Do the questions refer to the use of assistive devices?

The intention with the Short Set questions is to record, with the exception of seeing and hearing, difficulties people have with unaccommodated functioning (without the use of assistive devices or assistance).

The WG wants to be able to identify difficulties in functioning that may put a person at risk of limited or restricted participation. That risk of restricted participation – in the absence of accommodations – is ‘disability’ as defined by the UN Convention on the Rights of Persons with Disability (CRPD).

The domains of seeing and hearing are handled differently. In many cultures, both glasses/lenses and, to a lesser extent, hearing aids are ubiquitous and in most cases the use of these devices, especially glasses, is able to correct the difficulty almost completely. For this reason they are considered ‘within the skin’ or a part of the person. If, for example, the WG were to ask about difficulty seeing without the use of glasses, the resultant prevalence would be extremely high and would not identify a population at risk of participation restriction. However, in places where glasses or hearing aids are not common, the clause ‘even when wearing glasses’ can be omitted.

Can I change the answer categories?

Disability is not a Yes/No dichotomy but describes a dynamic and complex relationship between a person, the environment in which they live and their ability to participate in society on an equal basis with others.  The aspects of functioning that are captured by the six questions are also not dichotomies; functioning in each of these domains exists on a continuum.

A question with a Yes/No response option forces the person answering to self-identify as having the difficulty or not. It is better to offer a range of responses as in the WG questions. The four answer categories recommended by the WG describe a continuum of functioning from: no difficulty to cannot do at all. The continuum can be visualized like this:

The distribution above creates four points equally distributed among the continuum that allows respondents to easily discriminate among options. The recommended cut-off (at a lot of difficulty) identifies those with the intended level of difficulties. 

Can I ask a subset of the six questions? I don’t have the resources to add all 6 questions to my census/ survey, what should I do?

A comprehensive measure to determine disability includes all six domains of functioning: seeing, hearing, walking/climbing steps, remembering/concentrating, self-care and communication.

As noted in the 3rd revision of the Principles and Recommendations for Population and Housing Censuses (UNSD: https://unstats.un.org/unsd/statcom/doc15/BG-Censuses.pdf) four domains of functioning: seeing, hearing, walking/climbing steps, and remembering/concentrating are considered the most essential in determining disability status from census data in a way that would allow for international comparison. In circumstances where it is impossible for reasons of time or space to ask all six questions, these four domains should be included as the essential minimum. 

Furthermore, it has come to our attention that for reasons related to culture, in certain countries enumerators have had difficulty asking the self-care question. In such circumstances, the omission of this question is permissible.

To illustrate the net effect of asking six versus four questions, data from the 2013 U.S. National Health Interview Survey (NHIS) show that disability prevalence among those 18 years and older (weighted) using all six Short Set questions is: 9.5%. Omitting the questions on self-care and communication reduces the prevalence to: 9.3%. Disability is not a uniquely unidimensional or single domain phenomenon. Among those with functioning difficulties (over six domains) in the 2013 NHIS sample, 27% have multiple difficulties. It could further be demonstrated that 92% of those with self-care difficulties and 78% of those with communication difficulties were included among those identified as having difficulties in the other four domains of functioning (that is, they were not explicitly excluded but omitting the question makes it impossible to estimate the population with this type of functional difficulty and to look at the impact on participation).

Do I need to include the clause: “…even if wearing glasses” and “even if using a hearing aid”?

In a few countries we have learned that hearing aids are non-existent. In these cases it would be appropriate to omit the clause “…even if using a hearing aid.”

On the other hand, to indiscriminately omit the clause “…even if wearing glasses.” would grossly inflate disability prevalence since anyone who uses glasses or lenses to correct a visual impairment would answer affirmatively (many with serious difficulties).  Only in places where glasses are close to non-existent should the clause be removed.

If time and space permit, it may be preferable to split the two sensory questions, as in the Extended Set:

Do you wear glasses?

Yes

No

If Yes: Do you have difficulty seeing even if wearing your glasses?

If No: Do you have difficulty seeing? 

Is it possible to modify the way questions are administered?

It is recommended that the response options be read aloud as part of each of the six questions as follows:

Do you have difficulty walking or climbing steps? Would you say:

  1. No, no difficulty
  2. Yes, some difficulty
  3. Yes, a lot of difficulty
  4. Cannot do it at all. 

If the six questions are asked of multiple persons in the household, the answer categories do not need to be repeated for each question once the respondent becomes familiar with them and responds using the appropriate terminology; however, it is generally useful to repeat the answer categories every 2 or 3 questions.

The Demographic and Health Surveys (DHS) program has recently adopted a disability module that operationalizes the WG short set of questions. In order to maintain consistency with other DHS modules and the format of the DHS in general, a modification was implemented in the administration of the questions – not the content. Rather than the formulation recommended by the WG above, the DHS uses the following formulation:

I would like to know if (NAME) has difficulty walking or climbing steps. Would you say that (NAME) has no difficulty walking or climbing steps, some difficulty, a lot of difficulty, or cannot walk or climb steps at all?

Both the content of the question and the response options remain the same. This is essential in producing comparable disability statistics cross-nationally.  The possible effects of this modification are being evaluated.

How should the questions be administered?

It is recommended that the response options be read aloud as part of each of the six questions as follows:

“Do you have difficulty walking or climbing steps? Would you say:

No, no difficulty

Yes, some difficulty

Yes, a lot of difficulty

Cannot do it at all” 

Respondents may become familiar with the answer categories after the first few questions.  In this case, the recommendation to repeat the categories can be relaxed.  This is most likely to occur when the questions are asked of multiple people in a household. If respondents provide responses using the required answer categories, the categories do not need to be repeated after every questions. They should be repeated as soon as the respondent does not use the required category (e.g., responds ‘yes’) or after the second or third question. Enumerators will require training in when it is appropriate to not read the answer categories.

Does the Short Set apply to all age groups?

The six WG questions were designed for a census context (general population 5 years of age and above) where the collection of disability data in a country may be otherwise very limited. The WG has acknowledged that disability among children, due to the circumstances of child development and transition from infancy through adolescence, is not adequately covered by these questions and disability prevalence using the WG Short Set among those 5 – 17 years of age will be underestimated. In particular, children with difficulties associated with developmental or psychosocial disabilities may be missed. However, in the absence of other measures and other data collection exercises, these questions will provide an indication of child functioning in the domains covered for the population 5 – 17 years of age.

The WG and UNICEF collaborated on the development of the Child Functioning Module (CFM) which is the preferred tool for collecting information on children and adolescents with disabilities. For more information follow this link to Child Functioning Question Set.

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

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.

Can the Short Set be answered by a proxy respondent?

Ideally, the questions should be answered by the individual in question (self-report) with the exception of those who are not capable of responding themselves. However, in a census setting and for some types of surveys, it is common to have a primary respondent report for all other household members and this is acceptable in these context. In self-report situations, no one should be excluded because they cannot respond on their own (for example due to difficulty hearing, communicating, or an intellectual disability). The choice of a proxy respondent can be important and should be carefully considered before embarking upon the survey interview.

Where can the WG Short Set questions be applied?

The WG-SS questions were originally developed for censuses and large population-based surveys.

The WG-SS was designed as a core set of questions for self- or proxy-reporting of functional limitations at the individual level. Although they were developed to be appropriate for administration as part of a census, the questions can be included in any existing data collection activity within a program-level monitoring and evaluation framework or can be incorporated into smaller-scale surveys that collect data at the individual level.

The WG-SS is designed to avoid some of the failures of earlier ways of operationalizing disability (e.g. using only one question or a screening question such as ‘Do you have a disability?’).

As they were developed for use in censuses, the questions are as succinct and straightforward as possible without compromising their effectivity in the disaggregation of outcome data, for example, access to education or employment by disability status. Disaggregation allows for the determination of whether persons with disability have achieved the same level of participation as those without a disability on the selected outcome indicators.

In order to monitor compliance with the UN Convention on the Rights of Persons with Disability (CRPD) or evaluate whether programs are including people with disabilities and meeting their needs, baseline data on disability status collected at the individual level and follow-up data are required.  Conducting surveys that include the WG-SS at a minimum of two key points in a program (e.g. start and end) will provide valuable information on how people with disabilities have benefited from or been included in a program. These do not have to be large-scale surveys, which may be beyond the resources of a program. In many cases it will be possible to include the questions into the program’s usual data collection processes. Care should be taken to train enumerators to properly ask the questions. Sample sizes should be large enough so that information on the population with disabilities served by the program can be described.

Can the Short Set be used as a diagnostic tool?

  • The WG Short Set does not identify particular health conditions or diagnoses (the medical model of disability) but rather captures the possible impact of these conditions on functional abilities (the social model of disability).
  • Additional questions can be added to a survey – preferably after the WG questions – to obtain information on specific conditions or diagnoses or the cause of the functional difficulty if this information is desired.

How are people with disability identified by the WG-SS questions?

The WG-SS 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.

What is the purpose of the introductory statement? Can it be changed?

The introductory statement (The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM) was included for the purpose of transitioning from topic to topic in a census context.  The census format includes a small number of questions on different topics with topics changing quickly. The purpose of the introductory statement was to inform the respondent that the next set of questions had a health context. For example, if these questions followed a series of questions on another subject, sanitation, for example, the introductory statement would provide a transition to more health-related subject matter. In a larger survey, where this module might follow other health-related questions, and where the context is already established, the introductory statement could be dropped if the flow of the questionnaire is not adversely affected.

Examples of alternatives to the introductory statement:

  • The next questions ask about difficulties you may have in doing certain activities.
  • Now I am going to ask you some questions about your ability to do different activities.

Can I change or adapt the questions to meet my needs?

  • In order to collect internationally comparable data, it is important that the WG question be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability.
  • There are very limited exceptions to this rule. For example, in countries where hearing aids are not available, leaving the hearing aid clause off the hearing question is allowed.
  • Before making any modification consult the WG secretariat. Often the issues that arise in adapting to a particular country context can be addressed in how the questions are translated.
  • Detailed information about this topic can be found in the translation FAQ page, but if you have any doubt please get in touch with the Secretariat for advice. 

Can I use a screening question before the WG questions?

Evidence shows that single screener questions do not adequately identify the population of interest.  Most screeners are of the form “Do you have a disability?” with yes/no answer categories.  As noted above, the use of the term disability has very negative effects.  Questions of this type identify only a portion of those experiencing functional problems. They equate disability with a medical problem (disability lies within the person) and by forcing a respondent to make a choice between affirming disability which in some cultures is associated with stigma and discrimination. Some screeners do not use the term disability but ask about medical conditions.  While respondents can describe their difficulty doing activities, they often cannot report on their conditions. For example, respondents may not be aware of their conditions due to lack of medical care. The search for a one or two question screener that will identify the population of interest and results in no false negatives has been universally unsuccessful.  The WG-SS represent the fewest number of questions that can be used to identify the population with disabilities.

How is the WG Short Set meant to be used?

  • The WG-SS was not designed to be used in isolation. They should be used in conjunction with other measurement tools, i.e. include the WG-SS within a larger survey or registration form to enable disaggregation of other measures (employment status, educational attainment, etc.) by disability status.
  • It can be used in a census or survey format,
  • The focus on functioning and the brevity of the tool mean that it can be rapidly and easily deployed in a variety of settings.
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