Conducting a Participatory Situation Analysis of.pdf - Global HIV ...

Questionnaire Identification |___|___|___|
SECTION 0: IDENTIFICATION DATA
002 State____________________ 003 Local Government Area__________________
004 Name of Community/Neighbourhood__________________ 005 Cluster Name __________________
Introduction:
Orphans and Vulnerable Children Baseline Survey
for Heads of Households/Caregivers
“My name is ___________ and I’m working for Family Health International. We’re interviewing caregivers/heads of households
in [name of city, region or site] in order to find out about their situation and experience with orphans and other children in
need. First, I would like to know if you are the head of the household? If they are, proceed. If they are not, then ask to talk
with the head of the household. If that person is not available, then find out when it would be a good time to return, and
make an appointment to come back. Be sure and keep the appointment even if the head of household does not. Are there
any children living in this household who have lost either their mother or their father? Or children below 18 who are not
yours? If no, move to next house. Have you been interviewed in the past few days? If the respondent states that they have
been interviewed before, do not interview anyone in this household again. Tell them you cannot interview them a second time,
thank them, and end the interview. If they have not been interviewed before, continue:
Confidentiality and consent: “I’m going to ask you some personal questions that some people may find difficult to answer
about their feelings and their emotions. Your answers are completely confidential; your name will not be written on this form
and will never be used in connection with any of the information you give me. You do not have to answer any questions that
you do not want to answer, and you may end this interview at any time.
We are asking these question so that we can understand the situation better and be able to develop interventions and programs
with the community. We would greatly appreciate your help in responding to this survey. The interview will take about 30 minutes.
Would you be willing to participate?
Signature of Interviewer ___________________________________________________________
(Certifying that informed consent has been given verbally by respondent)
Interview Log
Date
Interviewer
Comment
Visit 1 Visit 2 Visit 3
Comment Codes
Appointment made for later today 1
Appointment made for another day 2
Refused to continue and no appointment made 3
Completed 4
Other (Specify) 5
006 INTERVIEWER: Code [____|____] Name__________________________
007 DATE INTERVIEW: ____\ ____ \ ____
CHECKED BY SUPERVISOR: Signature: ____________________ Date: ___________
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