Questionnaire Text

Questionnaire form view entire document:  text  image
Special Group Population
15. Is any member of the household disabled in any way?
[] Yes (fill in Disability Supplement)
[] No
Questionnaire instructions view entire document:  text  image
5.4 Disability

You are about to start a rather sensitive topic. Prepare the respondent by telling him/her that you are now going to start asking questions on disability.
A person with a disability is defined as a person who is limited in the kind or amount of activities that he or she can do because of the ongoing difficulties due to a long term physical condition, mental condition or health problem. Short term disabilities due to temporary conditions such as broken legs and illness are excluded. Only disabilities lasting for more than six months should be included.

P15 Are You Disabled in any Way?
Find out whether this person is disabled and shade appropriately. If the respondent is not disabled, skip to P18.

P16 What is Your Disability?
Find out what disability the person has and shade appropriately. Also note that a person may have more than one disability. Shade all disabilities reported.

5.4.1 Types of Disability

a. Blind: Complete loss of sight.

b. Partially Sighted: Loss of one eye or poor sight but does not mean complete blindness.

c. Deaf: Complete loss of sense of hearing.

d. Hard of Hearing: Partial loss of sense of hearing, and not complete loss of sense of hearing.

e. Mentally Ill: Psychological disorder related to the individual's mental state or state of mind.

f. Ex-mental: Any person that has suffered from mental disorder before but is now rehabilitated/or medically treated/or is undergoing rehabilitation.
g. Mentally Retarded: Any individual that is either very slow to learn or has deficiency of mental intellect (slow in grasping things, difficulties in remembering things, very slow at responding).

h. Physically Handicapped: Any person with a physical abnormality relating to the loss of bodily limbs or any deformity in the bodily stature, eg, the epileptics and lepers.