The DHS Program Pilot of a Household Survey Disability Module

1. The DHS ProgramPilot of a Household Survey Disability Module 6 OCTOBER 2015

2. Outline • Pilot testing of disability questions in Ghana • Context • Questions as piloted • Process • Results/Findings • Next steps

3. Context • Pilot testing of various new questions/modules, including disability questions modeled on Washington Group Short Set • Pilot took place in Ghana in June-July 2015 • Disability questions included in Household Questionnaire, all HH members age 5+ eligible • 3 processes: • Fieldwork • Fieldworker feedback • Cognitive interviews

4. Disability questions as piloted

5. Fieldwork process • Questionnaires in English, Akan, Ga, and Ewe • Convenience sample • Targeting HH with women age 15-49 and men age 15-59 • Total of 1,177 households • Mix of urban and rural • Total 5,161 HH members, of which 3,860 were age 5+ and eligible for disability Qs

6. Fieldwork results • 4% of total wear glasses/contacts • 9% of total have some degree of difficulty seeing • Prevalence of both glasses-wearing and difficulty seeing increases with age

7. Fieldwork results • 1 - 3% of total experience difficulty in various domains • Prevalence of all kinds of difficulty increases with age • Difficulty communicating has the lowest prevalence in all age groups • Little spike: difficulty washing/dressing age 5-9

8. Fieldwork results • Washington Group definition of disability: a lot of difficulty or cannot (see, hear, etc.) at all in at least 1 of the 6 domains • Excludes those with some difficulty • By that definition, overall disability prevalence is 3%; increases with age • Most of that 3% has difficulty in only 1 domain (seeing)

9. Fieldworker feedback process • After fieldwork, assembled field staff for debrief/feedback • Presentation on basic question design concepts • Feedback form – Qs on hearing, remembering/concentrating, walking/climbing steps • Did respondents have trouble with the question? • Did you (the fieldworker) have trouble with the question? • If so, please summarize the problems

10. Fieldworker feedback results • Does (NAME) have difficulty hearing even if he/she is using a hearing aid? Would you say (NAME) has no difficulty hearing, some difficulty hearing, a lot of difficulty, or can he/she not hear at all? • 16/27 fieldworkers had problems with this question • Written feedback: • Lack of familiarity with hearing aids made the question confusing to respondents • Conflation with children not paying attention

11. Fieldworker feedback results • Does (NAME) have difficulty remembering or concentrating? Would you say (NAME) has no difficulty remembering or concentrating, some difficulty, a lot of difficulty, or can he/she not remember or concentrate at all? • 9/27 fieldworkers had problems with this question • Written feedback: • Respondents did not understand the question

12. Fieldworker feedback results • Does (NAME) have difficulty walking or climbing steps? Would you say (NAME) has no difficulty walking or climbing steps, some difficulty, a lot of difficulty, or can he/she not walk or climb steps at all? • 5/27 fieldworkers had problems with this question • Written feedback: • Respondents needed clarification – does the question include getting tired, lack of endurance, and/or laziness?

13. Process of cognitive interviews • Separate from fieldwork • Field teams and implementing agency staff identified participants • 2-person teams, 1 interviewer and 1 note-taker • First administered the questionnaire, then asked scripted follow-up questions to identify problems understanding, being able to answer, and formulating answers to the questions • Administered in Akan and English, notes taken in English

14. Process of cognitive interviews

15. Process of cognitive interviews

16. Results of cognitive interviews • Does (NAME) wear glasses or contacts? • “Contacts” was a confusing term for most respondents • Respondents thought of medicated/prescription glasses • Does (NAME) have difficulty seeing? • Most respondents did not include people who wear glasses just for reading in their conception of people who have difficulty seeing • Does (NAME) have difficulty hearing? • Most respondents had not seen a hearing aid and had difficulty understanding the concept

17. Results of cognitive interviews • Does (NAME) have difficulty communicating? • Respondents did not have a perfectly common understanding of “difficulty communicating” • Some conflated it with speaking another language (including a sign language) • Does (NAME) have difficulty remembering or concentrating? • This was challenging for respondents to explain • Some gave examples of ordinary forgetfulness or children deliberately forgetting chores

18. Results of cognitive interviews • Does (NAME) have difficulty walking or climbing steps? • Most respondents would have included temporary difficulties like a broken leg • Does (NAME) have difficulty washing all over or dressing? • Some respondents with young children included them in this question; upon probing, they said the difficulty was due to the child’s age and was expected to pass as the child got older • Repetition of response categories • Mixed opinions

19. Next steps • Reviewed pilot results • Some minor revisions to questionnaire • More issues identified to be dealt with during fieldworker training • Suggested revisions submitted to USAID • Seeing screening question: change “contacts” to “contact lenses”, add phrase “to help them see” • Add screening question for hearing aids • Remove question-like phrasing of 1st sentence for all questions • Does (NAME) have difficulty seeing? -> I would like to know if (NAME) has difficulty seeing. Would you say (NAME) has… • Will be available as optional module for DHS surveys