated into all languages

## Tape recorded
Transcribed into original language
Translated into English
Themes in discussion: 
Understanding of disability
Consistent responses on proposed questions across different groups
Issues not covered
Relevance of issues
Sensitive information on disability

- Transcribed into original language
- Translated into English
- Themes in discussion:
- Understanding of disability
- Consistent responses on proposed questions across different groups
- Issues not covered
- Relevance of issues
- Sensitive information on disability

## Slide 20

## Slide 21

## Core vs detailed sets

- No major differences if use core domains for D1 vs ED1(except self care); more differences when comparing D3 vs ED3
- Significant increase if use additional domains of learning, social interactions and emotional functioning.
- ED1 without additional domains: 128/185
- ED1 with additional domains: 166/185

## Slide 23

## Slide 24

## Reactions to questions

- Generally understood easily
- Recall period: caused some difficulties (‘can’t remember everyday for last month’) or ignored (just answered as ‘usual/normal’)
- Distance reference: needs to be clear
- Sensitivity of questions: sometimes hurtful but not sensitive (emotional functioning); important to ‘tell the world’
- Sensitive topics: sexuality, toileting, direct questions about impairment, reading/writing for Deaf people, HIV status

## Reactions to questions (contd)

- Relevance of questions:
- Generally relevant especially for ‘disabled’ and ‘unsure’ groups
- Reflected their own lives – ‘unsure’ group but not ‘non-disabled’ group
- Identification with ‘disabled’: ‘unsure’ and ‘non-disabled’ groups did not identify
- Identification is used politically to get access to services (e.g. Deaf group)

## What is disability

- Descriptions provided by participants suggests that disability is:
- Permanent
- Visible and physical
- Not ‘curable’ or ‘solvable’
- ‘cannot do anything by themselves’ vs ‘can’t do’ only in impaired domain of functioning
- ‘Them’ and ‘us’ across all groups
- Not positive connotation

## What is disability? (contd)

- ‘Difficulty’ is less severe than disability and can be solved;
- Disability includes difficulty but difficulty does not include disability
- Disabled group were most aware of role of environmental factors on their functioning
- Health problem is a temporary feature and can be cured and not directly linked to disability
- Seeing, hearing, concentration, remembering, participation etc. are not health
- Aches and pains are health

## Recommendations for changes to proposed questions

- Introductory phrase: change use of ‘health problem’
- Change to introductory phrase of communication question
- Clear distance reference (‘across the road’)
- Training on phrase ‘even if wearing glasses or hearing aid’
- Retain question on participation
- Need further research on E questions
- Avoid mention of ‘disability’
- Add question on learning for young children (if space permits)

## Additional areas for survey questions

- More on mental functioning
- Issues of transport
- Accessibility of built environment
- Availability of services and meeting of needs
- Employment issues
- Attitudes towards disabled people
- Personal assistance
- Needs such as home based care
- Stress
- Issues of sleep and energy (psychiatric illness)
- Medication
- Balance (Deaf)

## Revised Qs for Survey 

**GENERAL HEALTH AND FUNCTIONING**
**The following questions ask about any difficulties that the person has because of a health problem or condition.**
**a) ****Does the person have difficulty in doing any of the following? **
**Seeing (even with glasses if he/she wear(s) them)**
**Hearing (even with a hearing aid if he/she wears one)**
**Walking a kilometre or climbing a flight of steps**
**Remembering**
**Concentrating**
**With self-care, such as washing all over or dressing**
**In communicating in his/her usual language, including sign language (i.e. understanding others or being understood by others)**
**Joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can**

## Response options: 1 = no; 2 = some; 3 = a lot; 4 = unable to do; 5 = don’t know

b) Does the person use any of the following? 
1 = Yes
2 = No
Eye glasses
Hearing aid
Walking stick or frame
A wheelchair
Chronic medication 

**b) Does the person use any of the following? **
- 1 = Yes
- 2 = No
- Eye glasses
- Hearing aid
- Walking stick or frame
- A wheelchair
- Chronic medication