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1、The Definition and Measurement of Disability: The Work of the Washington Group (continued),Daniel Mont Disability and Development Group The World Bank November 9, 2006,Cognitive Testing,Cognitive testing was undertaken in 15 countries to ensure validity and better understand how the questions operat
2、e. Purposive Samples Asked WG question and series of detailed questions in the same domains Collected information on response process Analyzed problematic response patterns Questions performed well with a few issues: Glasses and hearing aid clauses Communication question,More detailed questions on f
3、unctioning. For example, Cognitive Questions,Do you have difficulty remembering the names of people or places? Do you have difficulty remembering appointments? Do you have difficulty remembering how to get to familiar places? Do you have difficulty remembering important tasks, like taking medication
4、s or paying bills? Do you have difficulty concentrating on doing something for ten minutes? Do you have difficulty learning a new task, for example, learning how to get to a new place? Do you have difficulty finding solutions to problems in day to day life?,Information on response process,Questions
5、to interviewers Need to repeat any part of the question? Any difficulty in using response options? Did respondents ask for clarification or qualify their answers? Follow-up probes to understand response process,Correlates of cognition difficulty,Correlates of cognition difficulty,Socio- demographic
6、correlates of cognition difficulty,Overall, questions worked well,Well understood Responses consistent Two problem areas Glasses clause WG is revisiting but solution has a lot to do with translation protocol Communication Question WG will revisit to see if question can be simplified,Field Testing,Un
7、dertaken in South Africa and Vietnam Checking for Internal consistency Results comparable to changes seen in other countries with move towards functional approach to measuring disability,WG Census Question vs. Extended Questions For Field Test,Constructed three thresholds for disability based on WG
8、census question: D1=1 if any difficulty, D2=1 if a lot, D3=1 if unable to do Constructed three thresholds for disability based on extended questions: ED1, ED2, ED3 What was the D measure picking up compared to the ED measures?,Example: Mobility question,WG question: Do you have difficulty walking or
9、 climbing steps? D1=1 if “some difficulty”, “a lot of difficulty”, or “cannot do at all” D2=1 if “a lot of difficulty” or “cannot do at all” D3=1 if “cannot do at all” Extended Questions: Do you have difficulty going outside of your home?(0) Do you have difficulty walking a long distance such as a k
10、ilometer (or a mile)? ED1=1 if “some”, “a lot” or “cannot do” for either question ED2=1 if “a lot” or “cannot do at all” for either question ED3=1 if “cannot do at all” for either question,Vietnam Disability Rates Thai Binh Province,Functional Questions Lead to Higher Rates of Disability,Many Develo
11、ping Country Censuses ask “Do you have a disability?” but People think of disability as very serious and wont report minor or moderate disabilities “Disability” creates shame and stigma so people do not want to identify themselves that way, People think of disability relative to their expectations o
12、f normal functioning so it undercounts the elderly Switch to Functional Questions raises disability rate E.g., Brazil 14.5%, Ecuador 12.1%, Zambia 13.1%, Nicaragua 10.3%,But, no such thing as a single prevalence rate,In Ecuador, 12.1% of the population has a disability but 4% are significantly disab
13、led. Which is the right number? In a field-test of WG questions in India, 4% of the population has great difficulty walking or cannot walk, but 18% of the population has some difficulty walking? Which is the right number? It depends why you are asking,SINTEF study in Zambia (Loeb and Eide),Nationall
14、y representative sample WG questions as screen All disabled respondents asked detailed follow-up activity limitation questions Sample of non-disabled respondents asked similar questions,9 Domains & 44 Activities,Basic learning & applying knowledge: reading, writing Communication: producing and recei
15、ving messages Mobility: walking, moving around Self-care: washing, dressing Domestic life: shopping, preparing meals Sensory experiences: watching, listening Interpersonal relations: making friends, interacting with strangers Major life areas: going to school, getting a job Community, social and civ
16、ic life: clubs, religious, politics,Activity Limitation (a measure of capacity),How DIFFICULT it is for you to perform this activity WITHOUT ASSISTANCE? 0 - no difficulty 1 - slight difficulty 2 - moderate difficulty 3 - severe difficulty 4 - unable to carry out the activity,Activity Limitations,Activity limitation score,Disability Data Collection Recommendations,Do not use the word disability Functional approach Separate functional domains Scaled Responses Definition of disabilit
