Table of contents:
Recommendations for Moving Forward
The complexity of disability has resulted in the proliferation of statistics on disability that are neither comparable nor easy to interpret. Therefore, it is an accomplishment to have most of the Arab countries agreeing and following one standard approach by applying the unified collection method of the WG-SS. However, improvements are required to further extend this collective achievement to obtain comparable analysis at the regional and international levels, and to provide realistic data on the situation of people with disabilities through improving current methods applied by the countries and extending the domains beyond the WG-SS in order to measure other domains of relevance to the region.
Accordingly, ESCWA, in consultation with the mentioned countries and the WG, has developed two sets of recommendations: the first on measuring the prevalence of disability of regional domains; the second on better implementation of the WG approach.
1. Modified WG_SS of questions for the Arab Region
Statistics need to respond to policy needs and countries and, therefore, must compile data on specific domains of difficulty in order to design appropriate programs. A number of countries included in their national questionnaires unspecified domains such as “other” or “multi-difficulty” or “main” as answer options, the information from which is of no value to policymakers. Instead, it is recommended that countries make better use of the available space within the questionnaire in which specific domains relevant to a specific country could be added. At the regional level, policymakers maintain that upper body disability like movement of hands and arms are important to measure, and would yield higher rates of prevalence at the national and regional levels.
In fact, both Oman and the UAE have already considered the upper-body movement domain in their household surveys. In contrast, Palestine and Iraq have failed to consider the optional WG-SS on “self -care” in their household surveys or censuses for cultural reasons.
Since the domain “self-care” lacks sufficient comprehensiveness and is a sensitive subject to be asked about in some cultures, countries should consider adding two questions under the “self- care” domain relating to the hand and arm functions according to the WG-ES-F as follows: “Do you have difficulty raising a two-liter bottle of water or soda from waist to eye level?”; “Do you have difficulty using your hands and fingers, such as when picking up small objects like a button or pencil, or opening or closing containers or bottles? “. The addition of further questions under “self-care” on “upper body” movement will be acceptable and more comprehensible by the respondents, and thus yield further information on “self -care” functioning domains and produce accurate and higher prevalence rates.
These two questions, under the “upper body” domain, can be added to the WG-SS six basic activity functioning to constitute the Arab module for the WG-SS+ to include seven main domains in activity functioning.
Box 26 is the recommended set of questions for the Arab module of the WG_SS+ (AWG-SS+) six domains: Seeing, hearing, mobility (walking and climbing stairs), cognition (remembering and concentrating), self-care, and communicating, added to which is the upper body domain functioning relating to arms and hands functioning.
“The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM.”
| SEEING |
VIS_SS Do you have difficulty seeing, even when wearing glasses? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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If “Cannot do at all/Unable to do” to VIS_SS, skip to the next section (Hearing). VIS_1 Do you wear glasses to see far away? 1)Yes 2)No [If Yes, include glasses clause in VIS_2] |
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VIS_2 Do you have difficulty clearly seeing someone’s face across a room [even when wearing these glasses]? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all/unable to do |
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VIS_3 Do you wear glasses for reading or to see up close? 1) Yes 2) No
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VIS_4 Do you have difficulty clearly seeing the picture on a coin [even when wearing these glasses]? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all/unable to do |
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| HEARING |
HEAR_SS Do you have difficulty hearing, even when using a hearing aid? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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If "Cannot do at all" to HEAR_SS, skip to the next section (Mobility). HEAR_1 Do you use a hearing aid? 1) Yes 2) No If “No” to HEAR_1, skip to HEAR_3 and omit [hearing aid clause] in HEAR_3 and HEAR_4. If “Yes” to HEAR_1, continue with HEAR_2 and include [hearing aid clause] in HEAR_3 and HEAR_4. |
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HEAR_2 How often do you use your hearing aid(s)? 1) All the time 2) Some of the time 3) Rarely 4) Never |
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HEAR_3 Do you have difficulty hearing what is said in a conversation with one other person in a quiet room [even when wearing your hearing aid(s)? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all If “Cannot do at all” to HEAR_3, skip to the next section (Mobility). |
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HEAR_4 Do you have difficulty hearing what is said in a conversation with one other person in a noisier room [even when wearing your hearing aid(s)]? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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| MOBILITY |
MOB_SS Do you have difficulty walking or climbing steps? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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MOB_1 Do you have difficulty moving around inside your home? 1) Yes 2) No |
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MOB_2 Do you use any equipment or receive help for getting around? 1) Yes 2) No If "Yes" to MOB_2, continue with MOB_3 and include [aid clause] in MOB_4, MOB_5 and MOB_6. If “No” to MOB_2, skip to MOB_4 and omit [aid clause] in MOB_4, MOB_5 and MOB_6. |
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MOB_3 Do you use any of the following? a) Cane or walking stick? b) Walker or Zimmer frame? c) Crutches? d) Wheelchair? e) Artificial limb (leg/foot)? f) Someone’s assistance? g) Other (please specify): If respondent only answers “Wheelchair” to MOB_3, skip to next section (Communicating). |
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MOB_4 Do you have difficulty walking 100 meters on level ground, that would be about the length of one football field or one city block [without the 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all If “Cannot do at all” at MOB_4, skip to MOB_6. |
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MOB_5 Do you have difficulty walking half a km on level ground, that would be the length of five football fields or five city blocks [without the use of your aid]? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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MOB_6 Do you have difficulty walking up or down 12 steps [without the use of your aid]? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all If “Some difficulty”, “A lot of difficulty” or “Cannot do at all” to any of MOB_SS, MOB_1, MOB_4, MOB_5, MOB_6 and “No” to MOB_2 skip to next section (Communicating) If “No difficulty” to MOB_SS, MOB_1, MOB_4, MOB_5, MOB_6 and “No” to MOB_2 then skip to Section E Communicating. Otherwise, continue with MOB_7 |
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MOB_7 Do you have difficulty walking 100 meters on level ground, that would be about the length of one football field or one city block, when using your aid? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all If “Cannot do at all” to MOB_7, skip to MOB_9. |
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MOB_8 Do you have difficulty walking half a km on level ground, that would be the length of five football fields or five city blocks, when using your aid? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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MOB_9 Do you have difficulty walking up or down 12 steps, even when using your aid? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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| COMMUNICATING |
COM_SS Using your usual language, do you have difficulty communicating, for example understanding or being understood? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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COM_1 Do people have difficulty understanding you when you speak? 1) Yes 2) No If “No difficulty” to COM_SS and “No” to COM_1 then skip to next Section (Cognition). |
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COM_2 Do you use sign language? 1) Yes 2) No |
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| COGNITION (remembering or concentrating) |
COG_SS Do you have difficulty remembering or concentrating? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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If ‘No difficulty’, skip to next section (Upper Body). COG_1 Do you have difficulty remembering, concentrating, or both? 1) Difficulty remembering only 2) Difficulty concentrating only 3) Difficulty with both remembering and concentrating If ‘Difficulty concentrating only’ skip to cog_4 |
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COG_2 How often do you have difficulty remembering? 1) Sometimes 2) Often 3) All of the time |
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COG_3 Do you have difficulty remembering a few things, a lot of things, or almost everything? 1) A few things 2) A lot of things 3) Almost everything |
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COG_4 How much difficulty do you have concentrating for ten minutes? 1) A little 2) A lot 3) Somewhere in between a little and a lot If difficulty concentrating for ten minutes ‘somewhere in between a little and a lot of difficulty’ continue with CoG_5 Else Skip to next section (Upper Body). |
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COG_5 Is difficulty…. 1) Closer to a little? 2) Closer to a lot? 3) Exactly in the middle? |
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| SELF-CARE |
UB_SS Do you have difficulty with self care, such as washing all over or dressing? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
| UPPER BODY |
UB_1 Do you have difficulty raising a 2 litre jug of water or soda from waist to eye level? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
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UB_2 Do you have difficulty using your hands and fingers, such as picking up small objects, for example, buttons or a pencil, or opening or closing containers or bottles? 1) No difficulty 2) Some difficulty 3) A lot of difficulty 4) Cannot do at all |
Overall disability prevalence is determined according to a response that includes “a lot of difficulty” or “cannot do at all” in at least one of the six domains of functioning. Those with multiple domains at this level of difficulty are counted once. Anyone who has no domain coded “a lot of difficulty” or “cannot do at all” is considered without disability – even if individual domains were coded as “some difficulty”. Only domains with “a lot of difficulty” or “cannot do at all” are counted, thus anyone who has at least one domain coded “a lot of difficulty” or “cannot do at all” is considered with disability – even if individual has other functioning domains coded as “some difficulty”. The same cut-off will apply to individual domains of function: seeing difficulty, walking difficulty etc.
It is important to note that in some countries accessibility to assistive devices by the public may be restricted, especially in rural areas, for low-income families, for those who may not necessarily have access to or health insurance, or where the availability – or even knowledge of – hearing aids might be extremely limited, or the devices are imported and thus expensive and may not be subsidized. In such cases, countries may exclude the clause “even when wearing your glasses” or “even when using a hearing aid,” from the seeing and hearing questions, respectively. Countries that decide to omit the “assistive devices” clause(s) should provide justification on the extent of availability and use of devices by the public and whether subsidies and/or insurance coverage are applied.
2. Improving Implementation of WG Approach
The WG approach provides standardized tools which, when implemented appropriately, lead to harmonized data. However, implementation practices may differ and, therefore, yield incomparable data. A list of ‘do’s and don’ts’ have been compiled by ESCWA and is based on the actual implementation practices made by the countries in the region to provide tips for better data in the future, as follows:
- The recommended approach is to focus on people’s level of difficulty undertaking various activities, to enable comparisons in outcomes between people with and without disabilities, rather than enquiring directly whether or not they have a particular disability; translate questions into the local language; ask questions exactly as written; place the questions before any other questions on disability (if other questions are included); include and read the four response categories; place the WG module at the beginning of a survey or census questionnaire; use the recommended short and simple lead-in statement to make a smooth transition from the previous survey topic; refer only to having difficulty in performing certain activities related to a health issue and not to disability; each domain should be asked through a separate question; questions should be addressed to each single household member; if necessary, a proxy respondent can be used to report for the family member who is incapacitated. Make sure to account for each family member individually rather than ask a blanket question; in the absence of implementing the child functioning module the questions should be asked for fiveyears and above, alternating two different sources one for using the short set of questions every year in a household survey or every ten years in a census, and the extended version every three years in a household survey.
- Key principles to avoid: omitting any of the basic activity functioning; using a screening question or a list of diagnoses; specifying a duration when asking about difficulties; lead-in or introductory statement prior to asking the questions must make no mention of the term “disability; making reference to the impact on one’s life resulting from those difficulties; the word “disability” in the introductory statement, or even the title of the survey; using negative terms; inquiring in general questions on the presence of persons with disabilities in the household; adding the module at the end of the questionnaire; using “other” or “multi-difficulty” or “main” to refer to other unnamed domains; adding causes or any other variable that would affect the recommended sequence of administrating the questions.