rapid assessment of disability
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Rapid Assessment of Disability. Sally Baker Manjula Marella Co-authors: Alexandra Devine, Tanya Edmonds, Beth Sprunt, Kathy Fotis and Jill Keeffe. Disability Inclusive Development – where’s the data?. Achieving Article 32 of the UNCRPD is hampered by gaps in evidence. - PowerPoint PPT PresentationTRANSCRIPT
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Rapid Assessment of Disability
Sally BakerManjula Marella
Co-authors: Alexandra Devine, Tanya Edmonds, Beth Sprunt, Kathy Fotis and Jill Keeffe
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Disability Inclusive Development – where’s the data?
• Achieving Article 32 of the UNCRPD is hampered by gaps in evidence.
• Challenges include:– limited existing disability data; – limited knowledge of how to
include people with disability and their priorities across the program cycle; and
– lack of mechanisms to support design and measurement of effectiveness of disability inclusive development activities.
•
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Prevalence of disability
Samoa (2006)
Fiji (2008-09)
Nauru (2008)
Cook Islands (2012)
Tuvalu (-)
Tonga (2006)
New Caledonia (-)
Solomon Islands (2004-05)
Kiribati (2004-05)
Fed. St. Micronesia (2010)
Vanuatu (2009)
New Zealand (2006)
Australia (2009)
0% 5% 10% 15% 20%
1.2
1.4
1.5
1.7
1.9
2.8
2.9
2.9
4.1
11.0
12.0
16.6
18.5
Source: UNESCAP (2012) Disability at a Glance. Based on data submitted by governments.
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Comparison of types of question• Samoa Census 2006: 1.2%
• Vanuatu Census 2009: 12%
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• The Washington Group questions:– enable capture of disability prevalence data at the
population level. – Can be used to understand how particular issues
are experienced by people with disability at the population level, e.g.:
• Health issues• Education levels• Poverty
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But how can organisations design development programs which meet the priorities of people
with disability at the local level?
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Enter the RAD…
• A tool was needed that
could:– Identify people with disability,– Determine quality of life, and– Determine barriers which
impede access to the community.
• This data could be used by
development organisations:– As baseline data,– To inform the design of
disability inclusive development programs, and
– to contribute to evaluation.
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The methodology:
• Review and analysis of existing tools, including the Washington Group, ICF questions, WHOQOL, Kessler scale, PedsQL 4.0 and UNICEF 10Q.
• Focus group discussions and in-depth interviews with people with disability in Bangladesh.
• Review of drafts of the tool by advisory committees in Bangladesh, Fiji and Australia.
• Validation in Bangladesh and Fiji.
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People with disability as participants in the research
• Participants in advisory committees in Bangladesh, Fiji and Australia.
• Employed as data collectors in Bangladesh and Fiji.
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The RAD survey:
• 2 questionnaires– Household questionnaire– Individual questionnaire
• Demographic information• Self-assessment of Functioning• Rights awareness• Well-being• Access to the community
– Particular items were removed or rephrased after being found to be psychometrically invalid.
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Self-assessment of functioning• 15 items related to 8
domains: vision, hearing, communication, mobility, fine motor skills, cognition, appearance and mental health.
• In the last 6 months, have you had difficulties seeing, even if wearing glasses?– Yes/no– How often?
• Some of the time• Most of the time• All of the time
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Well-being• 16 items related to quality
of life and activity limitationIn the last 6 months, how often has your opinion been counted in the family?
1. All of the time2. Most of the time3. Some of the time4. Never5. Don’t know/can’t
remember
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Access to the community
In the last 6 months, to what extent could you access …… as much as you would have needed/liked?
Which of the following have limited your ability to …..? • Lack of information about …. opportunities• No …. facilities in the area• Physical accessibility of ….. facilities• Negative attitudes towards you • Cost • Difficulty getting to …. facilities from home• Family has difficulty assisting you to participate in ….
Which of these has limited your participation in ….. the most?
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Access to the community
• Health• Family decision making• Assistive devices• Rehabilitation services• Water and sanitation• Social activities• Religion• Government and social welfare• DPOs• Education• Disaster management
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Bangladesh RAD Survey
• To estimate the prevalence of disability and its impact in Bogra, Bangladesh, using the RAD questionnaire.
• Two-stage cluster random sampling– Compact segment sampling
• 66 clusters• Of 2315 adults living in 931 households, 1855
(80%) individuals were recruited.
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Findings from Bangladesh
• N=1855• 195 (10.5%, 95% CI: 8.78, 12.24) participants
reported difficulties with functioning.• Prevalence of disability extrapolated to Bogra district:
8.91% (95%CI: 7.34, 10.58)• Difficulties most frequently reported
– Seeing (5.5%)– Hearing (2.7%)– Mobility (2.3%)
• Psychological distress – 5.3%
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Sample (n = 1855) Prevalence (95% CI) Adjusted OR (95%CI)*Gender Female 10.26 (8.23, 12.28) 1Male 10.88 (8.56, 13.20) 0.97 (0.48, 1.94)Age (years) 18-24 2.71 (0.97, 4.45) 125-34 4.99 (3.00, 6.98) 2.04 (0.90, 4.67)35-44 10.55 (7.08, 14.03) 4.86 (2.17, 10.89)45-54 13.45 (9.44, 17.47) 6.49 (2.97, 14.19)≥55 25.15 (20.66, 29.64) 9.15 (4.11, 20.41)Socio-economic status Rich 8.17 (5.16, 11.19) 1Middle 7.57 (5.46, 9.67) 1.15 (0.65, 2.05)Poor 14.59 (11.58, 17.60) 2.11 (1.25, 3.56)Education 10 years or more 6.48 (3.52, 9.45) 15-9 years 6.80 (4.56, 9.05) 1.08 (0.47, 2.45)1-4 years 11.29 (8.02, 14.56) 1.17 (0.50, 2.71)None 14.58 (11.61, 17.55) 1.00 (0.45, 2.25)Occupation Housewife/working 8.70 (6.83, 10.56) 1Not working 39.84 (31.11, 48.57) 3.99 (2.19, 7.28)
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Well-being and Access to community
• People with disability had poor well-being scores (0.69, SD 1.25 logits) compared to the controls (1.67, SD 1.24 logits), p<0.001.
• Also had poor access to community compared to the controls (p<0.01).
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Disable
Control
55+
45-5435-44
25-34
18-24Poor
Middle
Rich
Male
Female no
1-4
5-9
10+
Unemployed
Farmer
LabourProfessional
Home maker
WB_Poor
WB_Medium
WB_Good
wo_Y
wo_N
wo_nn
hs_Y
hs_N
hs_nncc_Y
cc_N
cc_nn
sa_Y
sa_N
sa_nn
-.4-.2
0.2
.4.6
.81
Dim
ensi
on 2
( 3
6 %
)
-.4 -.2 0 .2 .4 .6 .8Dimension 1 ( 43 % )
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Conclusions from Bangladesh study
• Poor socio-economic status, old age and unemployment were independent predictors of disability supporting the previously established evidence on the relationship between poverty and disability.
• Participation in the community is associated with gender and disability.
• Data from RAD survey was useful to assess disability in terms of activity limitation, participation restriction and the contextual factors.
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Towards implementation of the RAD
• A manual was prepared to provide information on the principles of RAD and guide implementation of the RAD survey.
• A toolkit comprising questionnaires and the manual was launched last year.
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Further research needed
• Further validation of children version of RAD• Awareness of rights• Further testing is needed to investigate
– Application of RAD in disability inclusive development programs
– Responsiveness of RAD to identify change in participation after an intervention
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Current applications
• Philippines– W-DARE ADRA - to improve access to quality sexual and
reproductive health (SRH) programs for women with disability in the Philippines.
• Fiji– AQEP : To identify children with disabilities among those
who are not attending school in the communities surrounding five inclusive education demonstration schools.
• India– CBM India funded project in Andhra Pradesh and
Uttarakhand.
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Future plans
• Developing a RAD Consortium to share learnings from application of RAD in different settings
• Investing in software development to improve data entry and analysis and therefore improve usability of RAD
• Investing in regional RAD trainers
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Acknowledgments
• The research is funded by the Australian aid program through an Australian Development Research Award.
• International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)
• The Pacific Eye Institute, Fiji