Questionnaire Text

Questionnaire form view entire document:  text  image

3.7. Do you / does [the respondent] suffer from any long standing illness, disability or infirmity?
[] Yes
[] No (Go to Question 4.1)
[] Not stated

3.8. Does this limit your / [the respondent's] activities compared with most people of the same age?

[] Yes
[] No (go to Question 4.1)
[] Not stated

3.9. What type of disability of impairment do you / does [the respondent] have?

[] Sight only
[] Hearing only
[] Speech only
[] Physical disability only
[] Multiple disability
[] Slowness at learning or understanding
[] Mental retardation
[] Mental illness
[] Other (specify) ______
[] Not stated

Questionnaire instructions view entire document:  text  image

Section 3 - Characteristics

Questions 3.1 - 3.10 which comprise Section 3 provide some basic characteristics about the individual and are to be answered for all members of the household.

5.43 Question 3.7-3.10 General
These questions seek to determine whether the respondent has a physical or mental disability. In order to set the respondent at ease before asking these questions which might be seen as sensitive, begin by saying: "Now I would like to ask you some questions about any difficulty which you (or other members of the household) might have in carrying out every day activities due to mental or physical problems."

Disability - is defined as any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being. Such restriction or lack of ability must be as a result of an impairment. A person has an impairment if he or she has suffered any loss or abnormality of mind or body.

5.44 Question 3.9 Type of Disability
The categories are for the most part self-explanatory.

Physical Disability only - score this if the person's only impairment is the loss of use of parts of the body e.g. arms, legs.

Multiple Disability - score this for any combination of impairments.

Slowness at Learning or Understanding - score this only for persons who have been medically tested and found to be 'slow'.

Mental Retardation - it is very important to distinguish between mental retardation and mental illness. Mental Retardation exists where the person is born with a mental problem. Score this where it has been determined that the disease is one with which the person was born.

Mental Illness - is an illness acquired after birth.