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Apr 19, 2023 2
Screening for Disability on Censuses
• The main purpose of a screening instrument is to be as inclusive as possible in order to identify all eligible people for further study.
Apr 19, 2023 3
Screening Questions
• To be inclusive, questions should cover all three of the main dimensions described in the ICF: body structure & function, activity (basic actions), and participation (complex activities).
• Once the disabled population is identified, the follow-up survey could focus obtaining more information on a wide range of aspects of disability related topics.
Apr 19, 2023 4
Screening Questions
• Screening reduces total respondent burden and survey costs.
• However, the length of the ideal screener could be prohibitive, and
• The more inclusive the screened population – the larger the sample to be followed and the higher the costs
• Disability Supplement to the US NHIS screener took 25 minutes to administer and identified over 25% of the population
Apr 19, 2023 5
Canadian Experience
• The Census is used to develop a frame for a disability survey
• The Participation and Activity Limitation Survey (PALS) determines disability status
Apr 19, 2023 6
Census Filter Question - 20061. Does this person have any difficulty hearing,
seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?
2. Does a physical condition or mental condition or health problem reduce the amount or the kind of activity this person can doAt home? At work or at school? In other activities, for example, transportation?
Response categories:Yes, sometimes; Yes, often; No
Apr 19, 2023 7
2006 PALS
• 2006 Census• 2006 PALS collection (46,000 persons)
• Post collection follow-up• Face to face interviews with 50 false positives• Face to face interviews with 100 false negatives• Face to face interviews with 50 mild disabilities
Apr 19, 2023 9
False Negatives
• A person with a disability that does not get picked up by the filter question –• Proxy reporting• Timing of the Census – cyclical or
episodic disability• Mild to medium pain limitations• Psychological limitations• Perception of activity limitation
• Related to age, cultural identity, language
Apr 19, 2023 10
False Negative - Results• False negatives: persons with disabilities who say No
to the original screening questions but who WOULD have reported a limitation if they were administered the PALS survey.
• Following the 2006 PALS a small scale exercise for adults was conducted.
• Persons in Toronto and Ottawa who said No to the Census filters were administered the PALS survey.
• Some reported limitations and this cast some doubt on the effectiveness of the filter questions.
• But on analysis it was found that almost all respondents were coming in on the pain module - middle aged persons with sore knees or shoulders.
• For the adult population, the filter questions were not seen as missing large numbers of persons with disabilities.
Apr 19, 2023 11
False Positives
• A person without a disability who answers ‘Yes’ to a filter question –• Proxy responding• Short term disability or injury• Cyclical or episodic disability• High false positive rates for children
Apr 19, 2023 12
False Positive - Results• For adults, about 25% of PALS respondents are false
positives, i.e. they said Yes on the census but report no limitation on the PALS survey.
• The most common reasons are:1. short term injury 2. proxy effect as the census is completed by a
single household member and 3. mistake, often language based.
• For children, the false positive rate is about 50% - here, the proxy effect is less clear as both the Census and PALS are proxy for children.
Apr 19, 2023 13
Irish Experience• 2004 - Government decision to conduct
post-censal National Disability Survey (NDS)• Purpose
• Establish prevalence, severity and impact of disability in Ireland
• Identify improvements needed in policy and service provision
• Targeted survey - sample based on responses to 2006 Census questions on disability
9 Disability types in NDSSeeingHearingSpeechMobility and dexterityRemembering and concentratingIntellectual and learningEmotional, psychological and mental healthPainBreathing
15
NDS thresholds for disability
Level of difficulty in every day activities
Disability typeNo
difficultyJust a little
A moderate
level
A lot of difficulty
Cannot do at all
A. Seeing
B. Hearing
C. Speech E. Remembering &
concentrating
F. Intellectual & learning
G. Emotional, psychological, & mental health
H. Pain I. Breathing
16
Apr 19, 2023 17
Census and NDS – comparison• NDS private household sample matched
to Census data file• Analysis based on unweighted sample data
only• Comparison of distribution of ‘Yes’ and ‘No’
responses in each - ‘false positive’ / ‘false negative’ responses to Census question
• Types of disability reported in Census and NDS
• Consistency of reporting of disabilities between Census and NDS
Apr 19, 2023 18
Comparison of Yes and No responses
NDS Response
Census response No Yes Total NDS
No 1,321
8.4%
295
1.9%
1,616
10.3%
Yes 1,910
12.4%
12,062
77.4%
13,972
89.7%
Total Census 3,231
20.8%
12,357
79.3%
15,588
100.0%
Apr 19, 2023 19
Census ‘false positives’
• 14% of persons reporting a disability in Census did not report a disability in NDS
• 25% 65 and over• Report lower levels of limitation• 53% - Census category “Other
including chronic illness”
Apr 19, 2023 20
Census ‘false negatives’
• 18% of people who did not report disability in the Census did report disability in the NDS
• 51% aged 65 or over• Highest proportion of responses:
• Pain disability category - 51% • Mobility & dexterity disability category -
46%• Report lower levels of limitation
Apr 19, 2023 21
Prevalence rates
• Census: 9.3%• NDS: 18.5%
• 11.5% of false negatives are classified as disabled on the NDS; this group has large weights
Apr 19, 2023 22
Conclusions - Ireland• Matching of NDS records to Census at person level
increases statistical value of NDS output• A high proportion of the Census false positive responses
are due to responses in the residual ‘Other’ category• >3/4 of sample reported a disability in both surveys• The Census questions & methodology resulted in a
much higher level of single disability reporting than NDS• Learning related difficulties prevalent among children in
the sample• Mobility and Pain most prevalent disabilities for older
people• People of working age had a more mixed range of
difficulties