heDefinitionandMeasurementofDisabilityTheWorkofthe定义和残疾的工作测量.ppt

Cognitive TestinglCognitive testing was undertaken in 15 countries to ensure validity and better understand how the questions operate. lPurposive SampleslAsked WG question and series of detailed questions in the same domainslCollected information on response processlAnalyzed problematic response patternslQuestions performed well with a few issues:Glasses and hearing aid clausesCommunication questionMore detailed questions on functioning. For example, Cognitive QuestionslDo you have difficulty remembering the names of people or places?lDo you have difficulty remembering appointments? lDo you have difficulty remembering how to get to familiar places? lDo you have difficulty remembering important tasks, like taking medications or paying bills? lDo you have difficulty concentrating on doing something for ten minutes?lDo you have difficulty learning a new task, for example, learning how to get to a new place?lDo you have difficulty finding solutions to problems in day to day life?Information on response processlQuestions to interviewersNeed to repeat any part of the question?Any difficulty in using response options?Did respondents ask for clarification or qualify their answers?lFollow-up probes to understand response processCorrelates of cognition difficultyUnadjusted ORs 95% Conf. Int.Concerned11.18*7.34 17.05Learn new task7.93*4.95 12.70Problem solving7.22*4.59 11.35Correlates of cognition difficultyDifficulties rememberingUnadjusted ORs 95% Conf. Ints.People or places9.12*5.85 14.23Appointments6.55*4.36 9.82Finding places5.20*3.43 7.86Important tasks6.40*4.27 9.60Socio- demographic correlates of cognition difficulty Unadjusted ORs 95% Conf. Ints.Male 1.04 (non-sig)0.70 1.54Age 35-5455 +1.05 (non-sig)2.05*0.64 1.721.26 3.33Overall, questions worked welllWell understoodlResponses consistentlTwo problem areasGlasses clause WG is revisiting but solution has a lot to do with translation protocolCommunication Question WG will revisit to see if question can be simplifiedField TestinglUndertaken in South Africa and VietnamlChecking for Internal consistencylResults comparable to changes seen in other countries with move towards functional approach to measuring disabilityWG Census Question vs. Extended Questions For Field TestlConstructed three thresholds for disability based on WG census question: D1=1 if any difficulty, D2=1 if a lot, D3=1 if unable to dolConstructed three thresholds for disability based on extended questions: ED1, ED2, ED3lWhat was the D measure picking up compared to the ED measures?Example: Mobility questionlWG question: Do you have difficulty walking or 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”lExtended Questions: Do you have difficulty going outside of your home?(0)Do you have difficulty walking a long distance such as a kilometer (or a mile)?ED1=1 if “some”, “a lot” or “cannot do” for either questionED2=1 if “a lot” or “cannot do at all” for either questionED3=1 if “cannot do at all” for either questionVietnam Disability Rates Thai Binh ProvinceSeeingNPct.No Difficulty239070.3Some Difficulty80323.6A Lot of Difficulty1845.4Unable 230.7Walking or Climbing StepsNPct.No Difficulty263777.6Some Difficulty56416.6A Lot of Difficulty1765.2Unable 230.7Functional Questions Lead to Higher Rates of DisabilitylMany Developing Country Censuses ask “Do you have a disability?” butPeople 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 of normal functioning so it undercounts the elderly lSwitch to Functional Questions raises disability rateE.g., Brazil 14.5%, Ecuador 12.1%, Zambia 13.1%, Nicaragua 10.3%But, no such thing as a single prevalence ratelIn Ecuador, 12.1% of the population has a disability but 4% are significantly disabled. Which is the right number?lIn 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?lIt depends why you are askingSINTEF study in Zambia (Loeb and Eide)lNationally representative samplelWG questions as screenlAll disabled respondents asked detailed follow-up activity limitation questionslSample of non-disabled respondents asked similar questions9 Domains & 44 ActivitiesnBasic learning & applying knowledge: reading, writingnCommunication: producing and receiving messagesnMobility: walking, moving aroundnSelf-care: washing, dressingnDomestic life: shopping, preparing mealsnSensory experiences: watching, listeningnInterpersonal relations: making friends, interacting with strangersnMajor life areas: going to school, getting a jobnCommunity, social and civic life: clubs, religious, politicsActivity Limitation (a measure of capacity)How DIFFICULT it is for you to perform this activity WITHOUT ASSISTANCE?l0 - no difficultyl1 - slight difficultyl2 - moderate difficultyl3 - severe difficultyl4 - unable to carry out the activityActivity LimitationsActivity limitation scoreDisability Data Collection RecommendationslDo not use the word disabilitylFunctional approachlSeparate functional domainslScaled ResponseslDefinition of disability can be made ex post, and hinge on domains and thresholds used