Baseline Women's questionnaire - Yoruba/English

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Individual Consent: Woman’s Survey on Family Planning IntroductionHello! My name is _________________________________; I am part of a research team working for the National Population Commissionunder the Nigerian Urban Reproductive Health Initiative (NURHI). We are carrying out research on child spacing / birth spacing in urban areasof Nigeria. Your participation in this study will help to improve child spacing / birth spacing services in this city. We will be asking women aged15-49 questions from this household for this study.Explanation of ProcedureThe interview will take place in or around your home, somewhere private. The interview will take about 60 minutes. I will ask you questionsabout your home, child spacing / birth spacing, health-care seeking, and family size decisions. You may choose not to give the interview, or notto answer a question for any reason. You can stop the interview at any time by telling me that you want to stop it. If you decide not to give theinterview or not to answer a question, no harm will come to you, and there will be no effect on your access to health services in the future.ConfidentialityYour answers will not be shared with anyone outside this research project. Your name will not appear on the survey. We will not share answerswith community members, health providers, family or anyone else. At the end of the study, we will put all the answers together and make areport.In addition to the interview today, we would like to meet with you twice more to ask you some more questions. We will need to contact you in 2years to interview you a second time, and again two years after that to interview you a third time. We would like to interview you three times tosee how the circumstances in your life change. So we can find you again in two years, we need to ask questions on how, where and when tobest contact you. We will make every effort to plan the next interview without anyone knowing. Your contact information will be kept in a lockedcabinet, and kept apart from your answers to the questions. Once the study is finished, the list of names with your contact information, and thecompleted surveys will be destroyed.How many People will take part in this study?If you decide to be interviewed, you will be one of about 18,000 women from urban areas of Nigeria who will be interviewed.BenefitsResearch helps society by providing new knowledge. You may not benefit directly from this survey. However, your answers will be importantfor planning better programs to make sure women can access the health care they need.Risks and DiscomfortThere is the possibility you may feel uncomfortable about a question I ask. If you feel uncomfortable about any of the questions, you do nothave to answer them. I can skip those questions and go on to the next section. You can end the interview at any time. There is also thepossibility that someone may approach us during the interview to find out what we are discussing. We intend to do this interview in private, ifsomeone approaches us, we will stop the interview until we can continue in private.Some questions may not apply to you, but the interviewer must ask the same questions of everyone.Costs and Payment Individual Consent:There are no costs for being in this study. You will not receive any compensation for taking part in this study.Questions /Your rights as ParticipantsThis study has been approved by the Nigerian Ministry of Health Ethics Review Board and the University of North Carolina (USA). If you haveany questions about this study or the results, you can contact the following: The study coordinator, Mr. Babatunde Ishola Okuboyejo at theNational Population Commission (0803-497-0932) or the Institutional Review Board at the University of North Carolina at +1 919-966-3113.You have the right to ask, and have answers, to any questions you may have about this research. If you have questions or concerns, youshould contact the researchers listed above, or ask me before or after the interview. Do you have any questions now?ConsentNow, can you tell me if you agree to participate in this research? If you say yes, it means that you have agreed to be part of the study.May I begin the interview now? YES CONTINUENOTHANK RESPONDENT AND END INTERVIEWWould you like a copy of this document?Interviewer’s signature............................................................................. DATE [____/_____/2010]Page 2
SECTION 1: BACKGROUND CHARACTERISTICSQno Questions and filters Coding categories Skip toHOUR……………………………….[__|__]RECORD START TIME:MINUTES…………………………..[__|__]Thank you for agreeing to participate in this survey. As I mentioned in asking for your consent, we are looking to assess your health andinformation needs. To begin, we are going to ask you some background questions about yourself.E se pupo wipe e gba lati kopa ninu iwadi yi.Bi mo se so nigba ti mo beere fun ikopa yin, a fe mo awon ohun ti e nilo nipa eto ilera atiifitonileti ti e nilo. Ni akoko, a o bere awon ibere nipa arayin.Q101 In what month and year were you born?MONTH . . . . . . . . . . . . . . . . . ………[__|__]Ninu osu ati odun wo ni a bi yin?DON'T KNOW MONTH . . . . . . . . . . . . . . 98YEAR . . . . . . . . . . . . . . …..…[__|__][__|__]DON'T KNOW YEAR . . . . . . . . . . . . . . 9998Q102 How old were you on your last birthday?Kini ojo ori yin nigba ti e se ojo ibi kehinMPARE AND CORRECT Q101 AND/OR Q102 IFINCONSISTENTQ103 CHECK 101 & 102:IF AGE (15-49)YRSCHECK THAT CONSENT FORM HAS BEEN COMPLETEDAGE IN COMPLETED YEARS……[__|__]ELSEENDINTER-VIEWIF NOT, ENSURE THAT YOU OBTAIN A CONSENT FROM THE RESPONDENT BEFORE YOU CONTINUEQ104Q105Have you ever attended school?Se e lo si ile-iwe ri?What is the highest level of school you attended: Quranic only,primary, junior secondary, senior secondary, or higher?Ile-iwe ti o ga ju wo ni e lo: ile kewu nikan, ile-iwe alakobere,ipele kini ile- iwe giga, ipele keji ile iwe gigai, tabi ile-iwe ti o gajuyi lo?YES……………………NO ……………………..QURANIC ONLY…………………….PRIMARY…………………………….JUNIOR SECONDARY (JSS)…...SENIOR SECONDARY (SSS)….HIGHER…………………………12 Q10801234Q108Q110Q106What is the highest (class/form/year) you completed at thatlevel?CLASS/FORM/YEAR…………[__|__]Ibo ni e ka iwe naa de (Kilaasi, ipele eko/odun) ti e pari ni ipelena?IF NO YEAR COMPLETED, WRITE “00”Q107 CHECK 105:QURANIC OR PRIMARYJSS OR HIGHER(CODE 0 OR 1) (CODE 2, 3 OR 4)Q110Q108Now I would like you to read a sentence to me, but please tellme, what language are you most comfortable with?Ni bayi mo fe ki e ka gbolohun oro yi fun mi. sugbon ejowo,Ede wo ni o rorun ju fun yin lati ka?CIRCLE CODE FOR LANGUAGE SELECTED AND HANDTHE RESPONDENT A LITERACY CARD IN THE SELECTEDLANGUAGEHAUSA……………………………..YORUBA…………………………..IGBO……………………………….ENGLISH……………………………PIDGIN ENGLISH………………….RESPNDENT CANNOTREAD………………………………BLIND/VISUALLY IMPAIRED…….123451121Q110Q110OTHER_____________________(SPECIFY)96Page 3
Page 1: OFFICE USE ONLY: QUESTIONNAIRE NO:
Page 6 and 7: Q209 CHECK 208:Just to make sure th
Page 8 and 9: (Q217C)Line no.0506070809(Q218)What
Page 10 and 11: (Q217C)Lineno.15161718(Q218)What na
Page 12 and 13: Q239What type of facility is this?I
Page 14 and 15: SECTION 3: CONTRACEPTIONCHECK FOR P
Page 16 and 17: Now I would like to talk about fami
Page 18 and 19: Q309CHECK Q235 CURRENTLY PREGNANTNO
Page 20 and 21: NQ6How many living children did you
Page 22 and 23: Q330FOR A WOMAN WHO HAS BEEN STERIL
Page 24: NQ9Why did you switch from [PREVIOU
Page 27 and 28: Q346What are the main reasons why y
Page 29 and 30: EMERGENCY CONTRACEPTIONNow I would
Page 31 and 32: Quality of Care - Services and Trea
Page 33 and 34: Q406Q407Why didn’t you deliver in
Page 35 and 36: Q416In the last year, have you gone
Page 37 and 38: Q425At the time of your last test,
Page 39 and 40: Now I would like to ask you some qu
Page 41 and 42: Q606If it would be a problem, why?T
Page 43 and 44: Q617What are the impacts on the mot
Page 45 and 46: Q709Besides yourself (or your husba
Page 47 and 48: Q729Excluding your husband/partner,
Page 49 and 50: Q730 Q731 Q732 Q733 Q734 Q735RECORD
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Q822CHECK Q807 AND Q810:IF HE IS CU
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Now I am going to read some stateme
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Q905Which magazine(s) do you read m
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Q921Q922Where do you normally watch
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Q934Would you be comfortable receiv
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Q938. What are the names and types
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Q1008Q1009Q1010Q1011How long do you
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OFFICE USE ONLY: QUESTIONNAIRE NO:
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Baseline Women's questionnaire - Yoruba/English

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