Questionnaire Text

Questionnaire form view entire document:  text  image
[Questions P00-P20 were asked for persons in both the household and non-household populations.]

P18. Disability (answer for all persons).

[P18 was asked of all persons.]
Does [the respondent] have any serious disability that limits his/her full participation in life activities (such as mobility, work, social life, etc.?
a. Sight
[] Yes
[] No
b. Hearing
[] Yes
[] No
c. Speech
[] Yes
[] No
d. Physical
[] Yes
[] No
e. Intellect
[] Yes
[] No
f. Emotional
[] Yes
[] No
g. Other
[] Yes
[] No
If "yes" in g (other), specify: ________
Questionnaire instructions view entire document:  text  image
P18. Disability: This question is to be asked of all household members.

Does (name) have any serious disability that limits his/her full participation in some life activities (such as mobility, work, social life, etc.?)

Persons with disabilities are defined as those who are unable to or are restricted in the performance of specific tasks/activities due to loss of function of any part of the body as a result of impairment or malformation. Examples are persons with visual/sight impairment, hearing impairment, mental retardation, emotional or behavioral disorders and physically challenged persons. A disability could be partial or total, sensory or physical and an individual may suffer from one or more disabilities. A person is considered disabled if despite the use of assistive device or supportive environment (such as eye glasses and hearing aids), the limitation/restriction cannot be improved.

Note that for each of the categories (i.e. a - g), there should be either a 'yes' or 'no' response.

1. Visual/sight impairment (blind and partially sighted)
The purpose of this item is to identify those who are restricted in the performance of a specific task or an activity for which sight is essential. Persons who are completely or partially blind and those who have difficulty in seeing or reading fall into this category. If a person is wearing glasses, make sure they understand that the question refers to difficulties they may have seeing while wearing their glasses. For such persons, shade the circle below the "yes" column.

2. Hearing impairment (deaf, hard at hearing)
You should classify, under this category, persons who have serious hearing limitation or problems of any kind with their hearing that contribute to difficulty in doing any aspect of their daily activities. It can be that they cannot hear when someone talks to them directly in a quiet space. They may not be able to hear in one ear or both. Any problem with hearing that they consider serious or important should be captured. If the person is wearing hearing aids, make sure that they understand that the question refers to difficulties they may have in hearing when they are wearing their hearing aids. For such persons, shade the circle for "yes".

3. Speech impairment
Speech is said to be impaired when it deviates so much that it interferes with communication (that is, the speaker cannot be understood) or when the speech causes the speaker or listener to be distressed (e.g. stammering, stuttering, cluttering, and mis-articulation).

4. Physical (e.g. needs wheel chair, clutches or prosthesis, leg, hand usage limitations)
Persons in the household with difficulties in moving parts of their bodies such as arms, legs or neck should be classified in this category. They may have problems walking more than a block or some short distance, or the problem can be that they cannot walk up or down steps without difficulty. In other cases, they may not be able to walk a short distance without stopping to rest or they may not be able to walk without using some type of assistive device such as a cane, a walker, wheelchair or crutches.

The capacity to walk should be without assistance of any device or human support. If such assistance is needed, the person has difficulty in walking. Note: If the person is using an assistive device such as a wheelchair or has a person to help him or her in walking, it is highly likely that they have difficulty in walking. For such persons, shade the circle below the "yes" column.

5. Intellectual (serious difficulty in learning)
Intellectually challenged (or mentally retarded) persons are those who have substantial limitation in their mental functions. Such persons are characterized by sub-average intellectual functioning and this exists concurrently with one or more deficiencies in adaptive skills during the developmental period (0-18 years). Adaptive skills include communication skills, self-care, home living, social skills, etc. These persons usually have difficulty doing things their peers can do, for example, a ten-year old may have difficulty in doing things such as wearing a dress, using a spoon, playing with friends, etc. For such persons, shade the circle corresponding to "yes" under this heading.

6. Emotional/behavioral disorders
This refers to a disability that is characterized by behavioral and emotional responses which sometimes affect other people and impose undue stress on them. Emotional disorders are usually inward feelings that may lead to isolation, withdrawal, moodiness, weeping, etc., while behavior disorder is an outward expression characterized by hitting, shouting and distraction that are generally aggressive and violent. People who tend to hear voices or see things that others do not see or hear should be classified under this category. Also included in this category are persons who have changed so much that they have stopped cleaning themselves, dressing properly or tend to speak or move in a strange way. For such persons, shade the circle under the "yes" column in P18f.

7. Other (specify)
This category includes those considered by the household as having difficulty in carrying out normal activities but cannot be classified under any of the above-mentioned categories. This category also includes dwarfism, hunchback, albinism, etc. For such persons, shade the circle under the "yes" column and specify the type of disability in the space provided.