roster08_3a
29 June 2012, 15:00
Questionnaire



QUESTIONNAIRE OPTIONS
Option Setting
Parent Namesingle item
Child Namemultiple items
Max user text length50
Min user text length0
Text ConversionNone

MAIN SECTION (Sequential)
0. Roster number: Take from prompt sheet or use a new number (roster_id) - text, identifier
1. What is the name of this household member? (s1q0) - text, single item
2. What is {{s1q0}}'s relationship to the household head? (s1q2) - menu, single item
3. Please specify {{s1q0}}'s relationship to the household head. (s1q2s) - text, single item
4. What is {{s1q0}}'s gender? (s1q3) - menu, single item
5. How old is {{s1q0}}? (s1q4) - number, single item
6. To which ethnic group does {{s1q0}} belong? (s1q10) - menu, single item
7. What was the highest level of schooling attended by {{s1q0}}? [Interviewer: if other schooling, such as schooling for the blind, select closest equivalent to level completed.] (s1q6a) - menu, single item
8. What is the main occupation of {{s1q0}} now? (s1q7) - menu, single item
9. What is the secondary occupation of {{s1q0}}? (Interviewer: if only one occupation, then select "None" here.) (s1q8) - menu, single item
10. Did {{s1q0}} work on cocoa farms in the 2007/08 season? (s1q8a) - menu, single item
11. Health questions - message, none
12. Health Consent - message, none
13. For how many days in September 2008 has this person had malaria? (s1_malariamo) - number, single item
14. Does {{s1q0}} suffer from any physical disabilities? (s1q11) - menu, single item
15. What kind of physical disbability is this? [Choose all that apply.] (s1q12) - ticklist, single item
16. Does {{s1q0}} suffer from any long-term illnesses or disorders? (s1q13) - menu, single item
17. What kind of illness/disorders does {{s1q0}} suffer from? (Choose all that apply) (s1q14) - ticklist, single item
18. JUMP miss some health questions if less than 8 years old - jump, none
19. For how many days in NOVEMBER, DECEMBER, and JANUARY of the last MAJOR GROWING SEASON (2007 - 2008) was {{s1q0}} too sick to carry out his or her normal daily routine? (s1q16) - menu, single item
20. Which of the following best applies: From October 2007 to September 2008, {{s1q0}} has been sick... (s1q17) - menu, single item
21. HEALTH EXPENDITURE (Sequential)
22. Is {{s1q0}} registered for the National Health Insurance Scheme? (s1_nihs) - menu, single item
23. Has {{s1q0}} EVER visited a clinic or hospital? (s1q24a) - menu, single item
24. How many months ago did {{s1q0}} last visit a clinic or hospital? (s1q24) - number, single item

COMMON SECTION (Sequential)

HEALTH EXPENDITURE (Sequential)
1. From October 2007 to September 2008 how much was spent on the heathcare of {{s1q0}} (includes medicine, dental care, visits to doctor, preventative drugs, etc)? [AMOUNT] (s1q23) - number, single item
2. Health expenditure: please specify units (health_currency) - menu, single item



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