Questionnaire Text

Questionnaire form view entire document:  text  image

8. Check if the respondent was born before April, 2004 (5 years or older). [If yes, go to] Q9; otherwise, ask the next [person]
[Questions 9-16 were asked of persons age 5 or older]


11. Does [the respondent] have any difficulty:
If yes, how difficult is it? A little, very difficult, or unable.

a) Seeing (even if wearing glasses)?

[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable

b) Hearing?

[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable

c) Walking?

[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable

d) Remembering or paying attention?

[] 1 No difficulty
[] 2 A little difficulty
[] 3 Very difficult
[] 4 Unable

Questionnaire instructions view entire document:  text  image

Question 11: Does [the respondent] have any difficulty when...?
This question aims at the collection of information on disabilities of the respondent. The question is divided into 4 sub-questions to ask the respondent of the four abilities of seeing (even if wearing glasses), hearing, walking, and remembering or attention concentration. Therefore the enumerator must ask each of the abilities individually (three dots in [...] will be replaced by each of the above-mentioned abilities when interviewing).

For example: firstly, the enumerator asks "Does [the respondent] have any difficulty when seeing, even if wearing glasses?" If the answer is "No", the enumerator marks (x) in the small box next to code "1" (no difficulty), and asks the second ability "Does [the respondent] have any difficulty hearing?" If the answer is "Yes", the enumerator asks the respondent, "How difficult is it: difficult, very difficult or unable?" Basing on the answer of the respondent in combination with looking at the respondent (if he/she is present), the enumerator marks (x) in the appropriate small box. After that, the enumerator will ask about the next ability. Continue as such until the last ability, "Remembering or attention concentration".

[Graphic example omitted]

Note: Generally, the determination of the level of disability of the above-mentioned abilities is done by the respondent him/herself. However, a person who is clearly disabled cannot be classified as "No difficulty" on the ability that the person faces the problem, even he/she has answered "No difficulty". For example: a man with a bad eye cannot be classified as "No difficulty", even he answered that "he views things normally". Similarly, if a leg of the respondent is truncated, then that man cannot be classified as "No difficulty" even he answered that "he walks normally", etc.