How to investigate levels of Adherence to antiretroviral ... - INRUD

Chapter 5
Data collection tools and how to modify, print and fill them in
For a view of the Facility questionnaire see Appendix 2D.
Type in the shaded boxes only.
Questionnaire side one
As for the other forms, fill in the facility identifier, the date of data collection, the data
collector’s name, and the facility name.
Facility identifier
Date
Data collector
Region
Name facility
Q1
Q2
Q3
Facility type
Facility management
Supply source ARVs
Q4
Clinic location
Q1. Fill in the type of facility from the drop-down list. These options were defined on the
Country Customization sheet.
Q2. Fill in the type of facility management from the drop-down list. These options were
defined on the Country Customization sheet.
Q3. Fill in the source of ARVs for the facility from the drop-down list. These options were
defined on the Country Customization sheet. You may enter two sources.
Q4. Fill in the facility setting from the drop-down list. These options were defined on the
Country Customization sheet.
Q5. Fill in the number of hours the clinic and ARV pharmacy is open each day. The
opening hours of the clinic and pharmacy may be different, if so, fill in both;
otherwise just fill in the clinic hours.
Opening hours CLINIC
Days
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total hours =
Number of hours
45