Questionnaire Text

Questionnaire form view entire document:  text  image
Section V. Characteristics of the population

9. The following are some questions to find out if you have any permanent difficulty or limitation that prevents you from carrying out your daily activities normally. Do you have any permanent difficulty or limitation for:

(Read each alternative and fill in only one oval)

[] 1 Seeing, even when wearing glasses?
[] 2 Hearing, even with hearing aids?
[] 3 Speaking or communicating, even using sign language or other language?
[] 4 Moving or walking to use arms and/or legs?
[] 5 Understanding or learning (concentrating and remembering)?
[] 6 Relating to others based on thoughts, feelings, emotions, or behaviors?
[] 7 None
Questionnaire instructions view entire document:  text  image
For all persons
[Questions 1 to 10 are asked of all persons]

Question 9: Permanent difficulty or limitation

The following are some questions to find out if you have any permanent difficulty or limitation that prevents you from carrying out your daily activities normally, do you have any permanent difficulty or limitation for:

  • If, when reading each option to the respondent, he/she answers affirmatively, then fill in the corresponding oval.
  • Option 7, "none", should not be read. Fill it in only when the respondent answers that he/she does not have any permanent limitation or difficulty.


Disability: When a person has some permanent difficulty that limits him/her in one or more of the essential activities of daily living in the manner and amount expected for their age.

Seeing, even when wearing glasses: When the person has any sensory limitation as a result of the lack or dysfunction of the organ of vision, which totally or partially restricts the perception of light and images.

Hearing, even with hearing aids: When the person has some limitation in the sense of hearing (ear), which totally or partially restricts the detection and discrimination of sounds, their localization and the differentiation of speech from other sounds.

Speaking or communicating, even using sign language or other language: When the person presents some limitation in voice and speech, or in other way that prevents him/her from communicating with others and performing daily activities.

Sign language: Sign language, or signed language, is a natural language of gesture-spatial expression and visual perception (or even tactile perception by certain people with deaf/blindness).

Moving or walking to use arms and/or legs: When the person presents some motor limitation, to grip or hold objects or to stretch the arms; in the displacement or movement to walk, move from one place to another, use stairs, bend or kneel.

Understanding or learning (concentrating and remembering): When the person has limitations to develop activities of intellectual nature, i.e., the difficulty he/she has in comprehending, retaining, understanding, analyzing and transmitting ideas. Example: people with mental retardation, brain injury, meningitis with seizures.

Relating to others based on thoughts, feelings, emotions, or behaviors: When the person presents some psychic limitation, referred to mental disorders (addictive, psychotic, anxiety and personality disorders) that make it difficult or permanently prevent him/her from relating to others based on thoughts, feelings, emotions or behaviors.