Washington Group Meeting, Kampala, Uganda, Oct Mobility Barbara M. Altman Disability Statistics Consultant

Washington Group Meeting, Kampala, Uganda, Oct Part I: Discussion of Response Patterns

Washington Group Meeting, Kampala, Uganda, Oct Mobility Questions  Washington Group Question: Do you have difficulty walking or climbing steps?  No, No difficulty  Yes, Some difficulty  Yes, A lot of difficulty  Cannot do at all  Extended Questions - Aids: Do you use any kind of equipment, such as a wheelchair, walker, or cane to help you get around? /Yes/No

Washington Group Meeting, Kampala, Uganda, Oct Extended Questions  Problem Walking: Do you have difficulty going outside of your home?  Can’t do at all  A lot of difficulty  Some difficulty  No difficulty Do you have difficulty walking a long distance such as a kilometer (or a mile)?  No difficulty  Some difficulty  A lot of difficulty  Can’t do at all

Washington Group Meeting, Kampala, Uganda, Oct More Extended Questions  Problems Step, Stand, Sit, Stoop, Walk short distance: By yourself and not using aids, do you have any difficulty….  Walking for a quarter of a mile (about 2-3 blocks)?  Walking up ten steps without resting?  Standing or being on your feet for about two hours?  Sitting for about two hours?  Stooping, crouching or kneeling?  Answers:  Yes  No

Washington Group Meeting, Kampala, Uganda, Oct Non Problematic Patterns PatternWGAid Walk Distance Problem step, stand, etc Total 734 ANo 93 BYes 224 CYesNoYes 310 DNo YesNo *47 ENo Yes 107 FGFG Yes No Yes No 38 *15

Washington Group Meeting, Kampala, Uganda, Oct Problematic Patterns PatternWGAids Walk Distance Problem step, stand, etc Total 81 HYesNo 20 INo Yes *48 JNoYes 10 KYes No 3

Washington Group Meeting, Kampala, Uganda, Oct Other/Borderline Patterns PatternWGAids Walk Distance Problems stand, sit, etc. Total 38 LNoYesNoYes5 M NoYes8 N No14 ONoYesNo 10 PNoYes No1

Washington Group Meeting, Kampala, Uganda, Oct Country Examples  Examples from three countries who did cognitive testing Lesotho India South Africa

Washington Group Meeting, Kampala, Uganda, Oct Part II: Combined Test Results

Washington Group Meeting, Kampala, Uganda, Oct Special Aspects of Non Problem Patterns  D – No disability on WG question, but indication of a split between answering about going outside or having a problem walking distances. Can this be a cultural orientation problem? Viet Nam have 10 with D pattern, most are related to going outside Gambia has 7 with D pattern, most are related to some or a lot of difficulty walking long distances

Washington Group Meeting, Kampala, Uganda, Oct Special Aspects of Non Problem Patterns  E – No indication of disability on WG question, but indicators of problem with walking steps, standing, sitting, stooping or walking ¼ mile. Responses predominantly indicate that person has difficulty standing for 2 hours. Since WG question asks about walking or climbing steps connection is not really direct. Argentina had 6 respondents with this pattern, two who mentioned difficulty climbing steps. Is this a possible problem with translation of “or”, an problem with an interviewer or inattention.

Washington Group Meeting, Kampala, Uganda, Oct Special Aspects of Non Problem Patterns  F – Indication of a disability on the WG question associated with positive responses to the walking steps, standing, sitting, stooping or walking ¼ mile questions. In this instance the positive response is to the indicator of difficulty walking stairs which would be consistent with the WG question.

Washington Group Meeting, Kampala, Uganda, Oct Special Aspects of Non Problem Patterns  G – In this instance the pattern is a positive response to the WG question and a positive response on the problem walking distances or getting outside the home. This has a smaller number and the pattern seems to be more associated with walking long distances. Compared with D pattern which occurs more frequently – we seem to be more likely not to capture on the WG question. Cultural orientations may play a role?

Washington Group Meeting, Kampala, Uganda, Oct Reconciling Contradictory Patterns  D – WG Question = No; Walking = Yes G – WG Question = Yes: Walking = Yes  D pattern represented in 47 responses G pattern represented in 15 responses  D pattern more common, need to examine the characteristics of the two patterns to assess if this is related to age (G may reflect older group).  Also need to examine difference in these two responses by countries since in some places walking long distances is more commonplace.

Washington Group Meeting, Kampala, Uganda, Oct Problematic Patterns  H – WG question positive, no other positive responses to extended questions. Pattern only found in 20 respondents, 7 countries. Raises question of other limitations such as vision problems or self help. Need to look at those relationships. Cross limitation should also be examined for some other patterns we can’t explain

Washington Group Meeting, Kampala, Uganda, Oct Problematic Patterns: continued  I –Most commonly occurring problem pattern (48). No to WG question, but yes to functioning questions.  No immediate explanation that explains the pattern, however, most of the patterns reflect just some difficulty (lowest level) in walking long distances and problems with sitting, stooping or standing, not directly related to walking.  Only 5 have a more serious pattern

Washington Group Meeting, Kampala, Uganda, Oct Problematic Patterns: continued  J –No to WG question, yes in all the other areas. Only 10 responses in this pattern, 6 of these in Mexico, 8 in SA.  Would seem that a positive answer to using an aid would be directly related to a positive answer on WG question.  May demonstrate a form of cultural sensitivity or stigma.  K – Yes to WG question, yes to Aid. I don’t find that a problem pattern (3).

Washington Group Meeting, Kampala, Uganda, Oct Borderline Patterns  M and N – Yes on WG seems to be supported by yes on Aids questions and in one of the other functioning sections (22).  L, O and P – No on WG question but all with yes on use of an Aid and one other area (16). Almost all of these patterns found in Argentina, Paraguay, Mexico and India. May be another indication of the effect of stigma.

Washington Group Meeting, Kampala, Uganda, Oct Discussion of Problematic Responses  Only approximately 10% of responses are problematic. We don’t know how this translates into a random sample situation. Need field test results.  Also need further analysis to see if there is an age, gender or overlapping effects (other limitation statuses). Some evidence might indicate the effects of stigmatizing status.  Need to examine response rates when burden is not a problem.  I interpret these results as very encouraging and would expect that we won’t change this element at all.