Questionnaire Text

Questionnaire form view entire document:  text  image
III. Personal characteristics

Now I am going to ask you about (name): ________
Copy the name of the person from section II

For all persons
[Questions 1-10 are asked of all persons.]


10. Disability
Does [the respondent] have difficulty doing the following activities in his/her daily life:

Read all the options and circle those with an affirmative answer.

[] 10 Walking, moving, going up and down [the stairs]
[] 11 Seeing, even when using glasses
[] 12 Speaking, communicating or conversing
[] 13 Hearing, even when using a hearing aid
[] 14 Getting dressed, bathing or eating
[] 15 Paying attention or learning simple things
[] 16 Has any mental limitations
[] 17 This person does not have any physical or mental difficulties (go to 12)

Questionnaire instructions view entire document:  text  image
6.5 Section III. Characteristics of the people

In this section the information of the people who inhabit the dwelling, like the sex, age, level of studies, income, among others, is obtained.

Before requesting the information for each person, copy all the names in the spaces designated for them, and for each person start with the phrase: "Now I'm going to ask about (mention the name of the person you previously noted)", so that the informer knows about whom you will be asking the information.

For all persons
[Questions 1-11 are for all persons.]


10. Disabilities
This question identifies the people who have difficulties completing activities in daily life such as walking, seeing, speaking or communicating, listening, learning, or attending to their personal care.

For each question consider the following:

  • Ask all the people who live in the dwelling.
  • You can circle up to six codes when a person declares more than one difficulty.


People with disabilities are those who:
  • Have difficulties and limitations moving or getting around, going up stairs because of the lack of one or a part of one's leg; this also includes those whose legs are impaired or display movement restrictions, in such a way that they need the help of another person, wheelchair or other apparatus, like walkers or artificial legs.
  • Display total loss of vision in one or both eyes, as well as those with weak vision and those who while using glasses can't see very well because of their advanced visual problem.
  • Have difficulty communicating with others, due to the speech limitations or because they can't chat or converse in a comprehensible way. Remember to not include small children in this situation because due to their young age they still have natural difficulty speaking because they are still learning to do so.
  • Can't hear, as well as those who display difficulties hearing (weak audio), in one or both ears, or those who even while using an audial device have listening difficulties due to the advanced state of the problem.
  • Can't attend to their own personal care or display difficulties and limitations completing activities such as bathing themselves, getting dressed, or consuming food.
  • Declare limitations or difficulties learning a new task of paying attention for a determined amount of time, as well as limitations remembering information, or performing activities that should be completed in daily life.
  • This also includes the people who declare a mental problem like mental retardation or alternative conduct and behavior.


If the person declares that he/she has some sickness or suffering (diabetes, cancer, arthritis, among others), ask what limits or prevents him/her to complete the daily activities in the dwelling, work, or at school, according to the options of the responses indicated in the question.

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When the person discloses information or knows the response by direct observation, use the confirmation of the other members of the dwelling, but never record the response without verifying the information with the informer.

If after having read all the response options, they declare that the person doesn't have difficulties, circle code 17 and continue to question 12 "Indigenous languages" if the person is age 3 or older; if not, continue to the following person.