Questionnaire Text

Questionnaire form view entire document:  text  image
Personal Information

[12] What is the physical and mental disability of [the respondent]?

[] 1 No disability
[] 2 Physical disability
[] 3 Blind and low vision
[] 4 Deaf and hard of hearing
[] 5 Deaf-blind
[] 6 Speech problem
[] 7 Mental illness
[] 8 Intellectual disability
[] 9 Multiple disabilities
Questionnaire instructions view entire document:  text  image
Individual information
After collecting the introductory and household information of data sheet 1, there are questions for individual information collection on the right side of the page. To write individual information, a row has been allocated for each member of the family. Sequence and rules for information collection have been put accordingly. In line with this, ask the question and fill the information. The response of each individual question should be written in the respective column.

Column 12: is there any kind of physical or mental disability in [the respondent]?

[] 1 No disability
[] 2 Physical disability
[] 3 Vision disability
[] 4 Hearing disability
[] 5 Deaf and blind
[] 6 Speech related disability
[] 7 Mental disability
[] 8 Intellectual disability
[] 9 Multiple disabilities
[p. 58]

This question has been put to record information on physical and mental condition of each person to be enumerated. Some people might have one type of different types of physical or mental problem (disability) or do not have any kind of disability. At the time of enumeration, there might be members with disability in a family. While enumerating disabled persons, this should be done at their usual living place.

Definition of disability: Disability is the condition that creates problems in running daily activities normally and full participation in social life due to problems in body parts and physical system of a person, coupled with activity limitations and participation restrictions in the physical, social, and cultural environment, as well as communication. For the purpose of enumeration, different types of disabilities have been divided into eight different categories as above. In order to understand whether a person has disability or not, the following description has be illustrated.

1. No disability - At the time of enumeration, if a person has no disabilities, circle the reference 1 to indicate it.

2. Physical disability: A physical disability is a limitation on a person's physical functioning, mobility, dexterity, or stamina due to various problems in the structure and movement of spinal curve, muscle, joints, and bones. E.g. (of body parts) - if there are weak, thin, and deformed hand/leg, bending body or any kind of impairments that restricts the general movement of these body parts, such condition should be understood as physical disability. For example: The disabilities caused by polio, cerebral palsy, epilepsy, loss of physical organs, muscular dystrophy, spinal cord injury, club feet, rickets, bone deformities, etc. are physical disabilities. Short heights also fall under physical disability. If a person has any of the above stated physical disability, circle the reference 2.

3. Vision disability: Generally if a person has problems in seeing things clearly around him/her, sees the things blurry, or cannot see at all, it is vision disability. In other words, if a person does not have clear knowledge about an object's picture, size, types, and color due to vision impairment, it is vision disability. Vision disability has two types - (a) Blindness, and (b) Low vision.

(a) Blindness: If a person cannot identify or see his fingers from 10 feet distance even with treatment like medicine, surgery, and use of glasses, or cannot read the first line of the Snellen chart, such person is considered with blindness.

(b) Low vision: If a person cannot identify or see his fingers from 20 feet distance even with treatment like medicine, surgery, and use of glasses or cannot read the fourth line of the Snellen chart, such person is considered with weak vision.

If a person has any type of vision disability stated above (blindness and low vision), circle the reference 3.

4. Hearing disability: The problems of a person in the structure of hearing organs, identification of voice, its distance and location, loudness and quality is the hearing disability. Hearing disability are of two kinds - (a) Deaf and (b) Low hearing.

(a) Deaf: A person who is unable to hear, has unclear voice or inability to speak, and needs sign language for communication is deaf. The person is considered deaf who even cannot hear the sound above 80 decibels. In simple sense, a person should be considered deaf if he cannot hear the communication of two persons near him or completely unable to hear.

[p. 59]

(b) Low hearing: A person who cannot hear sounds clearly but speak clearly with minimum hearing and has to put a hearing device to hear is a person with low hearing or moderate hearing loss. Generally, the person who cannot hear sounds that are less than 65-80 decibels sound is a low hearing person.

If any person has the hearing problems stated above, circle the reference 4.

NB: Generally the person who cannot speak or his/her spoken voice is unclear is call dumb. But actually, they are low hearing people. Such person generally cannot hear clearly. But all the people who cannot hear would not be dumb. If a person cannot speak clearly or the spoken voice is unclear and are unable to hear, circle the reference 4.

5. Deaf and blind: The person having both problems of deaf and blind is considered with deaf and blind disability. If there is a person with such problem in the family, circle reference 5.

6. Speech related disability: The person who has difficulty in speaking, unclear voice, has problem of repeating words or letters while speaking due to the uneasiness in the speech related organs is the person with speech related disability. If a person has speech related disability, circle the reference 6. The person with cleft lips or palate is also counted under speech related disability.

7. Mental disability: Mental disability is a kind of illness. This illness may appear to a person at any age or situation due to failure, distress, or depression. It does not come with birth and can be healed with treatment. A person who has difficulty in daily living due to mental illness or distress should be understood as a person with mental disability. If a person has such problem, circle the reference 7.

8. Intellectual disability: The condition which creates problems or limitations to perform age or environment appropriate intellectual activities due to lack of intellectual development before the age of 18 should be understood as intellectual disability or mentally retarded problem. Intellectual disability is not a disease, it is a state. It might come along with birth. In simple words, the state where required help of others for daily activities of life (e.g. for eating, dressing, going to toilet, care, etc.) or has low memory power (quick forgetting) or slow in learning as per the age should be understood as mentally retarded. Similarly, persons with no sign of adaptive behaviors along with the age development, showing unusual reaction, repeating the same activity or unable to be close to other persons or acute mental illness, autism are also come under intellectual disability and to indicate the status of such person, circle the reference 8.

9. Multiple disabilities: If a person has two or more than two disability problems among the above stated disabilities from 2 to 8, circle the reference 9.