Appendix 2. The Survey Instruments: The Filter Questionnaire

From ESRI (Economic and Social Research Institute)

Filter for Pilot Survey of People with disabilities in Ireland, JULY 2003

Area:
Resp.:
Stem: 
Date: 
Intno: 
Int. name:

Hello, my name is __________. I’m from the Economic and Social Research Institute, the ESRI. We do research on a wide range of social and economic issues for government departments and state agencies . [You may have heard of our reports on the radio or TV or read about them in the newspaper.]

We are doing a confidential survey of the general population on disability. The purpose of the survey is to collect information on the experiences of people with disabilities so that services and facilities can be improved. This research is being undertaken on behalf of the National Disability Authority, and the questionnaire was developed in consultation with organisations such as The National Federation of Voluntary Bodies, The Irish Advocacy Network, NAMHI, The Disability Federation of Ireland, The Forum of People with Disabilities, and Comhairle.

As part of the research we need to collect information which will allow us to calculate the number of households in Ireland in which there is a person with a disability. To do this, we need to speak to a representative sample of ALL households. Would you have a few minutes now to take part in a short telephone survey?

[The survey is completely confidential and anonymous. Your phone number was selected at random. We simply used a computer to generate these random numbers. I do not know your name, address or any details at all about you.]

Before we go on, Could I just check that you are over age 18?

Gender of resp.:Male / Female
Age over 18?Yes / No
Proceed / End Interview

I would like to assure you that all the information you give me is completely confidential. We produce statistical reports on social issues that do not identify individual respondents.

So, are you ready?

TimeInterview began __ __ : __ __ [24 hour clock]

1. Does anyone in your household have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities? This person could be yourself, or a child or an adult of any age who is living in your household.

Yes sometimes1
Yes, often2
No3

2. Does a physical condition or mental health condition or health problem reduce the amount or the kind of activity you, or anyone in your household, can do …

(a) At home?Yes sometimes1
 Yes, often2
 No3
   
(b) At work or at school?Yes sometimes1
 Yes, often2
No3
   
(c) In other areas, for example, transport or leisure?Yes sometimes1
Yes, often2
 No3

3. How many people are there altogether living in your household?

Please include yourself in the total.

________________

4. And how many of these are age 18 or over?

________________

5. Interviewer Check: Check Questions 1 to 2c, above:

‘No’ is answered at all four of 1, 2a, 2b, and 2c above:1⇒Go to 15
Otherwise:2⇒Go to 6

6. Is there more than one person in your household who has any of the difficulties or reduced activities I asked about earlier?

Yes, more than one1⇒Go to 7
No, just one2⇒Go to 8

7. [If more than one] In answering the next few questions about a person who experiences any of these difficulties, I would like you to think of the one whose birthday is coming up next.

8. Thinking now of the person in your household who has these difficulties or reduced activities, could I ask into which age group he or she would fall?

Under 51
5 –152
16-243
25-444
45-645
65 or over6

9. What is the MAIN condition that causes this person’s difficulty or limits his/her activities, e.g., cataracts, arthritis, multiple sclerosis, etc.?

____________________________________________________________

10. Would he or she be willing to participate over the next few weeks in a survey on the experiences of people such difficulties?

In the case of children or people who would have difficulty participating in a face-to-face interview, we would like to speak to a family member or advocate who could answer on behalf of the person concerned or help interpret the interview.

  1. Yes - Go to 12
  2. No - Go to 11

11. What is the MAIN reason you [this person] would NOT be willing to take part in a survey on the experiences of people with disabilities?

  1. Lack of time,
  2. Lack of interest,
  3. Do not believe it will be of benefit to people with disabilities,
  4. Unable to participate,
  5. Other reason (please specify),

In each case go to Question 15

12. Could I ask for the name, address and phone number or Email address of the person in question?

This information will be used solely for the purpose of contacting the person for the survey.

Name:
Address:
Phone:
Email:

13. Would we be able to interview _________ [Name] directly in a face-to-face interview or would we need someone to speak for _______ [Name] or to interpret?

  1. Yes, could interview directly-Go to 15
  2. No, need advocate/interpreter-Go to 14
  3. Person is under age 16-Go to 14

14. Could you give me the name, address and telephone number or Email address of someone who might be willing to speak for _____________ [Name] or interpret the interview?

This information will be used solely for the purpose of contacting the person for the survey.

Name:
Address:
Phone:
Email:

Interviewer: Record Time Interview ended __ __ : __ __ [24 hour clock]

THANK YOU FOR HAVING PARTICIPATED IN THIS SURVEY.