Questionnaire Text

Cambodia 2019 Mauritius 2011 Senegal 2013 Suriname 2012
Indonesia 2010 Mexico 2020 South Africa 2011 Tanzania 2012
Laos 2015 Morocco 2014 South Africa 2016 Vietnam 2019
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Cambodia 2019 — source variable KH2019A_DISCARE — Having difficulty by self-care
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Form B household questionnaire part 2

Individual particulars
[This section except for questions 6 and 8 are to be completed by all persons]

[Questions 17-22 of this section are to be answered by persons aged 5 years and older]

17. Functional difficulty

17.5 Do you have difficulty with self-care (such as washing all over or dressing)?

[] 1. No -- no difficulty
[] 2. Yes -- some difficulty
[] 3. Yes -- a lot of difficulty
[] 4. Cannot do at all

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Indonesia 2010 — source variable ID2010A_SELFCARE — Self-care
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207. Does [the respondent] have difficulties in:
a. Seeing even when wearing glasses?

[] 1 No
[] 2 Some
[] 3 Total


b. Hearing even when using hearing aids?

[] 1 No
[] 2 Some
[] 3 Total


c. Walking or climbing stairs?

[] 1 No
[] 2 Some
[] 3 Total


d. Remembering, concentrating, or communicating with others because of a physical or mental condition?

[] 1 No
[] 2 Some
[] 3 Total


e. Take care of his/herself?

[] 1 No
[] 2 Some
[] 3 Total
Questionnaire instructions view entire document:  text  image

Question 207: Difficulty Carrying out Activities
The intention of this question is to obtain information about the number of disabled persons (functional disability) or those who have some difficulty in carrying out their day to day activities. Ask one by one how normal are the five physical and psychological functions of each household member to learn if they have difficulty: (a) to see, (b) to hear, (c) to walk, (d) to remember, to concentrate or communicate and (e) to take care of themselves.
Put a mark in one of the ovals for each item that indicates the level of difficulty: (1) None, (2) Some, or (3) Severe.
[Graphic illustrating example is not presented here.]

1. Seeing, even though eyeglasses are worn
A person is said to have difficulty seeing if at a distance of 30 cm and with sufficient lighting, he/she cannot see clearly shape, size or color. In the case where even though a person uses an aid (eyeglasses) he/she still has difficulty seeing, then this person is categorized as having difficulty. But, if a person using glasses can see normally, then that person is categorized as not having difficulty.
[p.118]
Those having difficulty seeing include:

a. Totally blind is the condition where there is no vision in either eye.
b. Low vision is the condition where both eyes cannot count the fingers that are being moved at a distance of 1 meter even though the person is wearing eyeglasses or there is sufficient light.
c. Color blind is the condition where both eyes cannot distinguish colors.

Note: If a person experiences difficulty seeing but doesn't wear eyeglasses, ask them how it would be if they were to wear glasses. If by wearing eyeglasses they would not have any difficulty seeing, then categorize this respondent as not having difficulty. On the other hand if the respondent still experiences difficulty when wearing glasses, ask the respondent the extent or degree of the difficulty.
2. Hearing, even though wearing a hearing aid
A person is said to have difficulty hearing if he/she cannot hear voices clearly, differentiate the source, volume and quality of sound and thus cannot respond to the sound properly. A person wearing a hearing aid, who can then hear normally, should not be categorized as having difficulty. Included in this category are those who have a disability in hearing.
Note: If a person has difficulty hearing but does not use a hearing aid, ask this person how it would be if they were to wear a hearing aid. If when using a hearing aid the person doesn't experience any difficulty hearing, then categorize this person as does not have difficulty. On the other hand if the person still has difficulty even though he/she uses a hearing aid, ask the extent or degree of difficulty.
[p. 119]
3. Walking or going up stairs
A person is said to have difficulty walking or going up stairs if he/she cannot walk normally for example going forward, backward, to the side, is unstable or has difficulty climbing stairs. Someone who must use an aid to walk or climb stairs is categorized as having difficulty.
4. Remembering or concentrating or communicating with others due to some physical or mental condition
A person is said to have difficulty remembering/concentrating if he/she experiences difficulty in remembering or concentrating. A person is said to have difficulty communicating if in face to face conversation, without there being anything such as a wall, loud music, something covering the ears, the person has difficulty understanding or can't converse at all due to some physical or mental problem. Included in this category are those who have difficulty hearing and speaking.
5. Take care of one's self
A person is said to have difficulty taking care of him or herself if he/she experiences difficulty with everyday activities such as eating bathing, dressing, going to the toilet, etc.
a. Difficulty eating refers to eating by one's self (being fed by someone else, difficulty using a spoon, fork for eating or difficulty drinking).
b. Difficulty taking a bath and cleansing one's entire body.
c. Difficulty dressing means taking the clothes from the place where they are stored, fastening the clothing [buttons, zippers, etc.], making a knot, etc.
d. Difficulty picking up or holding items (hands are weak, don't have all fingers).


[p. 120]
Select the answer "No" (code 1) if the household member does not have any difficulties. If the household member has difficulties, but can still carry out the activity, then select the answer some"(code 2). If the household member cannot carry out the activity or it is very difficult to carry out the activity, select the answer "severe"(code 3).
Be careful when asking questions about disabilities for babies and children under 5 years of age. For example, for the question about difficulties in taking care of themselves, babies and children under 5 normally are not able to take care of themselves; a baby or child under 5 is not considered to have a disability if he/she cannot take care of himself/herself. Babies and children under 5 of course are not yet able to take care of themselves without the assistance of their parents or others. This is also the case for Q207c and Q207d. A baby who is not yet 1 year old is normally not able to walk. However, if a baby is already 1 and a half years old and the development in walking is retarded or there is no development, then this child can be considered to have a disability. The extent of the disability is no disability, some disability, or severe relative to what is normal.
The purpose of question 207 is to know whether the household member is normal with regard to sight, hearing, walking/climbing stairs, remembering/concentrating/communicating, and taking care of himself/herself. The census only collects data regarding normalcy using observation, knowledge and admission of the household member. The scale used is not very precise. Nevertheless, the enumerator must thoroughly understand the intention of this question regarding difficulties or disabilities. No, some or severe difficulty of a household member is relative to what is considered normal.

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Laos 2015 — source variable LA2015A_DISCARE — Difficulty washing or dressing
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B. For all persons in the household

Do you have any difficulty with the following activities?

Q15. Washing/dressing
[] 1. No difficulty
[] 2. Yes, some difficulty
[] 3. Yes, a lot of difficulty
[] 4. Cannot do at all
Questionnaire instructions view entire document:  text  image
Questions Q11, Q12, Q13, Q14, Q15, Q16: Do you have the following difficulties?
The purpose of the question is to know the difficulties in seeing, hearing, walking or moving, remembering or concentrating, self-caring, speaking, and communicating in the daily life of the household members (except in the case of injury that prevents movement from time to time).
 
The data collection is divided according to categories of disabilities as follows:

Q15: Difficulty in self-care
Refers to a person who cannot or has difficulty in cleaning their body or dressing, such as people who are crippled, partially paralyzed, or wholly paralyzed.


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Mauritius 2011 — source variable MU2011A_DISCARE — Difficulty with self-care
Questionnaire form view entire document:  text  image
Individual form

P12B. If [Yes] at P12A, state the severity of all applicable difficulties as follows:

E. Looking after oneself with regard to feeding, personal care and hygiene

[] 1 Some difficulty
[] 2 A lot of difficulty
[] 3 Cannot do at all
Questionnaire instructions view entire document:  text  image
6. Population census topics and their usefulness

P12A and P12B - Disability
The question provides information which is needed for the formulation and implementation of programs in support of the disabled (e.g. special education, employment and social aid).

8. How to fill in the Population Census Questionnaire

P12A and P12B - Disability
[figure omitted]
This question should be asked tactfully to obtain information as to whether the person has any difficulty to perform a daily-life activity (as listed at P12B - A to I) considered normal for his/her age. If the answer is "Yes", ask for the severity of all applicable difficulties as follows:

1. Some difficulty
2. A lot of difficulty
3. Cannot do at all

[figure omitted]
Shade the degree of severity for all applicable difficulties. If a difficulty is not applicable, leave the corresponding boxes blank.
If a person has reported that he/she is experiencing "I - Other difficulties" at P12B, specify the nature of the difficulty in the adjacent boxes.
[figure omitted]


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Mexico 2020 — source variable MX2020A_DISCARE — Difficulty with bathing, dressing or eating
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10. Disabilities: In day-to-day life, does [the respondent] have difficulty:

Read all options and circle one code for each option: for codes 2, 3, 4 or 5, apply question 11
Bathing, dressing, or eating?
[] 1 No difficulty
[] 2 Little difficulty
[] 3 Great difficulty
[] 4 Unable to do it
Questionnaire instructions view entire document:  text  image
15.3 Section III. People characteristics

In this section, information is obtained for each of the people living in the housing unit.

Before requesting data for each resident, copy the details from Section II. List people and general data, their names, gender, and age, and write them down in the spaces provided. Do not forget to correct the person number when using more than one questionnaire.

[Figure omitted: image with text]

For the respondent to know who to provide the information about, start with the sentence: "Now I'm going to ask you about...", and mention the name of the person you previously wrote down.

Apply questions 1 through 11 for all the people who are habitual residents, including children, as well as elderly people.

10. Disability
This question identifies the degree of difficulty people have in performing some activities in their daily lives, such as seeing, hearing, walking, remembering or concentrating, providing self-care, speaking, or communicating. Also, if they have any mental problems or conditions.

The question consists of two parts. The first part asks about the degree of difficulty in six activities of daily living. The second part identifies people who have a mental problem or condition.

[p. 309]

[Figure omitted: image with text]

To ask these questions, consider the following:

- Apply them to all people living in the housing unit.
- You must circle seven codes for each person.
- In infants and young children, there are cases in which congenital anomalies, illnesses, or injuries are detected that imply difficulties or limitations from birth or in the first years of life. If so, record the difficulty or limitation in the activity stated by the respondent, but if the respondent mentions that the child cannot perform some activity because they are still small, that is, it is typical of the growth stage of babies and small children, do not record it as a limitation. If in doubt, confirm each of the options with the respondent.
- If the person states that they have difficulties typical of an older adult, or that they have any disease or condition such as diabetes, cancer, or arthritis, among others, ask what limits them or prevents them from carrying out their daily activities according to the answer options indicated in the questions.
- In case the respondent anticipates the answer for one or all of the people in the housing unit, it is important that when recording the information corresponding to each one, you confirm whether or not they present some degree of difficulty for each of the activities indicated. Also, check for any mental problems or conditions by circling the appropriate code. Never record the response without confirming the information; this will ensure that the entire population with a limitation or disability is identified.
[p. 310]
- For the application of the first part, read the complete question with each of its six complementary options, as well as each of the four degrees of difficulty, wait for the answer, and circle a code for each type of activity.
- If the respondent expresses discomfort when you apply the DISABILITY question, even though they gave you a general answer for all the residents of the housing unit, make it clear that you have to ask the question for each of them, in order to identify the people with limitations or disabilities, without omitting any of them.
Activity limitations
Keep in mind that activity limitations are difficulties a person may have in performing certain tasks of daily living due to a health problem such as:

- Visual difficulties, to distinguish the shape, size, and color of a visual stimulus at short and long distances and even wearing glasses (frame, contact, or intra-ocular lenses), the person cannot see well due to the advanced stage of a disease or problem visual; as well as total loss and weakness of sight in one or both eyes.
- Hearing difficulties, in one or both ears and who, even using a hearing aid or implant, cannot hear due to the advanced stage of a disease or hearing problem, or those with total or partial hearing loss
[p. 311]
- Walking or mobility difficulties, going up or down steps or slopes using their legs, due to the total or partial lack of legs or immobility of them.
- Difficulties remembering or concentrating due to problems recalling, focusing, keeping attention, recording and storing information, as well as retrieving it when necessary; exclude those activities related to the process of growth or development of the child population (younger than 3 years old). Remember that they are the result of a birth or health condition.
[p. 312]
- Difficulties bathing, dressing, or eating due to problems in performing self-care tasks or limitations in washing, caring for their own body, dressing (includes taking clothes from where they are usually kept, buttoning, tying laces, etc.), eating and drinking, or taking care of their own health. It excludes those activities related to the growth or development process of the child population (younger than 3 years old).
- Communicating or speaking difficulties, are those problems in producing and transmitting messages through oral (spoken) language, such as expressing a fact or telling a story; it includes the loss or restriction of speech, as well as difficulties in maintaining and understanding a conversation. It excludes limitations related to the growth or development process of the child population (younger than 3 years old).

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Morocco 2014 — source variable MA2014A_DISCARE — Difficulty taking care of himself or herself
Questionnaire form view entire document:  text  image
Difficulties in carrying out everyday activities

For all members of the household, specify the degree of difficulty the person has in
[Questions 16 to 21 were asked of all household members]

20. Taking care of him/herself, such as bathing or dressing

[] 0 Without difficulty (SD)
[] 1 Slight difficulty (DL)
[] 2 Considerable difficulty (GD)
[] 3 Unable to do so (IN)

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Senegal 2013 — source variable SN2013A_DISDAILY — Difficulty in self-care activities
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B. Individual characteristics

The entire population
[Questions B16 through B28 were asked of all resident persons.]

Population aged 1 year or older.
[Question B21 through B26 were asked of all resident persons age 1 or older.]

B21-B26. The following questions pertain to difficulties which you may have in carrying out certain activities due to a health problem.

Enter the corresponding codes to the answer given (see the bottom of the page)
B25. Does [the respondent] have any difficulties (in terms of self-care) in performing activities such as washing or bathing?
[] 0. No, no difficulties
[] 1. Yes, some difficulties,
[] 2. Yes, many difficulties
[] 3. not at all capable
Questionnaire instructions view entire document:  text  image
4.2. Part B: individual characteristics

B21/26: set of short questions on disability recommended for the censuses (population aged 1 year and over)
The questions about disability issues have been greatly altered in relation to what previous censuses proposed. It is about Senegal aligning itself with the progress made in this area. The United Nations, through their experts on global statistics, created in the 2000s a group of experts, the Washington group, which developed a series of short questions for censuses and surveys according to the Basic Principles of Official Statistics. These questions identify the majority of those most at risk in the general population who have limited or restricted participation in public life. It is not a question of identifying the handicap or the cause of disability, the question is to identify the limitations of the respondent (and/or one of his or her family members) to have/potentially have difficulty in performing actions linked to their lifestyle and related functions: seeing, hearing, walking, having cognitive faculty, taking care of themselves, and communicating. These are the areas the questions included in the census questionnaire concern.
The questions to ask relate to the difficulties that the respondent or a family member may have in fulfilling certain tasks in a sustainable manner (6 months or more, in a recurring manner):

1) Do you have difficulty seeing, even if you wear glasses?
- The answer of a person who wears glasses and has no difficulties will then be codified by choice 0 on the PDA.
- On the other hand, the answer of someone who wears glasses and who still has difficulties in seeing must be codified in 1 or 2 depending on the degree of difficulty in seeing.
2) Do you have difficulty hearing even with a hearing aid?
- In the same vein: the response of a person with a hearing aid (it is a device in the ear) but who would still have difficulty hearing would be codified in 1 or 2 depending on the degree of difficulty.
3) Do you have difficulty walking or climbing stairs?
4) Do you have trouble remembering or concentrating?
5) Do you have any difficulties (in taking care of yourself) in performing activities like washing yourself or dressing yourself?
[p. 41]
6) Using your usual (common) language, do you have difficulty communicating, (for example, to understand or make yourself understood by others)?

Each question has four response categories:

0 No, no difficulty,
1 Yes, some difficulties,
2 Yes, lots of difficulties,
3 Not at all able to do it.

The severity scale is used in the response categories to identify the full range of functional domains ranging from the most benign to the most severe form. This is very important because we will have a full range of the respondent's capabilities.
NB: This question concerns the population aged at least 1 year.
On the PDA, you will choose the answer on a drop-down list.


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South Africa 2011 — source variable ZA2011A_DIFFCARE — Difficulty with self care such as washing, dressing or feeding
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Section C: General health and Functioning
Ask of everyone listed in the flap.

P-12 Health and functioning
Does [the person have difficulty in the following?
Write the appropriate code [number from 1 to 6] in the box.

_ A. Seeing even when using eye glasses
_ B. Hearing even when using a hearing aid
_ C. Communicating in his/her language (i.e. understanding others or being understood by others)
_ D. Walking or climbing stairs
_ E. Remembering or concentrating
_ F. With self-care such as washing all over, dressing, or feeding
1. No difficulty
2. Some difficulty
3. A lot of difficulty
4. Cannot do at all
5. Do not know
6. Cannot yet be determined
Questionnaire instructions view entire document:  text  image
5. Section C: General health and functioning (remember to follow instructions)
Purpose: Helps to determine the number of people with disabilities in the country for planning and provision of services.

This section must be completed for every person listed on the questionnaire.

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South Africa 2016 — source variable ZA2016A_DISCARE — Difficulty with self-care
Questionnaire form view entire document:  text  image
3. Person information

[3.7] Household members

[3.7.3] General health and functioning
Now, I am going to ask you health-related questions.

[3.7.3.7] Does the respondent have difficulty with self-care such as washing, dressing or feeding him/herself?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Cannot do at all
[] 5 Do not know

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Suriname 2012 — source variable SR2012A_DISCARE — Difficulty with personal care
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Personal module

All persons (health)
[Questions P21a to P23 were asked of all persons about their health.]

P21a. Does this person experience difficulty / problems (with):

N.B.: The person has had (or is expected to have) the complaint(s) for at least 6 months.

Enter one of the following codes in each cell:

[] Tick this box if A to G = 1, 5, 7 or 9, and proceed to P22.
E. Personal care
[] 1 No difficulty / problems
[] 2 Some difficulty
[] 3 Much difficulty
[] 4 Not able to do this at all
[] 5 Doesn't apply, considering age
[] 7 Don't know
[] 9 No response

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Tanzania 2012 — source variable TZ2012A_DISCARE — Difficulty with self-care
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B. All persons
[Questions 1-19 were asked of all persons.]

Disability

11. Self-care

Does [the respondent] have difficulty in self-care, such as washing all over or dressing?

[] 1 No difficulty
[] 2 Some difficulty
[] 3 A lot of difficulty
[] 4 Unable to care
[] 5 Not applicable
Questionnaire instructions view entire document:  text  image
Questions 6 to 11 aim to get information on the disability status of people in the communities.
Is [the respondent] an albino, or has difficulty seeing, hearing, walking or climbing stairs, remembering or concentrating, caring for him/herself such as washing or dressing, has a cleft palate, has spinal befida, has spinal cord injuries, mental illness, or psoriasis?

Questions description
These questions aim to obtain information about disability status in the communities.
Answers on these questions will enable the nation understand how many people have disabilities and types of disabilities, and thus allow the nation develop sustainable programs for this special group in the community.

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Vietnam 2019 — source variable VN2019A_DISCARE — Difficulty with self-care
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Part 1. Information on household members

The next questions are about difficulties a person faces when performing certain activities due to health reasons.

13. Does [the respondent] have any difficulty with:

(If yes: How difficult is it? difficult, very difficult or completely unable)
e) Self-care (bathing, changing clothes, eating, going to the bathroom, etc)?
[] 1 Not difficult
[] 2 Difficult
[] 3 Very difficult
[] 4 Unable
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Part V: Instructions on how to question and record information on the census form

Part 1: Information about members of the household
Part 1 of the Census form consists of 41 questions, numbered sequentially from Question 1 to Question 41.

The respondent is the head of the household or a person knowledgeable about members of the household. For information on employment and birth history of women, DTV needs to interview DTDT face-to-face and collect information. In addition, for other information about members of the household, if the head of the household or the information provider is not knowledgeable, DTV also needs to interview DTDT face-to-face and record the information.

Question 13: Does [the respondent] have any difficulty when [...]?
This question is intended to gather information about difficulties a person may encounter in performing certain activities due to health problems/long term health problems, including difficulties due to the effects of old age, but does not include difficulties due to the children being young or not yet proficient in taking care of themselves (help from adults).

DTV asks about the conditions and level of difficulty of each person and in turn according to each ability, including vision, hearing, walking up the stairs, memory, self-care, and communication. Therein:

-Vision, even with glasses: DTV asked about the conditions and level of difficulty of DTDT when seeing. In case people have difficulty and have to wear glasses, DTV asks if they still have difficulty when wearing glasses and if so, the level of difficulty.

-Hearing, even with a hearing aid: DTV asks about the conditions and level of difficulty of DTDT when hearing. In case people have difficulty and have to use a hearing aid, DTV asks if they still have difficulty when using a hearing aid and, if so, the level of difficulty.