Questionnaire Text

Questionnaire form view entire document:  text  image

40. Physical disability
[For all members of the household]
Does any member of the household have at least one of the following?
[Question 40 provides three columns to insert up to three disabilities for each household member]

[] 0 None
[] 1 Blindness
[] 2 Deafness
[] 3 Speech and voice disorder
[] 4 Hand amputation
[] 5 Hand impairment
[] 6 Leg amputation
[] 7 Leg impairment
[] 8 Torso impairment
[] 9 Mental disorder

Questionnaire instructions view entire document:  text  image

29. Disability status, Columns 40/1 to 40/3
In this column, some specific types of disability should be recorded. These kinds of disabilities might be a result of disease, war, accident or congenital. Read the cases for the respondent in the order written in the questionnaire and ask them whether there is a person in the household who is facing at least one of these disabilities.
If none of the members of the household have any disability conditions, mark the box 2 ("No") and leave all the columns corresponding to this question blank. But if some of the members have at least one of the listed disabilities, mark box 1 ("Yes") and ask the respondent to specify the disabled person and the type of their disability. After identifying the disabled persons, write the corresponding code or codes to the type of disability in columns 40/1 to 40/3 and for other members of the household who do not have any of the disabilities listed, mark the column 40/1 with "--" and leave Columns 40/2 and 40/3 blank.
In case the disabilities listed in this column are not apparent enough for the respondent and s/he has difficulties identifying them, help them as follows:
[] 1, Blind: is referring to someone who has lost the sight of both eyes and cannot see, even with the help of a tool like glasses, or their ability to see is only enough for them to identify light around them but cannot recognize any movement farther than one meter (3 feet). Assign code 1 to a blind person, based on the above explanation.
[] 2, Deaf: a deaf person is someone who is not able to hear anything even with the help of a device like a hearing aid. In fact, a deaf person has no reactions even to a very loud sound like a shout. Assign code 2 to a deaf person.
[] 3, Speech and voice disorder: a speech and voice disorder means any kind of weakness in speaking or making sounds by throat in a normal and natural way. Some examples of speech and voice disorders are as follow:
- Those who are unable to speak (mute).
- Those who speak with involuntary pauses or repetitions (speech impediment).
- Those who due to a larynx defect, disease or any other reason are not able to make a natural sound from their throat, their voice breaks off or their voice is completely different than that of a normal one, like men whose voices are delicate because of a throat surgery.
- Those whose speaking is not fluent and smooth due to mental problems.

For any members of the household who have a speech and voice disorder, assign code 3.
[] 4, Hand amputation: the loss of thumb or other four fingers together or arm amputation from any point lower than the shoulder in any of the arms is considered as a hand amputation. For any member who has an amputation in a part of their hand/arm, assign code 4.
[] 5, Hand impairment: hand impairment means a shortage of performance or any deformation in the hand, forearm, elbow, arm or shoulder in any of the arms. Examples of hand impairment are as follow:
- Hand paralysis
- Loss of the pointing finger (note that the loss of other fingers besides the pointing finger and thumb is not considered as a hand impairment.)
- Any type of deformation of the arm like thinness or shortness compared to the normal condition, etc.
- Any kind of deficiency in performance in holding objects.

For any member who has an impairment in the arm, assign code 5.
- Note that since mentioning only "hand impairment" is not sufficient for the respondent to distinguish it from hand amputation, it is necessary to explain the examples for him.

[] 6, Leg amputation: leg amputation means the loss of toes, ankle, knee or thigh in any of the legs. In other words, any kind of loss lower than the pelvis in any of the legs is leg amputation. For any member who has a leg amputation, write code 6.
[] 7, Leg impairment: leg impairment means a shortage of performance or deformation of the toes, ankle, knee, thigh or pelvis in any of the legs. Examples of leg impairment are as follows:
- Leg paralysis
- Any unusual shape of the leg like shortness compared to the other leg, abnormal thinness, etc.
- Any type of deficiency in performance of the leg such as imbalance in walking (staggering), etc.

For any member who has a leg impairment, assign code 7. Since the phrase "leg impairment" is not sufficient for the respondent to distinguish it from leg amputation, it is necessary to explain some examples to them.
[] 8, Torso impairment: torso means the part of the body including the neck, back and chest and torso impairment means any deformation or deficiency in performance of the skeletal and muscular structure of the torso. Examples are as follows:
- Torso paralysis, meaning that the person is not able to change the position of the torso (for instance from resting to sitting, from sitting to standing) due to a general torso paralysis.
- Any deformation or deficiency in performance of the spinal column, like deflection of the spinal column to the sides or to the front (crooked back).
- Torso prolapsed, meaning that the person is not able to hold the body straight.

In case of disabilities related to the impairment of the hand, leg and torso, note the following:
- Those having myeloid impairment, based on the aspects of their impairment, are facing one or more of the hand, leg or torso impairments.
- Those having myeloid impairment in the bottom of the torso are mostly facing leg paralysis and those having myeloid impairment in their chest and neck are usually facing hand, leg and torso impairment.
- For any member having torso impairment, consider code 8.

[] 9, Mental disorder: a person has a mental disorder if their IQ is less than normal so that they have retardation. These people are weaker than others of the same age in learning and are dependent and in need of others for their daily personal matters. If a member of the household has a mental disorder based on the answer of the respondent, consider code 9 for them.
- Note that those studying in Special Children Schools (mentally retarded) and those who are under particular care in special organizations for mentally retarded people should be considered as having mental disorders.

To fill these columns, pay attention to the following:
Any person having a disability can have one or more types of disabilities. Therefore, Columns 40/1 to 40/3 are designed to record a maximum of three disabilities.
- If someone has only one kind of disability, write the code in column 40/1 and mark other columns with "--". For instance, for someone whose leg is amputated from their knee, write code "6" in column 40/1 and mark columns 40/2 and 40/3 with "--".
- If someone has two kinds of disabilities, write the codes in columns 40/1 and 40/2 and mark column 40/3 with "--". For example, for a deaf person who also has a speech disorder, write down code 2 in Column 40/1, code 3 in Column 40/2 and mark column 40/3 with "--".
- If a person has 3 types of the listed disabilities, write the codes in Columns 40/1 to 40/3. For instance, for someone who is completely paralyzed and is unable to move the arm, leg and torso, write codes 5, 7, and 8 in Columns 40/1 , 40/2, and 40/3. For someone who is blind, deaf and mute, put down codes 1, 2, and 3 in the mentioned columns.
- If a person's disabilities are more than 3 of the listed, identify the three of them that limit the person's life the most and write the corresponding codes in these columns.