Questionnaire Text

Questionnaire form view entire document:  text  image
P17. What is [the respondent's] disability?
Mark all those that apply

[] 1 Blind
[] 2 Partially sighted
[] 3 Deaf and dumb
[] 4 Deaf
[] 5 Hard of hearing
[] 6 Dumb
[] 7 Mental illness
[] 8 Intellectual
[] 9 Speech impairment
[] 10 Physically disabled
[] 11 Mentally retarded
[] 12 Other
Questionnaire instructions view entire document:  text  image
4.12 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. Remember that people who have just become amputees should be included as disabled. Short term disabilities due to temporary conditions such as broken legs and illness are excluded.

P-17: What is [the respondent's] disability?

Find out whether this person has difficult in the following and shade appropriately. Also note that a person may have more than one disability. Shade all disabilities reported (multiple responses are allowed).

4.12.1 Type of disability

1. Blind: Complete loss of sight in both eyes.
2. Partially Sighted: Loss of one eye or poor sight but does not mean complete blindness.
3. Deaf and Dumb: Complete loss of sense of hearing and speech. The lack or loss of the ability to hear and speak.
4. Deaf: Complete loss of sense of hearing. The lack or loss of the ability to hear.
5. Hard of hearing: Partial loss of sense of hearing but not complete loss of sense of hearing e.g. the person who uses hearing aids.
6. Dumb: Complete lack of ability to speak.
7. Mental illness: A condition of mental illness with a substantial, adverse and long-term effect on one's ability to carry out normal day-to-day activities.
8. Intellectual: Intellectual disability is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.
9. Speech impairment: This is a condition of people who fail to produce meaningful sound words.
10. Physically Disabled: Any person with a physical abnormality relating to the loss of bodily limbs or any deformity in the bodily stature, e.g., the epileptics and leper.
11. Mentally Retarded: Any individual that is either very slow to learn or has defficiency of mental intellect (slow in grasping things, difficulties in remembering things, very slow at responding).
12. Other: Any other disability not mentioned above.