Community Based Inclusive Development (CBID) Demonstration Model 
Assessment 
Baseline Survey Report
This publication was produced by the Nossal Institute for Global Health and World 
Education Inc., through USAID Okard, a five-year cooperative agreement funded by the U.S. 
Agency for International Development under Agreement No. AID-486-A-17-0004.”
This report is made possible by the generous support of the American people through the United 
States Agency for International Development (USAID). The contents are the responsibility of World 
Education and the Nossal Institute for Global Health and do not necessarily reflect the views of 
USAID or the United States Government.
This publication was produced by the Nossal Institute for Global Health and World 
Education Inc., through USAID Okard, a five-year cooperative agreement funded by the U.S. 
Agency for International Development under Agreement No. AID-486-A-17-0004.”
This report is made possible by the generous support of the American people through the United 
States Agency for International Development (USAID). The contents are the responsibility of World 
Education and the Nossal Institute for Global Health and do not necessarily reflect the views of 
USAID or the United States Government
ii
Copyright information and indexing
ISBN: 9780734055828
Authors:
Liem Nguyen
Wesley Pryor
Manjula Marella
Alex Robinson
Fleur Smith
Contributors
Approval and coordinator agent: National Committee for Disabled People and Elderly, 
Ministry of Labour and Social Welfare
Technical contributors:
Respondents (data providers)
1. Representative from Provincial Department of Labour and Social Welfare from 
Xieng Khouang and Savannakhet Provinces
2. Representative from Provincial Department of Health from Xieng Khouang and 
Savannakhet Provinces
3. Representative from Provincial Rehabilitation Center from Xieng Khouang and 
Savannakhet Provinces
4. Representative from Provincial Department of Vocational from Xieng Khouang and 
Savannakhet Provinces
5. Representative from District Health Office from Kham and Xayphouthong Districts
6. Representative from District Hospitals from Kham and Xayphouthong Districts
7. Villagers and village authorities in 7 target villages in Kham District (Ban Nahom, Ban 
Kornhiew, Ban Bouamphieng, Ban Chormthongtay, Ban Sun, Ban Nathong and Ban 
Namuaeng
8. Villagers and village authorities in 8 target villages in Xayphouthong District (Ban 
Muangkhai, Ban Dontoum, Ban Namphou, Ban Dongposy, Ban Nakham, Ban 
Phorntan, Ban Khamsan and Ban Kuordam.
Local Research Team
Alounny Keosouvanh, Local Research Coordinator
24 quantitative enumerators and 4 qualitative interviewers
USAID Okard Team (World Education Inc. and Humanity and Inclusion)
Recommended citation: Nguyen, L., Pryor, W. and Marella, M., et al., 2020. Community 
Based Inclusive Development (CBID) Demonstration Model Impact Assessment - Baseline 
Survey Report. World Education Inc, Vientiane. 
iii
List of Tables ................................................................................................................iv
List of Figures................................................................................................................v
Abbreviations ...............................................................................................................vi
Foreword .....................................................................................................................vii
Acknowledgements .....................................................................................................ix
I. Executive Summary...............................................................................................1
Summary of study design............................................................................................................ 1
Prevalence of disability increased with age and was higher than previous estimates... 1
Social and demographic characteristics associated with functional difficulties .............. 2
Persons with disabilities experience poorer health and wellbeing ................................... 2
Persons with disabilities require more access to health care............................................ 3
Community voice among persons with disabilities .............................................................. 3
What the community know and do about functioning and disabilities............................ 3
Key findings to inform CBID planning..................................................................................... 4
Further overall findings............................................................................................................... 5
II. Background.............................................................................................................7
The context for the USAID Okard project........................................................................... 7
CBID baseline survey aims......................................................................................................... 8
III. Methods...................................................................................................................9
Study location ............................................................................................................................... 9
Quantitative component ..........................................................................................................10
Qualitative survey component................................................................................................18
Research ethics...........................................................................................................................22
IV. Results ...................................................................................................................23
Prevalence of functional difficulty ...........................................................................................23
Demographic and socio-economic characteristics of the population with different 
levels of difficulty .................................................................................................................................28
Disparities in education, vocational training and work .....................................................34
Disparities in Health & Wellbeing ..........................................................................................46
Need and access to healthcare services...............................................................................52
Access to assistive products & rehabilitation ......................................................................61
Participation in social gatherings, community activities and access to benefits...........70
Knowledge, attitudes and practice in disability ...................................................................84
V. Discussion of key findings ..................................................................................103
Prevalence of disability and its impact.................................................................................103
Community participation........................................................................................................107
Knowledge, attitude and practice in disability ...................................................................108
Strengths and limitations of this survey ..............................................................................109
VI. Conclusion and implications for CBID projects..............................................111
Appendices ................................................................................................................113
Appendix 1 Gantt chart of the CBID baseline survey..........................................................114
Appendix 2: Quantitative survey tool – Long-form..............................................................115
3. Appendix 3: Focus Group Discussion Guide for community people with disability.....144
VII.References...........................................................................................................151
iv
List of Tables
Table 1: Respondents for FGDs...........................................................................................................18
Table 2: Respondents for KIIs...............................................................................................................18
Table 3: Prevalence of functional difficulty by sex, age, and place of residence ........................27
Table 4: Characteristics of the population with different levels of difficulty..............................31
Table 5: Factors associated with functional difficulty ......................................................................32
Table 6: Factors associated with level of education & vocational training .................................35
Table 7: Factors associated with working status..............................................................................42
Table 8: Self-rated health indicators....................................................................................................47
Table 9: Factors associated with poor health (self-rated)..............................................................47
Table 10: Factors associated with SWLS............................................................................................51
Table 11: Need and ability to access healthcare services...............................................................53
Table 12: Factors associated with the need of healthcare services.............................................54
Table 13: Factors associated with the use of assistive products...................................................63
Table 14: Need and ability to access rehabilitation .........................................................................65
Table 15: Factors associated with poor awareness of rehabilitation...........................................67
Table 16: Factors associated with participation in social events & festivals...............................72
Table 17: Factors associated with the voice in community ...........................................................77
Table 18: Factors associated with participation in local organization/association ....................79
Table 19: Factors associated with poor access to government benefits ....................................81
Table 20: Self-identification as a person with disability ...................................................................84
Table 21: Factors associated with interacting with persons with disabilities.............................87
Table 22: Proportion of respondent agreed to opinions on disability.........................................89
Table 23: Proportion of respondents think that persons with disabilities can access services 
as much as other people ........................................................................................................................90
Table 24: Perceived reasons for persons with disabilities accessing services less (2 districts 
combined)..................................................................................................................................................91
v
List of Figures
Figure 1 Map of survey districts and provinces................................................................................... 9
Figure 2: Summary of sampling strategy .............................................................................................11
Figure 3: Proportion of the population experiencing functional difficulty in 2 study districts24
Figure 4: Prevalence of disability at district level..............................................................................25
Figure 5: Proportion of the population experiencing functional difficulty by age .....................28
Figure 6: Proportion of the population experiencing functional difficulty by domain in Kham 
District (on the left) and Xayphouthong District (on the right)...................................................28
Figure 7: School attendance of school-aged children aged 5 to 18 years old ............................37
Figure 8: Dissatisfaction with current activity status.......................................................................41
Figure 9: Need to work in the past 3 months and ability to work as much as needed/all of 
the time......................................................................................................................................................43
Figure 10: Satisfaction with life in general among the population aged 9 years or older........49
Figure 11: Satisfaction with life in the past 3 months (15y+).........................................................49
Figure 12: Barriers to accessing health care - percentage of respondents who reported 
reasons for not being able to access healthcare services all of the time ....................................55
Figure 13: Barriers to accessing health care - percentage of respondents who reported most 
important reasons for not being able to access healthcare services all of the time ................56
Figure 14: Health seeking behavior after being sick in the past 3 months..................................58
Figure 15: Use of assistive products (AP) - % using AP for all difficulty levels ..........................62
Figure 16: Proportion of people reporting access to rehabilitation ‘as much as needed’.......66
Figure 17: Participation in social events and festivals......................................................................71
Figure 18: Voice in community & participation in DPO .................................................................75
Figure 19: Participation in local organisation/association ...............................................................78
Figure 20: Access to Government benefits .......................................................................................80
Figure 21: Awareness of persons with disabilities around .............................................................85
Figure 22: Interaction with persons with disabilities among those who reported awareness 
of anyone with a disability......................................................................................................................86
vi
Abbreviations
AP Assistive product 
AT Assistive technology
CBID Community Based Inclusive Development
CI Confidence Interval: A range of plausible values based on available data
OPD Organization of Persons with Disabilities 
FGD Focus group discussion
GoL Government of the Lao People’s Democratic Republic 
KII Key informant interview
KAP Knowledge, attitudes and practices
OR Odds Ratio: A ratio of the likelihood of two occurrences being associated
controlling for other known factors
PPS Probability proportional to size (sampling)
PSU Primary sampling unit
RAD Rapid Assessment of Disability
SDG Sustainable Development Goal
SWLS Satisfaction with life scale 
UNCRPD United Nations Convention on the Rights of Persons with Disabilities
UNESCAP United Nations Economic and Social Commission for Asia and the Pacific
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
WG Short Set Washington Group Short Set of questions on disability
WHO World Health Organization
vii
Foreword
The United States Agency for International Development (USAID) Okard project supports 
Disability Inclusive Development (DID) in Lao PDR. World Education implements USAID 
Okard in partnership with the National Committee for Disabled People and the Elderly 
(NCDE), Ministry of Health, Humanity & Inclusion, and civil society organizations. The 
project aims to increase and sustain the independent living and functional ability of people 
with disabilities, regardless of factors such as age, sex, gender expression, ethnicity or the 
cause of their health condition that reduces functioning.
To understand DID, it is important to understand ‘human diversity’ and ‘inclusion’. Human 
diversity is a fact and takes many forms. People are diverse in age, sex, gender expression, 
race, and ethnicity. People also have diverse levels of functioning. Celebrating diversity means 
members of the community recognize, understand, and appreciate, with empathy and 
respect, the diversity of human beings. Inclusion is a choice, a choice for government and 
nongovernment actors to take tangible actions that remove barriers to participation. 
In close consultation with persons with disabilities, the USAID Okard interventions apply a 
cohesive system strengthening approach and person-centered approach to engage 
government actors to develop and implement disability inclusion policies and inform 
community stakeholders about the ways they can contribute to an inclusive community. 
Underpinned by the United Nations Convention on the Rights of Persons with Disabilities 
(UNCRPD), USAID Okard aims to foster a society where persons who have long-term 
physical, mental, intellectual or sensory impairments due to a health condition and who 
achieve their optimal level of functioning after accessing rehabilitation and using assistive 
products; and who interact in a barrier free community, enjoy equal, full and effective 
participation and opportunities in society. A society where communities celebrate diversity 
and understand that disability is part of human diversity.
USAID Okard applies a cohesive approach to contribute to disability inclusive development. 
World Education sub-contracts several government and non-government partners to 
implement mutually reinforcing interventions that each play a tangible role toward disability 
inclusion. USAID Okard therefore assumes that if the government and non-government 
stakeholders are equipped and cohesively engaged in taking tangible actions that contribute 
to remove barriers to inclusion (systems-based approach), and if primary healthcare 
professionals effectively provide rehabilitation and assistive products services (receive training 
on essential rehabilitation techniques, rehabilitation equipment and supply simple assistive
products); and if the managers of private enterprises receive advisory services on accessibility 
and mainstreaming disability in the global workforce and hire persons with disabilities on equal 
basis with others; and if the members of organizations of persons with disabilities are enabled 
and empowered to effectively represent the voice of all person with disability and to advocate 
for their rights in national and regional policy maker forums and if the changed knowledge, 
attitude and practice of Laotians toward disability, enhance behavior that appreciates and 
respects diversity; then we can expect a lasting change in society where persons with 
disabilities enhance and sustain their independent living (livelihood) and optimal functional 
ability.
viii
The Community Based Inclusive Development (CBID) Demonstration Model, designed by 
USAID Okard, is a key element of the project, and is a community-level synthesis of the 
operationalization of national disability inclusion and rehabilitation laws, policies and 
strategies, stakeholder engagement through community dialogue to take tangible actions 
that remove barriers to participation, and the individualized case management that enables 
persons with disabilities to achieve their optimal level of functioning and increase their 
potential to participate in a more inclusive society.
To ensure that USAID Okard applies an evidence-based approach to measure the outcomes 
of the CBID Demonstration Model on full and effective participation of persons with 
disabilities on equal basis with others in society, WEI contracted the Nossal Institute for 
Global Health from the University of Melbourne to undertake a baseline survey in both 
districts. 
The CBID Baseline findings will not only provide all USAID Okard stakeholders with valid 
and reliable data to measure the effectiveness of the CBID Demonstration Model on the 
participation of persons with disabilities in their society but will also inform future 
adjustments and improvements to the approach and tools.
My wish for those reading this report is twofold. First, to provide access to accurate data on 
disability prevalence in Lao PDR and an evidence-based analysis of the remaining challenges 
that need to be addressed to ensure that persons with disabilities fully and effectively 
participate in society on an equal basis with others. Second, to support and encourage the 
mainstreaming of disability in programming of development initiatives at the government and 
civil society levels as a lasting approach toward disability inclusion.
I would like to share my deep gratitude to the Government of Lao PDR, particularly to the 
Ministry of Foreign Affairs and NCDE, for their close cooperation and administrative 
support, which made this CBID baseline possible. 
I am grateful to the NOSSAL team for sharing their disability inclusive development expertise 
with great passion throughout the design, implementation, and analysis of this CBID Baseline. 
A great thanks to all the enumerators that, under the coordination of Alouny Keosouvanh, 
committed their time to travel hours in the community and interview people with 
professionalism and empathy. 
This baseline could not have been effectively implemented without the strong commitment 
and collaboration of World Education and Humanity and Inclusion staff. I am grateful for 
their involvement at all stages of the baseline.
Last but not least, my deepest respect and appreciation goes to all persons with disabilities 
and their families that shared their stories. Their experiences are the key to ensuring the 
CBID Demonstration Model better understands their unmet needs and how it can 
contribute to meeting those needs.
Kind regards,
Bernard Franck, Chief of Party - USAID Okard, World Education, Inc.
ix
Acknowledgements
The team at the Nossal Institute is grateful to the World Education team and their project 
consortium for their collaborative approach to implement the survey and interviews used to 
conduct this baseline analysis. We were very grateful to Government of Lao PDR authorities 
for providing the necessary support and permissions required to work in and with local 
communities.
The enumerators involved in the quantitative and qualitative component went above and 
beyond to conduct thousands of individual surveys, and we were grateful to them. 
We gratefully acknowledge the financial contribution of USAID to the USAID Okard project 
which funded this work.
Finally and most importantly, we are grateful to the survey and interview participants and 
their community leaders who were generous with their time, hospitality, information and 
expertise.
1
I. Executive Summary
Persons with disabilities are a large and growing proportion of the population and are at risk 
of exclusion from social and economic participation. Community-based inclusive 
development (CBID) is a strategy of targeted support for people to achieve their goals in 
areas including health, wellbeing, livelihoods and community participation. 
This mixed-methods baseline study provides evidence to inform the Lao PDR USAID Okard
project overall and particularly the CBID demonstration model. 
Summary of study design
The baseline study was designed with the following elements:
• A quantitative screening survey to determine disability prevalence and identify 
participants for further surveying (5173 people screened; 48% male, 52% female; 21% 
5-15y, 67% 16-59y, 12% ≥60y).
• A comprehensive quantitative case-control study to determine the baseline situation 
for key program results (321 and 326 people with and without disabilities respectively 
were surveyed)
• A qualitative study of knowledge, attitudes and practice (KAP) using 14 focus group 
discussions and 28 key informant interviews
• Where possible, findings from the qualitative component were used to help interpret 
quantitative results for results other than KAP
→ More information about the methods are provided in part III (page 9)
Determining disability: Note for the reader:
In this baseline survey, disability was identified using the Washington Group (WG) Short Set 
Questions on Disability that screen for seeing, hearing, mobility, remembering and 
concentrating, self-care and communication. Individuals reporting ‘a lot of difficulty’ or 
‘cannot do at all’ on any one domain of functioning (DISABILITY3 threshold according to 
WG protocol) were identified as having a disability.
Prevalence of disability increased with age and was higher than previous estimates
In the two districts surveyed, estimated disability prevalence (combining people who report 
having ‘a lot of difficulty’ or ‘cannot do at all’ in doing functioning activities to create an 
estimate of ‘disability’) was 11.7%, with 13.4% in Kham district and 9.9% in Xayphouthong 
district. Disability prevalence was strongly associated with increasing age and poverty. 
Difficulty communicating and self-care were less common than seeing, walking, remembering 
and hearing difficulties. These estimates were higher than 2015 Census estimates, which was 
2.8% prevalence, even though WG questions were used. The variation is due to differences 
in the methods with this survey which used more reliable, internationally-accepted methods
of obtaining individual level data.
→ Prevalence of disability results are described in part IV-1 (page 23)
2
Social and demographic characteristics associated with functional difficulties
In Xayphouthong district, but not in Kham district, persons with disabilities were less likely 
to report having as much work as they need. Persons with disabilities were less satisfied with 
work than persons without disabilities in both districts. Access to work was the most 
infrequent among people with higher levels of difficulty in functioning. Access to work was
also associated with increasing age. 
Persons with disabilities were less likely to have attended school, and less likely to progress 
to secondary or higher levels of education than others. Of the 20 school age children with 
disabilities surveyed, 4 (20%) had never attended school, while less than 2% (2/110) of 
children without difficulties had never attended school.
These findings highlight that age-specific strategies, taking into account fewer opportunities 
for education among persons with disabilities, are required in component 2 economic 
empowerment strategies. 
Similarly, adults with difficulties were also less likely to have ever attended school compared 
to adults without disabilities. However, most of the differences in education are probably 
associated with age; older people are less likely to have attended and completed school than 
younger generations. Targeted CBID support needs to consider access to school for young 
people, but also account for education levels among older beneficiaries. Persons with 
disabilities were more likely to have ever been married, but also more likely to be divorced 
or separated, when compared to persons without disabilities in both districts. This finding
highlights how family arrangements and structure might intersect with access to work.
→ Social and demographic characteristics associated with disability are reported in part IV￾2 (page 28)
→ Access to vocational training (linked to project result ER 2.1) is reported in part IV-3
(page 34), with additional analysis of access to education, work satisfaction and barriers 
to livelihoods.
Persons with disabilities experience poorer health and wellbeing
Compared with 14.4% of persons without disabilities, 73.3% of persons with disabilities self￾reported poor health, and about twice as many persons with disabilities had been sick enough 
to miss three or more days of work or school. Persons with disabilities were 10 times more 
likely to report having poor health than those without disabilities after controlling for other 
socio-demographic variables. 
Having poor health was also associated with increased age, not completing secondary or 
higher levels of schooling and being from Xayphouthong district. 
While the statistical associations were not strong, persons with disabilities expressed less 
satisfaction with life overall. People in Kham district reported lower levels of life satisfaction
than people in Xayphouthong district. 
→ The health of people with and without disability (linked to project indicator HI-4) is
reported in section IV-4 (page 46)
3
Persons with disabilities require more access to health care 
Compared to persons without disabilities (27.5% in Kham district and 22.1% in 
Xayphouthong district), about twice as many persons with disabilities (56.0% and 43.1% in 
Kham and Xayphouthong districts respectively) reported needing health care in the last three 
months. Having disabilities did not affect how much people could access mainstream health 
services or the main health-seeking behaviors, but access to assistive products and 
rehabilitation services were low. Persons with disabilities could access health care, but the 
type of care they access is not necessarily appropriate for addressing functional difficulties. 
→ The need for healthcare and current access to health services (linked to project 
indicator HI-2 & HI-3) is reported in section IV-5 (page 52)
→ Results linked to the user experience of health (project results HR 1.1 and 1.2) are 
reported separately in section IV-5 (page 52)
Community voice among persons with disabilities
Persons with disabilities overall had less voice in their community. Being an active member 
of community decision-making is also associated with increasing age, more education and 
higher living conditions. Barriers to participating in community activities and groups were 
more common among people with ‘a lot’ of difficulties, and none of the respondents in this 
survey who ‘could not do at all’ in at least one domain of functioning reported participating 
in any community organizations. 
→ Results concerning stakeholder engagement in government processes (indicator SI-2) 
and engagement in community actions (linked to enabling environment and SR 3.3)
are reported in section IV-7 (page 70)
What the community know and do about functioning and disabilities
Nearly 60% of persons with disabilities in Kham district and nearly 75% in Xayphouthong 
district identified with the WG questions did not self-report having a disability. Three 
quarters of people reported that they know someone with a disability. The likelihood of 
interacting with persons with disabilities increased with age but was lowest among people 
with the most difficulties themselves. People in the middle socioeconomic status were more 
likely to know and interact with persons with disabilities, while people from Xayphouthong
district were half as likely to interact with persons with disabilities as those in Kham district. 
Between a third and half of all respondents reported that persons with disabilities have either 
the same or less access to healthcare, work, and education when compared with persons 
without disabilities. A smaller but important proportion of the population reported that 
persons with disabilities have more access to services than others. Generally, this does not 
reflect the reality of the experience of exclusion among persons with disabilities and is an 
important area of community perceptions that can be addressed. 
Overall, there were positive self-reported attitudes towards persons with disabilities. More 
than 90% of people reported that they would have no issues with working with or living near 
persons with disabilities. However, people were likely to respond more positively than they 
4
act in reality. Further, the 10% of people that self-reported negative attitudes are a concern 
for equity. 
Negative or inequitable attitudes were more frequent concerning the right of persons with 
disabilities to get married, and to have children. Persons with disabilities expressed fewer
positive attitudes towards equity concerning women with disabilities having the right to 
work. In Xayphouthong district, fewer persons with disabilities reported that they should be 
able to get married. 
→ Qualitative and quantitative findings concerning the enabling environment (SI-2 and SR 
3.3) are reported section IV-8 (page 84)
→ Qualitative results concerning current knowledge, attitudes and practice linked to the 
enabling environment for sustainability of health and economic program
components are described specifically in section IV-8, part C (page 99)
Key findings to inform CBID planning
Prevalence of disability and impairment
▪ Using internationally accepted methods, disability prevalence was higher than 
previously reported. 
▪ Overall, people understood functioning and disability differently. This is evidenced by 
a mismatch between frequency of functional difficulties and self-reported disability. 
▪ More people experienced difficulty functioning as they got older. 
▪ Persons with disabilities experienced different types of barriers and exclusion 
through the life course.
▪ People who experienced difficulties seeing and hearing, and people with difficulties 
communicating and remembering could be at the most risk of exclusion. 
▪ While less than 1% of the population reported they ‘cannot do at all’ in at least one 
domain, this group was at higher risk of exclusion and may have higher needs than 
other groups.
Living conditions and inclusion
▪ The living conditions of people generally and especially persons with disabilities in 
Xayphouthong district was poorer than in Kham district. 
▪ Persons with disability were often as included in areas of social life as people without 
disability, but the quality of their experience is poor. Examples included access to 
health where people were able to access health, but persons with disabilities 
reported limitations in services specific to their needs, and in work, where people 
reported being able to work, but were less likely to be paid. 
▪ Persons with disabilities were around 60% less likely to have completed higher 
(primary+) levels of education. 
5
▪ Barriers to school access included negative social attitudes, skills and knowledge of 
educators, stigma and bullying. Social attitudes preventing school access included 
perceptions of the value of education among parents and caregivers. 
Health, rehabilitation and assistive technology
▪ Persons with disabilities were more likely to experience poor health and have more 
frequent and complex health service needs. Persons with disabilities could access 
health, but the services offered were often inadequate. 
▪ There was a high unmet need for assistive products overall. 
▪ Rehabilitation was poorly understood, including among persons who are likely to 
need it. Most rehabilitation in Lao PDR has been targeted to war-related injury and 
may not be responsive to the complex health needs of a changing population 
(increase of noncommunicable diseases and ageing). 
Women and women with disabilities 
▪ Women overall (controlling for all other factors including functioning) experienced 
lower levels of education and vocational training, work, and some dimensions of 
social inclusion.
▪ Women appeared to assume most (but not all) caregiver responsibilities. 
Government benefits
▪ Persons with disabilities accessed government benefits as much as or more than 
others.
▪ People who reported ‘cannot do at all’ in any one domain were more than four times 
more likely to have accessed government benefits than people with no difficulty. 
▪ Access to social benefits for caregivers was infrequent and a prominent issue 
reported by caregivers and families of persons with disabilities. 
▪ Benefits were mostly targeted to UXO accident survivors and war veterans. 
Knowledge and attitudes about disability
▪ How people understand disability in themselves and in other people is a key driver 
of attitudes and practice. In general, there was a narrow understanding of disability, 
limited to highly visible and more profound impairments. 
▪ People reported positive and inclusive attitudes about disability, but other findings 
point to exclusionary and stigmatizing practice. 
▪ The community tends to understand that persons with disabilities should be able to, 
but cannot, participate with others. There are social norms that seem to imply 
persons with disabilities should not have to work and should be taken care of. 
Further overall findings
▪ The baseline findings highlight the profound and urgent need to re-think disability, 
functioning and how CBID services respond to them in Lao PDR. 
6
▪ Complex interactions between functioning and how the community understands and 
responds to disability demonstrates the relevance of USAID Okard’s approach, which 
emphasizes a comprehensive and individualized approach to functioning, combined 
with community programming to address persistent and potentially harmful attitudes 
about disability. 
▪ There were important differences between Kham and Xayphouthong districts, 
especially concerning living conditions and self-reported health, which were both 
lower in Kham district than in Xayphouthong District.
▪ Findings underscore the importance of understanding the quality of services, rather 
than ‘access’ alone. That is, people at risk of, or with disabilities, appear to have 
similar access to many services including health, social benefits, and many aspects of 
social life – but the quality of those interactions appear to be inadequate. 
▪ Findings highlight particularly at-risk groups. These include older people; people with 
the most difficulty functioning (who are unable to do at all at least one domain); 
school-aged children with disabilities who are still commonly excluded from 
education; women with disabilities especially in areas of vocational training and work; 
younger people looking for work, and men with disabilities in accessing social 
interactions. 
7
II. Background
The context for the USAID Okard project
Persons with disabilities face discrimination and exclusion from the social, cultural, political 
and economic life of their communities [1]. In many contexts, persons with disabilities are 
more likely to experience poverty and yet are excluded from development programs [2-4]. 
There is growing recognition of the need to understand the prevalence of disability and 
attitudes and barriers to inclusion in order to support the design, implementation and 
monitoring of effective inclusive development programs [1]. 
In the Lao PDR, there are different estimates on the prevalence of disability. Earlier estimates 
in 1996 and 2005 estimated 0.7%-1% and 1.3% prevalence of disability respectively. The 2015 
Lao PDR census estimated a disability prevalence of 2.8% [5]. Another disability survey in 
selected areas of Lao PDR in 2016 reported a significantly higher disability prevalence at 
10.8% [6]. This variation in the estimates is due to different methods used for measuring 
disability in the two surveys. Further information on participation of persons with disabilities
in their communities and their access to health and social services is not well studied in the
surveys conducted so far in the Lao PDR. 
World Education is a non-governmental organization working in the Lao PDR since 1992 in 
partnership with the Government of Lao PDR. World Education is currently managing and
implementing the USAID Okard Activity, which is a 5-year program that intends to improve 
and sustain the independent living and functional ability of persons with disabilities and their 
households in Lao PDR. It will be implemented in three target provinces – Vientiane Capital, 
Xieng Khouang and Savannakhet. 
The Activity utilizes a flexible two-tiered approach that integrates the systems and individual 
level interventions within the three components: 
• Health (Component 1)
• Economic Empowerment (Component 2)
• Stakeholder Engagement (Component 3)
World Education is the lead implementing agency with close support from Activity partners 
including Humanity & Inclusion (HI), Ministry of Health (Department of Healthcare and 
Rehabilitation), Center for Medical Rehabilitation (CMR), Ministry of Labor and Social 
Welfare (MoLSW) National Committee for Persons with Disabilities and the Elderly 
(NCDE), Quality of Life Association (QLA) and Association for Rural Mobilization and 
Improvement (ARMI).
As part of the Activity, the Community Based Inclusive Development (CBID) evidence-based 
demonstration model is implemented in two target districts to demonstrate the effectiveness 
at community level of both the Government of Lao PDR National Disability Policy and 
related strategy, and the National Rehabilitation Medicine Strategy. The CBID district teams
implement innovative and effective interventions that directly address the health, livelihoods, 
and social needs of persons with disabilities, with a focus on individuals, families, and 
communities. The lessons learned on the change created for persons with disabilities and 
8
their households should drive adjustments at the systems level (by increasing demand and 
utilization for inclusive services) and the societal level (by engendering new beliefs about the 
abilities of persons with disabilities). This will support the execution of the National 
Rehabilitation Medicine and National Disability Strategies and Action Plans by the
Government of Lao PDR (i.e., Tier 1 system-level activities) and serve to address the overall 
disabling environment for persons with disabilities in the Lao PDR.
The CBID demonstration model is implemented in Kham District in Xieng Khouang Province
and Xayphouthong District in Savannakhet Province. There is a need for baseline data in 
these two targeted districts on the level of activity and participation (function) and wellbeing 
of people living in target areas; and to understand the knowledge, attitudes and practices 
(KAP) of community stakeholders including persons with disabilities themselves and their 
family, regarding disability and inclusion. Having this data will support the planning of targeted 
interventions in the two districts and to assess the impact of the USAID Okard interventions.
CBID baseline survey aims
The Nossal Institute for Global Health, The University of Melbourne was contracted to 
undertake a baseline survey in both districts. The research questions for the baseline survey 
were:
1. What is the impact of disability on the level of participation, access to services and 
wellbeing and what are the barriers that restrict participation and access?
2. What do people in the community know and believe about disability, and how do 
they behave about including persons with disabilities in their community?
The baseline survey was conducted using mixed methods which involved quantitative and 
qualitative data collection. A quantitative population-based survey was undertaken to address 
Research Question 1, i.e. to determine the prevalence and correlates of disability, and the 
level of participation of persons with disabilities in their communities, their wellbeing and 
access to services, and barriers to participation.
Qualitative research comprising key informant interviews (KII) and focus group discussions 
(FGD) was undertaken to address Research Question 2, i.e. to explore community and 
selected stakeholder attitudes to disability and participation of persons with disabilities in 
community and social life. 
9
III. Methods
Study location
The USAID Okard Technical Committee had consulted with the Government of Lao PDR
to identify the target areas for the CBID project. The baseline survey was conducted in the 
two selected districts: Xayphouthong district (Savannakhet province) and Kham district 
(Xieng Khouang province). 
Figure 1 Map of survey districts and provinces
Kham district 
(Xieng Khouang 
province)
Xayphouthong 
district (Savannakhet 
province)
10
Xieng Khouang province is in the Xieng Khouang Plateau in the north-east of Lao PDR. The 
province is mostly mountainous, bordering Vietnam to the east and Vientiane province to 
the southwest. Kham is a remote district within the province where 80% of people live in 
rural situations with limited transportation. Kham city is a main circulation point between 
Phonesavanh and the remote north bordering province of Houaphan.
Savannakhet province is the southern part of the country and is the largest province in Lao
PDR. The province borders Vietnam to the east and Thailand to the west and is an important 
trading post between Thailand and Vietnam. Xayphouthong district within the province has 
a flat topography being part of the Mekong plain and 76% is rural. 
Quantitative component
a. Sampling strategy
A cross-sectional population-based household survey was undertaken in the two selected 
districts. Based on the estimates of disability prevalence available for the Lao PDR that ranged 
from 1% to 10.8%, we assumed a mid-range disability prevalence estimate of 5% to calculate 
the required sample for this survey. Assuming 5% disability prevalence with a 95% confidence 
level, sampling error of 20%, an estimated design effect of 1.5, and a non-response rate of 
20%, a sample size of nearly 3,300 individuals was required per district. Assuming 5% disability 
prevalence, around 160 persons with disabilities and 160 people without disability were
planned to be recruited.
A two staged cluster random sampling was used. Figure 1 summarizes the sampling stages 
and key quantitative survey steps. Using publicly available information concerning the 
population demographics (population, age distribution, broad local economic status, rurality), 
individual primary sampling units (villages or sub-villages) were divided into clusters. Clusters 
were then stratified into rural and urban areas. Clusters within each stratum were randomly 
selected with a probability proportionate to size (PPS), ensuring representation from each 
cluster. This resulted in 8 clusters from Xayphouthong District and 7 clusters from Kham 
district. 
Participants were identified by local enumeration teams who were allocated to the sampled 
villages, where all households were approached, and all eligible household members were 
invited to participate in the screening survey. The inclusion criteria were individuals aged 5 
years and older currently living in the sampled households, consented to participate, and 
available for interview within three visit attempts. Village or sub-village heads and Provincial 
and District Labor and Social Welfare departments were notified of the visits in advance and 
provided the necessary local authorizations for the survey teams. 
The screening survey identified people with functional difficulties, (referred to as persons 
with disabilities hereafter) based on their responses to a short survey. Following the initial 
screening of the sampled households, a number equivalent to 5% of the cluster population 
was calculated to recruit persons with disabilities using the simple random sampling method. 
The same number of persons without disabilities were also recruited randomly from the 
same cluster. This resulted in around 300 people with and without disabilities being randomly 
selected from each of the two districts (total of about 600 people). It was ensured that 
11
participants without disabilities were selected from the households that did not include a 
person with disabilities. 
Figure 2: Summary of sampling strategy
• 2 districts were selected by the USAID Okard Technical Committee in 
consultation with the Government of Lao PDR:
o Kham district (35 villages) in Xieng Khouang province
o Xayphouthong district (16 villages) in Savannakhet province
District
selection
• Large villages were divided into smaller clusters with similar 
population sizes
• Clusters were stratified into rural & urban
• Clusters in each stratum were randomly selected using population 
proportion to size sampling:
o 5/29 rural & 2/8 urban clusters selected in Kham District
o 6/34 rural & 2/9 urban clusters selected in Xayphouthong District
Cluster
selection
• Clusters were mapped
• Everyone living in the selected clusters (7,373 people) were 
approached for the screening
• 5,377 people were available at the time of survey
• 5,173 people agreed to be interviewed in the screening (96.3% 
response rate for the screening)
• Using the WG Short Set, respondents who completed the screening 
were stratified into 2 groups: 
o 1) People with a lot of difficulty or unable to do (disability) at least 
one of the functions (617 people); 
o 2) People with no or some functional difficulties (4,541 people)
o Note: 15 people were not classifiable due to missing information in 
at least one of the domains
Screening
• Selected respondents for the full survey using a simple random 
sampling method:
o Of the randomly selected 327 persons with disabilities (167 in 
Kham District & 160 in Xayphouthong District), 321 (166 in Kham 
District & 155 in Xayphouthong District) completed the survey
o Of the randomly selected 331 people without disability (168 in 
Kham District & 163 in Xayphouthong District), 326 people (165 
in Kham District & 162 in Xayphouthong District) completed the 
survey
Full survey
12
b. Questionnaires and data collection
Screening survey
The screening tool is included as a link to a web form.
1 The screening instrument was 
developed with the USAID Okard team drawing on the Washington Group (WG) Short Set 
questions on disability. The screening instrument comprised of:
• Preliminary information: including district, village and household identification, 
unique identifying features (to guide return visits if re-sampling or otherwise 
required), number of people usually living in the household, and global positioning 
system (GPS) coordinates.
• Functioning: for each consenting household member an individual ID was created,
and individual functional difficulties were screened using the Washington Group 
(WG) Short Set of questions on disability, which screen for difficulty in hearing, 
seeing, mobility, remembering and concentrating, self-care and communicating. Each 
question asks about difficulties in doing the activity due to a health problem using the 
4-point Likert scale: ‘no difficulty,’ ‘some difficulty,’ ‘a lot of difficulty,’ and ‘cannot do 
it at all.’ Individuals reporting having ‘a lot of difficulty’ or ‘cannot do it at all’ on any 
one domain of functioning were identified as having disability.
After introducing the survey, explaining the purpose to the household, and obtaining 
consent, the screening took between 5-7 minutes per person. 
Full survey
Data collected in the full survey is included in Appendix , and a web form.
2 The full survey 
had 8 main sections:
1. General information including whether the person is available and prepared to be 
interviewed;
2. Consent question bank;
3. Sociodemographic status: Age, sex, education, work, marital status & number of 
children (for respondents aged 12 years or older);
4. Health: Health conditions, health seeking behavior, the WG extended set questions 
on functioning, Patient Health Questionnaire (PHQ)-2 for assessing signs of 
depression, assistive product use/unmet needs;
5. Wellbeing: Overall life satisfaction module derived from existing instruments 
(modified for age groups 5-9, 10-14, 15+);
6. Access to community: Frequency of and unmet need for participation in
community domains including shopping, social gatherings, community decision￾making, cultural and leisure activities, social benefit schemes, support groups 
(modified for age groups 5-9, 10-14, 15+);
 
1 https://ee.humanitarianresponse.info/x/#1Rd65HzU
2 https://ee.humanitarianresponse.info/x/#OpaVK2bl
13
7. Knowledge and attitudes on disability: Self-identification; contributions of 
persons with disabilities, rights and inclusion, community responses to disability; 
8. Household information: Information on dwelling, water, cooking, animals and 
inventory to construct wealth index.
The survey instrument was developed specifically for this CBID baseline assessment to 
provide a baseline of results and indicators for the three major project components. Survey 
development drew on other validated approaches and tools including the Rapid Assessment 
of Disability (RAD). The RAD was developed by the University of Melbourne’s Nossal 
Institute for Global Health and the Centre for Eye Research Australia as a population-based 
household survey designed to identify persons with disabilities and measure wellbeing and 
access to the community for persons with disabilities. RAD has been tested and validated in 
Bangladesh and Fiji; and has been used in various settings including the Philippines, Vanuatu
and India, and implemented with more than 30,000 people. 
Self-rated health was assessed based on three indicators – general health status rating 
based on a 4-point Likert scale (very good to very poor), ever been sick for at least 3 days, 
and the likelihood of depression. 
The likelihood of depression was measured using patient health questionnaire-2 (PHQ￾2).3 The PHQ-2 asks about the frequency of depressed mood and anhedonia (inability to gain 
pleasure from activities) over the past two weeks. Scores range from 0 to 6, with a score of 
3 or higher indicating that major depressive disorder is likely. However, it should be noted 
that PHQ-2 was not validated before this survey.
Wellbeing was measured using the satisfaction with life scale (SWLS). SWLS has been used 
as a measure of the life satisfaction component of subjective wellbeing. Scores on the SWLS 
have been shown to correlate with measures of mental health and can be predictive of future 
behaviors such as suicide attempts. In the field of health psychology field, the SWLS has been 
used to measure the subjective quality of life of people experiencing serious health concerns. 
In this study, the SWLS uses 5 questions with 4-point Likert scale; its score ranged from 5 
to 20. Scores between 5 and 13 indicate the respondent is dissatisfied with life, whereas 
scores between 16 and 20 indicate the respondent is satisfied. 
This study includes two scales: one about SWLS in general applying to population aged 9 
years or older, and another SWLS in the past 3 months applying to population aged 15 years 
or older. The scale has not been validated for the Lao context but has shown strong internal 
consistency and reliability in other countries.
Use of assistive products was studied using the World Health Organization’s Rapid 
Assistive Technology Assessment (rATA) tool. This tool comprised of questions on different 
types of assistive products for different domains of functioning. 
Questions in the full survey were culturally adapted by a group comprising the USAID Okard 
team and their collaborators, including persons with disabilities and service providers. The 
 
3
See: https://www.hiv.uw.edu/page/mental-health-screening/phq-2 for details.
14
full survey tool took between 40 and 75 minutes to administer. Both surveys were translated 
into Lao language and back-translated into English by independent translators.
c. Communication arrangements and proxy interviews
In case of adult participants who are deaf, home-sign language facilitated by family members 
or a proxy respondent was requested. If the enumerators were uncertain of the individual 
capacity to provide consent, or respondents were not able to convey their own capacity to 
consent, a proxy respondent in the household was asked to provide consent and to be 
interviewed. This was alongside the best attempt to obtain agreement from the participant. 
Decisions about when it was appropriate to use a proxy and how to make reasonable 
attempts to communicate with all individuals was considered in enumerator training. Training 
was provided through detailed role play, feedback and information from organizations for 
disabled persons’ representatives about the importance of understanding consent and the 
capacity to give consent. 
d. Mobile tools for data collection
Survey software
The survey was administered using mobile hand-held Android based tablets4
, and 
‘KoBoToolbox’ survey software.
5 The KoBo platform is a free and open-source, fully￾featured software suite, developed for field-surveys with poor or varied internet 
connections. The suite is comprised of an online survey development tool, a password 
secured and encrypted database feature, and an Android ‘app’ installed on each device. 
The survey was hosted on the KoBo server, and retrieved onto handheld devices using a 
password and the KoBo app. The survey can be used offline on the handheld devices and 
uploaded to the database when a connection is available with data deleted from the handheld 
device at the completion of surveying each cluster.
Electronic survey design
Screening and full surveys were coded using the XLS-Form6
language. Both English and Lao 
questions could be viewed at any time, using a simple drop-down menu. 
The survey skip logic was coded to only populate relevant questions based on previous 
responses. This minimized enumerator error, shortened the time for each survey, and 
integrated questions for different age groups. This skip logic included only issuing survey 
questions if the enumerator selects and verifies the option for consent having been given by 
the participant. Constraints were used to minimize data entry errors, and time-gates 
(duration between different questions) were generated to assist data verification. 
Data monitoring, verification and quality assurance
Data were downloaded from KoBo Toolbox into Excel, for preliminary cleaning during data 
collection for verification and follow up with the survey teams. Verification included checks 
for duplicate or skipped households and individual numbers, general checks of GPS 
 
4
Samsung ™ Galaxy ™ Tab 3, 8.0 4G enabled or similar
5 http://www.kobotoolbox.org/
6 XLSForm.org 
15
coordinate positions against sampled sub-villages and checks for missing data. Where errors 
were found, enumerators were contacted for verification, and the data were adjusted 
directly in the database. 
The following data quality assurance measures were employed:
• Use of tablet-based data collection tools with built in quality control measures, 
including validity checks, skip patterns and logic checks to minimize data collection 
errors and uploading of data for real-time remote monitoring.
• Establishing communication protocols for the Nossal team to provide support to in￾field supervisors and/or coordinators during data collection.
• Provision of practical training to local survey team.
• Where possible, provision of onsite support by the Nossal team at critical periods, 
such as in initial stages of data collection and/or tool testing.
• Use of professional quantitative software to minimize errors in data analysis. 
• Regular communication between the Nossal team and the USAID Okard Technical 
Committee.
e. Survey teams
Surveys were administered by enumerators after a five day training on working with and 
interviewing persons with disabilities, specific consent methods and requirements for this 
survey, and data management protocols. Enumerators were appointed through 
advertisements and through links with OPDs to ensure there was at least one person with 
disabilities in each survey team. In each district, enumerators worked in two teams of five
enumerators, including at least one woman and one man in each team.
Enumerator training
Training included five days of formal training and five days of accompanied field-surveying. 
Training sessions included:
• The USAID Okard project;
• Disability in Lao PDR;
• Personal experiences of disability;
• Research ethics, consent;
• Interviewing techniques including preparation for conducting the survey in local 
ethnic languages;
• Interviewing persons with disabilities;
• Adverse event protocols;
• Working with children;
• Experiential learning on interviews and survey specifics;
• Mapping villages, team allocation;
16
• Data management; backup, file management, hard-copy management;
• Tablet use;
• Accompanied implementation, debriefing, troubleshooting. 
f. Data analysis
Data were first downloaded into Microsoft Excel for preliminary cleaning and verification 
using field running sheets and expected numbers of responses. Data were then transferred 
to the statistical package STATA SE (Ver15) for further cleaning and analysis. Data variables 
were re-coded, re-labelled, or calculated as necessary. Disability variables were created using 
the Washington Group protocols and the recommended (DISABILITY3) threshold, wherein 
selecting ‘a lot of difficulty’ or ‘cannot do at all’ on any one domain of functioning from the 
Photo Series1: USAID Okard MEL unit and 
experts from Nossal Institute for Global 
Health conducted Enumerator training for 
the CBID baseline on 13 - 17 May 2019.
Photo credit: Souliya Ounavong
Photo series 2: The USAID Okard MEL unit conducted the CBID Baseline Quantitative 
Survey in Savannakhet and Xiengkhuang province from 19 May to 5 June 2019.
Photo credit: Enumerator team
17
WG questions is considered to represent the presence of disability.
7 Weighted disability 
prevalence estimates were calculated with 95% confidence intervals (CIs) for the prevalence 
of disability in each district and both districts combined.
Variables on employment were guided by the United Nation’s key labor market indicators8
. 
Based on the employment status and type of working situation, working status was eventually 
categorized as a binary variable (working or not). A household wealth index was used as a 
proxy indicator for wealth status. The asset index was constructed using principal 
component analysis on data from household asset questions (see Section H in Appendix 4). 
The asset index was then divided into three household groups (tertiles): high, middle and 
low living standards.
The level of education was categorized into none, less than primary, primary school and 
secondary school or higher. Vocational training status was a binary variable – ever received 
vocational training or not. 
Univariate, bivariate and multivariate (logistic regression) analyses were performed to 
examine associations between disability and socio-demographic factors. In a regression 
model, all risk factors are analyzed together to avoid effects from interaction of different 
factors with each other (i.e. confounding effects). The result is presented in odds ratios for 
the response variable that is adjusted for the other exposure variables that may be interacting 
with each other.
Initially, a binary logistic regression model was created to understand the socio-demographic 
factors influencing the presence or absence of disability (response variable). Exposure 
variables were sex, age, urban/rural residence, marital status, school attendance, level of 
education, vocational training, current activity status, working status and living standards. 
Separate logistic regression models were undertaken to understand factors influencing self￾rated health status, access to services (education/skills training, work, healthcare, assistive 
products, and rehabilitation) and participation in the community (social gatherings and 
community events) in general. In these regression models (binary and multinomial), disability 
was considered as an exposure variable along with age, sex, urban/rural residence, marital 
status, education level, working status and living standards. This type of analysis was 
undertaken with the understanding that there are multitude of factors that might influence 
access to services and participation in the community other than disability. This provides 
new information about the general situation of the target communities for planning 
appropriate and feasible interventions through the CBID demonstration model
 
7 Washington Group. 2019. Analytic Guidelines: Creating Disability Identifiers Using the Washington Group 
Short Set (WG-SS) SPSS Syntax. http://www.washingtongroup-disability.com/publications/implementing/
8
ILO. 2016. Key Labor market Indicators: Analysis with household survey data. ILO, Geneva. 
https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---
publ/documents/publication/wcms_519717.pdf
18
Qualitative survey component
a. Respondents and sampling
The overall purpose of the qualitative component was to understand the knowledge, 
attitudes and practices (KAP) concerning disability inclusion of a broader range of 
stakeholders. Whilst the quantitative component compared people with and without 
disabilities, the qualitative component targeted additional stakeholders using focus group 
discussions (FGDs) and semi-structured key informant interviews (KIIs) in Kham District 
and Xayphouthong District. FGDs were conducted in one village in each district purposively 
selected using data on persons with disabilities from the screening survey to ensure a range 
of disability types were present in the villages.
Table 1: Respondents for FGDs
FGD Target group Gender Total number of 
FGDs for 2 
A Community members with disability Female districts 2
Male 2
B Community members without 
disability
Female 2
Male 2
C Caregivers of persons with 
disabilities
Female 2
Male 2
D CBID facilitators Mixed 2
14
Table 2: Respondents for KIIs
Target group Administrative 
level 
Number of 
Interviews 
A i Village heads Village 2
ii Village health workers Village 4
iii Women’s Group Leaders Village 2
B i Ministry of Health officials District 6
Province 2
ii Ministry of Labor & Social 
Welfare officials
District 2
Province 2
iii Ministry of Education and Sports 
officials
District 2
Province 2
C i Organizations of Persons with 
Disabilities (OPD)
Province 2
D I Employer District 2
28
Respondents were selected by purposive sampling in consultation with the USAID Okard 
Technical Committee. Selection of respondents included consideration of gender and 
disability status to ensure balanced representation. However, in some cases a male bias was 
hard to avoid due to structural limitations, for example, amongst national and local 
government officials.
19
20
b. Data Collection and tools
Focus group discussions
Semi-structured question guides were used to facilitate focus group discussions with the 
respective FGD group respondents. FGD question guides included questions about inclusion 
and participation in community events, work and social activities; community awareness and 
attitudes to disability; access to education and health care; and experiences of discrimination. 
The question guides included suggested prompts for further probing on each issue. 
Key informant interviews
Interview guides were developed for the different stakeholder groups interviewed. All guides 
included general questions relating to community attitudes and awareness of disability, 
inclusion and participation by persons with disabilities in community events, knowledge of 
policies and programs related to disability, but also included specific questions related to 
access and inclusion of persons with disabilities in the specific sector of the interviewee. 
All FGD and KII guides were developed according to the project requirements identified by, 
and in consultation with, the USAID Okard team. These guides were translated into Lao 
language by the USAID Okard project translator and back translated into English in-country. 
Data collection
During preparation for data collection, sample transcriptions from the enumerators 
completed during training and from field trials were translated into English by the USAID 
Okard team and provided to the Nossal team for review and feedback. Once transcriptions 
were of sufficient clarity for analysis, data collection proceeded under the lead of the local 
research coordinator recruited by the USAID Okard team. This process established 
expectations of the data quality required in the transcripts to be analyzed by the Nossal 
team.
FGDs were conducted in appropriate locations identified in advance by the USAID Okard 
team. The USAID Okard team considered privacy, accessibility and convenience for 
participants when selecting the locations. Participants were asked to attend a 1-1 ½ hour 
group discussion. This included a welcome by the facilitators, introduction to the research, 
and a facilitated discussion concerning knowledge and attitudes to disability alongside 
exploring issues of inclusion and barriers to accessing services. 
KIIs were conducted in the place of work of participants in the main and as identified by the 
USAID Okard team and agreed with the participant. At initial contact by the USAID Okard 
team, participants were asked to make an appointment at a convenient time within a specified 
research period. Testing of the question guides indicated that 60 minutes was sufficient to 
review and receive consent and conduct the interview. Participants were asked to answer 
respective semi-structured questions and questions arising from prompts and open-ended 
discussion.
FGDs and KIIs were digitally recorded with the informed consent of the participants; 
however, being recorded was not a condition of participation in the FGDs. The data from 
both the FGDs were transcribed and translated to English by the USAID Okard team for 
analysis by the Nossal team. 
21
c. Enumerator teams and training
Enumerator team
Focus group discussions and key informant interviews were completed by a team of four (4) 
enumerators (two woman and two men) after a five day training on working with and 
interviewing persons with disabilities, specific consent methods and requirements for the 
FGD and KII, and data management protocols. Enumerators were appointed through 
advertisements and selected based on previous significant experience conducting FGD and 
KII. In each district, enumerators worked in pairs with one enumerator asking KII questions 
or facilitating the FGD, and one enumerator transcribing responses in conjunction with audio 
recording. When respondents were mixed sexes, enumerator pairs would include one man 
and one woman. When respondents in FGD were separated into groups of women or men, 
two female enumerators would conduct the FGD with female respondents, and two male 
enumerators would conduct the FGD with male respondents
Enumerator training
Training included five days of formal training. Training sessions included:
• The USAID Okard project;
• Disability in Lao PDR;
• Personal experiences of disability;
• Research ethics, consent;
• Focus group discussion and key informant interview techniques;
• Interviewing persons with disabilities;
• Adverse event protocols;
• Experiential learning on interviews and FGD and KII specifics;
• Audio recorder use 
• Translation and transcription protocols including coding of respondents to respect 
confidentiality
• Data management; backup, file management of audio recordings and transcriptions;
• Tablet use.
Once in the field collecting data, enumerators were accompanied by the local research 
coordinator during all the qualitative data collection for debriefing and trouble shooting. 
d. Analysis of qualitative data
Following transcription and translation, data from the FGDs and KIIs were entered into the 
NVivo software. Thematic analysis was conducted by the Nossal team to identify pre￾determined and emergent themes. The analysis for FGDs and KIIs were combined for 
reporting purposes unless otherwise stated. Where possible data from qualitative 
component was used for triangulating quantitative survey findings.
22
Research ethics
The study was approved by the Human Research Ethics Committee at the University of 
Melbourne. Administrative approvals in Lao PDR were obtained by the USAID Okard team 
from relevant agencies. Potential participants were informed about the survey and were 
invited to participate in quantitative or qualitative interviews. Potential participants were 
encouraged to ask questions or request additional information prior to being invited to 
provide consent. For participants who were unable to sign the consent form, the consent 
form was read to them and their verbal agreement was recorded by the enumerator.
23
IV. Results
Sub-section IV.1 presents findings on prevalence of functional difficulty and its variations using 
screening data. Of the 7,373 people enlisted as living in the selected clusters of both districts,
5,377 people were available at the time of survey. A total of 5,173 people agreed to be 
interviewed in the Screening (96.3% response rate).
9 They represent 24,649 people aged 5 
years or older living in the 2 districts. The samples for analyses in this section for Kham and 
Xayphouthong Districts included 2,861 and 2,297 people respectively; they represented
12,831 and 11,818 people aged 5 years or older respectively. There was nearly equal 
distribution of men and women screened in both districts with 48.9% and 45.8% men in 
Kham and Xayphouthong districts respectively. In total, there were 21.3% children aged 5-
15 years, 67% for adults aged 16-59 years, and 12% adults aged 60 years or older in both 
districts, and there was difference in age distributions between the two districts.
Sub-sections IV.2 to IV.8 present findings using long-form survey data. The sample included
648 people who consented and completed the interview (331 people in Kham district and 
317 people in Xayphouthong district); the sample represents 11,111 and 13,336 people aged 
5 years old or older who were actually living in Kham and Xayphouthong districts
respectively. This does not include people who did not live in the district, who are mainly 
permanent or temporary out-migrants.
Prevalence of functional difficulty
▪ Estimated disability prevalence (people with a lot or more difficulty in any domain)
was 13.3% (95% CIs: 12.2%-8.35) in Kham district and 9.9% (95% CIs: 8.4%-11.7%) in 
Xayphouthong district.
▪ A further 18.7% (95% CIs: 15.5%-22.4%) and 25% (95% CIs: 22.3%-27.3%) in Kham 
and Xayphouthong districts respectively reported ‘some’ difficulty in at least one 
domain. 
▪ Disability prevalence was not significantly different between women and men, 
between the districts, or between rural and urban populations. 
▪ Less than 1% of the population reported ‘cannot do’ in any one domain, but this 
population is among the most important targets for programming. 
▪ People reporting ‘a lot’ of difficulty in any one domain account for most of the 
disability prevalence. 
▪ As people age, they are more likely to report functional difficulties.
▪ The most common domains of difficulty were in walking and seeing. 
▪ About half of people with disability experience a lot or more difficulty in more than 
one domain.
 
9 There were 15 people (difference between 5,173 and 5,158) whose information on functional difficulties was 
missing in at least 1 domain of difficulty; they were excluded from analysis. Given their small proportion (less 
than 0.3%), their exclusion resulted in very minor to no effect on the results.
24
a. Kham district (Xieng Khouang province)
An estimated 13.3% (95% CIs: 12.2%-8.35) of people (14.3% of men and 12.3% of women)
in Kham district experienced a lot of difficulty or were unable to perform activities in at least 
one domain (Figure 3). This comprised mostly of people who identified ‘a lot’ of difficulty as 
there was less than 1% of people who were unable to perform activities in at least one 
domain. An additional 18.7% (95% CIs: 15.5%-22.4%) of the population (17.0% of men and 
20.3% of women) experienced some difficulty in at least one domain. 
b. Xayphouthong district (Savannakhet province)
In Xayphouthong district, 9.9% (95% CIs: 8.4%-11.7%) of people (9.7% of men and 10.1% of
women) experienced a lot of difficulty or were unable to perform activities) in at least one 
domain. Similar to Kham district, fewer than 1% of the population reported they were unable 
to do activities in at least one domain. An additional quarter (25%, 95% CIs: 22.3%-27.3%) of 
the population (22.1% of men and 27.4% of women) experienced some difficulty in at least 
one domain.
In the two districts combined (Figure 4), two-thirds (66.7%, 95% CIs: 64.2%-68.1%) of the
population experienced no difficulty, 21.7% have some difficulty, 10.8% have a lot of difficulty, 
and 0.9% were unable to perform activities in at least one domain. Using the Washington 
Group recommended cutoff for the Short Set questions on disability, this represented an 
adjusted disability prevalence estimate of 11.7% (95% confidence interval/CI: 10.7%-12.6%).
c. Adjustment for unavailable or out-migrant population
About a quarter of people in Kham District and nearly one-third of people in Xayphouthong 
District were not available for the screening interview, mostly due to travel elsewhere in 
Lao PDR or neighboring Thailand for paid work or education. It is unclear whether this 
population would require support from CBID. If data is adjusted to account for this missing 
population and assumes they experience no functional difficulty, the prevalence of disability 
in the two districts reduces to 10.22% and 6.14% in Kham and Xayphouthong Districts,
respectively.
Figure 3: Proportion of the population experiencing functional difficulty in 2 study districts
68.1%
65.1%
18.7%
25.0%
12.4%
9.0%
0.9%
0.9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Kham
Xayphouthong
None Some A lot Unable
25
Figure 4: Prevalence of disability at district level
d. Variation of functional difficulty
The prevalence of disability was similar for rural and urban settings, between women and 
men, and between the two districts. As expected, the prevalence of disability was positively 
associated with increasing age in both districts (Adjusted OR 1.06; 95% CI 1.04-1.05; p<0.01). 
“Figure 5 presents the proportion of the population (women and men combined) with a lot 
or more difficulty by age, for both survey districts. There is a steady increase in the 
proportion of the population reporting some or more difficulty, with a trend towards a more 
rapid increase around 45 years. The proportion of those reporting at least some difficulty in 
one domain increases from 79% at ≥60 years to 90% at ≥80 years. Data for people who 
reported they cannot do one or more activities were limited by sample size but followed a
similar trend of steady increase with age.”
e. Domain of functional difficulty
Variation of the reported functional difficulties in the two districts were very similar. As 
shown in Figure 6, the most frequently reported difficulties at the ‘a lot’ or ‘cannot do at all’ 
levels were with seeing and walking, followed by difficulties with remembering and hearing. 
There were not many people that reported significant difficulties in communicating and self￾care. 
Multiple disabilities were common in both districts. Among those with disabilities, 42.4% & 
41.5% in Kham & Xayphouthong districts had difficulties in multiple domains (2 districts 
combined: 23.1% in 2 domains, 13.5% in 3 domains, and 5.5% in 4 or more domains),
respectively.
13.3%
9.9%
11.7%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
Kham district Xayphouthong district Both
Prevalence
Lower CI
Upper CI
26
27
Table 3: Prevalence of functional difficulty by sex, age, and place of residence
Level of difficulty
None
% (95% CIs)
Some
% (95% CIs)
A lot
% (95% CIs)
Unable
% (95% 
CIs)
Kham
District
Sex
 Male 68.8 (64.8-72.5) 17.0 (13.0-21.9) 12.5 (11.6-15.7) 0.8 (0.5-1.2)
 Female 67.3 (62.6-71.7) 20.3 (15.7-25.9) 11.4 (9.0-14.2) 1.0 (0.5-1.9)
Age ***
 Mean 24.7 44.7 55.3 63.8 
 95% CI 18.2-31.3 31.2-58.2 37.1-73.6 19.2-108.3 
Place of 
residence
 Rural 67.4 (62.2-72.2) 19.4 (14.9-25.0) 12.3 (11.0-13.8) 0.9 (0.6-1.4)
 Urban 70.3 (66.0-74.2) 16.2 (11.0-23.2) 12.6 (9.7-16.3) 0.9 (0.4-2.0)
Xayphouthong District
Sex
 Male 68.2 (64.6-71.6) 22.1 (18.8-25.8) 8.8 (7.0-10.9) 0.9 (0.2-4.0)
 Female 62.5 (58.5-66.4) 27.4 (25.2-29.7) 9.3 (7.0-12.2) 0.8 (0.3-2.5)
Age ***
 Mean 28.3 47.6 58.6 50.2
 95% CI 24.8-31.8 45.2-50.0 55.5-61.7 32.5-67.9
Place of residence
 Rural 63.3 (60.0-66.8) 25.8 (23.0-28.8) 10.0 (8.1-12.2) 0.9 (0.2-4.0)
 Urban 71.1 (67.0-74.8) 22.3 (19.2-25.7) 5.9 (4.8-7.2) 0.7 (0.3-1.5)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Kham: Some+ Kham: A lot+ XPT: Some+ XPT: A lot+
28
Figure 5: Proportion of the population experiencing functional difficulty by age
Figure 6: Proportion of the population experiencing functional difficulty by domain in Kham
District (on the left) and Xayphouthong District (on the right)
Demographic and socio-economic characteristics of the population with different levels 
of difficulty
▪ More women (52.7% of the sample) than men (47.4%) were surveyed.
▪ Being unmarried is associated with higher levels of functional difficulty.
▪ Persons with disabilities had lower levels of education.
▪ 17.9% and 12.1% of the overall population in Kham and Xayphouthong districts,
respectively, reported having skills or vocational training. There was a trend towards 
persons with disabilities having more vocational training than people without 
disability in Xayphouthong district. In Kham district, people with disability had less 
skills and vocational training than in Xayphouthong district.
▪ Persons with disabilities report working as often as persons without disabilities but
are less likely to be paid. 
▪ Persons with disabilities were half as likely to report high living conditions than 
persons without disabilities. 
a. Demographics of people with and without functional difficulty
6.4%
3.5%
5.9%
4.1%
0.4%
0.7%
11.9%
4.7%
7.5%
11.7%
1.0%
0.9%
0% 5% 10% 15% 20%
Seeing
Hearing
Walking
Remembering
Selfcaring
Communicating
Unable A lot Some
4.7%
2.1%
3.8%
3.0%
0.7%
0.5%
14.9%
4.2%
9.6%
16.0%
1.9%
1.0%
0% 5% 10% 15% 20%
Seeing
Hearing
Walking
Remembering
Selfcaring
Communicating
Unable A lot Some
29
Table 4 below provides information on basic demographic and socio-economic 
characteristics of the population at different levels of difficulty in Kham and Xayphouthong 
districts. There were slightly more females than males in both districts, and this pattern was
similar for populations with and without disabilities. Similarly, 23.1% and 20.8% of people in 
Kham and Xayphouthong districts, respectively, lived in urban areas. There was no difference 
in the prevalence of disability between rural and urban areas. 
Disability prevalence increased with age. About two-thirds (68.7% and 68.6% in Kham and 
Xayphouthong districts, respectively) of the sample that were married, a quarter (25.3% and 
23.4%) were never married, and the remaining 6% in Kham district and 8% in Xayphouthong,
respectively) reported being divorced or separated in both districts. In both districts, being 
unmarried is associated with higher levels of functional difficulty.
There were significant variations in education levels between people with and without 
disabilities. In both districts, persons with disabilities were significantly more likely to stay 
out of school and had lower levels of education completed. 
Nearly 2 out of 10 (17.9%) and 1 out of 10 (12.1%) people in Kham and Xayphouthong 
districts, respectively, have received skills or vocational training. Although the difference in 
proportions was not statistically significant, persons with disabilities (25.6%) were more likely 
to have received vocational training in Xayphouthong district compared to persons without 
disabilities (16.5%). Whereas the difference in proportion was significantly higher in Kham 
district with 12.8% of persons without disabilities receiving vocational services compared to 
6.5% persons with disabilities. 
In both districts combined, nearly two-thirds (67.6%) of persons with disabilities were 
working (paid/unpaid). This proportion was similar to that of persons without disabilities
(67.5%). However, persons with disabilities were significantly less likely to have paid work
(39.4% vs 10.2%), more likely to be unemployed (14.0% vs 2.3%), and less likely to be a 
student (10.7% vs 28.6%) compared to persons without disabilities.
Although the difference is not statistically significant, persons with disabilities tended to live 
in households with lower living standards in Xayphouthong district. There was no variation 
in the living standards among persons with disabilities in Kham district.
b. Factors associated with functional difficulty
An ordered logistic regression was used to determine how different sociodemographic 
characteristics are associated with the level of functional difficulty. The results in Table 5 
show age and living standards were independently associated with disability in both districts. 
As expected, older people were more likely to have higher levels of functional difficulty. 
After controlling for other factors or all else being equal (i.e. when people had the same age, 
same sex, same marital status, same level of education completed, same vocational training 
experience, same working status, living in the same rural or urban setting, and living in the 
same district), people with higher living standards were 50% less likely to have a disability 
compared to those reporting lower living standards. 
30
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
31
Table 4: Characteristics of the population with different levels of difficulty 
Level of difficulty
Kham District Xayphouthong District
None/ 
Some
A lot/ 
Unable Both None/ 
Some
A lot/ 
Unable Both
Sex
 Male 40.7% 47.3% 41.7% 47.9% 43.3% 47.4%
 Female 59.3% 52.7% 58.3% 52.1% 56.7% 52.7%
Age *** ***
 Mean 28.7 54.7 32.7 35.0 48.5 36.7
 95% CI 26.7-
30.7
48.1-
61.3
31.1-
34.4
27.3-
42.7
48.1-
61.3
28.8-
44.7
Place of residence
 Urban 23.6% 20.3% 23.1% 21.5% 16.1% 20.8%
 Rural 76.4% 79.7% 76.9% 78.6% 83.9% 79.2%
Marital status ** ***
 Never married 29.8% 4.9% 25.3% 25.4% 8.8% 23.4%
 Currently married/cohabited 66.6% 78.2% 68.7% 69.2% 63.8% 68.6%
 Divorced/Separated/Widowed 3.6% 16.9% 6.0% 5.3% 27.3% 8.0%
Ever attended school *** **
 Never attended school 7.5% 22.3% 9.7% 9.2% 32.1% 12.1%
 Currently attending 32.6% 2.6% 28.0% 23.4% 17.1% 22.6%
 Attended before 60.0% 75.1% 62.3% 67.5% 50.8% 65.4%
Level of education completed * **
 None 12.4% 24.3% 14.2% 11.4% 38.5% 14.9%
 Less than primary 25.7% 36.7% 27.4% 29.5% 38.5% 30.7%
 Primary 35.6% 28.0% 34.4% 40.0% 13.4% 36.6%
 Secondary or higher 26.3% 11.0% 24.0% 19.1% 9.6% 17.9%
Vocational training **
 Have received any skills or VT 16.5% 25.6% 17.9% 12.8% 6.5% 12.0%
 Have not 83.5% 74.4% 82.1% 87.2% 93.5% 88.0%
Main activity status *** **
 Student 32.6% 2.6% 28.0% 25.4% 18.8% 24.5%
 Not working & not looking for 
work 2.1% 9.6% 3.2% 0.2% 10.0% 1.4%
 Not working and looking for 
work 0.8% 3.3% 1.2% 1.6% 5.2% 2.1%
 Retired 0.8% 4.6% 1.4% 0.0% 2.0% 0.3%
 Full time 
homemaker/housewife 7.6% 10.7% 8.1% 11.7% 14.6% 12.1%
 Contributing family worker 13.1% 15.3% 13.4% 18.7% 23.3% 19.3%
 Employee 7.1% 4.4% 6.7% 12.8% 3.5% 11.6%
 Self-employed 35.1% 47.7% 37.1% 28.3% 15.6% 26.7%
 Other 0.8% 1.9% 1.0% 1.3% 7.1% 2.1%
Working status *** **
 Not working 2.9% 12.9% 4.4% 1.8% 15.2% 3.5%
 Having a paid work 7.1% 4.4% 6.7% 12.8% 3.5% 11.6%
32
Level of difficulty
Kham District Xayphouthong District
None/ 
Some
A lot/ 
Unable Both None/ 
Some
A lot/ 
Unable Both
 Having un-paid work 55.8% 73.7% 58.6% 58.7% 53.5% 58.0%
 Student 32.6% 2.6% 28.0% 25.4% 18.8% 24.5%
 Others 1.7% 6.4% 2.4% 1.3% 9.1% 2.3%
Living Standards
 Low 24.4% 32.4% 25.6% 33.0% 45.9% 34.6%
 Average 31.4% 33.7% 31.7% 31.8% 37.0% 32.5%
 High 44.3% 33.9% 42.7% 35.2% 17.2% 32.9%
Total 100% 100% 100% 100% 100% 100%
n 163 168 331 196 121 317
N 9,403 1,708 11,111 11,630 1,706 13,336
Note: *
shows test results from bivariate analysis; *
p<0.10 **p<0.05 ***p<0.01. 
Table 5: Factors associated with functional difficulty
33
Odds 
ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Sex
 Male (ref.) 1
 Female 0.96 0.63 1.46
Age 1.06 *** 1.04 1.08
Place of residence
 Urban (ref.) 1
 Rural 0.78 0.48 1.27
Marital status
 Never married (ref.) 1
 Currently married/cohabited 1.51 0.52 4.37
 Divorced, separated, widowed 1.56 0.56 4.34
Education level
 None (ref.) 1
 <Primary 1.57 0.71 3.51
 Primary school 0.83 0.34 2.00
 Secondary school + 0.73 0.27 2.01
Vocational training 0.99 0.54 1.81
Working 0.55 0.23 1.32
Living standards level
 Low (ref.) 1
 Middle 0.99 0.62 1.58
 High 0.49 *
0.19 1.23
District
 Kham (ref.) 1
 Xayphouthong 0.93 0.59 1.46
n 647
N 24,426
Note: *
p<0.10 **p<0.05 ***p<0.01. 
34
Disparities in education, vocational training and work
▪ Persons with disabilities were about 60% less likely to have completed higher 
education levels.
▪ Disability was not significantly associated with access to vocational training 
opportunities, however people reporting ‘cannot do’ in any domain were much less 
likely to work than people with no disabilities and people with ‘a lot’ of difficulty. 
▪ Being divorced, unmarried or separated was associated with lower educational 
standards. 
▪ Women, people in Xayphouthong district, and people with lower living standards,
were less likely to have vocational training.
▪ Children with disabilities were less likely to attend school compared to children 
without disabilities. 1 out of 5 school-aged children with disabilities have never 
attended school.
▪ Persons with disabilities were less likely to be working compared to those without 
disabilities (OR = 0.17; 95% CI: 0.05-0.52).
▪ Older age (OR = 1.10; 95% CI: 1.07-1.13) and higher levels of education (OR = 5.25; 
95% CI = 1.26-21.93) were independently associated with having work (paid/unpaid).
a. Factors associated with the level of education and vocational training
Disparities in education and vocational training were presented earlier under socio￾economic characteristics of respondents. This section explores associations between the 
level of difficulty and the level of education completed, and vocational training after 
controlling for other socioeconomic factors (Table 6). All else being equal (i.e. when people 
had the same age, same sex, same marital status, same working status, same living standards,
living in the same rural or urban setting, and living in the same district) persons with 
disabilities were nearly 60% less likely to complete a higher level of education compared to 
those having no functional difficulty. Although differences were not statistically significant, 
there was a similar tendency towards an association between the level of functional difficulty 
and participation in vocational training, with notable differences between the districts. 
Overall, females and those who were divorced/separated/widowed were less likely to have 
higher levels of education and people from higher living standards were more likely to have 
higher levels of education. Females and those living in Xayphouthong district were less likely 
to have vocational training and people from higher living standards were more likely to have 
vocational training.
35
Table 6: Factors associated with level of education & vocational training 
Level of education Vocational training
Odds 
ratios
95% CI
Odds ratios
95% CI
Lower Upper Lower Upper
Difficulty level
 None (ref.) 1 1
 Some 0.87 0.46 1.65 0.85 0.25 2.95
 A lot 0.44 ** 0.21 0.91 0.66 0.34 1.31
 Unable 0.37 ** 0.17 0.81 0.25 0.03 2.40
Sex
 Male (ref.) 1 1
 Female 0.65 *
0.40 1.05 0.45 *
0.15 1.35
Age 0.99 *
0.97 1.00 1.02 ** 1.00 1.05
Place of residence
 Urban (ref.) 1 1
 Rural 0.96 0.57 1.63 1.46 0.67 3.16
Marital status
 Never married (ref.) 1 1
 Currently married/cohabited 0.68 0.33 1.42 3.14 0.42 23.30
 Divorced, separated, widowed 0.14 *** 0.05 0.43 1.73 0.22 13.69
Working 3.93 *** 1.85 8.37 1.92 0.34 10.71
Living standards level
 Low (ref.) 1 1
 Middle 1.35 0.66 2.77 1.25 0.58 2.70
 High 1.79 *
0.80 4.02 2.19 *
0.92 5.23
District
 Kham (ref.) 1 1
 Xayphouthong 0.84 0.55 1.29 0.50 ** 0.28 0.90
n 647
N 24,426
Note: *
p<0.10 **p<0.05 ***p<0.01. 
36
37
b. Participation in school among school-aged children
Disparities in school attendance among school-aged children, i.e. 5 to 18 years old, are shown 
in Figure 7 Children with disabilities were less likely to attend school compared to children 
without disabilities. One out of 5 school-aged children with disabilities had never attended
school, while 1 out of 20 school-aged children with no disabilities had never attended school
in both districts. 
Figure 7: School attendance of school-aged children aged 5 to 18 years old
c. Qualitative findings: school participation
Analyzing in-depth interviews provided additional and richer information to understand 
school participation. Discussions of access to education for children with disabilities in the 
FGDs and KIIs focused almost entirely on mainstream village schools. There was very little
mention of special schools for children with disabilities by any respondent, except one 
participant noting that these schools do not exist in rural areas. Most respondents identified 
that if children with disabilities did attend school it was generally only for primary school and 
did not continue into secondary education, but it was not clear whether this was different 
between children with and without disabilities. 
Persons with disabilities themselves reported mixed experiences of having attended school. 
Some reported that they attended school, some started at an older age, many did not 
complete their education, and others did not attend at all – often despite their siblings having 
attended school. Some persons with disabilities reported that they did not ever want to go 
to school, with fears of bullying or an assumption of being unable to learn cited as reasons.
There was a sense from several participants (all adults) that children with disabilities were 
more likely to go to school now than when they had been of school age.
“The school was not as open for all as it is nowadays. These days, schools are more 
for everyone.” (FGD, Males with disabilities, Savannakhet)
80.0%
55.0%
18.2%
25.0%
1.8%
20.0%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
None/ Some
A lot/ Unable
Currently attending Attended before Never attended
38
There were also mixed experiences and beliefs from caregivers about whether children with 
disabilities do or should attend school. There was a general perception that many children 
with disabilities cannot go to school, or only children with certain types of impairments can 
attend school. Some participants reported their child had attended school up to a particular 
grade but did not continue, and some questioned the value of their child attending school.
These perceptions and beliefs were consistent between the male and female caregiver 
groups, and between provinces.
“From what I have observed, children with disabilities who can see, speak and walk 
can go to school….children who cannot help themselves cannot go.” (FGD, Male 
caregivers, Xieng Khouang)
“It depends on their difficulties, if someone who can walk and communicate with 
others they can [go to school], no problem, but if someone who does not be able 
to do as such, they should not go.” (FGD, Males with disabilities, Savannakhet)
One caregiver stated –
“They can study but when seizure happen it can be a challenge for learning, so I 
decided not to let them go to study.” (FGD, Female caregivers, Xieng Khouang)
While another parent of a child with a vision impairment said –
“Although she goes to school, she can’t really study.” (FGD, Male caregivers, Xieng 
Khouang)
Some reported successful experiences of children with disabilities attending school and being 
well-supported. 
“People actually support children with disabilities to go to school, there are not any 
negative thoughts about this. They support a child with disability to attend the grade 
6 this year.” (FGD, Male caregivers, Xieng Khouang)
Community members without disabilities reported that they believed children with 
disabilities should be able to attend school, and that this should be in the same classes as 
children who do not have disabilities. 
“I feel that they are different, but our children are normal. I want children with 
disabilities to feel as they are the same as us.” (FGD, Female community members 
without disabilities, Xieng Khouang)
“I think they are just like another child.” (FGD, Male community members without 
disabilities, Savannakhet)
Interestingly, in contrast, a group of caregivers reported that there should be separate classes 
for children with disabilities so as not to disrupt the children without disabilities.
39
“They may disturb or distract one another. I want to have the segregated special 
class for persons with disabilities.” (FGD, Male caregivers, Savannakhet)
Several barriers to education for children with disabilities were identified. These included 
family economic status, distance to school, the physical inaccessibility of school facilities, the 
need for a family member to accompany them, and parental awareness or attitudes towards 
the value of education for their child with disabilities.
Poverty was a key barrier to education identified by persons with disabilities in the focus 
groups. Some participants stated that while their impairment was a factor in discontinuing 
their education, the costs associated with schooling was also a significant factor to dropping 
out of school. It was not clear whether cost was also a barrier for children without disabilities
to the same extent.
“I quit school because I lost my eye and I did not learn anything like my friends 
did……The reason I left school was my parents were both very poor. I did not 
have clothes and could not afford to buy books, and pencils at that time.” (FGD, 
Males with disabilities, Xieng Khouang)
“It was difficult, because my legs hurt so I quit school. My parents could not afford 
to buy books, pens, and pencils for me and secondly, it was very challenging for 
me, so I quitted.” (FGD, Males with disabilities, Xieng Khouang)
Q: “Why didn’t you continue your study?” A: “Didn’t have money. (FGD, females 
with disabilities, Savannakhet)
School facilities that are not accessible for children with physical disabilities was frequently 
cited as a barrier to education.
“The physical accessibility of school also limited, the toilet, the door or even the 
entrance for children who use wheelchair will still be challenges.” (FGD, CBID 
workers, Xieng Khouang)
“We can see that school are not yet really accessible physically especially in getting 
to the building or toilet. (FGD, CBID workers, Savannakhet)
Distance to schools was also considered a barrier, particularly in rural areas, in addition to 
the other challenges of reaching schools.
“In the rural area, the villages are scattered over a large area and the school is 
quite far from their villages, so it’s difficult for parents to send their children to 
school which is different from children who live in the city” (OPD, male, Xieng 
Khouang)
“They need to use a wheelchair and for their parents to pick them up when they 
finish school. They cannot get there by themselves.” (FGD, Male community 
members without disabilities, Savannakhet)
40
“The place itself is not inaccessible. It is difficult for them to come to the place, 
because there is no one accompany them.” (FGD, Male community members 
without disabilities, Xieng Khouang)
There was a common perception that parents of children with disabilities do not value 
education as much for a child with disabilities as for a child without disabilities. 
“They think that their children are different and not complete so there is no point 
to send them to school, they better be out of school helping the household chores 
or doing some work.” (FGD, CBID workers, Xieng Khouang)
“Sometimes some children who has difficulties with their brain, their parent think 
that they should not go to school, because they (children with intellectual 
impairment) do not know anything.” (FGD, Males with disabilities, Savannakhet)
“Sometimes people think that there is no need for their children with disabilities to 
go to school because they think children with disabilities may not use knowledge, 
better that they stay at home and do something else.” (FGD, Female community 
members without disability, Savannakhet)
And finally, the skills of education staff in teaching children with disabilities was a perceived 
barrier to education for children with disabilities. 
“He went to school and learned it by his own way and didn’t know if it’s wrong or 
right because there was no specialized teacher to teach him.” (FGD, Male 
caregivers, Savannakhet)
“The school in our village can only accept children without disabilities, teacher do 
not know how to deal with person with disabilities.” (FGD, Female caregivers, 
Savannakhet)
d. Disparities in work & satisfaction with current activities
Disparities in current activity and working status were presented earlier under socio￾economic characteristics of respondents. Figure 8 provides further details about 
dissatisfaction with the current activity status; persons with disabilities were more dissatisfied 
with their current activity status than persons without disabilities.
41
Figure 8: Dissatisfaction with current activity status
e. Factors associated with working status
Working status was strongly associated with higher levels of functional difficulty after 
controlling for socioeconomic factors (Table 7). Controlling for other factors, people with 
more functional difficulty were less likely to be working. Compared to people with no 
difficulties, people who reported being ‘unable to do’ at least one functional domain were 
much less likely to work. Overall, working status was associated with age and education 
status.
4.3%
7.6%
20.5%
17.8%
0% 5% 10% 15% 20% 25%
Xayphouthong ***
Kham **
A lot/
Unable
None/
Some
42
Table 7: Factors associated with working status
Odds 
ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1
 Some 1.63 0.63 4.21
 A lot 0.23 ** 0.08 0.72
 Unable 0.01 *** 0.00 0.05
Sex
 Male (ref.) 1
 Female 1.27 0.76 2.11
Age 1.10 *** 1.07 1.13
Education level
 None (ref.) 1
 <Primary 2.48 0.47 13.09
 Primary school 3.17 *
0.94 10.66
 Secondary school + 5.25 ** 1.26 21.94
Have received vocational 
training 1.28 0.48 3.41
Living standards level
 Low (ref.) 1
 Middle 0.67 0.28 1.57
 High 0.64 0.30 1.41
Place of residence
 Urban (ref.) 1
 Rural 1.04 0.68 1.60
District
 Kham (ref.) 1
 Xayphouthong 0.98 0.61 1.59
n 647
N 24,426
Note: *
p<0.10 **p<0.05 ***p<0.01. 
43
f. Need to work & associated factors
Overall, most people with and without disabilities reported that they needed to work in the 
last 3 months. In Kham district, persons with disabilities were less likely to report they 
needed to work compared with persons without disabilities. Persons with disabilities in 
Xayphouthong District were less likely to report working as much as needed, but the 
difference was not statistically significant.
Figure 9: Need to work in the past 3 months and ability to work as much as needed/all of 
the time
g. Barriers to work and livelihoods
Qualitative findings showed limited formal and informal10 work opportunities for persons 
with disabilities. A few persons with disabilities interviewed reported having work and, of 
those, most reported periodic or casual home-based work. Some persons with disabilities
reported doing gardening or agricultural work. Another reported working as an occasional 
construction laborer. One veteran who was an amputee was previously a teacher and is now 
a village head.
There was general reflection, on the part of caregivers and persons without disabilities, that 
some persons with disabilities could do easy work and tasks. This included light household 
chores and possibly feeding livestock or rearing small animals. Persons with disabilities
reported wanting to work and needing appropriate work. A woman with disabilities reflected 
that she had applied to work for a beauty product firm making wigs and hair extensions. 
However, she did not get the job and reflected that she was ‘not very quick in doing things.’ 
A caregiver reflected that his work opportunities were also limited:
“There are several impacts [of being a caregiver]. I can’t do jobs, such as trading 
that mean I have to go to other places. Because if I leave my house for one or two 
 
10 We defined any paid work as formal work, while explicitly unpaid work was considered informal. Working 
on family farms or household duties were considered informal, but neither the quantitative questionnaire 
examined whether that type of work was paid or unpaid. 
78.4%
80.0%
79.1%
97.1%
52.8%
74.2%
80.1%
86.0%
0% 20% 40% 60% 80% 100%
As much as needed
Need to work
As much as needed
Need to work **
Xayphouthong Kham
A lot/
Unable
None/
Some
44
days I would be so worried about things at home and especially about my disabled
daughter.” (FGD, Male caregivers, Xieng Khouang).
One respondent noted that there were also seasonal difficulties for caregivers. He noted 
that during the rice harvesting periods everyone wants the opportunity to earn money. This 
leads to arguments in his family over who will care for their relative with disabilities.
In several discussions, respondents noted that people with either psychosocial or intellectual 
disability cannot work.
11 While it was noted that a few employers would employ a person 
with disabilities, it was noted in discussions that it was highly unlikely anyone would hire a 
person with a psychosocial disability. Parents of children with disabilities voiced concerns
about the future for their child:
“I saw that when he [Deaf son] was watching TV he was interested in a program 
about hairdressing. He would like to become a barber. […] I want him to go back 
to school if there is a sign language teacher available.” (FGD, Male caregivers, 
Savannakhet)
Self-perceptions also acted as a barrier to work. One respondent with disabilities (male) 
noted that because they are ‘unhealthy’ he could not work with other people as it would 
cause problems for the other people. Despite a demand for work from persons with 
disabilities, few could articulate what that work may look like. Aside from some mention of 
the need for vocational training, responses reflected highly limited work opportunities for 
persons with disabilities in USAID Okard work domains and for children with disabilities in 
the future. 
 
11 In Lao PDR (as in many other contexts), psychosocial disability is poorly understood, and it is often difficult 
to discern whether respondents are referring to psychosocial disability or intellectual disability. 
45
46
Disparities in Health & Wellbeing
▪ Persons with disabilities were more likely to experience poor health. Around three 
quarters of persons with disabilities (73.3%) in Kham district and about half (54.2%) 
in Xayphouthong district report poor health. 
▪ Persons with disabilities reported having been very sick much more than those 
without disabilities. 
▪ This study found that the likelihood of depression was not common (less than 5%) 
overall, and that there was no difference between persons with and without 
disabilities. 
▪ People with the most difficulties were less likely to report poor health than persons 
with ‘a lot’ of difficulty. 
▪ Persons with disabilities were less likely to be satisfied with their lives than persons 
without disabilities.
▪ People with more education were more likely to report higher satisfaction with their 
lives.
▪ People in Kham district were less likely to be satisfied with their lives than people in 
Xayphouthong district. 
a. Disparities in self-rated health status
Around 1 in 4 people reported poor health overall, however self-rated health was 
significantly poorer amongst persons with disabilities (Table 8). In Kham district, 73.3% of 
persons with disabilities reported poor health, compared with only 14.4% with no disabilities. 
In Xayphouthong district, 54.2% of persons with disabilities reported poor health compared 
with 8.6% of persons with disabilities. People in Xayphouthong district rated their health 
better in general compared to Kham district.
Compared with a self-rating of health, a more objective measure of health is whether the 
respondent has ever been very sick. About one-third of persons without disabilities reported 
that they had been very sick, compared with nearly two-thirds of persons with disabilities.
Self-rated likelihood of depression was less than 5% overall and was not associated with 
functioning in this population (Table 8). 
47
Table 8: Self-rated health indicators
Level of difficulty None/ 
Some
A lot/ 
Unable Both
Kham District
 Poor health (self-rated) *** 14.4% 73.3% 23.5%
 Ever been very sick *** 33.3% 61.9% 37.7%
 Depression likelihood 3.5% 5.2% 3.7%
Xayphouthong District
 Poor health (self-rated) *** 8.6% 54.2% 14.4%
 Ever been very sick ** 30.5% 58.1% 34.1%
 Depression likelihood 4.4% 6.5% 4.7%
Note: *
p<0.10 **p<0.05 ***p<0.01. 
b. Factors associated with self-rated health
Self-rated health was strongly associated with the level of difficulty (Table 9), but people with 
the most difficulty were less likely to report poor health than people with ‘a lot’ of difficulty. 
Controlling for other sociodemographic characteristics, the likelihood of reporting poor 
health increased with the level of difficulty, being highest i.e. 20 times more likely among 
those with a lot of difficulty and dropping to 10 times among those who were unable to do 
any one of the functions compared to people with no functional difficulty. Results also show 
that relationships between self-rated health and other social determinants of health are as 
expected. By district of residence, people in Xayphouthong district were less likely to report 
poor health than people in Kham district.
Table 9: Factors associated with poor health (self-rated)
Odds ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1
 Some 4.40 ** 1.31 14.80
 A lot 20.25 *** 6.15 66.67
 Unable 10.26 *** 2.68 39.35
Being sick in the past 3 
months 3.26 *
0.90 11.85
Have health insurance 0.45 *
0.19 1.06
Sex
 Male (ref.) 1
 Female 1.25 0.63 2.48
Age 1.03 ** 1.01 1.06
Place of residence
 Urban (ref.) 1
48
Odds ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
 Rural 1.56 0.46 5.26
Marital status
 Never married (ref.) 1
 Currently married/cohabited 1.52 0.40 5.83
 Divorced, separated, widowed 2.98 0.30 29.72
Education level
 None (ref.) 1
 <Primary 2.20 0.66 7.41
 Primary school 2.31 ** 1.05 5.11
 Secondary school + 0.96 0.27 3.36
Vocational training 0.97 0.42 2.20
Working 0.46 *
0.20 1.07
Living standards level
 Low (ref.) 1
 Middle 0.70 0.33 1.48
 High 0.56 0.21 1.49
District
 Kham (ref.) 1
 Xayphouthong 0.31 *** 0.15 0.64
n 646
N 24,414
Note: *
p<0.10 **p<0.05 ***p<0.01. 
c. Disparities in wellbeing
In general, the proportion of people dissatisfied with life was larger among persons with 
disabilities compared to persons without disabilities (Figure 9). This pattern was true in both 
districts: 36.5% vs 23.3% in Xayphouthong district, and 44.4% vs 34.5% in Kham district. 
People in Kham district seemed to be less satisfied with their life than people in 
Xayphouthong district.
49
Figure 10: Satisfaction with life in general among the population aged 9 years or older
Similar patterns of disparities were found when looking at SWLS in the past 3 months among 
the population aged 15 years or older (Figure 10). However, the SWLS difference between 
people with and without disabilities was even larger in Xayphouthong district (43.1% vs 
20.3%).
Figure 11: Satisfaction with life in the past 3 months (15y+)
36.2%
34.5%
44.4%
23.1%
23.3%
36.5%
14.7%
15.4%
11.2%
33.8%
34.8%
26.1%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Both
None/ Some
A lot/ Unable
Both
None/ Some
A lot/ Unable
Kham XPT
Dissatisfied Average Satisfied
37.8%
37.5%
39.0%
23.2%
20.3%
43.1%
9.4%
9.6%
8.2%
24.6%
25.0%
21.7%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Both
None/ Some
A lot/ Unable
Both
None/ Some
A lot/ Unable
Kham XPT **
Dissatisfied Average Satisfied
50
51
Table 10: Factors associated with SWLS
General SWLS among 
population 9 years or 
older
SWLS in last 3 months 
among population 15 years 
or older
Odds 
ratios
95% CI Odds 
ratios
95% CI
Lower Upper Lower Upper
Difficulty level
 None (ref.) 1 1
 Some 0.91 0.35 2.38 0.74 0.40 1.38
 A lot 0.72 0.38 1.38 0.55 * 0.28 1.08
 Unable 0.98 0.18 5.47 0.92 0.23 3.76
Being sick in the past 3 months 0.71 0.30 1.73 1.79 0.42 7.68
Having health insurance 1.35 0.86 2.14 1.65 * 0.90 3.03
Sex
 Male (ref.) 1 1
 Female 0.92 0.45 1.89 0.51 * 0.22 1.18
Age 1.00 0.98 1.03 1.01 0.99 1.02
Place of residence
 Urban (ref.) 1
 Rural 1.28 0.76 2.17 1.12 0.51 2.49
Marital status
 Never married (ref.) 1 1
 Currently married/cohabited 1.02 0.26 4.03 1.57 0.67 3.69
 Divorced, separated, widowed 0.35 0.06 2.24 0.61 0.15 2.56
Education Level
 None (ref.) 1 1
 <Primary 1.22 0.57 2.62 0.41 * 0.14 1.19
 Primary school 1.07 0.47 2.40 0.37 * 0.12 1.11
 Secondary school + 1.22 0.56 2.63 0.69 0.23 2.06
Received skill/vocational training 1.29 0.49 3.43 1.13 0.46 2.77
Currently working 0.79 0.36 1.72 1.79 0.71 4.49
Living standards level
 Low (ref.) 1 1
 Middle 1.15 0.73 1.81 1.40 0.80 2.43
 High 1.87 ** 1.09 3.23 1.83 * 0.96 3.49
District
 Kham (ref.) 1 1
 Xayphouthong 2.57 *** 1.80 3.67 2.24 *** 1.32 3.81
n 600 550
N 21,689 18,800
Note: *
p<0.10 **p<0.05 ***p<0.01. 
52
After controlling for other factors, it was found that it is not people who were unable to do 
one of the functions, but people with a lot of difficulty who have the lowest SLWS (Table 
10). Females aged 15 years or older had lower SWLS in the past 3 months than males. SWLS 
was associated with living standards and district of residence; people with higher level of 
living standards have higher SWLS, people living in Xayphouthong district have higher SWLS 
than those living in Kham district.
Need and access to healthcare services 
▪ A high proportion of the population overall (31.9% and 24.8% in Kham and 
Xayphouthong districts respectively) reported that they needed to access health 
services in the last three months. 
▪ Persons with disabilities were more likely to report needing healthcare. About half 
of all persons with disabilities reported needing health care in the last three months. 
▪ Persons with and without disabilities were able to access health care as frequently as 
each other, and access overall was high. 
▪ While access for persons with and without disabilities was high, persons with 
disabilities experience transport barriers, a lack of appropriate services, and negative 
staff attitudes.
▪ Attitudes and knowledge among health providers were barriers for persons with 
disabilities and a prominent theme in focus groups and individual interviews. 
▪ Access to assistive products was low, especially for those who need them the most. 
a. The need and ability to access healthcare services
As shown in Table 11, 31.9% and 24.8% of participants in Kham and Xayphouthong districts,
respectively, said that they needed to access healthcare services in the last 3 months. The 
likelihood of requiring healthcare services was significantly greater for persons with 
disabilities. 56.0% and 43.1% of persons with disabilities in Kham and Xayphouthong districts,
respectively, reported a need to access healthcare services, compared with 27.5% and 22.1% 
of persons with no disabilities in these districts respectively.
Despite higher needs for healthcare among persons with disabilities, there was no difference 
between persons with and without disabilities concerning their ability to access healthcare
services when it was needed. More than 90% and 80% of people in Kham and Xayphouthong
districts, respectively, who required healthcare in the last 3 months said they were able to 
access it, whether or not they had any functional difficulties, at all of the time. 
53
Table 11: Need and ability to access healthcare services
Level of difficulty
None/ 
Some
A lot/ 
Unable Total
Kham District
 Needed access over the past 3 months ** 27.5% 56.0% 31.9%
 Able to access all of the time a
97.0% 91.3% 95.4%
Xayphouthong District
 Needed access over the past 3 months ** 22.1% 43.1% 24.8%
 Able to access all of the time a
84.4% 81.2% 83.7%
Note: ** significantly different at p<0.05; a
Among those who needed.
From the qualitative findings, all groups reported that there was no disparity in health 
services available for persons with or without disabilities. Village health centers provide basic 
services and did not differentiate between persons with or without disabilities in the services 
they provide. If the case was more complex and cannot be managed by the health center,
they may be referred to the district or provincial hospital.
Persons with disabilities themselves reported that when visiting health services that they 
were happy with the services they received and were able to access health care as much as 
they need. They described service providers as polite and friendly and that health services 
were convenient, however the discussion of access to healthcare in the FGDs with persons 
with disabilities was limited, hence any challenges may not have been fully elicited.
Information provided by caregivers of persons with disabilities, adds to the picture of the 
experience of persons with disabilities in accessing health care. Caregivers reported that 
persons with disabilities face a lot of difficulties in accessing health care and cannot access as 
much health care as needed, or that the services they received were of variable quality.
“The hospital cannot fulfil all the needs of persons with disabilities and how doctors 
treat patients is different each time we visit the clinic. Sometimes they provided 
good care, but sometimes they didn’t. There are some changes between now and 
before….. it seems that they now don’t give full care like before.” (FGD, Male 
caregivers, Savannakhet)
Community members without disabilities had very poor awareness of the healthcare needs 
of persons with disabilities, with these groups reporting that they had not seen any persons 
with disabilities when they were visiting the health center themselves, with some stating that 
“persons with disabilities do not really get sick”.
b. Factors associated with the need of healthcare services
Significantly higher needs for healthcare services among those with higher levels of functional
difficulty remain after controlling for age, being sick in the past 3 months, and other socio￾economic factors (Table 12). Compared to those with no functional difficulty, those who 
have a lot of functional difficulty are three times more likely to need healthcare services, and 
54
those who were unable to do at least one of the functions are five times more likely to need 
health services.
Table 12: Factors associated with the need of healthcare services
Note: *
p<0.10 **p<0.05 ***p<0.01. 
Odds ratios 95% Confidence Interval
Lower limit Upper limit
Difficulty level
 None (ref.) 1
 Some 1.39 0.56 3.42
 A lot 3.16 ** 1.29 7.75
 Unable 5.14 ** 1.05 25.03
Being sick in the past 3 months 4.34 ** 1.32 14.24
Sex
 Male (ref.) 1
 Female 1.40 0.81 2.40
Age 1.01 0.98 1.03
Place of residence
 Urban (ref.) 1
 Rural 1.41 0.64 3.12
Marital status
 Never married (ref.) 1
 Currently married/cohabited 2.34 *
0.93 5.91
 Divorced, separated, widowed 2.09 0.62 7.07
Education level
 None (ref.) 1
 <Primary 1.34 0.60 2.97
 Primary school 1.80 0.54 6.01
 Secondary school + 3.35 *** 1.38 8.15
Working 0.36 ** 0.15 0.86
Living standards level
 Low (ref.) 1
 Middle 2.44 *** 1.55 3.85
 High 1.07 0.52 2.24
District
 Kham (ref.) 1
 Xayphouthong 0.74 0.46 1.17
n 646
N 24,399
55
c. Barriers to accessing healthcare services
Overall among those who reported they could not access healthcare services, a lack of 
information (including not knowing where to go), lack of assistance to attend healthcare 
facilities (e.g. no one taking the person to the healthcare facility), family not wanting the 
respondent to visit healthcare facility, or costs accounted for most of the barriers (Figure 
11). However, the reasons for not accessing healthcare services are very different between 
persons with and without disabilities. Besides a lack of information, which was a major barrier 
to both groups, family is a dominant barrier for persons without disabilities. By comparison, 
the major self-reported barriers for persons with disabilities include direct cost of healthcare 
services, distance to healthcare facility (too far) and transportation. 
Availability of healthcare services, accessibility of transportation means, and attitude of health 
staff were reported by persons with disabilities while none of the others reported them as 
barriers. While the results are interesting, they should be read with caution given the small 
sample sizes for analysis (11 people without disability and 17 persons with disabilities who 
could not access healthcare services all of the time). 
Figure 12: Barriers to accessing health care - percentage of respondents who reported 
reasons for not being able to access healthcare services all of the time
When asked about the most important reasons or barriers to access healthcare services
(Figure 12), the most frequent responses for persons with disabilities included direct cost of 
healthcare services, lack of information, distance to health facility, lack of assistance to get 
to the health facility, while there was a lack of information and a lack of assistance to get to 
health facility among those without disabilities.
0.0%
0.0%
0.0%
0.0%
2.1%
11.7%
8.4%
35.4%
32.2%
36.5%
5.5%
9.2%
10.6%
18.6%
19.9%
11.0%
34.7%
0.0%
16.7%
29.2%
0% 5% 10% 15% 20% 25% 30% 35% 40%
Do not like attitudes of health staff
Transport is not accessible
No healthcare services/facility
No transport available
Too far
Could not afford indirect costs
Could not afford the (direct) cost
Family did not want me to visit
Lack of assistant to the facility
Lack of information
A lot/
Unable
None/
Some
56
Figure 13: Barriers to accessing health care - percentage of respondents who reported most 
important reasons for not being able to access healthcare services all of the time
The survey results were mostly supported and extended by the qualitative findings. Despite 
a general belief that persons with disabilities can access health care services as much as they 
need to, several potential barriers to healthcare were identified. Barriers included direct and 
indirect costs, communication difficulties between persons with disabilities and health 
providers, lack of staff training and knowledge in interacting with persons with disabilities, 
and a lack of appropriate facilities and equipment to manage the needs of persons with 
disabilities. 
“If you look at the facilities you cannot see the room for person with disabilities, 
bed that designed to match their need, or even the toilets are not specific for them, 
they just use with others which sometimes hard for them to use” (FGD, Female 
community members without disability, Savannakhet)
Cost was a key barrier identified that impacts the ability to access healthcare, despite 
National Health Insurance being available to all people, which was mentioned by most 
respondents. There were no known healthcare subsidies specifically for persons with 
disabilities. Although the National Health Insurance reduced the cost of services, cost of 
medicines, transport and loss of income for accompanying family members, the remaining 
costs still incurred presented as a barrier for many people. Some reported selling livestock
or borrowing money from friends to cover the costs of transport and healthcare.
“It is just sometimes we do not have money, when we do not have money what we 
are going to pay? Sometimes person with disabilities are very poor. As we all know, 
when you got sick and you have to get services in Mahosot hospital (Vientiane), you 
could not, if you do not have money. This is the same. If you have money you can 
access to whatever level you want.” (FGD, Males with disabilities, Savannakhet)
0.0%
0.0%
4.2%
2.1%
8.4%
32.2%
32.3%
1.6%
5.5%
5.1%
14.3%
33.1%
11.2%
29.2%
0% 5% 10% 15% 20% 25% 30% 35%
No healthcare services/facility
Do not like attitudes of health staff
Could not afford indirect costs
Too far
Could not afford the cost of
healthcare
Lack of assistant to healthcare facility
Lack of information/do not know
where to go
A lot/ Unable
None/ Some
57
“I didn’t go to the health center because if I went there again, I would receive the 
same pain relief medicine. That would have wasted my money I didn’t have money. 
I am a person with disabilities, and it is difficult to make money. Only my children 
and wife can earn some money.” (FGD, Males with disability, Xieng Khouang)
Transportation to health centers was identified particularly by caregivers as a key barrier to 
healthcare access. Distance to health centers and a lack of accessible transport required
family members to accompany persons with disabilities and may have even required hiring a 
car, thereby incurring extra costs in addition to the loss of household income.
“It is difficult, because we don’t have transportation to take the persons with 
disabilities to the health center. Those who are not disabled can walk to the local 
public healthcare center unlike those who are disabled need someone to take them 
there which is one of the difficulties.” (FGD, Male caregivers of persons with 
disabilities, Xieng Khouang)
“If they come to the services in the province. It is really a big task for them. Let’s
imagine one small family of 5 people. If the father is not well they have to come 
for services, for sure the mother has to come with him, and the children surely 
cannot be left at home by themselves therefore it is really a big task for family 
when they have to come for services (Health sector, male, Xieng Khouang)
Strategies needed to improve health care access identified by respondents included health 
promotion activities specifically for persons with disabilities to inform them of the health 
services available to them and improving the physical accessibility of health centers.
d. Health seeking behavior
Health seeking behaviors after being sick enough to stay at home or rest for at least 3 days 
over the past 3 months were assessed. Most people regardless of their level of functional 
difficulty visited health facilities (Figure 13). However, self-medication (accessing drugs 
without prescription) was also common. There was also a high proportion of people who 
adopted other unfavorable health seeking behaviors, including doing nothing, home remedy
(traditional methods but not drugs from pharmacy or similar), visiting a traditional healer, 
seeking spiritual support, and buying medicine from a pharmacist over the counter (without 
prescription).
58
Figure 14: Health seeking behavior after being sick in the past 3 months
Note: Unfavorable = Did nothing, home remedy, visited traditional healer, seek spiritual support
In the FGDs, persons with disabilities reported that they visit their village health center when 
they are sick and need health care. If there is no health center in their village respondents 
would instead buy medicines from the pharmacy when they are sick.
There was a belief among some that doctors may not know how to help people with more 
severe disabilities and that this may impact whether they would access health services.
“For some simple case like getting fever, sore throat the doctor can help, but if it 
is more complex than that like someone who has severe disabilities, [or someone 
who is bedridden], the doctor do not know what and how to help them.” (FGD, 
Male community members without disabilities, Xieng Khouang)
e. Health service provision
Health service providers reported that persons with disabilities attend their health services, 
but mostly identified that these were people with vision or hearing impairments and that 
they were less aware of people with other types of impairments attending. Some reported 
that they believed people with physical impairments were less likely to access health services 
than other types of impairment.
“Some (children) who can walk, can stand (deaf or blind) do get weigh, but 
someone who cannot move at all, we do not have any interaction with him” (Health 
sector, female, Savannakhet)
While others reported the opposite and were more confident in providing services to people 
with physical impairments than those with difficulty hearing or seeing, or psychosocial 
impairments.
17.2%
16.3%
27.0%
68.1%
5.9%
25.0%
31.1%
72.8%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Visited pharmacist
Other unfavorable
Self-medicated
Visited health facilities
A lot/
Unable
None/
Some
59
60
“Mostly we can handle disabilities on lower and upper limb.... beside this, the vision 
impaired, arm, intellectual, deaf, blind we are not confident” (Health sector, female, 
Savannakhet)
“It is difficult when we talk to them [people with a hearing impairment] and they 
don’t understand. Sometimes we need to use hands [gesture], but it is difficult. 
Second is persons with an eye problem….When their cousins did not come with 
them it is more difficult because sometimes nurses and doctors cannot help them. 
We rely on their cousins or children to help.” (Health sector, female, Xieng 
Khouang) 
Some health sector respondents felt that because persons with disabilities did not attend 
health services frequently that they lacked the opportunity to develop their skills in 
supporting persons with disabilities. In addition, a lack of training and assistive devices made 
them feel inadequate in what they were able to provide.
“Because we do not have enough specialist and skill to help them [wheelchair user], 
even when they come to the district health office sometimes, we could not help” 
(Health sector, female, Savannakhet)
They acknowledged the insufficient facilities to treat some needs and that they would refer 
to other more well-resourced services.
“We must acknowledge the fact that our health center doesn’t have sufficient 
human resources and tools. But we always do our best to help patients with the 
resource that we have, if we are unable to heal patients probably than we will 
transfer patients to another health sector for a better treatment. We are a health 
center with limited resource of health service, we don’t have any materials to 
support persons with disabilities, so they might go to somewhere else that could 
respond to their needs.” (Health sector, female, Savannakhet)
Most health sector stakeholders reported that they did not provide any specific services or 
programs for persons with disabilities, although district health services reported specific 
programs for UXO survivors and visiting international specialists for cleft palate and cataract 
surgeries.
There were some reports of providing outreach services for those who were unable to 
attend the health center for preventative health activities, for example during vaccination 
campaigns.
“Even if I have made an announcement for vaccinations, persons with disabilities
still do not come. Therefore, I have to go to their houses.” (Health sector, female, 
Savannakhet)
61
Access to assistive products & rehabilitation
▪ 11.8% of participants overall used an assistive product, while 28.7% with disabilities 
reported using AP. 
▪ While not everyone with functional difficulties needed or wanted an AP, unmet need 
for assistive products was high; 71.3% of persons with disabilities did not use AP. 
▪ Access to AP was lower for people who reported ‘unable to do’ than others with ‘a 
lot’ of difficulty. 
▪ Women were significantly less likely to use AP than men. 
▪ People in Xayphouthong district were more likely to use AP than those in Kham 
district. 
▪ Services for AP access included community-level screening and rehabilitation centers, 
but barriers to access and quality included costs, transport, reliable information, and 
availability of the right products. 
▪ Among people who reported knowing what rehabilitation is, 3.3% of the population 
reported needing rehabilitation in the last 3 months. 
▪ Half of the people in Xayphouthong district with disabilities did not know what 
rehabilitation was. 
▪ People with more potential need for rehabilitation were not more likely to report 
knowing what rehabilitation is or being able to access it. 
a. The use of assistive products
Figure 14 shows the proportion of people who used AP across the different functional 
domains. 11.8% of the total participants used at least one assistive product (AP). The 
proportion of persons with disabilities using AP was 28.7%. This result probably implies a 
high level of unmet AP needs as nearly three-quarters of those with disabilities did not have 
an AP, though not all persons with a difficulty needed or wanted to use assistive products.
The use of AP among those with some functional difficulties was similar to those with a lot 
or higher levels of difficulty; together, AP prevalence among those with some or higher levels 
of difficulty was 28.8%.
Among those using any AP, 69.2% used one product, 19.2% used 2 products, 10.2% used 3 
products.
62
Figure 15: Use of assistive products (AP) - % using AP for all difficulty levels
After controlling for age and other socio-economic factors, compared with persons without 
functional difficulties, the likelihood of using assistive products was highest among those with 
‘some’ functional difficulties (nearly 10 times more likely), followed by those with ‘a lot’ of 
difficulties (nearly 9 times more likely) (Table 13). Gender differences were also very clear 
as females were 68% less likely to use AP than males. People in Xayphouthong district were 
also 2.5 times more likely to use AP than people in Kham district.
1.6%
2.2%
5.7%
15.3%
17.2%
27.4%
28.7%
0.6%
1.6%
3.3%
18.5%
9.6%
37.9%
28.8%
0.1%
0.2%
3.3%
5.5%
9.6%
10.6%
11.8%
0% 5% 10% 15% 20% 25% 30% 35% 40%
AP for hearing difficulty
AP for remembering difficulty
AP for communicating difficulty
AP for self-caring difficulty
AP for mobility difficulty
AP for seeing difficulty
AP for ANY DIFFICULTY
All
Some or more difficulty
A lot/ Unable
No difficulty
63
Table 13: Factors associated with the use of assistive products
Odds 
ratios
95% Confidence Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1
 Some 9.50 ** 1.50 60.05
 A lot 8.68 *** 2.42 31.21
 Unable 6.35 0.38 106.80
Sex
 Male (ref.) 1
 Female 0.32 *** 0.14 0.73
Age 1.06 *** 1.03 1.10
Place of residence
 Urban (ref.) 1
 Rural 2.77 *
0.89 8.66
Marital status
 Never married (ref.) 1
 Currently married/cohabited 3.30 0.31 35.45
 Divorced, separated, widowed 0.66 0.03 16.18
Education level
 None (ref.) 1
 <Primary 1.83 0.51 6.53
 Primary school 1.63 0.41 6.53
 Secondary school + 4.04 *
0.69 23.61
Working 0.30 *
0.07 1.31
Living standards level
 Low (ref.) 1
 Middle 1.00 0.36 2.82
 High 0.89 0.34 2.31
District
 Kham (ref.) 1
 Xayphouthong 2.45 ** 1.06 5.62
n 647
N 24,426
Note: *
p<0.10 **p<0.05 ***p<0.01. 
64
b. Access to assistive products
Assistive products such as prosthetics, crutches, wheelchairs and eyeglasses were mostly 
unavailable or difficult to access, especially outside provincial or more urban areas. To access 
products, people reported needing to travel to the provincial rehabilitation centers for 
assistive products, or that they could purchase products at shops in larger urban centers. 
War veterans reported that they were able to access assistive products with support from 
the Ministry of Defense, but that other persons with disabilities did not have the same access.
“No one is giving them [persons with disabilities] wheelchairs. For me I am a 
veteran, the government through the ministries (National Defense) has support this 
to me.” (FGD, Males with disability, Savannakhet)
There were some reports of specific projects by non-government organizations that
provided assistive products such as wheelchairs, crutches or eyeglasses, but not all people 
were aware of these or how to access products through these programs so had missed out. 
Some reported that referrals for assistive products mostly occurred via the village head.
“Every year there is someone coming to collect information on eyeglasses, or the 
wheelchair and then the health center will ask the head of village and then refer 
based on the referral process.” (Health sector, female, Savannakhet)
Lack of access to assistive products was seen as a key barrier to the participation of persons 
with disabilities in community activities such as festivals and in being able to access health 
care and education.
“Normally, the caregivers carried them to the gathering place to have 
injection/vaccination, apart from that they have to stay at home mostly. For other 
persons with disabilities, they all can walk or hop to places, but they don’t have any 
assistive devices to support them.” (Education sector, male, Xieng Khouang)
For ongoing monitoring and maintenance of assistive products it was stated that people 
needed to return to the provincial rehabilitation centers. For many persons with disabilities
this is not feasible, therefore assistive products fall into disrepair and are not able to be used. 
“I have someone I know who has a leg amputation, he used to get the assistive 
product - crutches and prosthesis. But years passed these things have been used a 
lot and have not be maintained in good condition. He now cannot use it and do 
not know where to get it. Now when you visit him you will see he hangs his assistive 
products as a decoration on his house as he cannot practically use it anymore.” 
(FGD, CBID workers, Xieng Khouang)
c. Access to rehabilitation services
Among those who felt they understood what rehabilitation is and what it aims to do, 3.3% 
of the participants in both districts reported a need to access rehabilitation in the last 3 
months. One quarter of people overall reported they did not know what rehabilitation was. 
65
Importantly, nearly half of persons with disabilities in Xayphouthong district did not know 
what rehabilitation was.
There was a trend towards people with more functional difficulty being more likely to report 
a need for rehabilitation in the last 3 months. Figure 15 shows 4 out of 5 (81.2%) of people 
with no difficulties were able to access rehabilitation when they needed it, compared with 
around 3 out of 5 (63.3%) people with functional difficulties.
Table 14: Need and ability to access rehabilitation
Level of difficulty
None/ 
Some
A lot/ 
Unable Total
Kham District
Needed to access rehabilitation *
Yes, need rehabilitation 2.8% 11.7% 4.2%
No, do not need rehabilitation 75.3% 75.0% 75.3%
Don't know what rehabilitation is 19.0% 13.3% 18.1%
Know rehab but don't know if it's needed 2.9% 0.0% 2.5%
Need to access rehabilitation among those 
who know about rehabilitation & their need 3.6% 13.5% 5.2%
Xayphouthong District
Needed to access rehabilitation **
Yes, need rehabilitation 2.5% 2.7% 2.6%
No, do not need rehabilitation 66.5% 42.5% 63.4%
Don't know what rehabilitation is 27.6% 46.1% 29.9%
Know rehabilitation but don't know if it's 
needed 3.4% 8.7% 4.1%
Need to access rehabilitation among those 
who know about rehabilitation & their need 3.7% 6.1% 3.9%
Note: *
p<0.10 **p<0.05 ***p<0.01. 
66
Figure 16: Proportion of people reporting access to rehabilitation ‘as much as needed’.
d. Factors associated with poor awareness of rehabilitation
Although it is not statistically significant (Table 16), people with higher needs of rehabilitation 
or levels of functional difficulties were either less likely to be aware of rehabilitation at all, 
or to understand their own needs for rehabilitation. As expected, persons living in rural 
areas and people with lower levels of education were more likely to have poor awareness 
of rehabilitation.
19%
37%
81%
63.00%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
A lot or unable
None / Some
Figure 16: Proporion of people reporting access to rehabilitation 'as much as 
needed'
Less than needed As much as needed
67
Table 15: Factors associated with poor awareness of rehabilitation 
Odds ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1
 Some 1.19 0.30 4.73
 A lot 1.56 0.76 3.21
 Unable 2.68 0.33 21.69
Sex
 Male (ref.) 1
 Female 0.90 0.52 1.54
Age 0.98 0.95 1.02
Place of residence
 Urban (ref.) 1
 Rural 5.48 *** 2.23 13.44
Marital status
 Never married (ref.) 1
 Currently married/cohabited 1.07 0.38 3.05
 Divorced, separated, widowed 1.83 0.40 8.50
Education level
 None (ref.) 1
 <Primary 0.80 0.44 1.46
 Primary school 0.47 *
0.20 1.10
 Secondary school + 0.67 0.29 1.55
Working 0.91 0.27 3.02
Living standards level
 Low (ref.) 1
 Middle 1.01 0.44 2.31
 High 1.59 0.77 3.30
District
 Kham (ref.) 1
 Xayphouthong 2.24 0.66 7.62
n 645
N 24,403
Note: *
p<0.10 **p<0.05 ***p<0.01. 
e. Rehabilitation service provision
Respondents from the FGDs and KIIs reported that people, such as those who have had a 
stroke or limb amputation, may need rehabilitation services. They identified that 
rehabilitation services were not available at the village level but required people to travel to 
a Provincial Rehabilitation Centre, although these are not available in every province. 
68
Travelling to these centers was inaccessible to many persons with disabilities who may 
benefit from rehabilitation. 
“The rehabilitation center is mainly available in the main city but not every province 
has this kind of center. This is difficult because if the main city has the rehabilitation 
center for persons with disabilities, other provinces and other districts also need to 
have this center or office like disabled people association. This is because persons 
with disabilities live in different places.” (Education sector, male, Xieng Khouang)
“We have a rehabilitation at the center. And [only] one outreach visit a year for 
one district for the whole province. It is very hard to get the services and equipment 
there, so we have encouraged them to come to the rehabilitation center in the 
province instead.” (Health sector, male, Savannakhet)
Some respondents suggested that rehabilitation should be available at village health centers
to improve access to rehabilitation services. 
“There was one man who has paralyzed, he come to us [at the village health 
center] for physical therapy, but we could not help because we do not know what 
to do. He has to go to the PRC in the province, but I think if we had that unit on 
rehabilitation in the community health center people will come to us more because 
we are closer than in the province when you have to travel for 60-70 km.” (Health 
sector, female, Xieng Khouang)
69
70
Participation in social gatherings, community activities and access to benefits
▪ Persons with disabilities reported less participation in most community activities, but 
overall, differences were small. 
▪ People with the most difficulty (reporting ‘cannot do at all’ in any domain) were much 
less likely to participate in community life than all others. 
▪ Women participated more in festivals than men. 
▪ Social participation was associated with higher levels of education and living 
standards. 
▪ Xayphouthong district appeared to have less participation of persons with disabilities. 
▪ Negative community attitudes that are likely to exclude persons with disabilities
persist, but people were unlikely to self-identify their own biases. 
▪ Access to government benefits was lower in Xayphouthong district than in Kham
district. 
▪ More persons with disabilities than persons without disabilities accessed benefits. 
▪ Only half of people in Kham district, and about one in 10 people in Xayphouthong
district (whether with or without disability) reported accessing the benefits they 
needed. 
▪ Assistance for caregivers and families was a commonly reported need for better 
social protection and assistance. 
a. Social & community participation
Compared with persons without disabilities, persons with disabilities tend to report they 
participated less in social gatherings with friends, peers, relatives or families over the past 3 
months. Neither sex nor age affected social participation overall, but controlling for other 
factors, women were around twice as likely to participate in festivals than men.
Differences between persons with and without disabilities were small, except for 
participation in social gatherings with friends or peers in Xayphouthong district (Figure 17). 
In Kham district, more persons with disabilities attended festivals than persons without 
disabilities. The proportion of people who said they have participated as much as needed 
was consistently lower among persons with disabilities compared to persons without
disabilities.
71
Figure 17: Participation in social events and festivals
Note: Participated = Participated in the past 3 months; As needed = Participated as much as 
needed
People with higher levels of difficulty in functioning (a lot or unable) were less likely to 
participate in social activities than those with some or no difficulties. Table 16 shows that 
people who reported they were ‘unable’ in at least one functional domain were significantly less 
likely to participate in gatherings with friends and gathering with families respectively than 
those with no difficulties. People with some or a lot of difficulties did not demonstrate 
significantly less participation than people with no difficulties. 
74.4%
89.8%
61.6%
65.2%
58.5%
75.0%
85.0%
63.8%
88.5%
62.8%
83.9%
60.0%
70.6%
81.1%
51.0%
55.0%
37.0%
46.2%
79.2%
74.9%
80.0%
62.0%
75.0%
58.3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
As needed
Participated
As needed ***
Participated
As needed ***
Participated ***
As needed
Participated **
As needed **
Participated
As needed
Participated
Festival
Social
gathering with
family/
relatives
Social
gathering with
friends/ peers Festival
Social
gathering with
family/
relatives
Social
gathering with
friends/ peers
Xayphouthong Kham
A lot/
Unable
None/
Some
72
Table 16: Factors associated with participation in social events & festivals
Gathering with friends or peers Gathering with families or relatives Participating in festivals
Odds Ratios 95% CI Odds Ratios 95% CI Odds Ratios 95% CI
Difficulty level
 None (ref.) 1 1 1
 Some 0.93 0.39 2.22 0.90 0.39 2.09 0.92 0.37 2.29
 A lot 0.91 0.40 2.03 0.91 0.40 2.09 1.08 0.56 2.11
 Unable 0.10 *** 0.03 0.30 0.19 *** 0.07 0.57 0.32 0.06 1.70
Sex
 Male (ref.) 1 1 1
 Female 1.04 0.75 1.45 0.96 0.63 1.46 2.14 ** 1.01 4.53
Age 1.00 0.98 1.02 1.00 0.98 1.01 1.02 *
0.99 1.05
Place of residence
 Urban (ref.) 1 1 1
 Rural 0.85 0.43 1.69 0.74 0.39 1.42 0.69 0.28 1.73
Marital status
 Never married (ref.) 1 1 1
 Currently married/cohabited 0.98 0.31 3.09 3.60 ** 1.26 10.27 1.00 0.27 3.75
 Divorced, separated, widowed 0.70 0.13 3.66 1.31 0.26 6.51 0.44 0.07 2.91
Education level
 None (ref.) 1 1 1
 <Primary 1.61 0.60 4.36 0.55 *
0.27 1.12 2.42 *
0.79 7.44
 Primary school 2.14 0.47 9.69 0.62 0.16 2.39 2.79 *** 1.23 6.30
 Secondary school + 7.35 *** 2.24 24.11 1.74 0.49 6.20 2.35 ** 1.03 5.35
Working 1.35 0.51 3.60 0.97 0.45 2.09 1.80 0.60 5.34
Living standards level
 Low (ref.) 1 1 1
 Middle 2.08 *
0.89 4.85 2.18 *** 1.24 3.84 1.34 0.73 2.48
 High 2.70 ** 1.04 7.02 2.06 ** 0.99 4.27 1.15 0.53 2.53
District
 Kham (ref.) 1 1 1
 Xayphouthong 2.23 *
0.96 5.16 1.28 0.58 2.78 4.69 *** 1.82 12.10
Note: n=647; N=24,426; *
p<0.10 **p<0.05 ***p<0.01. 
73
In FGDs and KIIs, prevailing attitudes towards persons with disabilities were most evident in 
discussions about community events. Community events included community meetings, 
communal work activities and festivals. Meetings referred to regular village meetings, 
farmers’ group meetings, youth organization meetings, women’s group meetings, village 
guard meetings and one-off meetings, such as on women’s health, and husband and wife 
relations in the household (latter assumed to be on gender-based violence). One-off meeting 
events in villages may be conducted by government outreach workers or NGOs.
Additional community activities included occasional communal village cleaning activities and 
village road (infrastructure) repair. Festivals included religious festivals and New Year 
festivals. Drinking parties were mentioned by some men as a part of festival celebrations. 
The only life cycle event referred to in community discussions were weddings. Community 
meetings were considered a key event in the surveyed villages and several respondents noted 
that all households should attend. However, others noted that rarely did a representative 
from each household attend every meeting. Attendance was considered a matter of personal 
preference and/or of interest in the topic of the meeting. Community members without 
disabilities expressed that if something was important they would be informed soon enough 
by the sub-village head. Some older respondents (without disabilities) also reflected that 
when they were younger they were invited to community events, but not so often now.
In line with the discussion of community attitudes (Section 8), initial responses in discussions 
and interviews were that persons with disabilities could participate in community events just
like all community members. Later responses during discussions indicated limited 
participation of persons with disabilities in community events. While physical barriers, 
including location and mobility restrictions, were noted, other barriers referred to, either 
directly or indirectly, were attitudinal.
“[Persons with disabilities do not normally attend festivals] because, firstly, it’s 
difficult for them to travel. Secondly, because of their disabilities they can’t really 
enjoy the festival, such as eating and drinking, like other people.” (FGD, Male 
caregivers, Xieng Khouang).
Responsibility concerning the decision to attend, or more commonly not, was often placed 
on persons with disabilities. That is, persons with disabilities choose not to attend rather
than being excluded from attending. However, it was noted that certain persons with 
disabilities should be excluded:
“People who have seizures should stay at home and not go out. They shouldn’t [be 
allowed] to get close to other people in community events.” (FGD, Female 
community members [without disability, Xieng Khouang)
Other respondents noted that some persons with disabilities did attend some community 
events. However, another qualified that persons with disabilities may be treated differently 
if they attend, while suggesting persons with disabilities could actually take it upon themselves 
to be part of the group:
74
“If they [persons with disabilities] go to events, we tend to give them separate food 
on their own. If they want to eat dessert, we will also give this to them separately 
and ask them to sit somewhere else. But if they want to join us, we will not have 
any objection. We have to help them and feed them.” (FGD, Female community 
members without disability, Xieng Khouang)
b. Voice in the community & Participation in activities of DPOs
There were large differences between Kham and Xayphouthong districts in terms of 
participation of persons with disabilities in community activities (Figure 18). Compared with 
people with no or some difficulties, a higher proportion of people with a lot of difficulties or 
unable to do from Kham district participated in community meetings or presented opinions 
on community issues to the village chief personally than those with no or some difficulties. 
But the opposite tendency was found in Xayphouthong district. Similarly, while there is a 
higher proportion of people with a lot of difficulties or unable to do participating in activities 
of OPDs in Kham district, the opposite was found in Xayphouthong district. The proportion 
of people who said they have participated in these community activities as much as needed 
were significantly lower in Xayphouthong district compared to Kham district.
6.2%
7.3%
23.8%
27.4%
32.6%
37.7%
48.3%
3.4%
69.5%
17.4%
71.1%
33.0%
6.0%
2.5%
15.9%
18.4%
24.7%
34.6%
51.2%
11.9%
65.7%
34.2%
76.6%
51.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
As needed
Participated **
As needed
Participated
As needed
Participated
As needed
Participated *
As needed
Participated **
As needed
Participated **
Join activities
of DPOs
Presenting
opinions on
community
issues to
village chief
personally
Contributing
opinions in
community
meetings
Join activities
of DPOs
Presenting
opinions on
community
issues to
village chief
personally
Contributing
opinions in
community
meetings
Xayphouthong Kham
A lot/ Unable
None/ Some
75
Figure 18: Voice in community & participation in DPO
Note: Participated = Participated in the past 3 months; As needed = Participated as much as 
needed
Participation in community meetings and contributing voice to the village chief depended on 
various factors. After controlling for other factors, the likelihood of participation in 
community activities decreased as the level of functional difficulty increased (Table 17). 
Those who reported being ‘unable to do’ in at least one functional domain were the least 
likely to participate and very few of these people. reported attended community meetings, 
and none met with village chiefs to share opinions on community issues.
In qualitative interviews, respondents also reflected that although persons with disabilities
could attend meetings and events, it was unlikely they would have anything, or be able, to 
contribute. It was also noted that persons with disabilities may not be invited.
76
77
Table 17: Factors associated with the voice in community
Contribute or present 
opinions in community 
meetings
Present opinions on 
community issues to the 
village head
Odds 
ratios
95% CI Odds 
ratios
95% CI
Lower Upper Lower Upper
Difficulty level
 None (ref.) 1 1
 Some 0.81 0.31 2.14 0.86 0.36 2.04
 A lot 0.73 0.16 3.33 0.55 0.12 2.51
 Unable 0.00 *** 0.00 0.16 a
- -
Sex
 Male (ref.) 1 1
 Female 0.64 0.30 1.37 0.61 *
0.31 1.21
Age 1.07 *** 1.03 1.11 1.05 *** 1.02 1.08
Place of residence
 Urban (ref.) 1 1
 Rural 1.05 0.57 1.94 1.75 0.62 4.92
Marital status
 Never married (ref.) 1 1
 Currently married/cohabited 1.79 0.58 5.52 9.30 *** 2.07 41.69
 Divorced, separated, widowed 1.29 0.36 4.61 10.19 ** 1.13 92.01
Education level
 None (ref.) 1 1
 <Primary 2.99 ** 1.00 8.91 1.59 0.53 4.79
 Primary school 4.99 *** 2.04 12.23 2.76 *
0.85 8.96
 Secondary school + 5.83 *** 1.76 19.26 3.17 *
0.93 10.78
Working 5.15 *** 1.58 16.78 3.31 *
0.88 12.36
Living standards level
 Low (ref.) 1 1
 Middle 2.77 ** 1.09 6.99 4.10 *** 1.77 9.50
 High 1.26 0.54 2.95 1.62 0.73 3.58
District
 Kham (ref.) 1 1
 Xayphouthong 0.71 0.36 1.39 1.06 0.49 2.29
n 647
N 24,426
Note: a None of respondents in this category did this; *
p<0.10 **p<0.05 ***p<0.01. 
78
More than three-quarters of people in both districts did not participate in any local 
organization or association (Figure 19). One out of five people in the two survey districts 
participated in mass-organizations, and the proportions of people participating in other 
organizations/associations were very small (less than 3%). It is important to note that 
participation in OPDs is nearly zero, but this is expected given nearly absence of OPDs 
outside the capital city. 
Figure 19: Participation in local organisation/association
Not one person with disabilities reported participating in local organizations or associations. 
As seen in Table 18, participation in local organizations/associations was not associated with 
disability. However, people with primary or secondary school education were significantly 
less likely to participate, which is possibly due to the types of activities explored during 
community groups targeting people with less socioeconomic means, such as groups activities 
related to self-help or microcredit.. Participants from Xayphouthong district were nearly 3 
times more likely to participate in local organizations/associations compared to participants 
in Kham district.
0.2%
0.4%
1.2%
1.4%
4.0%
20.0%
76.0%
0.0%
1.5%
0.6%
2.0%
4.8%
18.7%
76.3%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
DPO
Cooperative club
Self-help group
Micro-credit group/Village
fund
Other
Mass organisation
None
A lot/ Unable
None/ Some
79
Table 18: Factors associated with participation in local organization/association
Odds ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1
 Some 0.77 0.26 2.25
 A lot 1.18 0.35 3.96
 Unable a
Sex
 Male (ref.) 1
 Female 0.77 0.47 1.27
Age 0.98 0.95 1.01
Place of residence
 Urban (ref.) 1
 Rural 1.45 0.61 3.46
Marital status
 Never married (ref.) 1
 Currently married/cohabited 0.38 0.07 1.89
 Divorced, separated, widowed 0.25 0.02 3.01
Education level
 None (ref.) 1
 <Primary 0.32 0.07 1.58
 Primary school 0.32 * 0.08 1.26
 Secondary school + 0.06 *** 0.01 0.29
Working 0.49 0.18 1.37
Living standards level
 Low (ref.) 1
 Middle 0.95 0.43 2.09
 High 1.02 0.46 2.28
District
 Kham (ref.) 1
 Xayphouthong 2.92 *** 1.45 5.88
n 647
N 24,426
Note: a None of respondents in this category participated in this; *
p<0.10 **p<0.05 
***p<0.01. 
80
c. Access to government benefits
About 21.7% of persons with disabilities and 13.2% of persons without disabilities in Kham 
district respectively had accessed government benefits (e.g. social security fund) (Figure 16). 
In Xayphouthong district, however, there was no difference in proportions (at around 10 
percent) of people with and without disabilities accessing government benefits. Slightly more 
than half of people in Kham district reported that they have accessed government benefits 
as much as needed, while this rate was only slightly more than 10 percent in Xayphouthong 
district. Most common reasons included lack of knowledge about available benefits and how 
to get them.
Figure 20: Access to Government benefits
Table 19 reports how different demographic characteristics were associated with poor 
access to government benefits. Persons with disabilities were more than 4 times less likely 
to have accessed to government benefits than persons without disabilities despite the 
probable greater need among that group. People in Xayphouthong district were about 12 
times less likely to access Government benefits than people in Kham district.
10.4%
10.1%
54.8%
13.2%
12.4%
8.8%
51.7%
21.7%
0% 10% 20% 30% 40% 50% 60%
As much as needed
Have accessed
As much as needed
Have accessed
Xayphouthong Kham
A lot/ Unable
None/ Some
81
Table 19: Factors associated with poor access to government benefits
Odds ratios
95% Confidence 
Interval
Lower 
limit
Upper 
limit
Difficulty level
 None (ref.) 1.00
 Some 0.94 0.41 2.14
 A lot 1.20 0.57 2.54
 Unable 4.27 ** 0.87 20.92
Sex
 Male (ref.) 1.00
 Female 1.12 0.67 1.87
Age 0.98 0.95 1.01
Place of residence
 Urban (ref.) 1.00
 Rural 0.85 0.25 2.82
Marital status
 Never married (ref.) 1.00
 Currently married/cohabited 0.80 0.27 2.41
 Divorced, separated, widowed 0.63 0.09 4.18
Education level
 None (ref.) 1.00
 <Primary 1.28 0.55 2.97
 Primary school 0.70 0.33 1.46
 Secondary school + 0.44 ** 0.21 0.92
Working 1.14 0.52 2.53
Living standards level
 Low (ref.) 1.00
 Middle 1.49 0.59 3.75
 High 0.51 0.17 1.58
District
 Kham (ref.) 1.00
 Xayphouthong 12.42 *** 4.26 36.19
n 647
N 24,426
Note: *
p<0.10 **p<0.05 ***p<0.01. 
82
Qualitative findings revealed a mixed understanding of the government benefits that may be 
available to persons with disabilities and their families. 
Caregivers of persons with disabilities reported varied knowledge and experiences of 
accessing government benefits. Some stated that they received some government support 
whereas others reported that they hadn’t received any assistance. There was also a 
suggestion that those in rural areas received less than those in urban areas.
“I am looking after my daughter, she’s 9 years old. She has been disabled since 
she was born. The government hasn’t provided any kind of assistance or support 
to our family, there are only the both of us (parents) looking after her.” (FGD, Male 
caregivers, Xieng Khouang)
Caregivers expressed that it could be difficult caring for a family member with a disability 
and a desire to be able to access some supports, with an awareness that this is available in 
some other countries.
“It’s quite troublesome to look after a disabled person, but it would be really good 
if the government can provide some assistance for families that have members with 
disabilities like the case of my daughter” (FGD, Male caregivers, Xieng Khouang)
The main government benefit that people reported being able to access was the National 
Health Insurance, which was mostly understood to be available to all people in Lao PDR
once they had completed the appropriate administrative processes. But there were some 
that believed that national health insurance was not available for persons with disabilities. 
“The government have the health insurance scheme, but that does not cover for 
persons with disabilities.” (Person with disability, male,)
It was also understood by some that there are government supports for children with 
disabilities to access education, through school fee subsidies and providing financial support 
for materials and clothing.
“Recently there is support from the government represented through a scholarship 
for disabled children.” (FGD, Male caregivers, Xieng Khouang)
“For education sector they have a policy for persons with disabilities, such as getting 
a fee waiver or getting a discount. They also facilitate them by providing materials.” 
(Labor and Social Welfare sector, male, Xieng Khouang)
There was also a belief that there are income tax exemptions for persons with disabilities
that run small enterprises.
“The only law that we can see clearly is in income tax. They mentioned that persons 
with disabilities are all tax exempt for his/her income.” (Person with disability, 
male,)
83
Some reported there was a government benefit for people who had been in accidents, as 
well as specific benefits available for war veterans who had been wounded during military 
service. 
“If people had an accident and became disabled, we have accident benefits for the 
person with disabilities, but the paperwork is needed prior to receiving that sum 
of money. Person with disability will also get monthly payment which will be 
calculated in accordance with severity of their disabilities.” (Health sector, male, 
Savannakhet)
“Yes, there is [benefits for war veterans] and this depends on their performance 
case by case because these people fought for our nation and when they pass away, 
their families will receive some benefits” (Labor and Social Welfare sector, female, 
Savannakhet)
84
Knowledge, attitudes and practice in disability 
▪ Disability seemed to be understood as profound difficulties among a few impairment
types. People with psychosocial and intellectual disability appeared to be very poorly 
understood and highly marginalized. 
▪ People were less likely to report interaction with persons with disabilities in 
Xayphouthong district than Kham district.
▪ People with more severe disabilities were less likely to report interacting with other 
people with disability
▪ People self-report mostly (but not completely) positive and inclusive attitudes about 
disability, but these are not reflected in findings about how people are actually 
included. 
a. Quantitative findings
Self-identification of disability
Overall, 8.6% of respondents self-identified as having a disability. The proportion was higher 
in Kham district (12.4%) than Xayphouthong district (5.5%). Similar difference between the 
two districts is found for all levels of difficulty. 
As expected, people with higher level of functional difficulty were more likely to self-identify 
as a person with disability. As seen in Table 20, 40.9% and 24.2% of people who reported a 
lot of difficulty or unable to do in Kham and Xayphouthong districts respectively identified 
themselves as a person with disability. 
Table 20: Self-identification as a person with disability
Level of difficulty
None/ 
Some
A lot/ 
Unable Both
Kham ***
 No 92.7% 59.1% 87.6%
 Yes 7.3% 40.9% 12.4%
 Refused 0% 0% 0%
Xayphouthong ***
 No 97.3% 73.6% 94.3%
 Yes 2.7% 24.2% 5.5%
 Refused 0.0% 2.3% 0.3%
Total 100% 100% 100%
Note: ***p<0.01. 
Awareness of and interaction with persons with disabilities
When asked whether respondents from the quantitative survey knew anyone with a 
disability, around three-quarters of respondents in both districts reported that they knew of 
someone with disabilities among their family members, relatives, friends, neighbors or 
villagers. People with a lot of difficulties or unable to do were more likely to know of 
someone with disabilities, but the difference was statistically significant only in Kham district. 
85
About one-thirds of respondents reported that they knew of a neighbor with disability; but 
this rate was higher among persons with disabilities (39.3%) while lower among persons 
without disabilities (26.1%) in Kham district. 
Between 6.5% and 14% of respondents in Xayphouthong and Kham districts respectively 
reported that there was a person with disability among their friends.
Figure 21: Awareness of persons with disabilities around
Among those who knew of someone with disability, not all of them communicated or 
interacted with persons with disabilities. About 40% of people in Xayphouthong district and 
20% of people in Kham district never communicated or interacted with persons with 
disabilities whom they knew. In Kham district, the proportion of people who interacted with 
persons with disabilities were significantly higher among persons with disabilities and those 
without disabilities. 
11.0%
10.6%
12.4%
26.1%
47.4%
67.7%
6.5%
4.9%
15.3%
32.4%
54.5%
65.8%
14.0%
26.6%
27.3%
39.3%
39.1%
75.9%
7.6%
10.1%
15.5%
32.4%
59.6%
74.8%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Friends
Family members **
Relatives **
Neighbours *
Other villagers
Anyone *
Friends
Family members
Relatives
Neighbours
Other villagers
Anyone
Kham Xayphouthong
A lot/ Unable
None/ Some
86
Figure 22: Interaction with persons with disabilities among those who reported awareness 
of anyone with a disability
Interaction with persons with disabilities was higher for people with ‘some’ difficulty and 
‘unable to do’ than for people with ‘a lot’ of difficulty after controlling for other socio￾economic factors. People in Xayphouthong district were less likely to interact with persons 
with disabilities than people in Kham district.
72.1%
81.2%
58.5%
60.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
None/Some
A lot/Unable
None/Some
A lot/Unable
Kham * Xayphouthong
87
Table 21: Factors associated with interacting with persons with disabilities
Among everyone Among those who knew a 
person with disability
Odds 
ratios
95% CI Odds 
ratios
95% CI
Lower Upper Lower Upper
Difficulty level
 None (ref.) 1 1
 Some 2.20 *
0.90 5.41 2.87 *
0.74 11.19
 A lot 1.53 0.83 2.82 1.60 0.57 4.46
 Unable 0.34 ** 0.14 0.79 0.54 0.11 2.71
Sex
 Male (ref.) 1 1
 Female 1.01 0.57 1.80 0.93 0.45 1.92
Age 1.02 ** 1.00 1.04 1.01 0.99 1.04
Place of residence
 Urban (ref.) 1 1
 Rural 1.41 0.71 2.80 0.88 0.46 1.68
Marital status
 Never married (ref.) 1 1
 Currently married/cohabited 1.13 0.48 2.68 1.62 0.55 4.82
 Divorced, separated, widowed 0.45 0.11 1.76 1.24 0.37 4.21
Education Level
 None (ref.) 1 1
 <Primary 1.15 0.69 1.93 1.21 0.45 3.21
 Primary school 1.08 0.42 2.75 1.39 0.54 3.61
 Secondary school + 1.14 0.53 2.47 1.90 0.55 6.60
Currently working 1.10 0.43 2.81 0.80 0.20 3.18
Living standards level
 Low (ref.) 1 1
 Middle 1.50 *
0.90 2.49 1.64 *
0.83 3.25
 High 0.98 0.54 1.77 1.14 0.48 2.70
District
 Kham (ref.) 1 1
 Xayphouthong 0.50 *
0.22 1.13 0.41 *** 0.21 0.77
n 646 432
N 24,406 16,551
Note: *
p<0.10 **p<0.05 ***p<0.01. 
88
Community attitudes to disability
Positive self-reported attitudes to disability were evident from the quantitative survey. 
Sorting by proportion of people agreeing to the statements provided, higher proportions 
(greater than 90%) were seen for statements related to accepting persons with disabilities, 
but lower proportions on capability and participation of persons with disabilities.
More than 90% of respondents (including persons with and without disabilities) said there 
would ‘be no problem if a person with disability was’ either a colleague, neighbor or 
classmate. 
Reflecting on attitudes of others, 85% suggested children with disabilities play equally with 
others, and more than 95% suggested that health professionals would know what to do if a 
person with a disability sought their care. 
Fewer people agreed with statements concerning persons with disabilities living 
independently, ability to contribute to their village and having the same opportunities for 
work as persons without disabilities.
Around 1 in 4 or 1 in 5 people felt persons with disabilities were the subject of jokes and 
humiliation and that people have negative attitudes towards persons with disabilities. 
In general, persons with disabilities were more negative about community attitudes to 
disability on various issues. This may reflect both external stigma and self-stigma or lower 
level of self-confidence among persons with disabilities. 
89
Table 22: Proportion of respondent agreed to opinions on disability
Opinion
Kham Xayphouthong Total
None/ 
Some
A lot/ 
Unable
None
Some
A lot/ 
Unable
Health care providers know what to do if a 
person with disability needs their help 97.3% 97.6% 92.5% 98.0% * 95.1%
There would be no problem if you had a 
person with disabilities as your colleague or 
partner at work
94.3% 90.9% 92.0% 85.9% 92.4%
There would be no problem if you had a 
person with disabilities as your neighbour 95.2% 82.7% ** 91.8% 89.3% 92.3%
There would be no problem if you had a 
person with disabilities as your classmate 95.2% 91.8% 89.8% 85.0% 91.7%
Women with disabilities should be able to 
work 90.3% 87.1% 94.0% 74.1%
*
*
*
90.7%
In this village, children play with children with 
disabilities as much as children without 
disabilities
90.2% 75.1% ** 84.9% 69.6%
*
*
85.2%
Persons with disabilities should be able to get 
married the same as other people 89.1% 85.2% 81.6% 63.7% * 83.5%
Persons with disabilities should be able to 
have children 82.5% 83.3% 74.6% 64.5% 77.5%
People in this village frequently support 
persons with disabilities 84.0% 74.7% * 69.5% 71.3% 75.6%
Persons with disabilities are able to participate 
in family income generation activities as much 
as other members of the family
76.5% 69.8% 73.1% 61.5% 73.3%
Persons with disabilities should be encouraged 
to live independently 75.3% 83.6% * 64.7% 75.3% 70.8%
Persons with disabilities make positive 
contribution to this village 64.8% 66.2% 65.5% 51.2% 64.3%
Persons with disabilities receive adequate 
benefits from the Government 63.6% 59.1% 64.2% 49.9% * 62.6%
More women with disabilities than men with 
disabilities work 59.7% 49.3% * 66.9% 57.2% 62.2%
Persons with disabilities have the same 
opportunities to become famous doctor, 
government staff, business person
72.3% 66.1% 52.5% 63.2% * 61.8%
Persons with disabilities attend village 
meetings as much as other villagers 60.5% 51.8% 55.6% 40.7% * 56.2%
Persons with disabilities are subject to 
unacceptable jokes, comments, or humiliation 30.0% 32.9% 17.9% 24.9% 24.1%
People in this village have negative attitude 
towards persons with disabilities 17.5% 33.4% ** 23.7% 26.2% 22.2%
Note: % >=90% are highlighted in green; %>75% and <90% are highlighted in blue.
90
Community awareness of access to services of persons with disabilities
In the quantitative survey, nearly half of the participants in Kham district thought persons 
with disabilities could access services about the same as the others. The proportion was
slightly lower in Xayphouthong district with nearly one-third responding that persons with 
disabilities can access services as much as other people in the community. One-thirds to 
about half of people in both Kham and Xayphouthong districts thought that persons with 
disabilities can access services, especially paid work and education, less than other people in 
the community. 
Table 23: Proportion of respondents think that persons with disabilities can access services 
as much as other people
Level of difficulty None/ Some A lot/ Unable Total
Kham district
Health services
 More 16.5% 15.2% 16.3%
 About the same 48.6% 40.6% 47.4%
 Less 27.5% 37.4% 29.0%
Paid work
 More 3.7% 7.4% 8.0%
 About the same 43.3% 45.9% 43.7%
 Less 45.0% 42.9% 44.6%
Education
 More 2.2% 3.0% 2.3%
 About the same 51.6% 47.4% 51.0%
 Less 44.4% 44.6% 44.5%
Xayphouthong district
Health services
 More 12.9% 7.7% 12.2%
 About the same 40.1% 32.0% 39.1%
 Less 34.3% 44.2% 35.6%
Paid work
 More 10.6% 3.3% 9.7%
 About the same 28.1% 41.5% 29.8%
 Less 53.5% 39.9% 51.7%
Education
 More 7.30% 11.23% 7.80%
 About the same 45.45% 39.78% 44.72%
 Less 43.1% 32.3% 41.7%
Total 100% 100% 100%
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Community self-reported reasons for disparities in access to services
The main reasons perceived by the participants for poorer access to health services for 
persons with disabilities included the absence of services or facilities, lack of assistant to 
accompany them to health facilities, physical accessibility (accessible transportation and 
distance to services), indirect costs, and lack of information. Similar reasons except direct 
costs were given as main reasons for poorer access to paid-work for persons with 
disabilities. For education, the main reasons for poorer access were due to disability, poor 
health, lack of means of transportation, and lack of proper teaching aids and approaches.
Table 24: Perceived reasons for persons with disabilities accessing services less (2 districts 
combined)
Level of difficulty None/ 
Some
A lot/ 
Unable Total
Health services
No healthcare services/facility 27.4% 32.9% 28.3%
Lack of assistant to healthcare facility 25.2% 34.0% 26.7%
Transport is not accessible 24.9% 32.8% 26.3%
Too far 20.3% 23.7% 20.9%
Could not afford indirect costs 17.5% 22.6% 18.4%
Lack of information/do not know where to go 17.9% 16.0% 17.5%
No transport available 13.8% 11.3% 13.3%
Could not afford the cost of healthcare 10.6% 19.7% 12.2%
Do not like attitudes of staff at health facility 5.0% 0.3% 4.2%
Absence of reasonable accommodation at healthcare 
facility 3.6% 0.9% 3.1%
Family did not want them to visit 2.3% 6.7% 3.1%
Do not like attitudes of others at health facility 1.6% 0.3% 1.4%
Was previously badly treated 1.3% 0.3% 1.1%
Tried but denied at healthcare facility 0.0% 4.6% 0.9%
Other 8.6% 9.0% 8.6%
Don't know 9.0% 4.1% 8.2%
Paid work
No opportunities 35.5% 55.0% 37.9%
Means of transportation is not accessible 16.0% 16.8% 16.1%
Lack of assistant to work place 15.8% 16.8% 15.9%
Lack of job placement/support services 15.5% 16.6% 15.7%
Difficult applying for a job 16.0% 11.2% 15.4%
Lack of employment information 13.6% 16.7% 14.0%
No transport available 13.6% 11.8% 13.3%
Too far 12.8% 7.6% 12.2%
Absence of reasonable accommodation at workplace 9.7% 0.1% 10.0%
Family did not want them to work 8.5% 10.2% 8.7%
Do not like the attitudes of others 2.8% 7.2% 3.4%
Could not afford the cost of transport 2.6% 3.9% 2.7%
Not interested in work 2.4% 3.5% 2.6%
Other 21.4% 17.0% 20.8%
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Level of difficulty None/ 
Some
A lot/ 
Unable Total
Don't know 7.7% 2.2% 7.0%
Education
Disability 62.2% 67.3% 62.8%
Poor health 30.0% 52.1% 32.7%
Means of transportation is absent or difficult to use 26.9% 18.3% 25.8%
Absence of specific teaching aids and approaches 15.9% 18.3% 16.2%
Absence of personal assistance 13.7% 11.2% 13.4%
Family has difficulty assisting them to go to school 11.7% 12.4% 11.8%
School is not physically accessible 10.1% 12.8% 10.5%
School is too far away 9.4% 7.6% 9.1%
Cost of attending school 5.8% 11.7% 6.6%
Difficult road conditions to school 4.9% 8.0% 5.3%
Taking care of family 5.6% 2.6% 5.2%
Family did not want them to go to school 4.0% 7.4% 4.5%
Needed to get paid job 4.2% 2.6% 4.0%
Treated badly at school 2.6% 1.7% 2.5%
Being expelled from school 0.0% 0.1% 0.0%
They reached the level that they wanted
Other 4.2% 1.6% 3.9%
Don't know 11.0% 0.0% 9.7%
Note: Sorted by % in total column in each domain; % >15% are highlighted in orange.
93
b. Qualitative findings 
In previous sections, qualitative findings of community knowledge, attitudes and practices 
specifically relating to access to services (education, health care, rehabilitation and assistive 
products) and social participation (festivals, community meetings, family gatherings) for 
persons with disabilities have been described. This section focuses on the knowledge, 
attitudes and related behaviors towards disability more generally within the community, with 
a particular focus on the perceptions of community members both with and without 
disabilities. It is assumed that these findings may impact on interventions to improve practices 
of service delivery.
Community knowledge about disability 
Qualitative interviews identified that persons with disabilities as a group were viewed as 
different and distinct from most persons without disabilities. Respondents described their 
understanding of disability in terms of impairments; however, this was largely limited to 
visible physical impairments, vision impairments, and people who are deaf or hard of hearing.
Respondents from all groups were able to identify that they were aware of persons with 
disabilities living in their community, although again predominantly referred to people with 
vision, communication and physical impairments. The presence of people with psychosocial 
disabilities were generally only discussed following prompting from the interviewer after 
other impairments had been identified. People with possible psychosocial disability in the 
community were variably described by respondents in terms of behaviors such as “wandering 
along the roads”, “slow learner”, “cannot concentrate” or “poor socialization”.
Knowledge and awareness of psychosocial disabilities thus appeared particularly poor, both 
among community members with and without disabilities. These were sometimes referred 
to as “brain impairment” or “brain disabilities”, with no clear differentiation between 
intellectual disability and the disabling effects of mental illness. 
Limited knowledge and poor understandings of psychosocial disabilities and individuals with 
epilepsy may be contributing to particular discrimination against the individuals concerned. 
For example, there was a dominant view reported that epilepsy is contagious. 
“That person should be discriminated as epilepsy is incurable and it can be 
contagious. So they should be restricted not to attend events.” (FGD, Male 
caregivers, Xieng Khouang)
There was a sense among respondents that those with a person with disabilities in their 
family were more likely to have a better understanding of disability, while others found it 
harder to express how they understood the concept of disability.
“I don’t really know the detailed definition of the disability and understand that it’s 
difficult to define what it is.” (FGD, Male caregivers, Xieng Khouang)
“Q: Do you think people in the village know the word” disabilities”? A: Some may 
not know because they don’t have it happened to their family” (FGD, female 
caregivers, Savannakhet)
94
Some described disability in terms of people being “sick”, and others as being an experience 
of “feeling pain”. There was some understanding from discussion in one FGD that disability 
can present differently in different people.
“Persons with disabilities are different from one to another .It could be the arms 
and legs disabled, such as his daughter who can’t walk…..There are number of 
problems that disabled people have” (FGD, Male caregivers, Xieng Khouang)
There was some knowledge amongst respondents of the varying causes of impairment , that 
is that some people are born with impairments and some have impairments due to injuries 
or illnesses and infections. 
“Some people were paralyzed at birth and some elder people fall down by accident 
and became paralyzed……. Some people were blind at birth and some had gotten 
infectious flu and became disabled after” (FGD, Female community members 
without disability, Xieng Khouang)
Additionally, there was some knowledge that one type of impairment (e.g. difficulty walking) 
may be due to a number of different causes (e.g. polio, amputation, condition from birth).
However, there was also a common belief that disability is a result of sin or negative past 
karma. 
“[If] person have disabilities since birth they will think that it is a sin or a karma 
from the previous life, as they may done something wrong. But after, they have 
accident and become disabilities they also will think it is a sin of that person or 
his/her family” (FGD, CBID workers, Xieng Khouang)
There was little evidence of a recognition or understanding that persons with disabilities
have agency or the capacity to change their situation or lot in life. Instead disability was 
reported in terms of being an inevitability, for example: 
‘We help as much as we can, but it [their fate] is what they [persons with 
disabilities] are.” (FGD, Female community members without disability, 
Savannakhet). 
95
96
Community attitudes to disability: 
Framing responses on attitudes
Attitudes to disability were explored through discussing persons with disabilities’ access to 
services, and their participation in employment and community activities and events, 
alongside some more direct questioning on discrimination. This was to provide a tangible 
context and starting point for respondents to voice their awareness or opinions about the 
experience of persons with disabilities, and to help avoid self-censoring that can result from 
direct questioning on potentially sensitive issues such as disability. 
In FGDs and KIIs, initial responses relating to community attitudes to disability painted a 
positive picture. These initial responses did not differ greatly from the, generally, positive 
attitudes identified in the quantitative survey (as above). Respondents reported that persons 
with disabilities were not discriminated against and that persons with disabilities were ‘the 
same as others’ and that respondents did not treat persons with and without disability 
differently. However, more nuanced and contested attitudes emerged as discussions 
progressed.
Respondents reflected on how persons with disabilities were sometimes considered 
‘incomplete’ and not whole or, at times, weak or sick. Ideas of incompleteness were not only 
in terms of physical attributes, such as a ‘missing body parts’, but also in terms of persons 
with disabilities’ ability to participate in everyday activities. 
Q: “Do you know why they did not want you to join [school]?”
A: “I don’t know….because I am not complete like others” (FGD, Males with disabilities, 
Savannakhet)
In turn, these understandings were extended to the social sphere with persons with 
disabilities considered unable to contribute to household or community life and being a 
burden for their families.
“Our relatives may visit us once in a blue moon. But we have to provide care every 
day [to respondent’s father]. They [the relatives] don’t come because they have 
already assigned that burden to us”. (FGD, Male caregivers, Savannakhet).
Understandings of disability were frequently framed in terms of pitying persons with 
disabilities or seeing disability in line with a charity model of disability. While there was no 
evidence from FGDs and KIIs at the community level of what may be considered more rights￾based understandings, there was some acknowledgement that children with disabilities 
should be able to go to school and that some, but not all, persons with disabilities can work. 
It was also the case that ‘distancing’ or ‘deferral’ would be used as strategies in discussion of 
attitudes. For example, it was not uncommon to hear: ‘people may discriminate against 
persons with disabilities in that village over there, but not here’. This distancing indicates that 
certain attitudes and behaviors towards persons with disabilities were present, even if 
elsewhere, but may be interpreted as unreasonable by peers or outsiders – including 
interviewers. Such tensions were evident in discussions that related to attitudes and 
behaviors towards persons with disabilities.
97
“In our village we do not bully each other whether people are blind, deaf, or [have 
an] intellectual [disability]. We just feel pity for them [persons with disabilities] and
would like to help them.” (FGD, Male community members without disability, 
Savannakhet.)
Stigma and prejudice
Despite the outward facing positive messaging from respondents that persons with 
disabilities are treated the same as persons without disabilities, stigma and prejudice against 
persons with disabilities in the target communities was common.
A ‘hierarchy of prejudice’ emerged from discussions. Amputees, and particularly war 
veterans, were often considered more accepted and likely to participate in community life, 
including meetings, work and celebrations. It is also notable that the (male) head of one 
village surveyed had a physical impairment. People with visual or hearing impairments and 
the deaf were considered less able to participate and contribute to community life. People 
with psychosocial disabilities were the most prejudiced against of all. Although, not 
frequently mentioned this extended to the practice of caging people with psychosocial 
disabilities.
“Most of the time it’s [the discrimination is targeted to] the ones who can’t control 
themselves, and they have to be tied or caged.” (FGD, Male community members 
without disabilities, Savannakhet).
The stigma associated with disability is not limited to perceptions of the individual with 
disability. Discussions showed that stigma extended to the family directly, understood as a 
result of past sins or karma, or can be extended to other people in the community simply 
by association.
“I feel pity for them [persons with disabilities], but I also used to be afraid of being 
like them [acquiring a disability]. I definitely kept myself away from them [persons 
with disabilities], because [they are] contagious. I was taught to think like that. 
There was one family where I’m from, the son has severe disabilities, and his 
mother opened a noodle shop. But very few people visited her shop. They were 
afraid that they would get bad luck from interacting with that family.” (FGD, CBID 
workers, Savannakhet)
As noted previously, some community members reported that either they themselves, or 
other people, hold the belief that disability could be contagious. While this was particularly 
noted as being the case for people with epilepsy, the idea that disability could be passed on 
by physical contact or by proximity was extended beyond individuals to the source of 
individual’s livelihood, and by association existence:
“I used to be a vocational skills trainer for persons with disabilities. I trained persons 
with disabilities on how to take care of livestock. We had a study visit to a village 
near the training center. The villagers reacted in very negative way. They told 
everyone else in the village they should keep their animals away from the persons 
98
with disabilities because they [the animals] may catch some disease from them 
[persons with disabilities].” (FGD, CBID workers, Savannakhet)
Self-perceptions
In general, respondents with disabilities and caregivers were negative about their situation 
and how they were treated. Implications and limitations to having a disability were accepted.
“I am a bit disappointed because I never expected that my child would be born 
with a disability. I wish they [my child] could be as healthy and complete as others 
[children without disability], but we don’t have a choice.” (FGD, Female caregivers, 
Xieng Khouang).
In discussions, caregivers of persons with disabilities noted how other community members 
without disabilities would feel ‘disgusted’ when they saw them with their child. Some 
respondents reflected that they accepted this practice, or at least did not wish to argue, 
stating variously:
“I have no arguments with them” (FGD, female caregivers, Xieng Khouang)
and
“I [also] don’t want to argue because it is true that my child is a disabled person.” 
(FGD, Females caregivers, Xieng Khouang)
Another woman with a disability reflected that when she had been ‘bullied’ and ‘ridiculed’ 
she could not help but feel upset. ‘I didn’t want to [feel upset], but it just happened.’
However, several persons with disabilities reflected they would like to be ‘better’ or able to 
do things that persons without disabilities can do, particularly in terms of work.
“I am not very satisfied because I could not work as much as normal people. I am 
not satisfied because I could not work, I want (to be) like normal people” (FGD, 
Male with disability, Xieng Khouang)
A few respondents indicated directly and indirectly of how stigma and prejudice was 
internalized and impacted on their self-esteem. As one man with a disability (male) reflected, 
he did not go, and did not want to go to school, because he was ‘stupid’. A respondent with 
a disability recalled she had been to a community meeting but:
“I just listened. Although I wanted to speak, I wasn’t brave enough because I was 
scared, I might say something wrong […] I am scared that when I speak, other 
people will interpret it [what I say] in other ways.” (FGD, Females with disabilities, 
Savannakhet)
In short, stigma and prejudice seemed common in Kham and Xayphouthong districts and 
may be contributing to the disempowerment of persons with disabilities.
99
c. Community practices and behaviours toward persons with disabilities
Language and labelling
It was noted that persons with disabilities would usually be verbally ‘stamped’, or labelled, as 
having a disability. That is, people are defined by their impairment. Persons with disabilities
confirmed it was common to be referred to by their impairment, for example: ‘cleft lip 
person’, ‘Mr. Broken Leg’ or ‘Mr. Blind’. During discussions, people with psychosocial 
disabilities would be referred to as ‘mad’, someone who has ‘lost their mind’, or ‘crazy’.
“They [people in the community] think person with intellectual disabilities are crazy, 
and they do not respect” (FGD, Male community members without disability, 
Savannakhet)
Making jokes at the expense of persons with disabilities was commonly reported. This was 
justified in a number of ways. For example: 
“Some people may call them [persons with disabilities] names, but it’s not serious 
or an insult […] it’s alright.” (FGD, male caregivers, Savannakhet).
Alternatively: 
“[…] it’s not like they [the name callers] hate persons with disabilities.” (FGD, male 
community member without disability, Savannakhet).
One respondent noted that name calling depended on the age, with older and presumably 
more respected individuals less frequently subjected to name calling: 
“It’s only the young ones [persons with disabilities] who are called names, not the 
old ones.” (FGD, Female caregivers, Xieng Khouang).
Persons with disabilities indicated that name calling and being made fun of did not upset 
them, however, one person noted that they “made up their mind not to be upset”, hence 
indicating that this may not have been their initial response but they felt they had to make 
an active choice to accept this behavior.
“When I go here and there, my friends also make fun of me like calling me ‘Mr. 
blind’ but I was not upset (he said with laughing)” (FGD, Males with disabilities, 
Xieng Khouang)
“Sometimes they can make fun of me like Mr. broken leg, or arm impairment, 
what are you doing here?... But I feel nothing because I know that they are just 
making fun of me. I don’t feel anything I am an easy person. I make up my mind 
not to be upset.” (FGD, Males with disabilities, Xieng Khouang)
Bullying and exclusion
Aside from name-calling and labelling, qualitative findings provided some insights into the 
behaviors experienced by persons with disabilities, both positive and negative. 
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Many respondents stated that persons with disabilities were treated the same as all other 
people in the community. However, this idea ran counter to many statements that indicated 
evidence of bullying and exclusion of persons with disabilities.
One caregiver noted she was afraid for her child to attend school, and a CBID worker noted 
that it is common children with disabilities do not go to school due to bullying based on their 
physical appearance and differences. 
“When the child with disabilities go to school, they may experience bullying from 
other friends or someone in school, and that make they feel that going to school is 
unpleasant so their parents might decide not to send them to school.” (FGD, CBID 
workers, Savannakhet)
Other respondents referred to persons with disabilities being imitated by others, people 
playing jokes on them, being stared at when out in public, being shouted at or chased away.
“If person with disabilities go to the noodle shop, there will be a moment of silence 
when everyone stares at that person with disabilities.” (FGD, CBID workers, 
Savannakhet)
These behaviors appeared to be particularly prevalent towards people with psychosocial 
disabilities, with a sense of people in the community avoiding interactions with people with 
psychosocial disabilities.
“Based on what I see, for someone from my village who has mental disabilities, 
when he walks past the ceremony at someone house people will shout at him and 
chase him to go away.” (Person with disability male, Savannakhet)
“Some people said just stay away from this madman, he may hit you” (FGD, male 
caregivers, Savannakhet)
Additionally, there was evidence of persons with disabilities being excluded from public 
places as a result of bullying and intimidatory behaviors by community members.
“I have experience when the shop owner chases a person with disability away, as 
he comes early and brings a bad omen to her shop on that day” (Health sector, 
male, Savannakhet))
“It was in the temple, and he chased the person with disabilities to go away because 
he felt that person with disabilities is dirty” (Health sector, male, Savannakhet)
The findings also suggest that assumptions are made about what persons with disabilities can 
and cannot do and are subsequently excluded from participating in community activities and 
social occasions such as meetings and weddings.
“For example, in the wedding, and the person with disabilities are not invite, but he 
would like to join, when he tries to get in he will be ask to move out.” (FGD, CBID 
workers, Xieng Khouang)
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“I think because we are disabled and [people think] we cannot do anything and go 
anywhere. When they need to do something, they would never mention about us 
or ask us to help” (FGD, Males with disability, Xieng Khouang)
Empathy and a desire to help
In contrast to the many negative behaviors experienced by persons with disabilities, there 
was also evidence of positive behaviors and interactions exhibited towards them by others 
in the community. Caregivers reported generally feeling a sense of empathy from others in 
the community:
“As, I have a disabled daughter, people are empathetic for the hardships we face.” 
(FGD, male caregivers, Xieng Khouang)
Other stakeholders identified a sense of responsibility to initiate interactions with persons 
with disabilities to facilitate inclusion. 
“Many times, these people they feel embarrassed they have disabilities they don’t 
dare to go out, we have to approach them and make them feel comfortable” 
(Health sector, male, Xieng Khouang)
Several respondents described offering assistance to persons with disabilities that they come 
across in their community. For example, the following statements were made by participants 
during FGDs involving community members without disabilities: 
“Participant 1: If I encountered an elderly man who has legs pain then I would go 
and help.
Participant 2: I help out by leading the way for them if they are blind, helping them 
to cross the street, or if they call upon me then I’d also help.”
And:
“When we see children with disabilities, we want to give them food and snack, 
unlike meeting person without disabilities. Because you obviously see that they born 
different and need some help.” 
Although there was an acknowledgement that others in the community may not do the 
same or want to help or interact with persons with disabilities but feel unsure of how to do 
so.
“We see persons with disabilities, like the old blind guy, he is already very old, and 
I don’t know what to say to him” (Health sector, female, Savannakhet)
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V. Discussion of key findings
This baseline survey was undertaken to support planning interventions for the CBID projects 
in Kham and Xayphouthong districts by providing robust data concerning the impact of 
disability on social participation, access to services and on social attitudes to disability. 
In Kham and Xayphouthong districts, persons with disabilities had significantly poorer access 
to health, education and employment sectors and lower participation in the community 
compared to persons without disabilities. Strong associations were found between disability
and socio-economic factors such as age, living standards, education and employment. 
Further, key barriers were identified related to community attitudes, disability awareness in 
the community, lack of opportunities for persons with disabilities and costs for accessing 
services and participating in the community for persons with disabilities. There were
complex and unexpected interactions between disability, education levels, and community
participation. These key findings are discussed below with their implications for planning 
CBID interventions in the two districts.
There were significant differences in disability prevalence and proportions of people 
accessing services or participating in the community in general between Kham and 
Xayphouthong districts. These differences could possibly be explained due to the 
geographical and socio-political differences between both districts. Xayphouthong district is 
in Savannakhet province which has better infrastructure and services. Savannakhet province 
likely has better opportunities for accessing services compared to Kham district which is 
remote with limited infrastructure and development. 
Prevalence of disability and its impact
a. Disability prevalence
The prevalence of disability was 13.3% and 9.9% in Kham and Xayphouthong districts,
respectively, with a combined prevalence of 11.7%. These prevalence estimates are much 
higher than the previous estimates at 1.3% in the 2005 census and 2.8% in the 2015 census
[5]. The lower estimates from the census surveys are due to the method of data collection 
used. In the 2005 census, self-identification based on impairments was used. This method has 
been proven to result in lower estimates of disability [7]. Although the WG Short Set of 
disability questions were used in the 2015 census, a representative of the household 
responded to the questions for all individuals in the household. This is likely to have resulted 
in a lower estimate in the 2015 census. This survey estimate is similar (10.8%) to a disability 
survey conducted in 2016 in Vientiane, Savannakhet and Sayaboury provinces which also 
used the WG questions asked at the individual level [8].
In this baseline survey, self-identification of disability was also investigated for comparison
(Section 8a). Only a little more than one-third of persons with disabilities from Kham district
and nearly a quarter from Xayphouthong district identified using the WG questions self￾identified as a person with disability. Questioning on self-identification often captures obvious 
and severe disabilities and responses could be biased by various factors, such as stigma and 
awareness or knowledge of disability [7, 9]. Psychosocial disabilities are poorly understood. 
Interviews and focus groups revealed limited community knowledge about psychosocial 
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disabilities, whereas most participants identified visible impairments such as physical, vision 
and hearing as disability (section 8b).
The most commonly reported functional difficulties were seeing, walking and remembering 
in both districts. In an earlier study, Thorsen et al. reported 2.6% of their sample from three 
provinces in the Lao PDR had cognitive difficulties based on the responses to the WG 
questions on remembering or concentrating [10]. They also reported a strong association 
between cognitive difficulties and ageing with 10.2% of adults aged 60 years and over 
reporting ‘a lot of difficulty’ on this item. Thorsen et al. also identified poor understanding 
and stigmatization of people with intellectual/cognitive disabilities and the need for raising 
awareness and expanding services in Lao PDR. The quantitative and qualitative findings from 
our survey support these findings on the need to improve awareness in the community in 
general about less obvious or hidden disabilities such as psychosocial disabilities.
People who experience functional difficulties commonly do not self-identify as a person with 
a disability. This underscores a need for individualized approaches, and that people might 
need, want and benefit from services independent of how they identify. This is consistent 
with the CBID approach, which is both sensitive to persons with disabilities (who identify as 
such) and others who experience functional difficulties but do not identify as having 
disabilities. This is distinct from approaches that use self-identification or government 
certification as a starting point for allocating services. 
Finally, while disability prevalence is based on ‘a lot of difficulty’ or ‘cannot do’, at least 20% 
of the population also experienced at least ‘some’ difficulty in any one domain. This is 
potentially an important group for CBID and other services. Generally speaking, it is likely 
that people with more serious self-reported difficulties will be the priority for most 
programs, but this should not dismiss the needs of people with less severe difficulties, 
especially those who have progressive health conditions or who experience multiple 
difficulties. 
b. Socio-economic factors associated with disability and their implications
The prevalence of disability was strongly associated with age, being unmarried, poorer health 
and wellbeing, lower levels of education, unemployment, and lower living standards. The 
prevalence was similar for males and females and for those living in urban and rural areas. 
Age
As seen in Figure 4, the prevalence markedly increased with age in both districts. The 
disability prevalence was higher in Kham district than in Xayphouthong district, which could 
be due to the differences in the age distribution in both districts. There were more people 
in older age groups in Kham district reporting higher levels of difficulty than in Xayphouthong
district (Figure 4).
Lao PDR is experiencing a demographic shift as evidenced by the 2015 census report [5]. 
The population aged 15-64 years has increased from 54% in 2005 to 64% in 2015. Life 
expectancy has also increased from 59 years in 2005 to 62 years among males and from 63 
to 65 years among females in 2015. There is also increasing migration of young individuals in 
Lao PDR for education and employment. This type of demographic shift might result in older 
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people mostly living on their own and missing out on traditional family support. This type of 
demographic shift is similar to many other low- and middle-income countries and calls for 
strategies for health and rehabilitation systems, particularly at primary and community level 
to support older persons experiencing difficulties in functioning due to ageing and older 
persons with disabilities.
Health
A larger proportion of persons with disabilities reported poorer health compared to persons
without disabilities. This finding was further supported by a higher need for healthcare 
services among persons with disabilities compared to persons without disabilities. However,
there was no difference found between persons with and without disabilities accessing 
healthcare. While this is a promising finding in terms of accessible health, access alone does 
not indicate the appropriateness and effectiveness of that care or whether it is what people 
need. This is particularly the case for people with functional difficulties who might require 
more complex and long-term care, or who require services that are unlikely to be available 
in traditional healthcare settings. Further, barriers to accessing health services were different 
for persons with and without disabilities. Accessible transport, absence of appropriate 
services, costs and staff attitudes were important for persons with disabilities, but not for
people without difficulties who were unable to access health care. Service providers 
acknowledged their limited knowledge and skills for managing patients with different types 
of disabilities.
Further to general healthcare needs, this survey has identified that most persons with 
disabilities were unaware of what rehabilitation was. Most rehabilitation services are based 
at the provincial level making rehabilitation inaccessible for many. Similarly, assistive product 
services are also available in urban settings making it difficult for those living in rural areas to 
access them and to receive support for maintenance and ongoing management. People in 
Xayphouthong district were around 2.6 times more likely to use assistive products than in 
Kham district, which may be due to better services in Xayphouthong district. Access to 
assistive products was low among persons with disabilities in both districts. A little over a 
quarter of persons with disabilities used an assistive product and it was more common among 
those with some difficulty in functioning. Not everyone with functional difficulties requires 
an assistive product, but access to assistive products was poor overall, particularly for those 
who need them the most.
These findings on health and rehabilitation are in line with recent systematic reviews from 
127 low- and middle- income countries, which highlight that persons with disabilities
experience higher health care needs, but poorer coverage and more healthcare expenses
compared to those without [11]; and have poorer access to rehabilitation and assistive 
technology [12]. Disability-related skills and information is often missing in professional 
healthcare training in many countries [13]. Findings from this baseline survey and reports 
from other low- and middle-income countries emphasize the need for immediate actions for 
improving healthcare systems and policies. It is critical to ensure equal access to health care 
and reduce barriers for persons with disabilities as part of the Universal Health Coverage 
agenda and to achieve Goal 3 of the United Nations Sustainable Development Goal 3 (ensure 
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healthy lives and promote well-being for all at all ages). Kuper and Heydt [13], recommended
health worker training on disability, health provider accessibility audits, and making health 
information accessible as some of the immediate actions that could be considered to ensure 
disability inclusion in health. 
Using a common measure of likelihood of depression, this study found that depression was 
uncommon overall, and that there were no differences between persons with and without 
disabilities. The lack of relationship between functional difficulties and depression was 
unexpected; a previous multi-country study using a similar metric of depression [14] found 
that in all countries combined, the likelihood of depression is associated with physical health, 
and people with physical impairment in Lao PDR specifically were about 5 times more likely 
than others to report depression. It is probably self-evident that any CBID programming that 
does not take mental health into account is incomplete. However, these findings suggest that 
for most people who are likely to be CBID participants, other concerns and barriers to 
participation might be more common, but mental health and psychosocial support should 
remain an important aspect of programming. This finding further reinforces the merit of 
good screening to systematically understand peoples’ overall health and functioning 
experience before carefully refining individualized interventions to make the best match of 
available resources for the most important needs. 
Education and employment
Persons with disabilities were less likely to attend school in both districts and lower 
education level was strongly associated with having a disability. Being poor and being female 
were also independently associated with lower education levels. These findings are in line 
with current evidence from other countries [2]. As identified in the 2015 census, women in 
general were less likely to have higher education levels in the two districts surveyed [5].
Although we were unable to test for interactions in the regression models, it is reasonable 
to conclude that women with disabilities are more likely to be deprived of attaining higher 
levels of education. This survey has identified that those with higher levels of schooling were 
more likely to be employed, suggesting the importance of education for being financially 
independent.
Focus groups and in-depth interviews helped us further understand more about the barriers 
for persons with disabilities attending school. Although initial community attitudes were 
generally positive for children with disabilities attending school, further exploration in FGDs 
and KIIs highlighted that stigma and prejudice are one of the main challenges for sending 
children with disabilities to schools. Caregivers and persons with disabilities expressed fears 
of bullying at school from other children and believed that children with disabilities cannot 
go to school and that they should be separated from other children. This finding was also
supported by adult participants with disabilities who shared experiences of their families not 
being supportive of them attending school due to their poor awareness and negative 
attitudes. The survey also identified other barriers such as inaccessible school facilities, 
difficulties travelling to school and families’ low economic status in both quantitative and 
qualitative components.
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Findings reveal that there was no difference between the proportions of people with and 
without disabilities working, but persons with disabilities are less likely to be paid. This points 
to the importance of ensuring safe, dignified and equitable employment, rather than a focus 
on ensuring persons with disabilities can work at all. This finding could be associated with 
perceptions that persons with disabilities are unhealthy and therefore unfit for work. There 
was also little awareness of what types of work persons with disabilities could do, with 
limited options suggested by respondents – so while persons with disabilities do have 
employment, social norms and poor knowledge about inclusive work appear to constrain 
the types of opportunities available. 
Barriers to work are not limited to people with personal experience of disabilities. 
Caregivers of persons with disabilities face difficulties in being able to work away from home
and limiting the type of work they can do. This finding on the financial and work impacts for 
caregivers is not uncommon, even in high-income countries. Organization for Economic Co￾operation and Development (OECD) reports suggest that caring activities have negative 
impacts on household income, continuation of careers and job choices [15, 16]. Although 
this survey did not directly target caregiver challenges, evidence from the current literature 
suggests that caregivers of chronically ill family members experience poor mental and 
physical health [17, 18]. Qualitative findings from this survey provide some indication that 
caregivers of persons with disabilities experience challenges to their emotional well-being 
and support findings from the wider literature. These findings justify the CBID project’s focus
on caregiver wellbeing. Information from the Modular Tool will be used for individual level 
assessment of needs and caregiver needs to further inform the current situation of caregivers 
in the two study locations.
Poverty
Socio-economic status was measured indirectly based on the living standards of the 
household in this survey. This methodology is commonly used in surveys including the 
Demographic Health Surveys and Living Standard Surveys. Lower living standards were 
associated with disability in this survey supporting the current evidence on poverty and 
disability. Further, lower living standards were independently associated with lower levels of 
education, less likelihood of having undertaken vocational training, unemployment and more 
likely to experience poor wellbeing. While we did not analyze interactions between having 
a disability and poverty with other factors and did not have data to study causality, it is 
reasonable to assume the findings are supportive of the theory of a cyclical relationship 
between poverty and disability. Economic empowerment is one of the major components of 
USAID Okard’s Activity and findings from this baseline survey justify the need for financially 
empowering persons with disabilities in the two districts, specifically targeting most at-risk 
groups among persons with disabilities overall.
Community participation
Participation in social activities and having a voice in community decision making were
associated with having no disability, higher levels of education and having higher living 
standards. This association highlights intersections between wealth, education, and disability. 
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Persons with disabilities, in general, participated in fewer social gatherings and community 
activities in both districts. Qualitative findings suggested that negative attitudes in the 
community largely contributed to persons with disabilities not participating in community 
events as they were treated differently or sometimes considered they should not participate, 
for example, due to their health conditions such as epilepsy (believed as contagious).
In Kham district, persons with disabilities were more likely to report they contributed to 
community meetings compared to persons without disabilities. Whereas in Xayphouthong
district, participation overall was lower. These findings could be explained by different local 
political structures and engagement in the two districts, with more effective measures to 
engage with people in general, and specifically persons with disabilities in Kham district. 
Another likely contributor is the association between age and participation, with older 
people possibly more likely to participate in community activities. Disability being strongly 
associated with age, there is a possibility that older persons with disabilities were 
participating more in community activities. Controlling for individual characteristics including 
functional difficulties, women were twice as likely to participate in social activities. This might 
reveal both a greater impact if women with disabilities are excluded from social participation, 
and the tendency for men to interact in different ways compared with women. Together, 
these findings are a reminder of the importance of gender sensitive programming overall but
did not point to clear intersectionality between disability and gender when exploring social 
interactions. 
The type of disability and reason appeared to influence how persons with disabilities
participated in the community. It was identified that war veterans, including some with a 
physical impairment, received respect in the community and could even hold high-level 
positions, such as the village head. On the contrary, people with vision impairments, 
psychosocial disabilities and hearing difficulties were considered less able to participate and 
contribute to community life.
Knowledge, attitude and practice in disability
The quantitative survey identified that while three-quarters of respondents know someone 
with a disability, less than 10% report that they have a person with disabilities among their 
friends. These findings demonstrate how few people have close personal contact with 
persons with disabilities and that people tend not to understand how people experience
disability. This lack of interaction and persistent negative attitudes lead to discriminatory 
ideas and practices. 
While quantitative findings suggest positive attitudes towards disability in general, further 
probing in FGDs and KIIs identified negative attitudes and poor understanding of disability 
being prevalent in both districts. During the qualitative component, initial responses would 
also be generally positive towards disability; however, further discussion revealed that low 
awareness of disability, stigma and prejudice are common. Persons with disabilities were 
called names and sometimes the subject of jokes. Further, these attitudes were considered 
normal in some instances and persons with disabilities reported accepting this as normal. 
The disempowering effect of negative attitudes towards persons with disabilities came across 
109
strongly in the qualitative component. It was evident from the interviews that community 
members did not recognize some attitudes or behavior were negative and stigmatizing for 
persons with disabilities and their families. How persons with disabilities themselves respond 
to cultural and societal norms about well-meaning name calling was not clear from this 
analysis. This is important because attaching labels to people with functional impairment or 
persons with disabilities was very common among respondents. In some cultures, persons 
with disabilities find value in attaching labels to themselves – even pejorative labels – as a 
way of ‘taking back’ or reclaiming how people perceive disability. Caution is required when 
interpreting the meaning and impact of name-calling among persons with disabilities in Lao
PDR. 
These findings around ignorance in the community in general imply behavior change activities 
to tackle persistent negative attitudes should illuminate the experience of persons with 
disabilities (including through providing platforms for their own advocacy and messaging)
concerning the impact of name-calling and social inclusion. Findings demonstrate a 
disconnection between what persons without disabilities say they do, and how persons with 
disabilities describe their own experiences. Persons with disabilities are not universally 
socially excluded. Evidence provided here shows that some sociodemographic 
characteristics like education, work and living conditions can be protective of exclusion 
overall, and that people with the most severe disabilities are especially at risk of negative and 
exclusionary social attitudes. The individualized CBID approach combined with well￾evidence and targeted behavior change strategies have the potential to combine in powerful 
new ways to deliver a more enabling environment and individual support and capability 
strengthening to deliver the program objectives. 
Strengths and limitations of this survey
There are several strengths to this baseline survey. First, the mixed methods study design 
has allowed better understanding of the current situation of persons with disabilities in Kham 
and Xayphouthong districts. While the quantitative survey provided an assessment of the
magnitude of differences in participation, wellbeing and access to services between people
with and without disabilities, the qualitative component gathered perspectives of different 
community members including people with and without disabilities, caregivers, services 
providers and other key stakeholders. The qualitative component provided richer data to 
comprehensively understand certain barriers identified in the quantitative survey and to 
better understand prevailing community attitudes and practices towards persons with 
disabilities. 
Second, reliable methods were used for data collection. In the quantitative survey, data were 
collected directly from the individuals unless there was a need for a proxy in the case of 
children and those with cognitive difficulties. This method captures reliable information on 
the level of difficulty and challenges from the individuals experiencing them. Qualitative 
interviews were conducted by trained local interviewers who could probe further and collect 
detailed information related to the local context.
110
Third, the survey used standard and validated tools, where applicable. We have used the 
WG Short Set of questions to identify persons with disabilities making the data from this 
survey comparable to other surveys. Other tools used were the SLWS, PHQ-2 and WHO
Rapid Assessment of Assistive Technology tool. Although these tools were used for the first 
time in the Lao context, necessary steps for translation, cultural adaptation and cognitive 
testing were undertaken. 
Finally, the survey has identified some key findings, which are in line with existing evidence 
from other countries suggesting comparability. Further, there are key findings in this baseline 
survey that are critical for planning CBID projects in both districts.
This survey has some limitations. One of the limitations is disability in children was assessed 
using the WG Short Set questions on disability which can miss cognitive, behavioral and 
developmental disabilities. Although the UNICEF/WG Child Functioning Module was 
available at the time of survey, it was not used due to its length and time needed for the 
screening survey, given the limited resources available for this survey. However, we were 
able to capture the situation of persons with disabilities, including children with disabilities 
in both districts with the mixed methods design. There were some important findings on 
schooling, attitudes towards certain types of disabilities and caregiver issues that are relevant 
for children with disabilities and provide necessary information for the USAID Okard team 
to design their CBID projects.
Another limitation was that we did not perform sub-group analyses and run regression 
models for investigating interaction between different socio-economic factors. This was not 
feasible with the limited sample size in sub-groups. However, the analyses undertaken in this 
report provides good evidence for the needs of persons with disabilities and considerations
for planning CBID projects in both districts. 
111
VI. Conclusion and implications for CBID projects
There were a significant proportion of persons with disabilities in both districts with a 
prevalence of 13.3% in Kham and 9.9% in Xayphouthong districts. Persons with disabilities
are more likely to be older, have lower living standards, have lower education levels, be 
unemployed and have poorer health and wellbeing than persons without disabilities. Persons 
with disabilities are less likely to participate in the community and social gatherings and have 
poorer access to services. Barriers to participation and accessing services can be largely 
attributed to negative attitudes in the community, lack of accessible services and means to 
travel to services. 
The CBID evidence-based demonstration model is targeted to address the health, 
livelihoods, and social needs of persons with disabilities, with a focus on individuals, families, 
and communities. Based on baseline survey findings, the priority areas for planning 
interventions are around:
• Individual assessments of needs based on directly assessing the individuals rather than 
proxies to capture reliable information on their needs and challenges. This will be 
possible with the CBID Modular Tool.
• Behavior change strategies should focus on understanding disability and challenges of 
persons with disabilities and their families, disability inclusion at the community level 
and its benefits, and attitudes towards persons with disabilities and their families.
• Disability awareness and training programs at the systems level to ensure service 
providers and policy makers are familiar with disability concepts and plan disability 
inclusion in mainstream services.
• Developing training curricula for health workers on disability inclusion.
• Ensuring access to health for persons with disabilities considers the type and quality 
of healthcare provided, rather than ‘access’ alone. This could include referrals from 
healthcare services back to CBID or other services to provide long-term, 
individualized programming at home and in the community. 
• Working with existing rehabilitation services to widen the range of services to 
complement healthcare and CBID programming, and to ensure better knowledge of 
who might benefit from rehabilitation. 
• Consulting persons with disabilities and their representative organizations in planning 
and implementation of the project.
• Provision of rehabilitation services at the district level, which is closer than the 
current provincial level centers. 
• Consideration for availability of assistive products that are appropriately prescribed 
and ensure ongoing support for management and maintenance of assistive products.
• Providing information on the activities of the project and community level 
interventions in accessible formats for different types of disabilities. 
112
• Ensuring caregivers are not only engaged in care planning for individuals with 
disabilities but also ensuring their own health and wellbeing is considered and 
supported.
• Consider the particular needs and constraints of caregivers of people with different 
impairments and of different ages.
• Collecting data on the needs and challenges over time to capture outcomes and the 
impact of interventions from the CBID project. This is feasible through the CBID 
Modular Tool. 
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Appendices
Appendix 1: Overview of survey
Objectives Study design, method & tools Data analysis Target population
Identify the level of 
activity and 
participation 
(function), wellbeing 
and access to 
communities among 
persons with 
disabilities and 
persons without 
disabilities. (Note: 
measurement of the 
changes after the 
interventions is 
carefully considered 
under the study 
design of baseline 
survey).
- Study design: Population-based surveys in two 
districts with rapid screening in the first step, 
followed by long-form survey with structured 
questionnaires. Multi-stage stratified random 
sampling is considered and will be discussed with 
WE and local research team for final decision.
- Tool: Structured questionnaires at the individual
and household level.
- Modified RAD survey tool, which was developed 
by Nossal, contextualised for Lao PDR.
- Data collection: local enumerators will use tablet￾computers for higher accuracy; Nossal team will 
provide training and technical support to local 
research team.
- Type: Quantitative data analysis 
with survey data (i.e. controlling for 
design effect).
- Approach: Comparisons across 
different groups of target population 
to identify the gaps.
- Data analysis: Data will be 
transferred to Stata format for 
cleaning. Univariate, bivariate and 
multi-variate analyses with 
appropriate significant tests using 
Stata or other statistical packages, 
such as SPSS or SAS or R+. 
- Controlling for sex, age and other 
socio-economic characteristics.
Children with disabilities
Children without disabilities 
Adults with disabilities
Adults without disabilities 
Understand the 
knowledge, attitudes 
and practices (KAP) 
of persons with 
disabilities and 
different community 
stakeholders.
- As above plus KAP module. - As above. - As above
- Study design: Qualitative research study involving 
IDIs with the beneficiaries and stakeholders.
- Tool: Semi-structured questionnaires and 
question guides.
- Data collection: Local and international 
researchers. Nossal team will provide training and 
technical support to local research team. Nossal 
team may participate directly in some interviews.
- Type: Qualitative.
- Approach: as above.
- Data analysis: Content analysis, 
narrative analysis, and framework 
analysis with assistance of NVivo or 
other qualitative data software, such 
as Atlas ti.
Persons with disabilities
Persons without disabilities
Caregivers and household members of 
persons with disabilities;
Service providers (health, TVET, local 
businesses, education);
National and local officials;
Representatives of economic and socio￾political organizations;
OPDs
Project staffs or facilitators who are 
directly involved to the interventions.
114
Appendix 1 Gantt chart of the CBID baseline survey
2019
Jan Feb Mar Apr May Jun July Aug
D1
Design and 
Implementation 
Plan
Development, planning and design of quantitative component 
including drafting Ethics Application Development, planning and design of qualitative component 
including drafting Ethics Application 
Ethics approval process (Melbourne)
D2 Survey Tools
Questionnaire development
Data entry package development
In
-country workshop to finalize the questionnaire
Testing the data entry package and updating
Development of survey guidelines for enumerators 
& supervisors
Development of qualitative tools
D3
Training package 
for local survey 
team 
Development of training package and materials
In
-country training for local survey team
Training of local qualitative survey team & finalizing tool
Quantitative survey
- data collection
Qualitative survey
- interviews
D4
Data quality 
assurance 
reports 
Technical support for survey data collection & database 
monitoring
Technical support to qualitative data collection and supporting 
initial data collection
D5
Database, initial 
data analysis and 
presentation of 
initial findings
Data synchronizing & merging 
Data cleaning
Development of report structure and data analysis plan
Data analysis
Graph, chart, table preparation
In
-country presentation of preliminary quantitative findings
Qualitative data analysis
D6 Reporting
Writing up quantitative finding report Writing up qualitative finding report 
Finalizing quantitative report
Finalizing qualitative report
2019 Lao OKARD Survey Questionnaire – NIGH & WE 115
Appendix 2: Quantitative survey tool – Long-form 
2019 Community-Based Inclusive Development Survey
USAID Okard, Lao PDR
Note: [red] variable name; (blue) Note to interviewer/KoBo
[start] (start) Time at the start of survey (automatically recorded)
A. GENERAL INFORMATION
1. [a1dist] (Interviewer to complete) District:
1 = Kham district (Xienkhuang province)
2 = Xayphouthong district (Savannakhet province)
2. [a2village] (Interviewer to complete) Village: (select from the list: run between 1 and 15)
3. [a3nouy] (Interviewer to complete) Nouy: (select from the list)
4. [a4hhid] (Interviewer to complete) Household number: (enter from screening)
5. [a5indid] (Interviewer to complete) Individual identification of the respondent (IID from 
screening)
6. [a6rural] (Interviewer to confirm) Rural/Urban place of residence: (automatically generated 
from village name/code; Interviewer to confirm)
1 = Rural 0 = Urban
7. [a7enum] (Interviewer to complete) Interviewer’s name or ID: (select from the list)
8. [a8visit] (Interviewer to complete) Number of visit (maximum 3): 1 2 3
9. [a9sampleg] (Interviewer to complete) Sampling group from the screening?
1 = Persons with difficulties
0 = Persons without difficulties
10. [a10avail] (Interviewer to complete) Was the respondent available?
1 = Yes 0 = No, I could not meet the respondent → END THE SURVEY
2019 Lao OKARD Survey Questionnaire – NIGH & WE 116
11. [a11elig] (Interviewer to complete) Is the respondent eligible? (examples of illegible 
respondents: the person does not exist, out-migrated, younger than 5 years old)
1 = Yes 
0 = No, the respondent is not eligible → END THE SURVEY
12. [a12cons] We would like to ask you some questions about you and your community. Is 
that OK?
1 = Yes, OK 
0 = No, it’s not OK → END THE SURVEY
B. PARTICIPANT INFORMATION SHEET & CONSENT
PLEASE READ ALOUD
My name is ________________. I am working for an organisation called World Education. 
In partnership with Humanity and Inclusion, Nossal Institute for Global Health, QLA and 
ARMI, and under approval of Ministry of Labor and Social Welfare National Committee for 
Disabled and Elderly (NCDE), we are conducting a survey to strengthen health and 
community based inclusive development in 2 districts of Lao. 
We would like to invite you to participate in this survey. We do not provide any direct 
incentive for your participation, but we expect findings from this study will contribute to 
health and community development in general, especially for vulnerable persons. We respect 
your privacy and so your identity and personal information will be kept confidential. Your 
participation is totally voluntary; you can refuse to participate, refuse to answer questions 
that you don't want to, stop the interview at any time you want without any risk to you or 
your family. I am also providing you a hard copy of further detail information and contact if 
you have any concern, complain or need of any further information. The project has been 
approved by the Human Research Ethics Committee (HREC) at the University of Melbourne 
in Australia and the Ministry of Labor and Social Welfare National Committee for Disabled 
and Elderly (NCDE).
The survey will take about 45 to 60 minutes. We will delete your name from surveyed data, 
and data will be destroyed after 5 years. If you participate, your honest responses are 
important to us because we want your critical feedback so we can improve.
CONSENT
PLEASE READ ALOUD
Please indicate whether you agree with these statements (select as acknowledged).
 I understand the previous statements read to me, the purpose and risks of this 
project.
 I have had an opportunity to ask questions and I am satisfied with the answers I have 
received.
 I freely agree to participate in this research and I understand that my participation 
will involve participating in an interview for up to 60 minutes, and if I agree, my 
responses will be entered into a tablet computer, saved, and analysed.
 I acknowledge that: 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 117
o participation in this interview is voluntary and I am free to withdraw from the 
interview at any time without explanation or prejudice.
o The interview is for the purpose of strengthening health and community 
development in Lao PDR.
 I have been informed that information from my interview will be kept securely for 5 
years after the last time it is used and then destroyed.
Interviewer check: If not all the points have been acknowledged, please return and check, or 
conclude the interview if the person doesn’t want to continue.
If you have any questions, you can ask me or contact the Survey Coordinator, Ms. Alounny 
XXXX through email at XXXXX, cell phone XXXXX, or mail address at XXXXX). The 
contact details are also in the form I have given you. If you have any concerns or complaints 
about the conduct of this research project, there are details in the document I gave you about 
other people to contact.
1. [b1yob] What year were you born in? ………………………. (record year of birth) 
2. [b2age] (Interviewer to confirm or ask if year of birth is not available; use best estimate if 
exact age is not available) Enter or verify age: ………………. (record age in years) 
C. SOCIO-DEMOGRAPHIC BACKGROUND
1. [c1sex] What is your sex? 
1 = Male 2 = Female
2. [c2ethnic] What is your ethnicity? 
1 = Lao 2 = H’mong 3 = Khmou
4 = Phouthay 5 = Phong 6 = Tai
7 = Others (specify) ……[c2o] ……
3. [c3marstat] (SKIP if age<12) What is your current marital status? 
1 = Currently married 2 = Stay together 3 = Separated
4 = Divorced 5 = Widowed 0 = Never married/
 Never cohabitated
4. [c4child] (SKIP if age<12) Do you have any children? 
1 = Yes 0 = No → SKIP to C.6
5. [c5nchild] How many children do you have? ……………………. 
6. [c6schoolatt] Have you ever attended school?
0 = No → SKIP to C.12
1 = Yes, currently attending → SKIP to C.10
2019 Lao OKARD Survey Questionnaire – NIGH & WE 118
2 = Yes, attended before
7. [c7] When did you leave school?
 a. Month: ………… b. Year: ……….……….
8. Why did you leave school? (Select all that apply)
[c8_1] 1 = I reached the level that I wanted
[c8_2] 2 = Poor health 
[c8_3] 3 = Needed to get paid job
[c8_4] 4 = Taking care of family
[c8_5] 5 = Disability
[c8_6] 6 = Absence of personal 
assistance/caregiver 
[c8_7] 7 = Family did not want me to go to 
school
[c8_8] 8 = Family has difficulty assisting me 
to go to school
[c8_9] 9 = School is too far away
[c8_10] 10 = Means of transportation to 
school is absent or difficult to use
[c8_11] 11 = Difficulty road conditions to 
school
[c8_12] 12 = School is not physical 
accessible
[c8_13] 13 = Absence of specific teaching 
aids and approaches 
[c8_14] 14 = Cost of attending school (e.g. 
tuition fees, uniform, transport)
[c8_15] 15 = Being expelled from school
[c8_16] 16 = Treated badly at school (e.g. 
bullied or discriminated by friends or 
teachers or staffs or other people met 
at school)
[c8_88] 88 = Other (specify) ..…[c8o]…..
[c8_98] 98 = Don’t know /Don’t 
remember
→ SKIP to C.10 if less than 2 options were selected in C.8
9. [c9] What is the most important reason? (Write one of the selected codes above) ……..
10. [c10] What level of school did you COMPLETE? 
1 = Primary
2 = Junior secondary
3 = Senior secondary or higher
11. [c11] What is the highest class that you have COMPLETED in school?
0 1 2 3 4 5 6 7 8 9 10 11 12 13=13 or 
higher
→ SKIP to C.14
12. Why have you never gone to school? (Select all that apply)
2019 Lao OKARD Survey Questionnaire – NIGH & WE 119
[c12_1] 1 = I think it’s not necessary
[c12_2] 2 = Poor health 
[c12_3] 3 = Needed to get paid job
[c12_4] 4 = Taking care of family
[c12_5] 5 = Disability
[c12_6] 6 = Absence of personal assistance
[c12_7] 7 = Family did not want me to go to school
[c12_8] 8 = Family has difficulty assisting me to go to school
[c12_9] 9 = School is too far away
[c12_10] 10 = Means of transportation to school is absent or difficult to use
[c12_11] 11 = Difficulty road conditions to school
[c12_12] 12 = School is not physical accessible
[c12_13] 13 = Absence of specific teaching aids and approaches 
[c12_14] 14 = Cost of attending school (e.g. tuition fees, uniform, transport)
[c12_15] 15 = School did not admit me
[c12_16] 16 = Treated badly at school (e.g. bullied or discriminated by friends or teachers or 
staffs or other people met at school)
[c12_88] 88= Other (specify) …[c12o]…
[c12_98] 98 = Don’t know /Don’t remember
→ SKIP to C.14 if less than 2 options were selected in C.12
13. [c13] What is the most important reason? (Write one of the selected codes above) ……..
14. [c14] Have you ever received any skills or vocational training (for example from a TVET 
center or from a technical trainer?)
1 = Yes 0 = No
15. [c15] Over the past 3 months, have you needed any skills or vocational training?
1 = Yes 0 = No → SKIP to C.19
16. [c16] To what extent have you been able to receive skills or vocational training as much 
as you needed?
1 = All of the time → SKIP to C.19 2 = Most of the time
3 = Some of the time 4 = Never
98 = Don’t know /Can’t remember → SKIP to C.19
17. Why did you give that answer? (Select all that apply)
[c17_1] 1 = Lack of information /Do not know where to go 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 120
[c17_2] 2 = No services/facility for vocational training 
[c17_3] 3 = Absence of the training in area that I wanted
[c17_4] 4 = Too far
[c17_5] 5 = Means of transportation is absent or difficult to use 
[c17_6] 6 = Means of transportation is not accessible
[c17_7] 7 = Poor road condition or road is not accessible
[c17_8] 8 = Could not afford the cost of skills or vocational training 
[c17_9] 9 = Nobody to accompany me
[c17_10] 10 = Do not like the attitudes of the staff at the training centre/school 
[c17_11] 11 = Do not like the attitude of other trainees at the training centre/school 
[c17_12] 12 = I was previously badly treated (e.g. bullied or discriminated by friends 
or teachers or staffs or other people met at skills or vocational training 
centres)
[c17_13] 13 = Tried but denied training / Training centre did not admit me
[c17_14] 14 = Absence of reasonable accommodation at the training centre/school 
[c17_15] 15 = Family did not want me to participate in skills or vocational training
[c17_88] 88 = Other (specify) ……[ c17o] ………
[c17_98] 98 = Don’t know /No response
→ SKIP to C.19 if less than 2 options were selected in this C.17
18. [c18] What is the most important reason? (Write one of the selected codes above) ……..
19. [c19] What is your current main activity status?
1 = Student
2 = Not working and not looking for work
3 = Not working and looking for work (unemployed)
4 = Retired
5 = Full time homemaker/housewife
6 = Contributing family worker (helping without pay in a household/family business) 
7 = Employee /paid work for someone else (including paid apprentice or intern)
8 = Self-employed (Employer with regular employees OR own-account worker 
without regular employees)
88 = Other (specify): ……[c19o] ……… 
20. [c20] How do you feel about this current activity status? Very satisfied, satisfied, 
unsatisfied, or very unsatisfied? 
1 = Very satisfied 2 = Satisfied
2019 Lao OKARD Survey Questionnaire – NIGH & WE 121
3 = Unsatisfied 4 = Very unsatisfied
21. [c21] Do you currently earn any income from your current and/or previous work? 
1 = Yes 2 = No or Not applicable → SKIP to C.23
22. [c22] How much in the following range do you currently earn per month? (Interviewer: 
READ response options)
1 = <180,000 LAK/month 2 = 180,000 - <500,000 LAK/month
3 = 500,000 - < 1 mil LAK/month 4 = 1 mil - <2 mil LAK/month
5 = 2 mil - <5 mil LAK/month 6 = 5 mil - <10 mil LAK/month
7 = 10 mil or more LAK/month 98 = Don’t know/Refused 
23. [c23] Over the past 3 months, have you needed to work?
1 = Yes 0 = No → SKIP to C.27
[c24] To what extent have you been able to work as much as you needed?
1 = All of the time → SKIP to C.27 2 = Most of the time
3 = Some of the time 4 = Never/Not at all
98 = Don’t know /Can’t remember → SKIP to C.27
24. Why did you give that answer? (Select all that apply)
[c25_1] 1 = Lack of employment information /do not know where to go
[c25_2] 2 = No opportunities
[c25_3] 3 = Lack of job placement/support services
[c25_4] 4 = Not interested to work 
[c25_5] 5 = Difficult applying for a job
[c25_6] 6 = Family did not want me to work
[c25_7] 7 = Lack of assistant to workplace
[c25_8] 8 = Too far
[c25_9] 9 = No transport available
[c25_10] 10 = Means of transportation is not accessible
[c25_11] 11 = Could not afford the cost of transport
[c25_12] 12 = Do not like the attitudes of others 
[c25_13] 13 = Absence of reasonable accommodation at workplace
[c25_14] 14 = Disability
[c25_88] 88 = Other (specify) ……[c25o] ……
[c25_98] 98 = Don’t know
→ SKIP to C.27 if less than 2 options were selected in this C.25
2019 Lao OKARD Survey Questionnaire – NIGH & WE 122
25. [c26] What is the most important reason? (Write one of the selected codes above) ……..
26. Are you participating in any local organizations/association? (Select all that apply)
[c27_0] 0 = None
[c27_1] 1 = Micro-credit groups / Village fund
[c27_2] 2 = Self-help Group
[c27_3] 3 = OPD
[c27_4] 4 = Cooperative clubs 
[c27_5] 5 = Mass organizations, such as Youth Union, Farmer Associations, etc. 
[c27_88] 88 = Others (specify) ……[ c27o] ……….
D. HEALTH & ACCESS TO HEALTH SERVICES
1. [d1] How do you rate your current health status in general? Very good, good, poor, or 
very poor? 
1 = Very good 2 = Good
3 = Poor 4 = Very poor
2. [d2] Do you have health protection/insurance?
1 = Yes 0 = No
3. [d3] Have you ever been sick enough to stay home or rest for at least 3 days?
1 = Yes 0 = No → SKIP TO D.8
4. [d4] When was the last time you got sick and had to stay at home or rest for at least 3 
days?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3+ years ago 
5. What did you do during the week immediately after that? (Select all that apply)
[d5_1] 1 = Did nothing [d5_2] 2 = Home remedy
[d5_3] 3 = Self-medicated [d5_4] 4 = Visited pharmacist 
(without prescription)
[d5_5] 5 = Visited public health facilities [d5_6] 6 = Visited private health facilities
[d5_7] 7 = Visited traditional healer [d5_8] 8 = Seek spiritual support (e.g. 
 visited religious leader /Imam /Priest)
[d5_88] 88 = Other (specify) ……[ d5o] …… [d5_98] 98 = Can’t remember
2019 Lao OKARD Survey Questionnaire – NIGH & WE 123
6. [d6] Did your sickness get worse, same or better after one week?
1 = Worse 2 = Same
3 = Better 98 = Don’t remember 
7. What did you do after the first week? (Select all that apply)
[d7_1] 1 = Did nothing [d7_2] 2 = Home remedy
[d7_3] 3 = Self-medicated [d7_4] 4 = Visited pharmacist 
(without prescription)
[d7_5] 5 = Visited public health facilities [d7_6] 6 = Visited private health facilities
[d7_7] 7 = Visited traditional healer [d7_8] 8 = Seek spiritual support (e.g. 
 visited religious leader /Imam /Priest)
[d7_88] 88 = Other (specify) ……[ d7o] …… [d7_98] 98 = Can’t 
remember
8. [d8] Over the past 3 months, have you needed to access healthcare services?
1 = Yes 0 = No → SKIP to D.12
9. [d9] To what extent have you been able to access healthcare services as much as you 
need?
1 = All of the time → SKIP to D.12 2 = Most of the time
3 = Some of the time 4 = Never
8 = Don’t know /Can’t remember → SKIP to D.12
10. Why did you give that answer? (Select all that apply)
[d10_1] 1 = Lack of information /do not know where to go
[d10_2] 2 = No healthcare services/facility
[d10_3] 3 = Family did not want me to visit healthcare facility
[d10_4] 4 = Lack of assistant to healthcare facility / Nobody accompany me
[d10_5] 5 = Too far
[d10_6] 6 = No transport available
[d10_7] 7 = Transport is not accessible
[d10_8] 8 = Could not afford the cost of healthcare
[d10_9] 9 = Could not afford indirect costs, e.g. transportation, food, 
accommodation, accompanied person
[d10_10] 10 = Do not like the attitudes of staff at health facility
[d10_11] 11 = Do not like the attitudes of others at health facility
[d10_12] 12 = Was previously badly treated or discriminated
[d10_13] 13 = Tried but denied at healthcare facility
[d10_14] 14 = Absence of reasonable accommodation at healthcare facility
2019 Lao OKARD Survey Questionnaire – NIGH & WE 124
[d10_88] 88 = Other (specify) ……[ d10o] ………
[d10_98] 98 = Don’t know
→ SKIP to D.12 if less than 2 options were selected in D.10
11. [d11] What is the most important reason? (Write select one of the codes above) ……..
12. [d12] Have you EVER needed to access health services?
1 = Yes 0 = No 
13. [d13] In general, how satisfied are you with healthcare services that you have received?
1 = Very satisfied 2 = Satisfied 
3 = Unsatisfied 4 = Very unsatisfied
Interviewer, read: Now I am going to ask you some questions about your ability to do 
different activities, and how you have been feeling.
14. [d14] Do you use any assistive product such as glasses or other products to help 
seeing; such as to read, write, seeing in distance or up-close?
1 = Yes 0 = No → SKIP to D.16
15. What assistive product do you use to manage your seeing difficulty? (Interviewer: Show 
the respondent Showcard #1 and read all options)
[d15_53] 53 = Glasses/spectacles prescription [d15_54] 54 = Reading glasses
[d15_52] 52 = Magnifiers, Optical [d15_4] 4 = Magnifiers, Digital
[d15_3] 3 = Braille displays [d15_6] 6 = Braille writing equipment
[d15_46] 46 = Watches, talking/touching [d15_8] 8 = Pill organizers
[d15_34] 34 = Recorders [d15_10] 10 = White cane
[d15_55] 55 = Smartphone app [d15_12] 12 = Other (specify)…[d15o]...
16. [d16] You said you had <enter level of difficulty from the Screening> seeing, [for those 
wearing glasses: even when wearing your glasses]. Is that right? 
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP to D.18 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7= Refused 8 = Don’t know
17. [d17] When did your vision become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
2019 Lao OKARD Survey Questionnaire – NIGH & WE 125
18. [d18] Do you use any assistive product to help hearing; such as hearing aid or other 
devices?
1 = Yes 0 = No → SKIP to D.20
19. What assistive product do you use to manage your hearing difficulty? (Interviewer: 
Show the respondent Showcard #2 and read all options)
[d19_17] 1 = Hearing aid [d19_88] 2 = Others (specify) …[d19o]...
20. [d20] You said you had <enter level of difficulty from the Screening> hearing, [for those 
using hearing aid: even when using a hearing aid(s)]. Is that right?
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP to D.22 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
21. [d21] When did your hearing become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
22. [d22] You said you had <enter level of difficulty from the Screening> walking or climbing
steps. Is that right?
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP TO D.24 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
23. [d23] When did your mobility become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
24. [d24] Do you use any assistive product to manage your mobility difficulty?
1 = Yes 0 = No → SKIP to D.26
25. What assistive product do you use to manage your hearing difficulty? (Interviewer: 
Show the respondent Showcard #3 and read all options)
[d25_5] 5 = Walking Canes/sticks simple or quadripod
[d25_45] 45 = Walking Frames/rollator
[d25_22] 22 = Orthoses, lower limb
[d25_31] 31 = Prostheses, lower limb
2019 Lao OKARD Survey Questionnaire – NIGH & WE 126
[d25_56] 56 = Joint support (cervical collar, knee support and arm slings)
[d25_47] 47 = Wheelchair - Manual for active
[d25_48] 48 = Wheelchair - assistant-controlled
[d25_49] 49 = Wheelchair - manual with postural support
[d25_57] 57 = Tricycles
[d25_11] 11 = Crutches – Axillary
[d25_58] 58 = Crutches - elbow
[d25_59] 59 = Standing Frames, Adjustable
[d25_60] 60 = Seating system (pediatric wheelchair)
[d25_29] 29 = Pressure Relief Cushions
[d25_30] 30 = Pressure Relief Mattresses
[d25_28] 28 = Positioning wedges / cushions
[d25_16] 16 = Hand Rails/Grab Bars
[d25_8] 8 = Club foot braces
[d25_88] 88 = Others (specify) ……[d25o] ….
26. [d26] You said you had <enter level of difficulty from the Screening> communicating, for 
example understanding or being understood, when using your usual (customary) 
language. Is that right?
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP TO D.28 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
27. [d27] When did your communication become that difficult? 
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
28. [d28] Do you use sign language?
1 = Yes 0 = No
98 = Refused /Don’t know
29. [d29] Do you use any assistive product to manage your communicating difficulty?
1 = Yes 0 = No → SKIP to D.31
30. What assistive product do you use to manage your communication difficulty? 
(Interviewer: Show the respondent Showcard #4 and read all options)
[d30_1] 1 = Lao talk app
2019 Lao OKARD Survey Questionnaire – NIGH & WE 127
[d30_2] 2 = Communication board
[d30_88] 88 = Others (specify) …… [d30o] ……….
31. [d31] You said you had <enter level of difficulty from the Screening> remembering or 
concentrating. Is that right?
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP TO D.33 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
32. [d32] When did your remembering/concentrating become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
33. [d33] Do you use any assistive product to manage your difficulty remembering?
1 = Yes 0 = No → SKIP to D.35
34. What assistive product do you use to manage your remembering difficulty? 
(Interviewer: Show the respondent Showcard #5 and read all options)
[d34_27] 27 = Pill organisers
[d34_34] 34 = Recorders
[d34_37] 37 = Simplified mobile phones
[d34_41] 41 = Time management products
[d34_25] 25 = Personal digital assistant (PDA)
[d34_42] 42 = Travel aid, portable
[d34_15] 15 = Global positioning system (GPS) locator 
[d34_13] 13 = Fall detectors
[d34_26] 26 = Personal emergency alarm system
[d34_88] 88 = Other (specify) ……[d34o] ……
35. [d35] You said you had <enter level of difficulty from the Screening> self-care, such as 
washing all over or dressing. Is that right?
Interviewer: Select option that is confirmed by the respondent.
0 = No difficulty → SKIP TO D.37 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
36. [d36] When did your self-care become that difficult?
2019 Lao OKARD Survey Questionnaire – NIGH & WE 128
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
37. [d37] Do you have difficulties raising a 2 litter-bottle of water from waist to eye 
level? Would you say no difficulty, some difficulty, a lot of difficulty, or cannot do at all?
0 = No difficulty → SKIP TO D.39 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
38. [d38] When did that activity become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
39. [d39] Do you have difficulties using your hands and fingers, such as picking up small 
objects, for example, a button or pencil, or opening or closing containers or bottles? 
Would you say no difficulty, some difficulty, a lot of difficulty, or cannot do at all?
0 = No difficulty → SKIP TO D.41 1 = Some difficulty
2 = A lot of difficulty 3 = Cannot do at all /Unable to do
7 = Refused 8 = Don’t know
40. [d40] When did your use of hands and fingers become that difficult?
1 = <3 months ago 2 = 3 to <6 months ago
3 = 6 months to <1 year ago 4 = 1 to <3 years ago
5 = 3 years ago or before that
41. [d41] Do you use any assistive product to help you eat; for toileting or washing; to 
dress by yourself or to manage other daily activities?
1 = Yes 0 = No → SKIP to D.43
42. What assistive product do you use?
[d42_22] 22 = Orthoses, lower limb [d42_32] 32 = Prostheses, upper limb
[d42_16] 16 = Hand rails /Grab bars [d42_65] 65 = Continence products
[d42_66] 66 = Chairs for shower/bath/toilet [d42_62] 62 = Adapted cutlery
[d42_63] 63 = Adapted cooking tools [d42_64] 64 = Adapted drinking tools 
[d42_67] 67 = Transfer board
[d42_88] 88 = Others (specify) …[d42o] …. 
43. [d43] Do you use any other assistive products that were not listed previously?
2019 Lao OKARD Survey Questionnaire – NIGH & WE 129
0 = No → SKIP to SKIP after D.46 1 = Yes 
44. [d44] How many other assistive products (which were not listed previously) do you 
use? …………………………
a. [d44a] Other assistive product number 1: ……………
b. [d44b] Other assistive product number 2: ……………
c. [d44c] Other assistive product number 3: ……………
45. [d45] From the assistive products you use, please select three most important ones: 
<write codes of up to 3 assistive products> ……………………
46. [d46] May we take a picture of this/these assistive devices? 
0 = No 1 = Yes 
→ SKIP to D.54 if the respondent does not use any assistive product
The next questions asking about your 3 most important assistive devices: 
AP 1 AP 2 AP 3
(a) (b) (c)
47. Code/name [d47a] [d47b] [d47c]
48. Approximately how much did you pay for 
the device?
[d48a] 
KIP
[d48b] 
KIP
[d48c] 
KIP
49. Does the device meet your needs? (does 
it do everything that you want it to do?) [d49a] [d49b] [d49c]
50. Where did you get it from? [d50a] [d50b] [d50c]
Response codes: 
D.47: 1 = Glasses/spectacles prescription; 2 = Reading glasses; 3 = Magnifiers, Optical; 
4 = Magnifiers, Digital; 5 = Braille displays; 6 = Braille writing equipment; 7 = 
Watches, talking/touching; 8 = Pill organizers; 9 = Recorders; 10 = White cane; 
11 = Smartphone app; 12 = Walking Canes/sticks simple or quadripod; 13 = 
Walking Frames/rollator; 14 = Orthoses, lower limb; 15 = Prostheses, lower limb; 
16 = Joint support (cervical collar, knee support and arm slings); 17 = Wheelchair 
- Manual for active; 18 = Wheelchair - assistant-controlled; 19 = Wheelchair -
manual with postural support; 20 = Tricycles; 21 = Crutches – Axillary; 22 = 
Crutches – elbow; 23 = Standing Frames, Adjustable; 24 = Seating system 
(pediatric wheelchair); 25 = Pressure Relief Cushions; 26 = Pressure Relief 
Mattresses; 27 = Positioning wedges / cushions; 28 = Hand Rails/Grab Bars; 29 = 
Club foot braces; 30 = Lao talk app; 31 = Communication board; 32 = Orthoses, 
upper limb; 33 = Prostheses, upper limb; 34 = Continence products; 35 = Chairs 
for shower/bath/toilet; 36 = Adapted cutlery; 37 = Adapted cooking tools; 38 = 
Adapted drinking tools; 39 = Transfer board; 40 = Others (specify) ……
D.49: 0 = No, not at all; 1 = Partly; 2 = Mostly; 3 = Yes
D.50: 1 = Rehabilitation centre; 2 = Hospital; 3 = Other health care facilities; 4 = Local 
market; 5 = Pharmacist; 6 = Made by self, friend or family; 7 = Made by artisan; 8 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 130
= NGO or Charity; 9 = Religious organisations; 10 = Government; 11 = Provided 
by healthcare professional; 12 = Ministry of Labour and Social Welfare; 88 = 
Others (specify) …………
51. [d51] Do you think you might benefit from an assistive device that you do not already 
have?
1 = Yes 0 = No → SKIP TO D.54
98 = Don’t know
52. Which of the following reasons restrict you from using an assistive device?
[d52_1] 1 = Lack of information /Don’t know about specific assistive devices
[d52_2] 2 = Assistive device is not available locally
[d52_3] 3 = Cannot afford (to buy) the assistive devices
[d52_4] 4 = They are not worth to buy (I think it is more expensive than its value)
[d52_5] 5 = Family did not want me to have it
[d52_6] 6 = Concern about their negative or side effects
[d52_88] 88 = Other (specify) ………[d52o] …………
[d52_98] 98 = Don’t know
53. [d53] What is the most important reason? (Write one of the selected codes above) ……..
54. [d54] Do you need any assistive device that you currently don’t have?
1 = Yes 0 = No → SKIP TO D.57
98 = Don’t know → SKIP TO D.57
55. Why don’t you have them? (Select all that apply)
[d55_1] 1 = Lack of information /Don’t know about specific assistive device
[d55_2] 2 = Assistive device is not available locally
[d55_3] 3 = Cannot afford (to buy) the assistive devices
[d55_4] 4 = They are not worth to buy (I think it is more expensive than its value)
[d55_5] 5 = Family did not want me to have it
[d55_6] 6 = Concern about their negative or side effects
[d55_88] 88 = Other (specify) ……[d55o] ……
[d55_98] 98 = Don’t know
→ SKIP to D.57 if less than 2 options were selected in this D.55
56. [d56] What is the most important reason? (Write one of the selected codes above) ……..
57. [d57] Over the past 3 months, have you needed to access rehabilitation services?
0 = No 1 = Yes → SKIP to D.62
2019 Lao OKARD Survey Questionnaire – NIGH & WE 131
2 = Don’t know what rehabilitation is → SKIP to D.62
3 = Know rehabilitation but don’t know if it’s needed → SKIP to D.62
58. [d58] Have you ever needed to access rehabilitation services?
1 = Yes 0 = No → SKIP to D.62
98 = Don’t know → SKIP to D.62
59. [d59] To what extent have you been able to use rehabilitation services as much as you 
need?
1 = All of the time → SKIP to D.62 2 = Most of the time
3 = Some of the time 4 = Never
98 = Don’t know /Can’t remember → SKIP to D.62
60. Why did you give that answer? (Select all that apply)
[d60_1] 1 = Lack of information /do not know where to go
[d60_2] 2 = No rehabilitation services/facility
[d60_3] 3 = Family did not want me to access rehabilitation
[d60_4] 4 = Lack of personal assistant to access rehabilitation /Nobody accompany 
me
[d60_5] 5 = Too far
[d60_6] 6 = No transport available
[d60_7] 7 = Transport is not accessible
[d60_8] 8 = Could not afford the cost of rehabilitation
[d60_9] 9 = Could not afford indirect costs, e.g. transportation, food, expenses for 
accompanied person, accommodation
[d60_10] 10 = Do not like the attitudes of staff at rehabilitation facility
[d60_11] 11 = Do not like the attitudes of others at rehabilitation facility
[d60_12] 12 = Was previously badly treated or discriminated
[d60_13] 13 = Tried but denied at rehabilitation facility
[d60_14] 14 = Absence of reasonable accommodation at rehabilitation
[d60_88] 88 = Other (specify) ……[d60o] ……
[d60_98] 98 = Don’t know
→ SKIP to D.62 if less than 2 options were selected in this D.60
61. [d61] What is the most important reason? (Write one of the selected codes above) ……..
62. [d62] In general, how satisfied are you with rehabilitation services that you have 
received?
1 = Very satisfied 2 = Satisfied 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 132
3 = Unsatisfied 4 = Very unsatisfied
63. [d63] Over the past 2 weeks, how often have you been bothered by little interest or
pleasure in doing things?
0 = Not at all 1 = Several days
2 = More than half the days 3 = Nearly every day
64. [d64] Over the past 2 weeks, how often have you been bothered by feeling down, 
depressed or hopeless?
0 = Not at all 1 = Several days
2 = More than half the days 3 = Nearly every day
2019 Lao OKARD Survey Questionnaire – NIGH & WE 133
E. WELL-BEING
Check E1: If respondent <9 years old → SKIP to F.1
Check E2: If respondent aged between 9 and <15 years old → SKIP to E.6
Interviewer: Give respondent the flashcard below during this section.
Strongly 
disagree
Disagree Agree Strongly Agree
1 2 3 4
I am now going to ask how you feel about life in general in the last 3 months. Below are five 
statements that you may agree or disagree with. Using the 1to 4 scale in flashcard, indicate 
your opinion with each item by telling me the appropriate number for that item.
# Question Strongly 
disagree Disagree Agree Strongly 
Agree
1. [e1] Generally speaking, my life 
closely corresponds to my ideals 1 2 3 4
2. [e2] My living conditions are 
excellent 1 2 3 4
3. [e3] I am satisfied with my life 1 2 3 4
4. [e4] So far, I have obtained the main 
things I wanted from life 1 2 3 4
5. [e65] If I could start my life again, 
there is very little I would change 1 2 3 4
I am now going to ask how happy you feel with your life. Below are five sentences about life 
in general. Using the 1to 4 scale in flashcard, indicate your opinion with each item by telling 
me the appropriate number for that item.
# Question Strongly 
disagree Disagree Agree Strongly 
Agree
6. [e6] In most ways, my life is close to 
the way I want it to be 1 2 3 4
7. [e7] The things in my life are 
excellent 1 2 3 4
8. [e8] I am happy with my life 1 2 3 4
9. [e9] So far, I have gotten the main 
things I want in my life 1 2 3 4
10. [e10] If I could start my life again, I 
would have it the same way 1 2 3 4
2019 Lao OKARD Survey Questionnaire – NIGH & WE 134
F. ACCESS TO THE COMMUNITY
The following questions ask you about your activities and access to services over the LAST 3 MONTHS.
Activities/Access
How often 
do you
<…>?
To what extent 
have you been 
able to <…> as 
much as you 
need?
Why not ‘all of the time’?
Most 
important 
reason?
(a) (b) (c) (d)
1. Go shopping / Going to the market [f1a] 
0 1 2 3 4 5 
6
[f1b] 1 2 3 4 5 98
[f1c_1 to f1c_10 f1c_88 
f1c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f1d]
2. Have a social gathering (e.g. playing sport, singing) with friends 
or peers (who are not family or close relatives)
[f2a] 
0 1 2 3 4 5 
6
[f2b] 1 2 3 4 5 98
[f2c_1 to f2c_10 f2c_88 
f2c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f2d]
3. Have a social gathering (e.g. playing sport, singing) with family 
/relatives
[f3a] 
0 1 2 3 4 5 
6
[f3b] 1 2 3 4 5 98
[f3c_1 to f3c_10 f3c_88 
f3c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f3d]
4. Contribute or present your opinions in community meetings [f4a] 
0 1 2 3 4 5 
6
[f4b] 1 2 3 4 5 98
[f4c_1 to f4c_10 f4c_88 
f4c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f4d]
5. Present your opinions on community issues to the village head 
personally
[f5a] 
0 1 2 3 4 5 
6
[f5b] 1 2 3 4 5 98
[f5c_1 to f5c_10 f5c_88 
f5c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f5d]
6. Participate in community festivals [f6a] 
0 1 2 3 4 5 
6
[f6b] 1 2 3 4 5 98
[f6c_1 to f6c_10 f6c_88 
f6c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f6d]
7. Access Government benefit/s, such as any government social 
assistant or social security funding
[f7a] 
0 1 2 3 4 5 
6
[f7b] 1 2 3 4 5 98
[f7c_1 to f7c_10 f7c_88 
f7c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f7d]
8. Join activities of disability-specific support groups, such as 
disabled people groups or organizations 
[f8a] 
0 1 2 3 4 5 
6
[f8b] 1 2 3 4 5 98
[f8c_1 to f8c_10 f8c_88 
f8c_98] 
1 2 3 4 5 6 7 8 9 10 88 98
[f8d]
2019 Lao OKARD Survey Questionnaire – NIGH & WE 135
Response categories for column: 
(a) 0 = Never; 1 = Daily; 2 = Twice-three times a week; 3 = Weekly; 4 = Two times a month; 5 = Monthly; 6 = Two-three times in three 
months or less
(b) 1 = All of the time → SKIP to Next Activity/Access or G.1; 2 = Most of the time; 3 = Some of the time; 4 = Never; 5 = Not applicable: 
No need at all; 98 = Don’t know → SKIP to Next Activity/Access or G.1
(c) & (d): 1 = Lack of information; 2 = No services/facility; 3 = Physical accessibility; 4 = Absence of reasonable accommodation; 5 = Negative 
attitudes towards me at the services/facility; 6 = Cost of service/facility; 7 = Difficulty getting to services/facility from home; 8 = Absence of 
personal assistance; 9 = Family did not want me to access services/facilities; 10 = Family has difficulty assisting me to access services/facility; 88 
= Other (please specify [f#co]); 98 = Don’t know; Note: → SKIP column (d) if less than 2 options are selected in column (c).
2019 Lao OKARD Survey Questionnaire – NIGH & WE 136
G. KNOWLEDGE & ATTITUDE TO INCLUSIVE DEVELOMENT 
1. [g1] Do you identify yourself as a person with disability?
1 = Yes 0 = No 7 = Preferred not to answer /Don’t 
know
2. Is there any person with disability among your … (Interviewer: read response category 
one by one and select all that apply)
[g2_1] 1 = Family members [g2_2] 2 = Relatives
[g2_3] 3 = Friends [g2_4] 4 = Neighbours
[g2_5] 5 = Other villagers 
[g2_88] 88 = Any other groups (specify) … [g2o] …
[g2_0] 0 = None → SKIP to G.4
3. [g3] How often do you communicate or interact with them?
0 = Never 1 = Daily
2 = Twice-three times a week 3 = Weekly
4 = Two times a month 5 = Monthly
6 = Two-three times in three months 7 = Less than twice a year
I am now going to ask you about how persons with disabilities access major services. 
4. [g4] Do you think persons with disabilities can access HEALTH SERVICES as much as 
persons without disabilities?
1 = A lot more → SKIP to G.6 2 = A little more → SKIP to G.6
3 = About the same → SKIP to G.6 4 = A bit less
5 = A lot less 98 = Don’t know
5. What are the main reasons persons with disabilities access HEALTH SERVICES less 
than other people? (Select all that apply)
[g5_1] 1 = Lack of information /do not know where to go
[g5_2] 2 = No healthcare services/facility
[g5_3] 3 = Family did not want them to visit healthcare facility
[g5_4] 4 = Lack of assistant to healthcare facility / Nobody accompany them
[g5_5] 5 = Too far
[g5_6] 6 = No transport available
[g5_7] 7 = Transport is not accessible
[g5_8] 8 = Could not afford the cost of healthcare
[g5_9] 9 = Could not afford indirect costs, e.g. transportation, food, 
accommodation, accompanied person
2019 Lao OKARD Survey Questionnaire – NIGH & WE 137
[g5_10] 10 = Do not like the attitudes of staff at health facility
[g5_11] 11 = Do not like the attitudes of others at health facility
[g5_12] 12 = Previous experience of stigma or discrimination
[g5_13] 13 = Persons with disabilities are denied at healthcare facility
[g5_14] 14 = Absence of reasonable accommodation at healthcare facility
[g5_88] 88 = Other (specify) ……[g5o] ……
[g5_98] 98 = Don’t know
6. [g6] Do you think persons with disabilities can access PAID WORK as much as persons 
without disabilities? 
1 = A lot more → SKIP to G.8 2 = A little more → SKIP to G.8
3 = About the same → SKIP to G.8 4 = A bit less
5 = A lot less 98 = Don’t know
7. What are the main reasons persons with disabilities access PAID WORK less than 
other people? (Select all that apply)
[g7_1] 1 = Lack of employment information /do not know where to go
[g7_2] 2 = No opportunities
[g7_3] 3 = Lack of job placement/support services
[g7_4] 4 = Not interested to work 
[g7_5] 5 = Difficult applying for a job
[g7_6] 6 = Family did not want them to work
[g7_7] 7 = Lack of assistant to work place
[g7_8] 8 = Too far
[g7_9] 9 = No transport available
[g7_10] 10 = Means of transportation is not accessible
[g7_11] 11 = Could not afford the cost of transport
[g7_12] 12 = Do not like the attitudes of others 
[g7_13] 13 = Absence of reasonable accommodation at workplace
[g7_88] 88 = Other (specify) ……[g7o] ……
[g7_98] 98 = Don’t know
8. [g8] Do you think persons with disabilities can access EDUCATION as much as 
persons without disabilities? 
1 = A lot more → SKIP to G.10 2 = A little more → SKIP to G.10
3 = About the same → SKIP to G.10 4 = A bit less
5 = A lot less 98 = Don’t know
2019 Lao OKARD Survey Questionnaire – NIGH & WE 138
9. What are the main reasons persons with disabilities access EDUCATION less than 
other people? (Select all that apply)
[g9_1] 1 = They reached the level that they wanted
[g9_2] 2 = Poor health 
[g9_3] 3 = Needed to get paid job
[g9_4] 4 = Taking care of family
[g9_5] 5 = Disability
[g9_6] 6 = Absence of personal assistance
[g9_7] 7 = Family did not want them to go to school
[g9_8] 8 = Family has difficulty assisting them to go to school
[g9_9] 9 = School is too far away
[g9_10] 10 = Means of transportation to school is absent or difficult to use
[g9_11] 11 = Difficulty road conditions to school
[g9_12] 12 = School is not physical accessible
[g9_13] 13 = Absence of specific teaching aids and approaches 
[g9_14] 14 = Cost of attending school (e.g. tuition fees, uniform, transport)
[g9_15] 15 = Being expelled from school
[g9_16] 16 = Treated badly at school 
[g9_88] 88 = Other (specify) ……[g9o] ………
[g9_98] 98 = Don’t know /Don’t remember
Interviewer: Give respondent the flashcard below during this section.
Strongly 
disagree
Disagree Agree Strongly Agree
1 2 3 4
What do you think of the following opinions? Would you strongly disagree, disagree, agree, 
or strongly agree? 
Opinion Strongly 
disagree Disagree Agree Strongly 
agree
Don’t 
know
10. [g10] Persons with disabilities attend 
village meetings as much as other 
villagers
1 2 3 4 98
2019 Lao OKARD Survey Questionnaire – NIGH & WE 139
Opinion Strongly 
disagree Disagree Agree Strongly 
agree
Don’t 
know
11. [g11] Persons with disabilities make 
positive contribution to this village 1 2 3 4 98
12. [g12] Persons with disabilities have 
the same opportunities to become 
famous doctor, government staff, 
businessperson
1 2 3 4 98
13. [g13] Persons with disabilities are 
subject to unacceptable jokes, 
comments, or humiliation
1 2 3 4 98
14. [g14] Persons with disabilities are 
able to participate in family income 
generation activities as much as other 
members of the family
1 2 3 4 98
15. [g15] More women with disabilities 
than men with disabilities work 1 2 3 4 98
16. [g16] People in this village have 
negative attitude towards persons 
with disabilities
1 2 3 4 98
17. [g17] People in this village frequently 
support persons with disabilities 1 2 3 4 98
18. [g18] Persons with disabilities receive 
adequate benefits from the 
Government
1 2 3 4 98
19. [g19] In this village, children play with 
children with disabilities as much as 
children without disabilities. 
1 2 3 4 98
20. [g20] There would be no problem if 
you had a person with disabilities as 
your neighbour
1 2 3 4 98
21. [g21] There would be no problem if 
you had a person with disabilities as 
your classmate
1 2 3 4 98
22. [g22] There would be no problem if 
you had a person with disabilities as 
your colleague or partner at work 
1 2 3 4 98
23. [g23] Persons with disability should 
be encouraged to live independently 1 2 3 4 98
24. [g24] Persons with disabilities should 
able to get married the same as other 
people
1 2 3 4 98
25. [g25] Persons with disabilities should 
be able to have children. 1 2 3 4 98
26. [g26] Women with disabilities should 
be able to work 1 2 3 4 98
27. [g27] Health care providers know 
what to do if a person with disability 
needs their help
1 2 3 4 98
2019 Lao OKARD Survey Questionnaire – NIGH & WE 140
28. In your opinion, what do most people think are the main cause/s of disabilities? (Select 
all that apply)
[g28_1] 1 = Fate [g28_2] 2 = Genes
[g28_3] 3 = Sin of family [g28_4] 4 = Religious practices
[g28_5] 5 = UXO [g28_6] 6 = Health conditions
[g28_7] 7 = Traffic [g28_8] 8 = Other accidents
[g28_9] 9 = Diet [g28_88] 88 = Other (Specify) … [g28o] …
[g28_98] 98 = Don’t know
H. HOUSEHOLD INFORMATION
1. Who do you live with? (Read response options and select all that apply)
[h1_1] 1 = No body [h1_2] 2 = Father (bio/in-law)
[h1_3] 3 = Mother (bio/in-law) [h1_4] 4 = Spouse
[h1_5] 5 = Brother [h1_6] 6 = Sister
[h1_7] 7 = Daughter [h1_8] 8 = Son
[h1_9] 9 = Other female relative [h1_10] 10 = Other male relative
[h1_11] 11 = Female non-relative [h1_12] 12 = Male non-relative
2. [h2] Could you please tell me the total income of all household members over the last 
year?
1 = <10,000,000 LAK 2 = 10,000,000 to <20,000,000 LAK
3 = 20,000,000 to <30,000,000 LAK 4 = 30,000,000 to <40,000,000 LAK
5 = 40,000,000 to <50,000,000 LAK 6 = 50,000,000 to <60,000,000 LAK
7 = 60,000,000+ LAK 98 = Refused to answer
3. [h3] What is the sum again if you make a more accurate estimate? ……..…………. 
LAK
2019 Lao OKARD Survey Questionnaire – NIGH & WE 141
4. What assets does this household own which are currently in working order? (Read 
name of all assets one by one)
Assets
1. [h4_1] Tractor
2. [h4_2] Car or van
3. [h4_3] Motorcycle or scooter
4. [h4_4] Bicycle
5. [h4_5] Boat with a motor
6. [h4_6] Radio
7. [h4_7] Television
8. [h4_8] Fixed Telephone
9. [h4_9] Mobile phone
10. [h4_10] Computer or tablet
11. [h4_11] Washing machine
12. [h4_12] Air conditioner
13. [h4_13] Electric fan
14. [h4_14] Refrigerator/freezer
15. [h4_15] Agricultural plots of land
16. [h4_16] Tuk-tuk
17. [h4_17] CD/DVD player/Home 
theatre
18. [h4_18] Water pump
19. [h4_19] Steamed/Rice cooker
20. [h4_21] Tractor motor
21. [h4_22] Rice thresher
22. [h4_23] Rice mill machine
23. [h4_2] Grass cutter
88 [h4_88] Other (specify) …[h4o]..
2019 Lao OKARD Survey Questionnaire – NIGH & WE 142
5. How many of the following livestock/animals do your household own? (Read respond 
options)
[h5_0] 0. None
[h5_1] 1. Buffaloes ………[ h5_n1] ……….
[h5_2] 2. Cows ………[ h5_n2] ……….
[h5_3] 3. Horses ………[ h5_n3] ……….
[h5_4] 4. Fishes
[h5_5] 4. Goats/Sheep ………[ h5_n5] ……….
[h5_6] 5. Pigs ………[ h5_n6] ……….
[h5_7] 6. Ducks ………[ h5_n7] ……….
[h5_8] 7. Chicken ………[ h5_n8] ……….
[h5_88] 88. Other livestock/animals/poultry ………[ h5_n88] ………
6. [h6] What is the main material of the roof of the dwelling?
1 = No roof 2 = Tile/Sipax/Concrete 
3 = Zinc/Metal/Tin 4 = Wood
5 = Bamboo/Palm 6 = Grass/Thatch/Palm leaves
88 = Other (specify) ………[h6o] ……….
7. [h7] What is the main material of the wall of the dwelling?
1 = Brick /Concrete 2 = Wood
3 = Bamboo 88 = Others (specify) ……[h7o] …. 
8. [h8] What is the main material of the floor of the dwelling?
1 = Ceramic tiles 2 = Concrete
3 = Wood 4 = Bamboo/Palm
88 = Others (specify) ……[h8o] ………. 
9. [h9] What is this household’s main source of drinking water?
1 = Piped water in/outside 2 = Protected Well/ Borehole
3 = Unprotected Well/Borehole 4 = River/Stream/Dam/Lake
5 = Rain water 6 = Bottle/can water
88 = Other (specify) ……[h9o] …….
2019 Lao OKARD Survey Questionnaire – NIGH & WE 143
10. [h10] What is the type of toilet facility mainly used by this household?
1 = Flush/pour flush 2 = Pit latrine ventilated
3 = Pit latrine others 4 = Composting toilet
5 = Bucket 6 = Hanging toilet
7 = No facility /Bush /Field 98 = Other (specify) ……[h10o] ……
11. [h11] Does this dwelling have electricity?
1 = Yes with own meter 2 = Yes with shared meter
3 = Yes with own generator 4 = No – use batteries 
5 = No electric or batteries 
12. [h12] What is the household’s main source of energy for cooking?
1 = Electricity 2 = Paraffin/fuel
3 = Wood 4 = Coal
5 = Charcoal 6 = Sawdust
7 = Gas 88 = Other (specify) ……[h12o] ….
13. [h13] Does your household currently hold any loan?
1 = Yes 0 = No 7 = Refused 98 = Don’t know
14. [h14] Does your household currently have any saving?
1 = Yes 0 = No 7 = Refused 98 = Don’t know
Interviewer: Please read aloud:
Thank you for answering these questions. I have finished asking my questions now. Do you 
have any questions, or would you like to discuss any other issues?
Thank you for participating in this survey! 
Interviewer to complete: 
15. [h15] Who answer the questionnaire?
1 = Totally by the respondent 2 = Mainly (>50%) by the respondent
3 = Mainly by another person 4 = Totally by another person
16. Interviewer’s note: …………………………………………………………………
END INTERVIEW!
[end] (end) Time at the end of survey (automatically record
2019 Lao OKARD Survey Questionnaire – NIGH & WE 144
3. Appendix 3: Focus Group Discussion Guide for community people with disability
USAID Okard CBID Baseline: Qualitative Data Collection 
People with Disabilities: Focus Group Discussion (FGD) Guide
A. General
A General data Number of 
participants
1 FGD No.
2 FGD location.
3 Sex Female
Male
4 Age Under 18 years
18 years +
5 Participants with 
disability?
Physical
Hearing
Vision
Psychosocial
Speech and communication
Intellectual
Note: throughout consider and explore if there are differences for different types 
of disabilities.
If has not already been done, read through the Plain Language Statement, and obtain 
written or verbal consent from the participants.
B. Inclusion and participation in the community
We are going to begin by talking generally about your community – this may be your 
family or household, or the wider community around you. We want to talk about how well 
people are included in and participating in family and community life, and whether there are 
people or groups of people that may be left behind when it comes to community life and 
activities.
B Core item: 
Inclusion and 
Participation
Follow up questions Notes & prompts 
1 What are the 
key activities 
and events 
that you and 
• What are the main social 
events or meetings?
• Where are these held?
• Who organises them?
Prompt to think 
about any social 
events (e.g. religious, 
recreation, 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 145
C. Awareness & attitudes to disability
We are now going to talk more specifically about knowledge and attitudes about disability. We 
are really interested in hearing your opinions and experiences of how people respond to disability 
in your community. 
your family 
members 
participate in, 
in your 
community?
• Who attends them?
• Who from your 
household does/doesn’t 
attend these activities or 
events?
• Why/why not?
• Are there other people 
in the community that you 
have noticed also do not 
attend these activities or 
events?
• Why do you think this 
is?
• Are there some groups 
of people more excluded 
than others?
community solidarity 
events) or 
community meetings 
that happen in their 
community.
E.g. older people, 
poor people, people 
from different ethnic 
groups, people with 
disability, sick 
people.
2 How are 
decisions made 
in your 
community?
• Who makes the 
decisions?
• How are decisions 
made?
• What about in your 
family, how are decisions 
made?
• Are there members of 
the community/your family 
that do not have the 
opportunity to participate in 
decision making?
If so, who? Why are they not 
involved?
Will need to gauge 
whether asking 
about family 
decision making is 
too sensitive for 
discussion within the 
group. May wish to 
keep to community 
decisions only.
C Core item: 
Awareness
Follow up questions Notes & prompts 
1 What do you 
think people 
in this 
community 
think when 
they hear the 
word 
‘disability’?
• Do people in the 
community think about 
disability as only certain 
impairments (e.g. physical) and 
not about others (e.g. vision, 
psychosocial)
• Is it usual to see people 
with disability in public places 
in your community? 
Prompt them to think 
of their own 
experiences in the 
community and of 
other people with 
disabilities with 
different impairment 
types.
2019 Lao OKARD Survey Questionnaire – NIGH & WE 146
D. Work & social participation
Next we are going to talk about participation in work and social activities in the community for 
people with disabilities?
• How would you describe 
people’s attitudes to disability 
in the community? 
• What do people do or say 
when they meet a person with 
disability?
• What has been your 
experience? How have people 
treated you?
D Core item: 
Work
Follow up questions Notes & prompts 
1 Are 
participants 
currently 
working?
If yes: 
• What kind of work?
• How did they start in that 
work?
• Do they think they have 
enough work?
• Do they enjoy their 
work?
• Is there other work they 
would prefer to be doing?
Use work to 
introduce idea of 
social participation 
as it is a common 
activity. Working 
includes non-paid 
work e.g. looking 
after the house 
(house 
wife/husband). 
Always ask why or
why not as 
appropriate.
If no:
• Why not?
• Is anything preventing you 
from working?
• What do you need to be 
able to work?
• If people are not working, 
how do they support 
themselves financially?
If not working is the 
person in 
school/studying? 
What do they do?
Use to explore 
barriers.
2 What is 
needed to 
change in your 
community so 
that people 
with disabilities 
have greater 
access to work 
opportunities?
Prompt participants 
to think about 
changes to 
attitudes, physical 
access, transport 
policies etc.
3 Do 
participants 
If yes: What sort of events 
or meetings?
2019 Lao OKARD Survey Questionnaire – NIGH & WE 147
E. Access to services
The next part of the discussion will focus on access to services such as education and health for 
people with disabilities in your community.
take part in 
any community 
events or 
meetings?
• Which meetings do you 
participate in and why?
• What do you do in these 
meetings /events? Can you 
describe?
Can you participate as much 
as you would like? Why? Why 
not?
Explore what 
makes events 
accessible. How do 
people participate? 
Do they speak? Are 
they listened to?
If no:
• Would you like to attend?
• Why not?
• What is preventing you 
from attending? 
What can you suggest that 
would help you to participate 
more in the things you would 
like to do?
Do people feel 
unwelcome? Are 
there physical 
barriers? Do you 
receive information 
on meetings? Are 
you invited? 
E Core item: 
Education
Follow up questions Notes & prompts 
1 Did you go to 
school? 
If yes:
Which school? 
To what age?
What was your experience like?
• What could have made 
your school experience better?
If no: 
• Why not?
• Did other family members 
go to school?
If they didn’t complete 
school, why not?
Prompt to discuss their 
experience of all levels 
of education –
primary, secondary 
and tertiary/vocational 
education.
2 Do most 
children with 
disability in 
this 
community go 
to school 
now?
Has anything 
changed since 
your 
childhood?
If yes: 
• Which school/s?
• What do you think their 
experience would be like?
• Are there any extra 
supports for children with 
disabiliites to help them attend 
school?
To start, elicit what 
schools are in this 
community/area? 
What level?
Consider Special or 
inclusive schools.
Primary, secondary, 
tertiary?
If no:
• Why not?
• Is anything preventing 
children from going to school?
Do you think other 
community 
members would be 
happy if children 
with disability went 
2019 Lao OKARD Survey Questionnaire – NIGH & WE 148
• What needs to be done to 
ensure children with disability 
go to school?
to school here? The 
same school or 
different school as 
children without 
disability? 
Do you know if any 
children with 
disability drop out 
of school? Why?
3 Do you ever go 
the health 
centre? Or 
receive health 
care in another 
way? (e.g. doctor 
visiting the 
house) 
If yes: 
• Where? Which health 
centre?
• What is your experience 
at the centre?
Did you experience any 
problems when trying to 
access health care?
Start by eliciting 
what health services 
there are in the 
village/area?
Prompt participants 
to think about all 
levels of healthcare, 
i.e. prevention (e.g. 
vaccination), 
promotion (e.g. 
hand washing), 
treatment (e.g. 
medical services).
Were you ever 
referred to other 
services? If so, 
what, why and 
when?
If no:
Why not?
Is anything preventing you from 
going to the health centre?
What needs to be done so you 
can go to the health centre/get 
the health care you need?
Attitudes: Are 
staff helpful, 
friendly or 
otherwise?
Physical: Can they 
physically get into 
health services?
Financial: are 
there costs for 
health care?
3 Do you think 
people with 
disability in 
this 
community are 
able to access 
health care as 
often as they 
need to?
Do people without disabilities 
also have any difficulties accessing 
health care? 
How are the experiences the 
same/different for people with 
and without disabilities?
Why / not?
What about 
yourselves 
personally?
2019 Lao OKARD Survey Questionnaire – NIGH & WE 149
F. Barriers
Note: If you think this has already been covered in your discussion you do not need to 
ask the following question.
G. Questions on discrimination
The following should be answered as a group and should be used as a basis for exploring 
experiences of discrimination. Introduce what is meant by discrimination as in prompts 
below.
F Core item: 
Barriers
Follow up questions Notes & prompts 
1 Do you 
think 
people 
with 
disability 
can 
participate 
in 
community 
life and 
access 
services in 
the same 
way as 
people 
without 
disability?
• Why do you think that?
• Is it the same for all people 
with disability?
• What are the main 
barriers/obstacles/ challenges do 
people with disability face in this 
community?
• How can this be changed? 
What needs to be done?
Consider: physical, 
hearing, visual, 
psychosocial.
Why / not?
G Questions/core items Response Prompts 
1 Over the last 12 months, 
how often have you 
experienced 
discrimination?
1. All the time [READ the responses 
in this section.] For 
example, being 
treated rudely, with 
disrespect, ignored, 
insulted or refused 
access to a place or 
goods or services.
2. Most of the time
3. Some of the time
4. Rarely
5. Never
2 Where did this 
discrimination occur?
In this community, 
at a health centre, 
market, work place 
etc?
3 1. Disability Explore.
2. Caste
2019 Lao OKARD Survey Questionnaire – NIGH & WE 150
H. Is there anything else you would like to share?
[END]
Was this discrimination 
due to…? [can choose as 
many as you like]
3. Race / ethnicity Inc. language.
4. Age
5. Gender
6. Sexuality
7. Other [please 
specify]
2019 Lao OKARD Survey Questionnaire – NIGH & WE 151
VII. References
1. World Health Organization and World Bank, World report on disability. 2011, Geneva, 
Switzerland: World Health Organization.
2. Filmer, D., Disability, poverty, and schooling in developing countries: results from 14 
household surveys. The World Bank Economic Review, 2008. 22(1): p. 141-163.
3. Marella, M., et al., Prevalence and correlates of disability in Bogra district of Bangladesh 
using the Rapid Assessment of Disability survey. BMC Public Health, 2015. 15.
4. Trani, J.-F., et al., Disability and Poverty in Morocco and Tunisia: A Multidimensional 
Approach. Journal of Human Development and Capabilities, 2015: p. 1-31.
5. Lao Statistics Bureau, Results of population and housing census 2015. 2016, Ministry of 
Planning and Investment: Vientiane Capital.
6. Fielding, A., et al., Improving Access to Social and Economic Services for People with 
Disability in Lao PDR. 2017.
7. Loeb, M.E., A.H. Eide, and D. Mont, Approaching the measurement of disability 
prevalence: the case of Zambia. ALTER-European Journal of Disability Research/Revue 
Européenne de Recherche sur le Handicap, 2008. 2(1): p. 32-43.
8. Fielding, A., et al., Report on research findings: Improving access to social and economic 
services for people with disability in Lao PDR. 2016.
9. Mont, D., Measuring disability prevalence. Social protection discussion paper No. 0706.
2007.
10. Thoresen, S.H., et al., A snapshot of intellectual disabilities in Lao PDR: Challenges for the 
development of services. Journal of Intellectual Disabilities, 2017. 21(3): p. 203-219.
11. Bright, T. and H. Kuper, A systematic review of access to general healthcare services for 
people with disabilities in low and middle income countries. International journal of 
environmental research and public health, 2018. 15(9): p. 1879.
12. Bright, T., S. Wallace, and H. Kuper, A systematic review of access to rehabilitation for 
people with disabilities in low-and middle-income countries. International journal of 
environmental research and public health, 2018. 15(10): p. 2165.
13. Kuper, H. and P. Heydt, The missing billion: Access to health services for 1 billion peopl 
with disabilities. 2019: London.
14. Stubbs, B., et al., Depression and physical health multimorbidity: primary data and country￾wide meta-analysis of population data from 190 593 people across 43 low- and middle￾income countries. Psychol Med, 2017. 47(12): p. 2107-2117.
15. Colombo, F., et al., Help Wanted? Providing and Paying for Long-Term Care. 2011, 
OECD Publishing.
16. Grimmond, D., The economic value and impacts of informal care in New Zealand. 
Infometrics report for Carers NZ and the NZ Carers Alliance. 2014: New Zealand.
17. Chang, H.-Y., C.-J. Chiou, and N.-S. Chen, Impact of mental health and caregiver burden 
on family caregivers’ physical health. Archives of gerontology and geriatrics, 2010. 
50(3): p. 267-271.
18. Savage, S. and S. Bailey, The impact of caring on caregivers' mental health: a review of the 
literature. Australian health review, 2004. 27(1): p. 111-117.