WHO&ESCAP Pilot disability survey - Field test 2005
   
Questionnaire Overview sections first level Overview sections second level Linking to the ICF Items on disability? Capacity & Performance specified? Time frame (only disability questions) Response options (only disability questions) Any known instrument included? Filter (for the whole section) Checked (x) Relevant Comment
(e. g. household, individual, etc)     only chapter level None Capacity   Frequency SF-36     0=no  
        1 to 5 Performance   Intensity WHODAS     1=yes  
        5 to 10 Both   Statement WG-6        
        10 to 20 Not clearly stated   Others Others (please specify)        
        More than 20     Yes/No None        
  SECTION 1 Face Sheet               all x 0 Items F1 - F5 has to be completed by the interviewer prior to starting each interview
  SECTION 2 Demographics and background information   PF, d8           all x 0  
  SECTION 3 Disability question sets Question Set 1 d1, d2, d4, d5, d3 5 to 10 Both   Intensity WG-6 all x 1  
    Question Set 2: Part 1: Introduction               x 0  
    Question Set 2: Part 2: Questions on body functions b1, b2, b4, b5, b6, b7, b8, d4 10 to 20 Both last 30 days Intensity None all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 1 Understanding and Communicating b1, d1, d3 5 to 10 Capacity last 30 days Intensity WHODAS all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 2 Getting around d4 1 to 5 Capacity last 30 days Intensity WHODAS all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 3 Self Care d5 1 to 5 Capacity last 30 days Intensity WHODAS all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 4 Getting along with people d7 1 to 5 Capacity last 30 days Intensity WHODAS all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 5 Life activities d6, d8 5 to 10 Capacity last 30 days Intensity WHODAS all x 1 Disability questions asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 3: Questions on A&P: DOMAIN 6 Participation in Society d8, e, b1, nc 5 to 10 Capacity last 30 days Intensity WHODAS all x 1 Disability questions and impact of health condition (on him/herself and on the family) asking about difficulties sb experiences due to health problems.
    Question Set 2: Part 4: Questions on need of assistance d3, d4; d5; e3 1 to 5 Performance   Frequency None all x 1 Asking for need of assistance
 
General impressions
The questionnaire Version A was assessed during the DISABILITY QUESTION SET TESTING (Pilot test in five countries) in 2005.
All disability questions are asked due to health problems. However, there are no filter questions for existing health conditions.