Frequently Asked Questions

The Washington Group (WG) uses a functional approach in its data collection tools as opposed to other approaches that ask directly if someone has a disability, has conditions or impairments that can lead to disability, or has participation restrictions that result from having functional difficulties in an unaccommodating environment. For example, the Washington Group Short Set on Functioning (WG-SS) includes a question on difficulties walking, but does not include questions on impairments, like missing limbs or musculoskeletal conditions, or on participation, for example problems shopping. There are both conceptual and logistical reasons for this decision.

Conceptually, it is the functional characteristics, not the impairments or conditions, that interact with environmental characteristics to reduce participation. Policies to improve participation focus on adjusting the environment to meet those functional needs. Logistically, there are many different conditions or impairments that can lead to the same functional limitation. The number of questions needed to cover all conditions or impairments would be very large, while fewer questions can capture the major functional domains.

The WG-SS was designed to be used in censuses and surveys where space is limited, so the set needed to be as short as possible to identify most people at risk of exclusion. The six questions ask directly about functioning in each of six universal activity domains (seeing, hearing, walking, communication, cognition and self-care) and do so in a structurally consistent manner. For example, the question “Do you have difficulties concentrating or remembering?” addresses cognitive functioning using a single question and the response set is the same as that used for the other five questions.

Comprehensive approaches to identifying the population with disabilities need to obtain information on psychosocial functioning. The WG-SS does not include a specific question on psychosocial functioning as developing a single question with appropriate responses structured similarly to the other six domains is not possible. For example, it is not possible to ask respondents if they have difficulty in “psychosocial functioning.” In addition, psychosocial functioning encompasses a number of concepts, including thoughts, feelings, and behaviors, thus making it difficult to craft a single question which can be universally understood.

The population with disabilities that the WG-SS identifies does, however, include some of those with psychosocial disability, as this type of disability can manifest in functional difficulties in other WG-SS domains, such as cognitive functioning, communication and self-care. However, the six questions do not capture all persons with psychosocial disability. It is also not possible to distinguish those with psychosocial difficulties among those identified by difficulties in these other related domains. For example, reported difficulties in communication may result from psychosocial difficulties, or from hearing difficulties, or from both.

To address this gap, targeted questions on psychosocial disability were included in the WG Short Set on Functioning – Enhanced (WG-SS Enhanced) and the WG Extended Set on Functioning (WG-ES). These sets were developed for data collections where more information is needed and more questions can be included. Like questions in other domains, the psychosocial disability questions do not ask about having or being diagnosed with specific psychological or mental health conditions. However, these questions take a somewhat different approach than the other questions in the sets. They ask about feelings associated with psychosocial functioning as opposed to the functional consequences of having a psychosocial condition. For example, the question about walking does not ask about the range of impairments and conditions that can affect walking, or the non-functionally based symptoms associated with those conditions, such as pain. The questions used for psychosocial functioning ask directly about anxiety and depression  feelings that reflect psychosocial functioning and not about the functioning itself. The approach used for the psychosocial domain reflects how psychological functioning is defined. Much more than physical health conditions, the diagnosis of a psychological or mental health condition depends, in part, on the nature of its impact on daily life. Diagnoses of psychological disorders result when difficulties cause distress and interfere with how people go about their everyday lives.

An alternative to designing questions on feelings associated with anxiety and depression is to develop questions that directly tap emotional and psychological difficulties. At the time the WG-ES was developed, such questions did not exist. The approach taken by the WG to meet the need for questions addressing this functional domain was to include questions on the frequency and intensity of feelings associated with two of the most common mental health problems – anxiety and depression. The rationale is that those experiencing intense and frequent feelings of depression and anxiety are at higher risk of experiencing participation restriction, so asking about feelings of anxiety and depression is a reasonable way to address psychosocial functioning. Other mental health disorders, such as schizophrenia and schizoaffective disorder, were not included in the question set given their low prevalence and the challenges of crafting one or two questions that would capture the feelings associated with these conditions. Including direct questions on having received a mental health condition diagnosis was not considered due to the stigma associated with these conditions in some countries and limited access to mental health services for many populations, both of which would bias the reporting of diagnosed conditions. 

The WG’s Mental Health and Psychosocial Disability Work Group is returning to the development of questions that will capture psychosocial functioning that are more consistent with the functional approach for identifying the population with disabilities. The work group is developing questions that address the functional consequences of mental health and emotional problems, such as forming and maintaining relationships and friendships, interacting with people, and controlling behaviors and emotions. It should be noted, however, that the difficulties identified by these questions could result from non-psychosocial factors, but their impact would be in the psychosocial domain. As in the WG-SS, where communication difficulties could be due to difficulties hearing, cognition or could have psychosocial origins, difficulty in interacting with people can also be related to vision, hearing or communication difficulties. Testing of these questions has begun, and more testing is planned.

The WG questions are intended to be administered individually to each person selected to be a respondent in a data collection. In some population censuses or sample surveys, only specific members of the household are selected as a sample respondent while in others all members of the household are included. In the latter case, the questions may be administered to a household respondent who responds for all members in the family or household rather than asking each member to respond for him or herself. Relying on a household respondent administration style of data collection may require question wording adaptations. Questions that are part of the Washington Group tools, which were designed to be asked of each person, can be modified so they can be asked of the household respondent.

For example, the following WG question is asked directly of the subject: 

• Do you have difficulty seeing even if wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty or cannot do at all?

There are two ways of modifying the question when a household respondent is chosen to answer on behalf of each individual in the household:

Alternative 1:

• Does [NAME] have difficulty seeing even if wearing glasses? Would you say no difficulty, some difficulty, a lot of difficulty or cannot do at all?

Note that [NAME] is determined according to list of names from the family/household roster.

Alternative 2:

• Does anyone in this household have difficulty seeing even if wearing glasses? Response: Yes/No
• If Yes: Who would that be?

[Individuals determined according to list of names from the family/household roster.] 

• Would you say that he/she has no difficulty, some difficulty, a lot of difficulty or cannot do at all?

The administration style of the first alternative is closer to the version used when asking the questions of the survey subject directly. The wording of the question and the response categories is not altered from the original WG question and the question is repeated for each person on the household roster.

The second alternative, while possible and has been used, runs the risk of an unintended loss of information particularly for household members who may have mild difficulty [some difficulty] in a particular domain of functioning. In this instance, the first question functions much like a screening question with a dichotomous yes/no response set. The respondent has not heard the answer categories and may not be considering the full range of functioning when responding to the question. This can be alleviated to some extent by adding a statement to be read before the question is asked that introduces the question and the answer categories. For example, the following could be included – “The next questions ask about difficulties members of your family/household may have doing activities. Consider the full range of difficulties when answering: no difficulty, some difficulty, a lot of difficulty or cannot do the activity at all when answering.”

The WG has not cognitively tested either alternative  or the example of text that could be added to Alternative 2, therefore, we have no evidence to support the use of these methods of question administration – or how it may impact the results. However, we are aware that this method is used. Furthermore, evidence from a mixed-administration style methodological test of Alternative 1 in the U.S. National Health Interview Survey, where both approaches (asking each person to report about themselves and Alternative 1) were implemented, suggests that the household administration style using Alternative 1 yields slightly lower estimates of disability than administering the questions to each selected household member directly.

Given the differences that may result from varying question wording across different administration styles, the WG recommends survey planners and managers take into consideration the effects that administration style may have on the resulting data and the estimates produced from these data. As much as possible, varying the wording or number of questions or the response categories should be minimized.

This module of six questions is best situated either at the beginning of a survey questionnaire (together with the demographic information collected on household family members) or towards the beginning of a section that deals with health information. It is recommended that the module not be added on at the end of the questionnaire.

The intention with the Short Set questions is to record, with the exception of seeing and hearing, difficulties people have with unaccommodated functioning (without the use of assistive devices or assistance).

The WG wants to be able to identify difficulties in functioning that may put a person at risk of limited or restricted participation. That risk of restricted participation – in the absence of accommodations – is ‘disability’ as defined by the UN Convention on the Rights of Persons with Disability (CRPD).

The domains of seeing and hearing are handled differently. In many cultures, both glasses/lenses and, to a lesser extent, hearing aids are ubiquitous and in most cases the use of these devices, especially glasses, is able to correct the difficulty almost completely. For this reason they are considered ‘within the skin’ or a part of the person. If, for example, the WG were to ask about difficulty seeing without the use of glasses, the resultant prevalence would be extremely high and would not identify a population at risk of participation restriction. However, in places where glasses or hearing aids are not common, the clause ‘even when wearing glasses’ can be omitted.

The WG questions do not address duration. Based on test results, the WG determined that when people answer the Short Set of questions, more often than not, they think of the difficulties they have in their usual state. That is, if someone has a broken leg – and temporarily has difficulty walking – that person tends to answer no difficulty because usually they do not have any difficulty and soon after the bone has mended, they will return to their normal state.  Some respondents may answer that they do have difficulty walking even if the difficulty is expected to be temporary. The WG does not consider this to be a problem. At any given point in time there will be a portion of the population that has some temporary difficulty with one or more of the domains covered in the Short Set. Individuals who answer in this way are also temporarily at risk of participation restrictions and in need of accommodations. 

There are hidden but significant costs to identifying those with only long-term difficulties. These include: 1) making incorrect assumptions about recovery; i.e. not all those with temporary difficulties will make a complete recovery and would, therefore, benefit from inclusion; and 2) the ability to identify the population that would benefit from universal design; i.e. even those with temporary difficulties will benefit, for the duration of their reduced functional capacity, from accommodations that reduce barriers to participation.

Modifying the questions to direct the respondent to only respond in terms of their usual functioning or to include temporary difficulties involves adding in a long, complex introductory statement. Respondents seldom listen to all of the instructions when survey modules are preceded with such long and wordy opening statements. For example, beginning a series of questions with the following instructions is often counterproductive:

• The next questions ask about difficulties you may have doing certain activities only because of your HEALTH.

• Please think about the last 30 days taking both good and bad days into account. Only consider difficulties that have lasted or are expected to last for 6 months or more. 

• Now thinking only about your health I want you to answer these questions WITHOUT taking into account any help.

A respondent has to think of, and remember, all those instructions when answering the questions that follow. Cognitive testing has shown that they do not always take these considerations into account when they respond. Respondents may focus on the instructions at the beginning of the statement or at the end, but they do not recall or consider all, or at times, any of the instructions.

For the reasons discussed above, the WG determined that measurement error (incorrect identification of a functional difficulty) was minimized by not referencing long term difficulties in the questions.

Disability is not a Yes/No dichotomy but describes a dynamic and complex relationship between a person, the environment in which they live and their ability to participate in society on an equal basis with others.  The aspects of functioning that are captured by the six questions are also not dichotomies; functioning in each of these domains exists on a continuum.

A question with a Yes/No response option forces the person answering to self-identify as having the difficulty or not. It is better to offer a range of responses as in the WG questions. The four answer categories recommended by the WG describe a continuum of functioning from: no difficulty to cannot do at all. The continuum can be visualized like this:

The distribution above creates four points equally distributed among the continuum that allows respondents to easily discriminate among options. The recommended cut-off (at a lot of difficulty) identifies those with the intended level of difficulties. 

A comprehensive measure to determine disability includes all six domains of functioning: seeing, hearing, walking/climbing steps, remembering/concentrating, self-care and communication.

As noted in the 3^rd revision of the Principles and Recommendations for Population and Housing Censuses (UNSD: https://unstats.un.org/unsd/statcom/doc15/BG-Censuses.pdf) four domains of functioning: seeing, hearing, walking/climbing steps, and remembering/concentrating are considered the most essential in determining disability status from census data in a way that would allow for international comparison. In circumstances where it is impossible for reasons of time or space to ask all six questions, these four domains should be included as the essential minimum. 

Furthermore, it has come to our attention that for reasons related to culture, in certain countries enumerators have had difficulty asking the self-care question. In such circumstances, the omission of this question is permissible.

To illustrate the net effect of asking six versus four questions, data from the 2013 U.S. National Health Interview Survey (NHIS) show that disability prevalence among those 18 years and older (weighted) using all six Short Set questions is: 9.5%. Omitting the questions on self-care and communication reduces the prevalence to: 9.3%. Disability is not a uniquely unidimensional or single domain phenomenon. Among those with functioning difficulties (over six domains) in the 2013 NHIS sample, 27% have multiple difficulties. It could further be demonstrated that 92% of those with self-care difficulties and 78% of those with communication difficulties were included among those identified as having difficulties in the other four domains of functioning (that is, they were not explicitly excluded but omitting the question makes it impossible to estimate the population with this type of functional difficulty and to look at the impact on participation).

In a few countries we have learned that hearing aids are non-existent. In these cases it would be appropriate to omit the clause “…even if using a hearing aid.”

On the other hand, to indiscriminately omit the clause “…even if wearing glasses.” would grossly inflate disability prevalence since anyone who uses glasses or lenses to correct a visual impairment would answer affirmatively (many with serious difficulties).  Only in places where glasses are close to non-existent should the clause be removed.

If time and space permit, it may be preferable to split the two sensory questions, as in the Extended Set:

Do you wear glasses?

Yes

No

If Yes: Do you have difficulty seeing even if wearing your glasses?

If No: Do you have difficulty seeing? 

‘Disability’ is a word whose meaning can vary not only across cultures but among people in the same culture.  Moreover, in some cultures the term is associated with shame and/or stigma. In order to avoid casting the questions in a negative frame or light and to reduce response variability due to differential understanding of the term, more neutral language needs to be used.  In addition, rather than ask directly about disability per se, the focus of the questions is on functioning. The domains of functioning covered are both basic and universal; they are common to all countries and cultures and evidence has shown that they are recognized by people in different languages.  The use of the term disability in the questionnaire or in interaction between the interviewer/enumerator and the respondent will reintroduce variability in how the term is understood including introducing stigma and can reduce or eliminate the validity of the questions set.

It is recommended that the response options be read aloud as part of each of the six questions as follows:

Do you have difficulty walking or climbing steps? Would you say:

1. No, no difficulty
2. Yes, some difficulty
3. Yes, a lot of difficulty
4. Cannot do it at all. 

If the six questions are asked of multiple persons in the household, the answer categories do not need to be repeated for each question once the respondent becomes familiar with them and responds using the appropriate terminology; however, it is generally useful to repeat the answer categories every 2 or 3 questions.

The Demographic and Health Surveys (DHS) program has recently adopted a disability module that operationalizes the WG short set of questions. In order to maintain consistency with other DHS modules and the format of the DHS in general, a modification was implemented in the administration of the questions – not the content. Rather than the formulation recommended by the WG above, the DHS uses the following formulation:

I would like to know if (NAME) has difficulty walking or climbing steps. Would you say that (NAME) has no difficulty walking or climbing steps, some difficulty, a lot of difficulty, or cannot walk or climb steps at all?

Both the content of the question and the response options remain the same. This is essential in producing comparable disability statistics cross-nationally.  The possible effects of this modification are being evaluated.

It is recommended that the response options be read aloud as part of each of the six questions as follows:

“Do you have difficulty walking or climbing steps? Would you say:

No, no difficulty

Yes, some difficulty

Yes, a lot of difficulty

Cannot do it at all” 

Respondents may become familiar with the answer categories after the first few questions.  In this case, the recommendation to repeat the categories can be relaxed.  This is most likely to occur when the questions are asked of multiple people in a household. If respondents provide responses using the required answer categories, the categories do not need to be repeated after every questions. They should be repeated as soon as the respondent does not use the required category (e.g., responds ‘yes’) or after the second or third question. Enumerators will require training in when it is appropriate to not read the answer categories.

Three main purposes for the collection of disability data have been identified:

1. Monitor the Population: to understand the scope of disability in a population for evaluating policies and interventions designed to address disability in the population.
2. Service Provision: seeks to identify those with specific needs in order that services are designed and implemented to meet those needs. Interventions might be general – servicing the entire population (i.e., universal design), or specific - targeted for people more specific needs (e.g., wheelchair users). Addressing service provision requires more extensive information than monitoring the functioning of the population, and cannot be served by censuses.
3. Equalization of Opportunities: assesses whether persons with disability are participating in social and economic life at the same level  as persons without disability, This is accomplished by disaggregating population data by disability status to determine if important outcomes (e.g., access to education and employment) are different for people with disabilities compared to their non-disabled peers.

A UN International Seminar on Disability Measurement held in 2001 highlighted the need for standard principles and measures of disability in all national data collection systems and the improvement of cross-national comparability among disability measures.

To meet recommendations for consistency and transparency in disability measurement cross-nationally, the WG was constituted under the auspices of the UN Statistical Commission as a City Group. Specifically the WG was tasked to:

• address the need for reliable and comparable population-based measures of disability,
• foster international cooperation in the area of health and disability statistics,
• produce internationally tested measures to monitor status of persons with disability, and
• incorporate disability into national statistical systems.

The WG-SS has been

• used in censuses or surveys in over 75 countries,
• has been promoted by international aid programs (DFID/UK and DFAT/Australia) as the means to collect disability data in all programs and projects,
• has been introduced as the means for collecting disability data by the UN Statistical Division (UNSD) and the UN Economic Commission for Europe for the 2020 round of censuses, and
• has been endorsed by an Expert Group under the auspices of United Nations Department of Economic and Social Affairs (UNDESA) as the means to disaggregate Sustainable Development Goal (SDG) indicators by disability status.
• UNICEF has included the Child Functioning Module (CFM) and WG-SS in the Multiple Indicator Cluster Surveys (MICS)
• US AID has developed a disability module that includes the WG-SS in the Demographic and Health Surveys (DHS)
• World Bank (WB) is scaling up the inclusion of the WG-SS into future WB-sponsored household surveys, including the Living Standards Measurement Study (LSMS).

Membership is open to any United Nations Member State. If you are interested in attending a meeting or organizing training you should contact The Secretariat.

The Washington Group (WG) on Disability Statistics is a United Nations Statistics Commission City Group formed of representatives of National Statistical Offices (NSOs) working on developing methods to improve statistics on persons with disabilities globally. In this work, NSOs (currently over 135) are joined by various international agencies and experts including UN agencies (e.g., UNICEF, ILO, World Bank), bilateral aid agencies (e.g. DFID, DFAT, USAID), NGOs (e.g., Humanity & Inclusion, Sightsavers), Disabled People Organizations (DPOs), and researchers.

The United National Statistical Commission authorized the formation of the WG to address methodological issues that were identified at the International Seminar on Measurement of Disability in New York in June 2001. The consensus of that seminar was the recognition that statistical and methodological work was needed at an international level in order to facilitate the comparison of data on disability cross-nationally.

The WG, like all City Groups, invites representatives from all national statistical agencies to come together and participate in addressing the statistical challenges to collecting valid, reliable and cross-nationally comparable data on disability.

The six WG questions were designed for a census context (general population 5 years of age and above) where the collection of disability data in a country may be otherwise very limited. The WG has acknowledged that disability among children, due to the circumstances of child development and transition from infancy through adolescence, is not adequately covered by these questions and disability prevalence using the WG Short Set among those 5 – 17 years of age will be underestimated. In particular, children with difficulties associated with developmental or psychosocial disabilities may be missed. However, in the absence of other measures and other data collection exercises, these questions will provide an indication of child functioning in the domains covered for the population 5 – 17 years of age.

The WG and UNICEF collaborated on the development of the Child Functioning Module (CFM) which is the preferred tool for collecting information on children and adolescents with disabilities. For more information follow this link to Child Functioning Question Set.

While the key informant method may identify some people with disabilities, particularly those with more obvious types of impairment, assessing functioning of individuals through observation or assumed knowledge of individuals is subjective and can be very inaccurate.

This method might be appropriate in some situations if programs are interested in getting a preliminary count of the number of persons with functional limitations in area of interest.  It must be understood that the estimates will likely be an underestimate but it will be difficult to determine the magnitude of the underestimate. This method also doesn’t allow for disaggregation of by disability and other characteristics (i.e. age, gender).  This approach could be seen as a first step to be followed up by a broader data collection at the individual level such as using the WG Short Set on a representative sample of the community (e.g. one in ten households, or one in five people at a community event).

In some data collection efforts, key informants used tend to come from the membership of Disabled People Organizations because they are easy to locate. It should be kept in mind that this is not a representative group. They tend to be more knowledgeable and have greater access to services.

Using the key informant method to identify people with disabilities for services will likely miss many persons with disabilities who could be program participants.

Ideally, the questions should be answered by the individual in question (self-report) with the exception of those who are not capable of responding themselves. However, in a census setting and for some types of surveys, it is common to have a primary respondent report for all other household members and this is acceptable in these context. In self-report situations, no one should be excluded because they cannot respond on their own (for example due to difficulty hearing, communicating, or an intellectual disability). The choice of a proxy respondent can be important and should be carefully considered before embarking upon the survey interview.

Training enumerators in how to use the WG questions is crucial and should ideally be followed up by ongoing supervision in the field. Key points to emphasize in training include:

• The word ‘disability’ is not mentioned in the introductory statement or the questions and should NOT be mentioned at all during data collection.
• The reasons why WG focuses on ‘functioning’ as opposed to ‘disability’, noting that the questions are not diagnosis, disease or condition-based, but instead focus on difficulties that anyone might experience.
• The use of screening questions (e.g. ‘Do you have a disability?’) or introductory statements (e.g. ‘The next set of questions are about disability’) will affect responses to the subsequent WG questions. Screening questions or statements should not be used under any circumstances, whether in a census or in a household survey.
• Questions need to be asked exactly as they have been worded. If questions are explained to participants using inappropriate or negative language, this may influence the way participants respond. This includes the response categories. These should be kept as is, and definitely not changed to yes/no responses.
• Enumerators should never skip questions or fill in the answers based merely on their observations (e.g. if they observe that respondent is using a wheelchair): they must ask all the questions to the participant.

The WG question sets have been carefully developed and tested and should be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability. Extensive testing and experience in a variety of contexts has demonstrated that making changes to the questions in an attempt to ‘improve’ them tends to have unforeseen consequences in terms of reducing accuracy. Using the questions as developed also allows for comparability of data across communities within countries or internationally among countries.

A possible exception to the ‘no change’ rule is if pre-testing highlights aspects of the questions that are not relevant or confusing in particular contexts. For example, in Bangladesh it was observed that hearing aids are for the most part non-existent. In this situation the removal of reference to the use of hearing aids in the hearing question was permitted. If in any doubt, it is best to contact the WG Secretariat and ask about the implications of any adaptations.

If additional information on functioning or health conditions is required, these questions should be added following the WG questions – not before. It is important to maintain the integrity of the WG questions. 

The short intro to the question set was developed given the census context where questions cover many disparate areas.  The introductory sentence ‘The next questions ask about difficulties you may have doing certain activities because of a HEALTH PROBLEM’ was included as a way of transitioning from one section of the questionnaire to another. Programs may choose not to use this introductory sentence, but it is important to not replace this with a sentence that uses the term ‘disability’. The WG-SS has deliberately been developed to focus attention on functioning – using neutral language and does not use the term ‘disability’.

Reporting of results using the WG questions should clearly state how the questions were used, the age range of participants and the cut-off points used to determine disability status. To allow comparison of data cross-nationally, the WG recommends that those who respond to at least one of the six questions with a lot of difficulty or cannot do at all be considered as with disability.

Information on children with disability is necessary in order to:

• understand the situation of children with disabilities in terms of child development, and with respect to prevalence, social circumstances and geographic location, unmet needs and the quantity and quality of the support they are receiving,
• assess the role of environmental factors (including societal attitudes and physical barriers) in the matters of inclusion (for example, access to education),
• advocate for the rights of children with disabilities,
• prioritize interventions: inform policies and programs, facilitate the planning of services, and improve participation and quality of life of children with disabilities and their families, and
• monitor progress on the UN Convention on the Rights of People with Disabilities (CRPD) and the Convention on the Rights of the Child (CRC).

The WG-SS questions were originally developed for censuses and large population-based surveys.

The WG-SS was designed as a core set of questions for self- or proxy-reporting of functional limitations at the individual level. Although they were developed to be appropriate for administration as part of a census, the questions can be included in any existing data collection activity within a program-level monitoring and evaluation framework or can be incorporated into smaller-scale surveys that collect data at the individual level.

The WG-SS is designed to avoid some of the failures of earlier ways of operationalizing disability (e.g. using only one question or a screening question such as ‘Do you have a disability?’).

As they were developed for use in censuses, the questions are as succinct and straightforward as possible without compromising their effectivity in the disaggregation of outcome data, for example, access to education or employment by disability status. Disaggregation allows for the determination of whether persons with disability have achieved the same level of participation as those without a disability on the selected outcome indicators.

In order to monitor compliance with the UN Convention on the Rights of Persons with Disability (CRPD) or evaluate whether programs are including people with disabilities and meeting their needs, baseline data on disability status collected at the individual level and follow-up data are required.  Conducting surveys that include the WG-SS at a minimum of two key points in a program (e.g. start and end) will provide valuable information on how people with disabilities have benefited from or been included in a program. These do not have to be large-scale surveys, which may be beyond the resources of a program. In many cases it will be possible to include the questions into the program’s usual data collection processes. Care should be taken to train enumerators to properly ask the questions. Sample sizes should be large enough so that information on the population with disabilities served by the program can be described.

• The WG Short Set does not identify particular health conditions or diagnoses (the medical model of disability) but rather captures the possible impact of these conditions on functional abilities (the social model of disability).

• Additional questions can be added to a survey – preferably after the WG questions – to obtain information on specific conditions or diagnoses or the cause of the functional difficulty if this information is desired.

• Where more detailed information is required, the WG Extended Set of questions (WG-ES) can be used.
• The WG-ES includes information on upper body functioning; psychosocial difficulties (anxiety and depression); pain and fatigue; and the additional information in certain domains of functioning both with and without the use of assistive technology/aids.

• The WG-SS will identify most, but not all, people with disabilities
• WG-SS questions were not designed to measure all aspects of difficulty functioning that people may experience, but rather those domains of functioning that are likely to identify a majority of people at risk of participation restrictions. These include difficulties seeing, hearing, walking or climbing stairs, remembering or concentrating, with self-care, and difficulty communicating.
• Those with psychosocial difficulties that do not impact cognition, communication or self-care will be under-reported. This issue is addressed in the extended set.

The WG-SS question response categories capture a range of severity in the difficulty experienced. Multiple disability scenarios can be described depending on the domain(s) of interest and the choice of severity cut-off. There is more than one way to capture disability through the application of this set of core questions; resulting in not one but several possible population prevalence estimates that will vary in both size and in composition of the group identified as having a disability.

The WG recommends that the following cut-off be used to define the populations with and without disabilities for the purpose of computing prevalence and differentials in participation for international reporting and cross-national comparability:

The population disabled includes everyone with at least one domain that is coded as a lot of difficulty or cannot do it at all.

Countries using the WG short set of questions should not feel restricted to only producing data based on the above cut-off. Data can be presented by individual domains of functioning, and at several levels of severity from very mild (some difficulty) to very severe (unable to do at all). For example, discovering that in rural regions of the country participation restrictions tend to kick in at lower levels of activity limitations than in urban areas could be suggestive that barriers to participation are more significant in areas with poorer infrastructure.

An accurate translation that conveys the context or conceptual meaning (rather than a literal translation) of the WG questions is crucial.

Guidelines for translating the questions can be found here, and protocols for cognitively testing translated versions of the questions can be found here. 

A few translated versions of the WG questions are available here. 

We are continuing to expand the number of languages into which this tool has been translated. If you cannot find a translated version in your local language, contact the WG Secretariat – there may be a version on file.

The introductory statement, “The next questions ask about difficulties you may have doing certain activities.” was included for the purpose of transitioning from topic to topic in a census context. The census format includes a small number of questions, usually on a variety of different topics, with topics changing quickly. The purpose of the introductory statement is to inform the respondent that the next set of questions will focus on a new topic. For example, if these questions followed a series of questions on another subject, sanitation for example, the introductory statement would provide a much-needed transition to new subject matter. In a larger survey, where this module might follow other health-related questions, and where the context is already established, the introductory statement could be dropped if the flow of the questionnaire is not adversely affected. It is also possible to change the wording of the introduction, as needed, as long as the word ‘disability’ is not used. 

Examples of alternatives to the introductory statement:

• The next questions ask about difficulties you may have in doing different activities.
• Now I am going to ask you some questions about your ability to do different activities.

• In order to collect internationally comparable data, it is important that the WG question be used without any changes to the wording of questions, order of questions, response categories, and cut-off points for classification of disability.
• There are very limited exceptions to this rule. For example, in countries where hearing aids are not available, leaving the hearing aid clause off the hearing question is allowed.
• Before making any modification consult the WG secretariat. Often the issues that arise in adapting to a particular country context can be addressed in how the questions are translated.
• Detailed information about this topic can be found in the translation FAQ page, but if you have any doubt please get in touch with the Secretariat for advice. 

Evidence shows that single screener questions do not adequately identify the population of interest.  Most screeners are of the form “Do you have a disability?” with yes/no answer categories.  As noted above, the use of the term disability has very negative effects.  Questions of this type identify only a portion of those experiencing functional problems. They equate disability with a medical problem (disability lies within the person) and by forcing a respondent to make a choice between affirming disability which in some cultures is associated with stigma and discrimination. Some screeners do not use the term disability but ask about medical conditions.  While respondents can describe their difficulty doing activities, they often cannot report on their conditions. For example, respondents may not be aware of their conditions due to lack of medical care. The search for a one or two question screener that will identify the population of interest and results in no false negatives has been universally unsuccessful.  The WG-SS represent the fewest number of questions that can be used to identify the population with disabilities.

• The WG-SS was not designed to be used in isolation. They should be used in conjunction with other measurement tools, i.e. include the WG-SS within a larger survey or registration form to enable disaggregation of other measures (employment status, educational attainment, etc.) by disability status.
• It can be used in a census or survey format,
• The focus on functioning and the brevity of the tool mean that it can be rapidly and easily deployed in a variety of settings.

Every year in preparation for the annual meeting, the WG asks member countries to report their own use of WG questions sets: the WG-SS, WG-ES or CFM. Results of this accounting are presented at the annual meeting under the title: Summary of Annual Activities Related to Disability Statistics. Therein are overviews of country activities (not data) on use of WG disability questions.

The WG does not maintain a database of survey or census data results for countries that have used the WG questions.  The data is owned and maintained by the countries or researchers who conducted the data collections.  However, we have occasionally conducted exercises where have asked our membership to complete and submit table shells with data collected using the WG questions and/or other disability measures.  The results from one of these exercises is to be found in a chapter in: An analysis of international census/survey data using the short set of disability questions developed by the Washington Group on Disability Statistics, In: International Measurement of Disability: Purpose, Method and Application – The work of the Washington Group on Disability Statistics. B. Altman (ed). Springer, Social Indicators Research Series, Volume 61:255-304, 2016.

More recently (2018), the WG conducted an exercise to assess the feasibility of countries to disaggregate selected SDG indicators by disability status.  The report containing results from that assessment, which includes some country data, can be found on the WG website at the following location: http://www.washingtongroup-disability.com/wp-content/uploads/2018/11/Disagregation-Data-Report_F4.pdf

Other potential sources of disability data:

·World Health Organization (WHO) / World Bank (WB) World Report on Disability: https://www.who.int/disabilities/world_report/2011/report.pdf

·United Nations Flagship Report on Disability and Development: https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2018/12/UN-Flagship-Report-Disability.pdf

·United Nations Disability Statistics Data Portal: https://unstats.un.org/unsd/demographic-social/sconcerns/disability/statistics/

·Disability Data Review: A collation and analysis of disability data from 40 countries

https://www.disabilitydataportal.com/fileadmin/uploads/lcdp/Documents/rep