General Disability Measures Used in Developed Countries: Question Characteristics Beth Rasch representing the collaborative work of the UN, ISTAT, and

General Disability Measures Used in Developed Countries: Question Characteristics

Beth Rasch representing the collaborative work of the UN, ISTAT, and the U.S. National Center for Health Statistics

1/9/03 National Center for Health Statistics, CDC

Background1st WCG Meeting A question typology was proposed by Barbara Altman

to categorize the types of questions that currently exist to measure disability

A matrix was also proposed linking the purposes of measurement with question characteristics

We also began collecting general disability measures that countries have used or are using

2nd WCG Meeting These documents have been revised and will be

used as reference materials for this presentation (see handouts)


Purpose Provide examples of general disability

measures used in developed countries that represent the range of question types in the typology

Describe characteristics of these measures relative to the matrix

Identify matrix characteristics that are not captured or are only partially captured in general disability measures from developed countries


Methods

Disability measures were chosen from developed countries if:

– They were general measures– Data were available– The questions added to the depiction

of question typologies– The questions added to the depiction

of question characteristics


Question typologyType 1: Impairment identification

Asks about the presence of an impairment based on different parts of the body system

Type 2: Identification of a disability

Asks directly if the person is disabled; may also identify the disability in terms of functional limitations

Type 3: Indication of limitations in activities / participation

Asks about limitations in activities or participation

Type 4: Combination questions

Asks whether respondent has difficulty / limitations with body structures or functions AND performing activities or participating

Type 5: Questions based on legal definitions of disability


ResultsType 1: Impairment identification

Australia: 2001 Disability Module (question #1)

I would now like to ask about any conditions you may have, that have lasted, or are likely to last, for six months or more. Do you have any of these conditions? Which ones?

Sight problems not corrected by glasses or contact lenses

Hearing problems

Speech problems

Blackouts, fits, or loss of consciousness…

(list continues; see handout)


ResultsType 2: Identification of a disabilityHungary: 1990 Census (questions #1-2)

Have you any physical, mental deficiency, or deficiency of the sense organs?

Yes / No

a) If so, of what kind?Physically defective

Defective in motion

Mentally defective

Hard of hearing…



ResultsType 3: Indication of limitations in activities / participationIsrael: 1999/2000 Health Survey (Screener question)

Does anyone in the household (aged 5 and over) have a physical disability that makes it difficult for him to carry out day to day activities, such as: movement from place to place, eating, dressing, control over sphincters, etc. (disabilities lasting six months or more)?

Yes / No


ResultsType 4: Combination questions

Australia: 2001 Disability Module (question #2)

Still thinking of conditions lasting 6 months or more, are you restricted in everyday activities by any of these? Which ones?

Shortness of breath, or difficulty breathing?

Chronic or recurring pain

A nervous or emotional condition



ResultsType 4: Combination questions

United States: 2000 CensusDoes this person have any of the following long-lasting conditions:(a) Blindness, deafness, or a severe vision or hearing impairment?

Yes / No

(b) A condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying?

Yes / No


ResultsType 5: Questions based on program eligibility (legal definition of disability)

Poland: 1996 POLHIS (Screener question #2)

Do you have a valid certificate of disability?Yes, disability was stated as permanent

Yes, disability was stated as temporary

No

Don’t know (if proxy is reporting)


Empirical matrix: description of question characteristics (see handout)

ICF domain

Duration specified

Response categories

Neutral terminology

Australia:

2001 Disability Module

BS, BF, A/P

Long term

(6 months)

Dichotomous No

Canada:

2001 Census

BF, A/P No Yes, sometimes

Yes, often

No

Yes

Israel:

1999/2000 Survey

BF, A/P Long term

(6 months)

Dichotomous Yes (but uses word disability)


Results: question characteristicsUse of a general measure Several countries use screener questions to identify

persons with disability (Canada, New Zealand) These questions are used to identify persons for

more extensive disability surveys or sets of survey questions

Some countries rely on more extensive question sets or surveys (i.e. more than 2-3 questions) to identify the population of persons with disability, such as Australia (Disability module and Survey of Disability, Ageing, and Carers)


Question characteristics: ICF domain BS, BF, and A/P domains are represented in

questions from developed countries with an emphasis on A/P

On the whole, the domain of environment is not captured

Questions referring to AT use provide some information about environment

Australia: Disability module (question #6)

Even though you can do these self-care, mobility and communication tasks without difficulty, do you use any aids to assist with these tasks?

Yes / No


Question characteristics: reference to mental functioning

United States: 2000 Census

Because of a physical, mental, or emotional condition lasting 6 months or more, does this person have any difficulty in doing any of the following activities:

Learning, remembering or concentrating?

Dressing, bathing, or getting around inside the home?



Question characteristics: neutral terminologyCanada: 2001 Census

Does this person have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?

Yes, sometimesYes, oftenNo

Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can do:

at home?at work or at school?in other activities, for example, in transportation or leisure?

Yes, sometimesYes, oftenNo


Question characteristics: norm / reference

New Zealand: 2001 Census

Does a health problem, or a condition you have (lasting 6 months or more) cause you difficulty with, or stop you doing:

a) Everyday activities that people your age can usually do

b) Communicating, mixing with others or socializing

c) Any other activity that people your age can usually do

d) No difficulty with any of these?


Summary:Capture of matrix characteristics

Some developed countries are not using general measures

ICF domain: environment not represented Duration usually specified as lasting > 6 months Response categories are generally dichotomous Attribution to a health condition usually present Most countries are using some language that could

be interpreted negatively, such as the word “limited”


Summary:Capture of matrix characteristics A norm or reference is rarely used Questions are generally complex (respondent has to

consider more than one concept simultaneously) Mental functioning is usually included but may not be

differentiated into cognitive versus psychological / emotional components

A wide variety of descriptors are used to characterize ability to perform body functions, activities or participate such as difficult, problem, reduced, limited, restricted, or unable

Documents

General Disability Measures Used in Developed Countries: Question Characteristics Beth Rasch representing the collaborative work of the UN, ISTAT, and