5 th Annual Meeting of the Washington Group

Instruments • Study Protocols • Questionnaire – Version A – Version B • Cognitive

Support Material • Translation – Guidelines – List of key terms – Ling. Evaluation

Highlights from the Field Test Fiji India Indonesia Mongolia Philippines 1002 1000 800 1062

Individual item properties between Question Set 1 (WG Short set) and Question Set 2

Frequencies of any difficulty by WG questions n=4512 CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH

Frequencies of any difficulty by Question Set 2 (Impairments) n=4512 CLASSIFICATIONS … BUILDING BLOCKS

Frequencies of any difficulty by Question Set 2 (Activities & Participation) n=4512 CLASSIFICATIONS …

Frequencies of any difficulty by Question Set 2 (Activity & Participation) n=4512 CLASSIFICATIONS …

Frequencies of complete difficulties in Question Set 1 and Question Set 2 n=4512 1

Scenario 1: Use of WG Short set in census CLASSIFICATIONS … BUILDING BLOCKS OF

Scenario 2: Use of comprehensive set WHO-DAS II Structure 36 item version 12 item

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Scenario 2: Use of comprehensive set Threshold A: disability prevalence in general population =

Some initial findings • Item properties – Question Set 1 (WG Short Set) has

Possible Recommendations • Improvements on existing WG Short set – – Include thresholds in

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5 th Annual Meeting of the Washington Group on Disability Statistics Rio de Janeiro, Sept 21 -23 2005 WHO/UNESCAP Disability Question Set Field Testing Overview and preliminary results WORK in PROGRESS Nenad Kostanjsek Classifications Assessment Terminology Measurement and Health Information Systems www. who. int/classifications/icf e-mail: kostanjsekn@who. int

Instruments • Study Protocols • Questionnaire – Version A – Version B • Cognitive Interview Schedule CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Support Material • Translation – Guidelines – List of key terms – Ling. Evaluation form CLASSIFICATIONS • Interview Guidelines & Q by Q Spec. • Disability Statistics Training Manual • Quality Assurance Standards & Guidelines • Data Entry Program … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Highlights from the Field Test Fiji India Indonesia Mongolia Philippines 1002 1000 800 1062 1057 Study 2 Re-test Interviews 100 100 100 Study 3 Cognitive Interview & Ling. Eval. 100 100 100 Study 1 Interviews CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Individual item properties between Question Set 1 (WG Short set) and Question Set 2 (WHO/UNESCAP) n=4512 Sensitivity Specificity Seeing (W 1) * Seeing a person across the road (B 1. 6) 59% 90% Seeing (W 1) * Seeing an object at arm's length (B 1. 7) 62% 90% Hearing (W 2) * Hearing someone talking (B 1. 8) 38% 98% Hearing (W 2) * Hearing what is said in quite room (B 1. 9) 37% 96% Hearing (W 2) * Understanding what people say (D 1. 5) 20% 95% Hearing (W 2) * Starting & maintaining a conversation (D 1. 6) 20% 95% Hearing (W 2) * Need for assistance communication (E 3) 25% 95% Walking or climbing steps (W 3) * Walking a long distance >1 km (B 2. 5) 50% 91% Walking or climbing steps (W 3) * Need for assistance: Movement (E 2) 75% 82% Remembering or concentrating (W 4) * Remembering to do important things (D 1. 2) 45% 88% Self care (W 5) * Washing whole body (D 3. 1) 50% 98% Self care (W 5) * Getting dressed (D 3. 2) 57% 97% Self care (W 5) * Need for assistance: Self Care (E 1) 84% 98% Communicating (W 6) * Understanding what people say (D 1. 5) 31% 95% CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Individual item properties between Question Set 1 (WG Short set) and Question Set 2 (WHO/UNESCAP) CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Frequencies of any difficulty by WG questions n=4512 CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Frequencies of any difficulty by Question Set 2 (Impairments) n=4512 CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Frequencies of any difficulty by Question Set 2 (Activities & Participation) n=4512 CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Frequencies of any difficulty by Question Set 2 (Activity & Participation) n=4512 CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Frequencies of complete difficulties in Question Set 1 and Question Set 2 n=4512 1 2 3 4 5 6 7 8 9 10 D 2. 5 Walking >1 km E 3 Need assistance communication E 1 Need assistance self care E 2 Need assistance movement D 2. 1 Standing 30 min. D 3. 4 Staying by yourself D 4. 5 Sexual activities W 3 Walking & climbing D 5. 4 Doing household work (time) D 6. 1 Community activities CLASSIFICATIONS Total 104 79 75 73 68 63 63 62 59 55 % 2. 30% 1. 75% 1. 66% 1. 62% 1. 51% 1. 40% 1. 37% 1. 31% 1. 22% … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Scenario 1: Use of WG Short set in census CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Scenario 2: Use of comprehensive set WHO-DAS II Structure 36 item version 12 item version Domain specific summary score 0 -100 6 items 2 items 1 Cognitive 5 items 2 Mobility Overall Disability Score 4 items 2 items 3 Self care 5 items 2 items 4 Getting Along 8 items 2 items 5 Life Activity 6 items 2 items 6 Participatio n CLASSIFICATIONS Generic summary score 0 -100 … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Scenario 2: Use of comprehensive set Threshold A: disability prevalence in general population = 8% Threshold B: person eligible for support services = 10% CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Some initial findings • Item properties – Question Set 1 (WG Short Set) has good specificity but low sensitivity – Substantial proportion ( > 10% ) of people may not be not picked up by Question Set 1 but by A&P domains from Question set 2 • Frequencies – Within Question set 1 high endorsement rates for W 3, 4, 1 (mobility, cognition, vision) – Very high endorsement rates for Question set 2 across the whole severity spectrum – High endorsement rates for A&P and EF question • Question wording – Inclusion of meaningful thresholds are found to be useful in cognitive tests – Difficulties in understanding W 6 • Utility – Question set 1: • FIXED prevalence rate: <5% for severe and complete difficulties, and >20% for any and mild difficulties ( non-scalable ) – Question set 2 : • MULTIPLE and scalable prevalence rates: the same data set can be used for various purposes CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …

Possible Recommendations • Improvements on existing WG Short set – – Include thresholds in question Replace W 2 Hearing with communication question Clarify W 4 Remembering & Concentrating Improve phrasing of question W 5 self care & W 6 communication – Possible extension to cover missing dimensions of disability • Extended set – Cover full spectrum rather than focus on deeper detail in selected domains CLASSIFICATIONS … BUILDING BLOCKS OF HEALTH & Disability INFORMATION …