Survey Design for TANF Caseload Project: Summary Report and Recommendations. Common Measures Used, Pros and Cons


Physical Health and Functional Limitations. The SF-36 Health Survey (Ware et al. 1993) is a widely used and well-validated survey measure of general health and physical functioning.(2) One of its advantages is that scores can be compared to age-specific national norms. An abbreviated version of the measure, the SF-12, was used in the Healthcare for Communities Survey and in the CalWORKS Prevalence Project. Several of the items in the SF-12 ask about limitations with respect to vigorous and moderate physical activities, such as lifting heavy objects or moving a table. Respondents are asked to indicate the degree to which they have difficulty with bathing or dressing themselves, walking over one mile, walking several blocks, and walking one block. Other items are brief indicators of emotional or mental health distress.

Several surveys that do not use the full SF-12 include its first item, which asks respondents to rate their overall physical health (see Nebraska, the SPD, NSAF, Iowa, and Alameda). This single item has repeatedly been shown to have very good predictive validity for mortality and disability. The item is frequently supplemented by other questions aimed more closely at the population targeted by the survey. For example, the Nebraska survey used three items to measure physical health: the self-rating of overall health, and two questions about whether the respondents health had interfered with his or her ability to work or attend training in the past 12 months. The Alameda survey of welfare recipients asks about medical problems in the past month, as well as such health behaviors as the frequency of check-ups and cigarette smoking.

An alternative measure of functional limitations that may be especially useful for a study of welfare recipients was developed by the NHIS. It asks the number of days in the previous months that the respondent was unable to function at work or school, as well as the number of days on which he or she went to work or school but was less productive because of poor health.

Disabilities or Chronic Conditions. The SPD goes beyond the measure of health and general functioning to ask about such disabilities as limitations in vision and hearing and the need for special aids, such as a wheelchair. It also asks whether the respondent has difficulty walking or carrying things, and whether any chronic condition limits their daily activities. In the 1999 SPD, the respondent is not asked to name the specific limiting condition. In contrast, the WES and the Healthcare for Communities Survey include a question asking the respondent to name any chronic health or medical condition he or she may have; the WES explicitly asks the respondent to name only those conditions that prevent or interfere with working or doing regular activities (for example, diabetes, asthma, and cancer). The open-ended responses are then coded into categories. The Alameda survey uses a lengthy list asking respondents about the presence of each disabling or chronic condition. Respondents are then asked whether each of the problems interfered with the respondents ability to work, look for work, or participate in job training.

Access to Health Care. Almost all surveys of welfare recipients include questions about whether the respondent has any health insurance, including Medicaid or employer-provided coverage. Health care is likely to be an important factor in determining whether health problems interfere with participating in employment and employment activities.

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