Presentation on CommunicationQuestion 6

6th Meeting of the Washington Group

Kampala,Uganda

10 – 13th October 2006

Definition of responses

WG6: Disability: Because of a physical, mental or health condition, do you have difficulty communicating, for example understanding or being understood by others?– ‘Some’, ‘a lot’ or ‘unable to do’ = yes– ‘no’ = no

1. Do you feel shy in group or social situations? Yes/no2. Do you have difficulty in making new friends? Yes/no3. Do you have difficulty in starting and maintaining a

conversation? (0 – 3)4. Do you have difficulty in generally understanding what

people say? (0 – 3)5. Combination: 2 X ‘yes’ on 2, 3 and 4

Patterns: non-problematic

• A: No difficulty on WG6 and no other reported difficulties (true negative)

• B: no difficulties except for ‘shy’ : Not a communication difficulty?

• H: yes on everything: True positive; not sure of ‘yes’ on ‘shy’ and ‘friends’ – part of, secondary or unrelated to communication difficulty

Patterns: borderline

• C: Similar to B with additional ‘yes’ on ‘friends’. Not a communication difficulty. (unproblematic)

• D: ‘no’ on WG6 but ‘yes’ on ‘conversation’• E: ‘no’ on WG6 but ‘yes’ on ‘understanding what others

say’– D and E: ? Role of hearing loss where cannot hear to

‘understand’ and ‘conversation’ but where do not feel they have communication difficulty.

• F: ‘No’ on WG6 but yes on others (Combination of 2) – ? Same as for D & E but slightly more effect

• I: As for F but with ‘yes’ for WG6: worse than F as has enough effect to be noted on WG6 as a problem.

Patterns borderline (Contd)

• J: ‘yes’ for WG6 and ‘say’ – ?significant effect of poor understanding

• K: as for J with ‘yes’ for conversation.

• L: ‘yes’ for WG6 and for ‘friend’ and ‘shy’ but ‘no’ for understand and conversation – see being shy and not making friends as being communication problem.

Problematic

• G: ‘no’ for WG6 but ‘yes’ on all others. Intermittent problem (e.g. from epilepsy seizure) or different frame of reference for WG6 and detailed Qs

• M: ‘yes’ on WG6 and ‘no’ on all others except for ‘shy’ – effects of a mental illness rather than a communication and focus on introductory comment

• N: ‘yes’ on WG6 and no on all others – focus on introductory phrase.

Argentina patterns: Communication (N=102)

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Egypt : Communication (N = 70)

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A B H C D E F I J K L G M N Miss

DR Congo patterns: Communication

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Paraguay (N = 111)

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Mexico (326)

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A B H C D E F I J K L G M N Miss

Patterns

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Comments on frequencies of patterns

• NOTE: Frequencies are number of times a pattern arises and NOT a ‘disability rate’

• Unproblematic patterns (A, B and H) make up the majority of patterns

• Borderline patterns (C, D, E, F, I, J, K, L) are less frequent than unproblematic but more than problematic

• Problematic are least frequent

Analysis of ‘why’ comments

• Reviewed 600 responses (until finding no new themes in responses)

• Coded themes: • Showing understanding of the question (WG6) with

or without difficulties• Problematic responses: ambiguous, focus on the

introductory phrase, second language problems, non-health reasons, etc.

• Other

• Frequency of occurrence of each in first 600 cases of the cognitive dataset

Explanations of WG6 response

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response types

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Showing understanding of WG6• No difficulty and mention understanding and expressing

– Communication is not a problem– I speak and the respond perfectly– I don’t have a problem understanding people or being

understood– I can communicate with people freely and I can write and have a

mobile– Because we sit and converse and laugh together

• No difficulty but no mention of understanding and expressing– I don’t have such problems– I am healthy– The way I feel– I feel confident– I am cheeky (!)

Show understanding (contd)• No difficulty and mention hearing

– Can talk and hear as no problem– I have good communication. I don’t have problem

hearing and speaking

• Has difficulty and mentions hearing – mostly Deaf– Sign language users gave responses of 1 or 2 – Indicated no problems when talking to sign language

users– Also included hard of hearing

Show understanding (contd)

• Has difficulty and mentions physical problem related to communication– stroke– Epilepsy– Cleft lip and palate– Stammering – Heavy tongue

• Weakness and illness– I can’t communicate when my mental illness

increases– I get very weak following my dialysis. My mood is

often off and I don’t talk too much

Borderline

• Has difficulty but no specific attribution – does not seem to have a clear frame of reference for the Q– Because people talk too quickly– When people talk to me I understand very little of

what they say– This is the major problem– There is limitation in the communication because of

the complex– Am not intelligent– Just because – Because of the accident

Problematic understanding

• Focus on introductory phrase (With/without difficulty)– I don’t have any mental or physical problem– I have no mental problem– Mentally fit

• Shyness and lack of socialisation (have difficulty)– Complex because of albinism, self pity and not

confident– Rarely communicate– Shy with new communication– Being shy with partners, particularly girlfriend

Problematic (Contd)

• Cognition (have difficulty) – Sometimes I can’t remember and understand

others– I forget things

• Unrelated physical problem– Because of weak legs and arms, feel

embarrassed– Because cannot see, cannot present very well

• Second language problem

Problematic (contd)

• Ambiguous – some have difficulty and others not– Don’t go out because of hand surgery (1)– Am handicapped (3)– I am now sensitised (0)– Thanks God (0)– Job application (1)– Because I have no stories to tell them (0)– I feel nothing (0)– When I get nervous I shout and then get mute

because of the shock (2)– It is true (0)– Because you asked (1)

Other

• Development issue– Because he is still young

• Missing

• ‘Don’t know’ or ‘no answer’

Conclusions

• Generally question is understood• Hearing is only part of the understanding of

communication• Introductory phrase can be misleading• Reference to Sign language could change

response category from ‘yes’ to ‘no’. • Some confusion with cognitive problems and

shyness• Few confusions with second language• Reference to problems such as blindness and

weakness in legs and arms