Questionnaire Text

Questionnaire form view entire document:  text  image

Disability

P11. Does [respondent] have any physical or mental disability?

Encircle code

1 Yes
2 No, skip to P13.


P12. What type of disability does [respondent] have?

___ Enter appropriate code listed below.
If others, specify.

1 Blindness
2 Deafness
3 Muteness
4 Deafness/Muteness
5 Speech Impairment
6 Mental Illness
7 Mental Retardation
8 Orthopedic Handicap
9 Multiple Disability
0 Others, specify
Questionnaire instructions view entire document:  text  image

P11 and P12 Disability

Disability refers to any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Data on disability will enable planners to prepare plans for rehabilitation, education development and preventive programs.

P11 - Does ____ have any physical and mental disability?

Ask the question in P11, "Does ____ have any physical or mental disability?" for all persons. If the answer is Yes, encircle 1 in P11 and ask the question in P12, "What type of disability does ____ have?". Otherwise, encircle 2 in P11 and enter a dash (-) in P12.

P12 - What type of disability does ______ have?

A person is considered physically or mentally disabled if he has any of the following impairments:

1 Blindness - if one eye or both eyes are reported totally blind and have no vision.

2 Deafness - if one ear or both ears are reported the incapable of hearing sounds or noises. A person can be completely deaf or partially deaf. Completely deaf persons do not hear sounds or noises at all. Partly deaf persons can hear or respond to loud noises only, but not to soft or low noises. Persons who are partly deaf hear a little when people speak to them.

3 Muteness - if the person is unable to speak or utter words.

4 Deafness and Muteness - if the person is reported to be both deaf and mute.

5 Speech Impairment - if the person can speak but not sufficiently clear to be understood. This also includes those people who can only make meaningless sounds.

6 Mental Illness - if the person suffers from schizophrenia, manic depressive illness, psychosis, or severe depression characterized by strange behavior.

7 Mental Retardation if the person has disorders/damage of the brain resulting in mental retardation.

8 Orthopedic handicap - if the person suffers from bone deformities or has the following impairments:

- absence or deformity of one or both hands or arms
- absence or deformity of one or both feet or legs
- fractures
- severe scoliosis kyphosis third degree burns, etc.


9 Multiple Disability - if the person is reported to have a combination of two or more disabilities.

0 Others - if the answer does not fall in any of the pre-coded answers, write the answer as stated by the respondent on the space provided. Examples: cancer, leprosy, paralysis, cerebral palsy, cross-eyed, etc.