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Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

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296 | Appendix E<br />

Introduction <strong>and</strong> Consent<br />

Hello. My name is _______________________________________ <strong>and</strong> I am working with NATIONAL STATISTICS DIRECTORATE.<br />

We are conducting a national survey about various health issues. We would very much appreciate your participation in this survey.<br />

This information will help the government to plan health services. The survey usually takes between <strong>10</strong> <strong>and</strong> 15 minutes to complete.<br />

As part <strong>of</strong> the survey we would first like to ask some questions about your household. Whatever information you provide will be kept<br />

strictly confidential, <strong>and</strong> will not be shared with anyone other than members <strong>of</strong> our survey team.<br />

Participation in this survey is voluntary, <strong>and</strong> if we should come to any question you don't want to answer, just let me know <strong>and</strong> I<br />

will go on to the next question; or you can stop the interview at any time. However, we hope you will participate in the survey since<br />

your views are important.<br />

At this time, do you want to ask me anything about the survey?<br />

May I begin the interview now?<br />

Signature <strong>of</strong> interviewer: Date:<br />

RESPONDENT AGREES TO BE INTERVIEWED . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . 2 END

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