Using the WG questions for the first time

What are the important considerations for using the WG question sets in a new setting?

Short Answer

 The WG question sets should be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability. A possible exception is if pre-testing highlights aspects of the questions that are not relevant or confusing in particular contexts. One example is eliminating the clause about hearing aids in a location where they are not available. If in any doubt, it is best to contact the Washington Group.

If additional information on functioning is required, the extended set can be used or questions can be added the short set, rather than taking away or changing the set items. If questions are added they should follow the WG questions instead of preceding them or being interspersed among them.

If resources really do not allow all six questions to be included, the first four questions (seeing, hearing, walking/climbing and remembering/concentrating) are considered essential.

The introductory sentence ‘The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM’ was included as a way of transitioning from one section of the questionnaire to another. Programs may choose not to use this introductory sentence, but it is important to not replace this with a sentence that uses the term ‘disability’.

Programs reporting on data that have been gathered using the WG tools need to articulate clearly how the questions were used, the age range of participants and the cut-off points used to determine disability status.

Extended Answer

The WG question sets have been carefully developed and tested and should be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability. With respect to the latter, see Q3 below. Extensive testing and experience in a variety of contexts has demonstrated that making changes to the questions in an attempt to ‘improve’ them tends to have unforeseen consequences in terms of reducing accuracy. Using the questions as developed also allows for comparability of data across communities and contexts. A possible exception is if pre-testing highlights aspects of the questions that are not relevant or confusing in particular contexts. In this situation small adaptations, such as removal of reference to the use of hearing aids in contexts where they are not used, can be made. If in any doubt, it is best to contact the Washington Group and ask about the implications of any adaptations.

If additional information on functioning is required, questions should be added to the short set, rather than taking away or changing the set items. For example, programs may want more information on availability and use of assistive devices. In this instance a question similar to that included in the WG Extended Set such as ‘Do you wear glasses?’ can be included.  If questions are added they should follow the WG questions instead of preceding them or being interspersed among them, as the order in which questions are asked can influence the responses.

If resources really do not allow all six questions to be included, the first four questions (seeing, hearing, walking/climbing and remembering/concentrating) are considered essential.

The short intro to the question set was developed given the census context where questions cover many disparate areas.  The introductory sentence ‘The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM’ was included as a way of transitioning from one section of the questionnaire to another. Programs may choose not to use this introductory sentence, but it is important to not replace this with a sentence that uses the term ‘disability’. The WG Short Set has deliberately been developed to focus attention on functioning and does not use the term ‘disability’ given the many different ways it can be interpreted and the stigma that can be associated with the term.

Programs reporting on data that have been gathered using the WG Short Set need to articulate clearly how the questions were used, the age range of participants and the cut-off points used to determine disability status. To allow comparison of data across programs, ANCP partners should be using the same cut-off point to identify disability.

How do I translate the questions into the local language(s)

Short Answer

An accurate translation that conveys the context or conceptual meaning (rather than a literal translation) of the WG Short Set is crucial. Avoid situations where bilingual enumerators translate the questions at the time of administering the survey, as it means that enumerators will be asking different questions.

The WG is currently developing official translations. If a country has appropriately translated the Short Set for use in their national census, use this version. A translation protocol exists which should be used in conjunction with cognitive testing. The old translation/back translation protocol is not recommended. Do not change the wording of the questions unless cognitive testing highlights particular concerns with the current wording

There is a translation guideline and we recommend reading this page to ensure an accurate translation for cognitive testing and data collection.

How do I train the enumerators?

Short Answer

Training enumerators on how to properly use the Short Set is crucial and would ideally be followed up by ongoing supervision in the field. Key points to emphasise to enumerators:

  • The reasons why WG focuses on ‘functioning’ as opposed to ‘disability’
  • The use of screening questions (e.g. ‘Do you have a disability?’) or introductory statements (e.g. ‘The next set of questions are about disability’) should be avoided, as they will affect responses to the subsequent short set questions. Screening questions or statements should not be used under any circumstances.
  • Questions need to be asked exactly as they have been worded.
  • Enumerators should never skip questions or fill in the answers based merely on their observations

Extended Answer

Many ANCP programs work with local partners to implement activities on the ground, including data collection to support monitoring and evaluation. Local partners differ in their understanding of disability, and their capacity to appropriately use the WG Short Set in communities and then analyse and use the data to inform programs. Training enumerators in how to use the Short Set is therefore crucial and would ideally be followed up by ongoing supervision in the field. Key points to emphasise in training include:

  • The reasons why WG focuses on ‘functioning’ as opposed to ‘disability’, noting that the questions are not diagnosis, disease or condition-based, but instead are looking at difficulties that anyone might experience.
  • The use of screening questions (e.g. ‘Do you have a disability?’) or introductory statements (e.g. ‘The next set of questions are about disability’) will affect responses to the subsequent short set questions. Screening questions or statements should not be used under any circumstances, whether in a census or in a household survey.
  • Questions need to be asked exactly as they have been worded. If questions are explained to participants using inappropriate or negative language, this may influence the way participants respond. This includes the response categories. These should be kept as is, and definitely not changed to yes/no responses.
  • Enumerators should never skip questions or fill in the answers based merely on their observations (e.g. if they observe that respondent is using a wheelchair): they must ask all the questions to the participant. 

 

Can we adapt the WG Questions to meet our needs?

Short Answer

In short, this is not recommended. The WG Short Set have been carefully developed and tested and should be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability

Extensive testing and experience in a variety of contexts has demonstrated that making changes to the questions in an attempt to ‘improve’ them tends to have unforeseen consequences in terms of reducing accuracy.

There are some possible exceptions for adaptations. Please contact the WG if you need to make adaptions.

 

How is disability determined using the six questions with four response categories?

Short Answer

 The WG question response categories capture a range of severity in the difficulty experienced. Multiple disability scenarios can be described depending on the domain(s) of interest and the choice of severity cut-off.

The WG recommends that the following cut-off be used to define the populations with and without disabilities

The population people with a disablity includes everyone with at least one domain that is coded as a lot of difficulty or cannot do it at all.

Countries using the WG short set of questions should not feel restricted to only producing data based on the above cut-off. Data can be presented by individual domains of functioning, and at several levels of severity from very mild (some difficulty) to very severe (unable to do at all).

Extended Answer

The WG question response categories capture a range of severity in the difficulty experienced. Multiple disability scenarios can be described depending on the domain(s) of interest and the choice of severity cut-off. There is more than one way to capture disability through the application of this set of core questions; resulting in not one but several possible population prevalence estimates that will vary in both size and in composition of the group identified as having a disability.

The WG recommends that the following cut-off be used to define the populations with and without disabilities for the purpose of computing prevalence and differentials in participation for international reporting and cross-national comparability:

The population disabled includes everyone with at least one domain that is coded as a lot of difficulty or cannot do it at all.

Countries using the WG short set of questions should not feel restricted to only producing data based on the above cut-off. Data can be presented by individual domains of functioning, and at several levels of severity from very mild (some difficulty) to very severe (unable to do at all). For example, discovering that in rural regions of the country participation restrictions tend to kick in at lower levels of activity limitations than in urban areas could be suggestive that barriers to participation are more significant in areas with poorer infrastructure.

 

Can I change the introductory statement?

Short Answer

The introductory sentence ‘The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM’ was included as a way of transitioning from one section of the questionnaire to another. Programs may choose not to use this introductory sentence, but it is important to not replace this with a sentence that uses the term ‘disability’

 

Can I use proxy respondents to answer the questions?

Short

The questions were designed ask about individual functioning and therefore questions need to be asked of individuals.  If the questions are revised to ask if ‘anyone in the household’ has difficulty in each of domains, households with a member with a disability can be identified but this doesn’t allow understanding of the different experiences of family members with and without disabilities. It may be necessary to use a proxy if a person is unable to give consent or participate directly due to their level of functional difficulty. Proxies tend to under-identify people with disabilities but are highly preferable to skipping respondents who cannot answer.

Extended

 The questions were designed to be asked about individual functioning.  If the questions are revised to ask if ‘anyone in the household’ has difficulty in each of domains, households with a member with a disability can be identified but unless intra-household equity in participation and access can be assumed, it doesn’t allow understanding of individual level access to programs. This makes it difficult to evaluate whether the program has effectively included people with disabilities. Questions need to be asked directly of individuals. Proxy respondents answering functioning or disability questions tend to under-identify persons with functional limitation, either deliberately or inadvertently. It is necessary to use a proxy if a person is unable to give consent or participate directly due to their level of functional difficulty.  If a proxy is not used, person with functional limitations will be missed.  A key challenge is that individual level surveys cost more than obtaining information from the head of the household or some other community informant. However, there are ways to reduce the costs of the data collection. If the program visits households and interacts with household members for other purposes, data collection can be incorporated into those visits. It is also not necessary to obtain information on all program participants, but to obtain the information needed using a random sample of participants.

 

Can I use the key informant method to identify specific individuals with disabilities for further support?

Short

While the key informant method may identify some people with disabilities, assessing functioning of individuals through observation or assumed knowledge of individuals is subjective and can be very inaccurate. Using the key informant method to identify people with disabilities for services will likely miss many persons with disabilities.

This method might be appropriate in some situations however it must be understood that the estimates will likely be an underestimate and it will be difficult to determine the magnitude of the underestimate. This approach could be seen as a first step to be followed up by a broader data collection at the individual level

Extended

 While the key informant method may identify some people with disabilities, particularly those with more obvious types of impairment, assessing functioning of individuals through observation or assumed knowledge of individuals is subjective and can be very inaccurate.

This method might be appropriate in some situations if programs are interested in getting a preliminary count of the number of persons with functional limitations in area of interest.  It must be understood that the estimates will likely be an underestimate but it will be difficult to determine the magnitude of the underestimate. This method also doesn’t allow for disaggregation of by disability and other characteristics (i.e. age, gender).  This approach could be seen as a first step to be followed up by a broader data collection at the individual level such as using the WG Short Set on a representative sample of the community (e.g. one in ten households, or one in five people at a community event).

In some data collection efforts, key informants used tend to come from the membership of Disabled People Organizations because they are easy to locate. It should be kept in mind that this is not a representative group. They tend to be more knowledgeable and have greater access to services.

Using the key informant method to identify people with disabilities for services will likely miss many persons with disabilities who could be program participants.

 

What is the age suitability of the question sets?

Short

 The domains covered by the WG questions are suitable for children five years and above.  However, the WG has acknowledged that the short set of questions are not ideally suited for the child population, and that certain domains of functioning particular among children will be ‘missed’ when using the short set, especially children with developmental disabilities. The WG is currently collaborating with UNICEF to develop and test the Washington Group/UNICEF Module on Child Functioning and Disability. The Child Functioning questions  can be found on this website 

Extended

The domains covered by the WG questions are suitable for children five years and above, however there are other domains that are also relevant to child development which are not covered in the WG Short Set. The WG has acknowledged that the short set of questions are not ideally suited for the child population, and that certain domains of functioning particular among children will be ‘missed’ when using the short set; for example, difficulty learning, focusing attention, or controlling behaviour. While the short set has been used for children (5 years and older) in a census format, a tool developed specifically for use with children is currently being developed by the Washington Group and UNICEF to more accurately identify disability in children (i.e., those children at a higher risk of limited participation because of difficulty functioning). The WG is collaborating with UNICEF to develop and test the Washington Group/UNICEF Module on Child Functioning and Disability. UNICEF and the WG have also begun a similar process to develop a module on inclusive education: identifying facilitators and barriers to school participation for children with disabilities.

For more information, see the Child Disability question set page .

 

I don’t have the resources to add all 6 questions to my census/ survey, what should I do?

Short

If resources do not allow all six questions to be included, the first four questions (seeing, hearing, walking/climbing and remembering/concentrating) are considered essential.

 

 

 

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This page was updated on: Thursday, February 25, 2016
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