Questionnaire Text

Questionnaire form view entire document:  text  image
Details of persons in the household -- All household members
[Questions 1 to 14: All persons]


14. Does [the respondent] have any difficulty in moving, seeing, hearing, speaking or learning?

(Mark all that apply)
[] 1 Limited use of legs
[] 2 Loss of leg(s)
[] 3 Limited use of arms
[] 4 Loss of arm(s)
[] 5 Difficulty in hearing
[] 6 Deaf
[] 7 Difficulty in seeing
[] 8 Blind
[] 9 Difficulty in speaking
[] 10 Mute
[] 11 Mental disability
[] 12 No disability
[] 13 Don't know

Questionnaire instructions view entire document:  text  image

Q14 "Does [the respondent] have any difficulty in moving, seeing, hearing, speaking or learning?" Continuing with the first person listed "Person 01", ask question 14. You must ask the question exactly as it is written on the questionnaire. Do not ask if the person has any form of handicap or disability.
  • If the respondent states that a person has no difficulty in moving, seeing, hearing, speaking or learning, shade "12" for "No disability"
  • If the respondent states that a person does have difficulty in moving, seeing, hearing, speaking or learning, ask the respondent to mention all problems the person has. Shade the appropriate number of all problems mentioned. For example, a person may be deaf and mute, which means that you would shade "6" for "Deaf" and "10" for "Mute"
  • If the respondent doesn't know if a person has any difficulties, ask if anyone else in the household would be able to answer the question. If no one is able to speak for the person, then shade "13" for "Don't know"
  • This is a multiple response question. Shade all difficulties mentioned for a person, or shade 12 for "No disability" or 13 for "Don't know"