PROGRAMA ESCUCHAR LISTING BASELINE QUESTIONNAIRE HOUSEHOLD-LEVEL SURVEY

Transcription

1 PROGRAMA ESCUCHAR LISTING BASELINE QUESTIONNAIRE HOUSEHOLD-LEVEL SURVEY

2 [Questions LL001_intro to LL002_lon_s are displayed as a table] LL001_intro Please enter the Latitude and Longitude from the GPS device LL001_lat_d Latitude degrees String LL001_lat_m Latitude minutes String LL002_lon_d Longitude degrees String CH029 FormID String CH013 What is the name of the interviewer who collected this listing? String CH013_b # Integer CH013_date Date String CH001 Can you please give me your complete address? [IWER: PLEASE LIST STREET NAME AND HOUSE NUMBER] String CH001_a Street String CH001_b Number String CH001_c cross streets String CH001_d cross streets String CH002 City String CH003 Municipality 50 Mérida CH016 Neighborhood String CH020 Meter String CH014 Block number String CH015 Listing number Integer Language 1 English 2 Spanish 3 Mayan 4 Proxy Spanish 5 Proxy Mayan 6 Proxy English < > Different to

3 CH018 AGEB String CH019 Other comments about the address (description etc) String [Questions CH004 to CH028 are displayed as a table] CH004 When would be the best day and time for us to come back to give you more information about the study and if you are interested, to complete the interview? String CH017 Or appointment-general indication String CH006 Can you please give me your telephone number? String CH005 We can conduct the interview either in Spanish or Mayan. What language would the persons who are 70 years or older in this household prefer to speak? 1 Spanish 2 Mayan 3 Some in Spanish, some in Mayan CH028 How many people over 70 years old live in this household? Range: LOOP FROM 1 TO [NUMBER OF PEOPLE OVER 65] DO [Questions CH007_a [over65cnt] to CH008_e [over65cnt] are displayed as a table] CH007_a Could you please give me the name of the [oldest/second/third/fourth/fifth sixth/seventh/eigth/nineth/tenth] person in the household? Please give me their name as it appears on their birth certificate. [IWER: PRINT FIRST AND LAST NAMES] String CH007_b Could you please give me the name of the oldest person in the household? Please give me their name as it appears on her/his birth certificate. [IWER: PRINT FIRST AND LAST NAMES] String CH007_c Could you please give me the full name of the oldest person in the household? Please give me her/his name as it appears on her/his birth certificate. [IWER: PRINT FIRST AND LAST NAMES] String CH008_a What is his/her date of birth? Range: CH008_b 1 January 2 February 3 March 4 April 5 May 6 June 7 July 8 August 9 September 10 October 11 November 12 December CH008_c Range: CH008_d OR Age: Range: CH008_bornba OR Indication: 1 Person older than 70

4 2 Person younger than 70 CH008_e Gender 1 Male 2 Female CH008_rel What is [NAME RESPONDENT]'s relationship with the oldest member? 1 Himself/herself 2 Husband/wife 3 Son/daughter 4 Stepson/stepdaughter 5 Adopted son/daughter 6 Person was taken in 7 Mother/father 8 Father-in-law/ mother-in-law 9 Grandmother/grandfather 10 Grandson/granddaughter 11 Great grandson/ great granddaughter 12 Son-in-law/ daughter-in-law 13 Brother/ stepbrother/sister/stepsister 14 Brother-in-law/ sister-in-law 15 Uncle/aunt 16 Nephew/niece 17 Other relative that lives in the household 18 Not related that lives in the household 19 Relative that lives outside 20 Not related and lives outside IF (CH008_c = RESPONSE AND CH008_c < = 1940) OR CH008_d > = 70 OR CH008_bornba = Person older than 70 THEN [Questions CH009 [peoplecnt] to CH022 [peoplecnt] are displayed as a table] CH009 Will [FIRST NAME OLDEST RESPONDENT] be able to participate in the interview? 1 Yes 2 No CH010 Is there someone else in this household who knows about the health and daily life of [FIRST NAME OLDEST RESPONDENT] that could answer the interview in her/his instead? 1 No 2 Yes -> Fill out name and relationship below CH011 What is this person s name? String CH012 How is this person related to [FIRST NAME OLDEST RESPONDENT]? 2 Husband/wife 3 Son/daughter 4 Stepson/Stepdaughter 5 Adopted son/daughter 6 Person was taken in 7 Mother/father 8 Father-in-law/ mother-in-law 9 Grandmother/grandfather 10 Grandson/granddaughter 11 Great grandson/ great granddaughter 12 Son-in-law/ daughter-in-law 13 Brother/ stepbrother/sister/stepsister 14 Brother-in-law/ sister-in-law 15 Uncle/aunt 16 Nephew/niece 17 Other relative 18 Not related CH022 3) Do you allow us to give [FIRST NAME OLDEST RESPONDENT]'s name and address to other government institutions? 1 Yes 2 No ENDIF ENDDO IF CH028 > 1 THEN CH118 Later in this interview, we will be asking questions about your house and about your family's financial situation, for example about your family's income

5 and the support you may be receiving. Which of you would be the most able to answer questions about your family's financial situation? 1 [NAME RESPONDENT] 2 [NAME RESPONDENT] 3 [NAME RESPONDENT] 4 [NAME RESPONDENT] 5 [NAME RESPONDENT] 6 [NAME RESPONDENT] 7 [NAME RESPONDENT] 8 [NAME RESPONDENT] 9 [NAME RESPONDENT] 10 [NAME RESPONDENT] 11 [NAME RESPONDENT] 12 [NAME RESPONDENT] 13 [NAME RESPONDENT] 14 [NAME RESPONDENT] 15 [NAME RESPONDENT] 16 [NAME RESPONDENT] 17 [NAME RESPONDENT] 18 [NAME RESPONDENT] 19 [NAME RESPONDENT] 20 [NAME RESPONDENT] 21 [NAME RESPONDENT] 22 [NAME RESPONDENT] 23 [NAME RESPONDENT] 24 [NAME RESPONDENT] 25 [NAME RESPONDENT] [Questions CH119 to CH119_other are displayed as a table] CH119 What is the name of the person who completed the HH roster? 1 [NAME RESPONDENT] 2 [NAME RESPONDENT] 3 [NAME RESPONDENT] 4 [NAME RESPONDENT] 5 [NAME RESPONDENT] 6 [NAME RESPONDENT] 7 [NAME RESPONDENT] 8 [NAME RESPONDENT] 9 [NAME RESPONDENT] 10 [NAME RESPONDENT] 11 [NAME RESPONDENT] 12 [NAME RESPONDENT] 13 [NAME RESPONDENT] 14 [NAME RESPONDENT] 15 [NAME RESPONDENT] 16 [NAME RESPONDENT] 17 [NAME RESPONDENT] 18 [NAME RESPONDENT] 19 [NAME RESPONDENT] 20 [NAME RESPONDENT] 21 [NAME RESPONDENT] 22 [NAME RESPONDENT] 23 [NAME RESPONDENT] 24 [NAME RESPONDENT] 25 [NAME RESPONDENT] 26 Other: CH119 other String ELSE ENDIF