- GHANA 2014 - MAN'S QUESTIONNAIRE
MINISTRY OF HEALTH, GHANA
GHANA STATISTICAL SERVICE
LOCALITY NAME _____
NAME OF HOUSEHOLD HEAD _____
CLUSTER NUMBER _____
STRUCTURE NUMBER _____
HOUSEHOLD NUMBER _____
REGION _____
DISTRICT _____
URBAN/RURAL:
RURAL 2
NAME AND LINE NUMBER OF MAN _____
LINE NO. __________
FIRST VISIT: (REPEAT FOR SECOND AND THIRD VISITS)
DATE _____
INTERVIEWER'S NAME _____
RESULT* ______
NEXT VISIT:
DATE _____
TIME _____
FINAL VISIT:
DAY ___
MONTH ___
YEAR 2014
INT. NUMBER ___
RESULT ___
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____
AKAN 2
GA 3
EWE 4
NZEMA 5
DAGBANI 6
OTHER 7 (SPECIFY) _____
AKAN 2
GA 3
EWE 4
NZEMA 5
DAGBANI 6
OTHER 7 (SPECIFY) _____
NO 2
SUPERVISOR
NAME _____
DATE _____
FIELD EDITOR
NAME _____
DATE _____
OFFICE EDITOR ___
KEYED BY ___
SECTION 1. RESPONDENT'S BACKGROUND
INTRODUCTION AND CONSENT
INFORMED CONSENT
Hello. My name is _______________. I am working with Ghana Statistical Service and the Ministry of Health. We are conducting a survey about health all over Ghana. The information we collect will help the government to plan health services. Your household was selected for the survey. The questions usually take about 20 minutes. All of the answers you give will be confidential and will not be shared with anyone other than members of our survey team. You don't have to be in the survey, but we hope you will agree to answer the questions since your views are important. If I ask you any question you don't want to answer, just let me know and I will go on to the next question or you can stop the interview at any time.
In case you need more information about the survey, you may contact the person listed on the card that has already been given to your household.
Do you have any questions? May I begin the interview now?
SIGNATURE OF INTERVIEWER: __________
DATE: _____
RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)
MINUTES ___
101A) During the interview I would like to measure your blood pressure. This will be done three times during the interview. This is a harmless procedure. It is used to find out if a person has high blood pressure. If it is not treated, high blood pressure may eventually cause serious damage to the heart.
The results of this blood pressure measurement will be given to you after the interview together with an explanation of the meaning of cannot provide any further testing or treatment during the survey. Do you have any questions about the blood pressure measurement so far? If you have any questions about the procedure at any time, please ask me. You can say yes or no to having the blood pressure measurement now. You can also decide at any time not to participate in the blood pressure measures.
Would you allow me to take your blood pressure measurement at this time?
Signature of interviewer: _________________
Date: _____
RESPONDENT DOES NOT AGREE 2 (GO TO 102)
101B) Before taking your blood pressure, I would like to ask a few questions about things that may affect these measurements.
Have you done any of the following within the past 30 minutes:
a) Eaten anything?
b) Had coffee, tea, cola or other drink that has caffeine?
c) Smoked any tobacco product?
d) Conducted any vigorous physical activity or exercises?
NO 2
NO 2
NO 2
NO 2
101C) May I begin the process of measuring your blood pressure?
BEFORE TAKING THE FIRST BLOOD PRESSURE READING, MEASURE THE CIRCUMFERENCE OF THE RESPONDENT'S ARM MIDWAY BETWEEN THE ELBOW AND THE SHOULDER.
RECORD THE MEASUREMENT IN CENTIMETERS.
101D) USE THE ARM CIRCUMFERENCE MEASUREMENT TO SELECT THE APPROPRIATE BLOOD PRESSURE MONITOR MODEL AND CUFF SIZE. CIRCLE THE CODE FOR THE MODEL AND CUFF SIZE.
MODEL 767
MEDIUM: 24 CM - 35 CM 2
LARGE: 36 CM - 41 CM 3
MODEL 789
101E) TAKE THE FIRST BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q102.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.
DIASTOLIC ___
REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996
102) In what month and year were you born?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
103) How old were you at your last birthday?
COMPARE AND CORRECT 102 AND/OR 103 IF INCONSISTENT.
104) Have you ever attended school?
NO 2 (GO TO 108)
105) What is the highest level of school you attended: primary, middle/JSS/JHS, secondary/SSS/SHS, or higher?
MIDDLE 2
JSS/JHS 3
SECONDARY 4
SSS/SHS 5
HIGHER 6
106) What is the highest (grade) you completed at that level?
IF COMPLETED LESS THAN ONE YEAR AT THAT LEVEL, RECORD '00'.
AGE 25 OR OLDER (GO TO 107)
106B) At what age did you enroll in primary school?
106C) Are you currently attending school at any level?
NO 2
106D) Why did you stop attending school?
MOVED 02
NO MONEY TO COVER COSTS 03
HAD BAD GRADES 04
HEALTH REASONS 05
GOT MARRIED/ FAMILY REASONS 06
COMPLETED DESIRED LEVEL 07
NO DESIRE TO CONTINUE 08
OTHER (SPECIFY) _____ 96
SECONDARY/SSS/SHS OR HIGHER (GO TO 110)
108) Now I would like you to read this sentence to me.
SHOW CARD TO RESPONDENT.
IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE:
Can you read any part of the sentence to me?
ABLE TO READ ONLY PARTS OF A SENTENCE 2
ABLE TO READ WHOLE SENTENCE 3
NO CARD WITH REQUIRED LANGUAGE (SPECIFY LANGUAGE) _____ 4
BLIND/VISUALLY IMPAIRED 5
CODE '1' OR '5' CIRCLED (GO TO 111)
110) Do you read a newspaper or magazine at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
111) Do you listen to the radio at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
112) Do you watch television at least once a week, less than once a week or not at all?
LESS THAN ONCE A WEEK 2
NOT AT ALL 3
ANGLICAN 02
METHODIST 03
PRESBYTERIAN 04
PENTECOSTAL/CHARISMATIC 05
OTHER CHRISTIAN 06
ISLAM 07
TRADITIONAL/SPIRITUALIST 08
NO RELIGION 09
OTHER (SPECIFY) _____ 96
114) To which ethnic group do you belong?
GA/DANGME 02
EWE 03
GUAN 04
MOLE-DAGBANI 05
GRUSSI 06
GRUMA 07
MANDE 08
OTHER (SPECIFY) _____ 96
115) In the last 12 months, how many times have you been away from home for one or more nights?
NONE 00 (GO TO 201)
116) In the last 12 months, have you been away from home for more than one month at a time?
NO 2
201) Now I would like to ask about any children you have had during your life. I am interested in all of the children that are biologically yours, even if they are not legally yours or do not have your last name. Have you fathered any children with any woman?
NO 2 (GO TO 206)
DON'T KNOW 8 (GO TO 206)
202) Do you have any sons or daughters that you have fathered who are now living with you?
NO 2 (GO TO 204)
203) How many sons live with you?
And how many daughters live with you?
IF NONE, RECORD '00'.
204) Do you have any sons or daughters that you have fathered who are alive but do not live with you?
NO 2 (GO TO 206)
205) How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.
206) Have you ever fathered a son or a daughter who was born alive but later died?
IF NO, PROBE: Any baby who cried or showed signs of life but did not survive?
NO 2 (GO TO 208)
DON'T KNOW (GO TO 208)
207) How many boys have died?
And how many girls have died?
IF NONE, RECORD '00'.
208) SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL.
IF NONE, RECORD '00'.
HAS HAD ONLY ONE CHILD (GO TO 212)
HAS NOT HAD ANY CHILDREN (GO TO 301)
210) Did all of the children you have fathered have the same biological mother?
NO 2
211) In all, how many women have you fathered children with?
212) How old were you when your (first) child was born?
NO LIVING CHILDREN (GO TO 301)
214) How old is your (youngest) child?
OTHER (GO TO 301)
216) What is he name of your (youngest) child?
WRITE NAME OF (YOUNGEST) CHILD:
217) When (NAME)'s mother was pregnant with (NAME), did she have any antenatal check-ups?
NO 2 (GO TO 219)
DON'T KNOW 8 (GO TO 219)
218) Were you ever present during any of those antenatal check-ups?
NOT PRESENT 2
219) Was (NAME) born in a hospital or health facility?
OTHER 2
219A) What was the main reason why (NAME)'s mother did not deliver in a hospital or health facility?
FACILITY NOT OPEN 02
TOO FAR/NO TRANSPORTATION 03
DON'T TRUST FACILITY/POOR QUALITY SERVICE 04
NO FEMALE PROVIDER AT FACILITY 05
NOT THE FIRST CHILD 06
CHILD'S MOTHER DID NOT THINK IT WAS NECESSARY 07
HE DID NOT THINK IT WAS NECESSARY 08
FAMILY DID NOT THINK IT WAS NECESSARY 09
FAMILY/HUSBAND DID NOT ALLOW 10
NOT CUSTOMARY 11
S/HE DID NOT KNOW WHERE TO GO 12
HE COULD NOT ACCOMPANY HER 13
INCONVENIENT SERVICE HOUR 14
LONG WAITING TIME 15
OTHER (SPECIFY) _____ 96
DON'T KNOW 98
220) When a child has diarrhea, how much should he or she be given to drink: more than usual, about the same as usual, less than usual, or nothing to drink at all?
ABOUT THE SAME 2
LESS THAN USUAL 3
NOTHING TO DRINK 4
DON'T KNOW 8
301) Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy.
Have you ever heard of (METHOD)?
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
NO 2
302) In the last few months have you:
a) Heard about family planning on the radio?
b) Seen anything about family planning on the television?
c) Read about family planning in a newspaper or magazine?
NO 2
NO 2
NO 2
303) In the last months, have you discussed family planning with a health worker or health professional?
NO 2
304) Now I would like to ask you about a woman's risk of pregnancy. From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant when she has sexual relations?
NO 2 (GO TO 306)
DON'T KNOW 8 (GO TO 306)
305) Is this time just before her period begins, during her period, right after her period has ended, or halfway between two periods?
DURING HER PERIOD 2
RIGHT AFTER HER PERIOD HAS ENDED 3
HALFWAY BETWEEN TWO PERIODS 4
OTHER (SPECIFY) ______ 6
DON'T KNOW 8
306) I will now read you some statements about contraception. Please tell me if you agree or disagree with each one.
a) Contraception is a woman's business and a man should not have to worry about it.
b) Women who use contraception may become promiscuous.
DISAGREE 2
DON'T KNOW 8
DISAGREE 2
DON'T KNOW 8
307) CHECK 301 (07):
KNOWS MALE CONDOM
NO (GO TO 311)
308) Do you know of a place where a person can get condoms?
NO 2 (GO TO 311)
309) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
310) If you wanted to, could you yourself get a condom?
NO 2
311) CHECK 301 (08):
KNOWS FEMALE CONDOM
NO (GO TO 401)
312) Do you know of a place where a person can get female condoms?
NO 2 (GO TO 401)
313) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
FAMILY PLANNING CLINIC D
MOBILE CLINIC E
FIELDWORKER/OUTREACH/PEER EDUCATOR F
OTHER PUBLIC (SPECIFY) ______ G
PRIVATE DOCTOR I
PHARMACY J
CHEMICAL/DRUG STORE K
FP/PPAG CLINIC L
MATERNITY HOME M
OTHER PRIVATE MEDICAL (SPECIFY) _____ N
CHURCH P
COMMUNITY VOLUNTEER Q
FRIEND/RELATIVE R
314) If you wanted to, could you yourself get a female condom?
NO 2
SECTION 4. MARRIAGE AND SEXUAL ACTIVITY
401) Are you currently married or living together with a woman as if married?
YES, LIVING WITH A WOMAN 2 (GO TO 404)
NO, NOT IN UNION 3 (GO TO 402)
401A) Was bridewealth negotiated in your current union?
NO 2
401B) Why was the bridewealth not negotiated?
BRIDEWEALTH NOT NEGOTIABLE B (GO TO 404)
HUSBAND NOT GIVEN OPPORTUNITY TO NEGOTIATE C (GO TO 404)
FAMILY TIES D (GO TO 404)
I DID NOT AGREE E (GO TO 404)
NO NEED F (GO TO 404)
PRESTIGE G (GO TO 404)
DETECTED WIFE WAS PREGNANT H (GO TO 404)
OTHER (SPECIFY) _____ X (GO TO 404)
401C) What is the status of the bridewealth in your current union?
PARTLY PAID 2
NOT PAID AT ALL 3
OTHER (SPECIFY) _____ 6
401D) Why was the bridewealth not completely paid?
AGREED TO PAY IN INSTALMENTS B (GO TO 404)
INTENTIONALLY C (GO TO 404)
DETECTED WIFE WAS PREGNANT D (GO TO 404)
FINANCIAL CONSTRAINT E (GO TO 404)
PART OF BRIDEWEALTH WAS USED FOR OTHER PURPOSES F (GO TO 404)
FAMILY TIES G (GO TO 404)
CUSTOMARY DEMANDS H (GO TO 404)
OTHER (SPECIFY) _____ X (GO TO 404)
402) Have you ever been married or lived together with a woman as if married?
YES, LIVED WITH A WOMAN 2
NO 3 (GO TO 413)
403) What is your marital status now; are you widowed, divorced, or separated?
DIVORCED 2 (GO TO 410)
SEPARATED 3 (GO TO 410)
404) Is your (wife/partner) living with you now or is she staying elsewhere?
STAYING ELSEWHERE 2
405) Do you have other wives or do you live with other women as if married?
NO (ONLY ONE) 2 (GO TO 407)
406) Altogether, how many wives or live-in partners do you have?
ONE WIFE/PARTNER: Please tell me the name of (your wife/the woman you are living with as if married).
MORE THAN ONE WIFE/PARTNER: Please tell me the name of each of your wives or each woman you are living with as if married.
RECORD THE NAME AND LINE NUMBER FROM THE HOUSEHOLD QUESTIONNAIRE FOR EACH WIFE AND LIVE-IN PARTNER. IF A WOMAN IS NOT LISTED IN THE HOUSEHOLD, RECORD '00'.
LINE NUMBER ______
408) ASK 408 FOR EACH PERSON.
How old was (NAME) on her last birthday?
MORE THAN ONE WIFE/PARTNER (GO TO 411A)
410) Have you been married or lived with a woman only once or more than once?
MORE THAN ONCE 2 (GO TO 411A)
411) In what month and year did you start living with your (wife/partner)?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
411A) Now I would like to ask about your first (wife/partner). In what month and year did you start living with her?
DON'T KNOW MONTH 98
DON'T KNOW YEAR 9998
412) How old were you when you first started living with her?
413) CHECK FOR THE PRESENCE OF OTHERS.
BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
414) Now I would like to ask some questions about sexual activity in order to gain a better understanding of some important life issues.
How old were you when you had sexual intercourse for the very first time?
AGE IN YEARS ____
FIRST TIME WHEN STARTED LIVING WITH (FIRST) WIFE/PARTNER 95
415) Now I would like to ask some questions about your recent sexual activity. Let me assure you again that your answers are completely confidential and will not be told to anyone. If we should come to any question that you don't want to answer, just let me know and we will go to the next question.
416) When was the last time you had sexual intercourse?
IF LESS THAN 12 MONTHS, ANSWER MUST BE RECORDED IN DAYS, WEEKS OR MONTHS. IF 12 MONTHS (ONE YEAR) OR MORE, ANSWER MUST BE RECORDED IN YEARS.
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____ (GO TO 430)
417) When was the last time you had sexual intercourse with this person?
WEEKS AGO 2 _____
MONTHS AGO 3 _____
418) The last time you had sexual intercourse (with this second/third person), was a condom used?
NO 2 (GO TO 420)
419) Was a condom used every time you had sexual intercourse with this person in the last 12 months?
NO 2
420) What was your relationship to this person with whom you had sexual intercourse?
IF GIRLFRIEND: Were you living together as if married?
IF YES, CIRCLE '2'.
IF NO, CIRCLE '3'.
LIVE-IN PARTNER 2
GIRLFRIEND NOT LIVING WITH RESPONDENT 3 (GO TO 423)
CASUAL ACQUAINTANCE 4 (GO TO 423)
CLIENT/PROSTITUTE 5 (GO TO 423)
OTHER (SPECIFY) _____ 6 (GO TO 423)
MARRIED MORE THAN ONCE OR BLANK (GO TO 423)
OTHER (GO TO 423)
423) How long ago did you have sexual intercourse with this (second/third) person?
WEEKS AGO 2 _____
MONTHS AGO 3 _____
YEARS AGO 4 _____
424) How many times during the last 12 months did you have sexual intercourse with this person?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF TIMES IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
426) Apart from (this person/these two people), have you had sexual intercourse with any other person in the last 12 months?
NO 2 (GO TO 428)
427) In total, with how many different people have you had sexual intercourse with in the last 12 months?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
NO PARTNERS ARE PROSTITUTES (GO TO 430)
429) CHECK 420 AND 418 (ALL COLUMNS):
OTHER (GO TO 434)
430) In the last 12 months, did you pay anyone in exchange for having sexual intercourse?
NO 2
431) Have you ever paid anyone in exchange for having sexual intercourse?
NO 2 (GO TO 434)
432) The last time you paid someone in exchange for having sexual intercourse, was a condom used?
NO 2 (GO TO 434)
433) Was a condom used during sexual intercourse every time you paid someone in exchange for having sexual intercourse in the last 12 months?
NO 2
DON'T KNOW 8
434) In total, with how many different people have you had sexual intercourse in your lifetime?
IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE. IF NUMBER OF PARTNERS IS 95 OR MORE, WRITE '95'.
DON'T KNOW 98
435) CHECK 418, MOST RECENT PARTNER (FIRST COLUMN):
NOT ASKED (GO TO 438)
NO CONDOM USED (GO TO 438)
436) You told me that a condom was used the last time you had sex. What is the brand name of the condom used at that time?
IF BRAND NOT KNOWN, ASK TO SEE THE PACKAGE.
GOLD CYCLE 02
PANTHER 03
BAZOOKA 04
BE SAFE NO LOGO 05
OTHER (SPECIFY) _____ 96
DON'T KNOW 98
437) From where did you obtain the condom the last time?
PROBE TO IDENTIFY TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12
GOVT. HEALTH POST/CHPS 13
FAMILY PLANNING CLINIC 14
MOBILE CLINIC 15
FIELDWORKER/OUTREACH/PEER EDUCATOR 16
OTHER PUBLIC (SPECIFY) _____ 17
PRIVATE DOCTOR 22
PHARMACY 23
CHEMICAL/DRUG STORE 24
FP/PPAG CLINIC 25
MATERNITY HOME 26
OTHER PRIVATE MEDICAL (SPECIFY) ____ 27
CHURCH 32
COMMUNITY VOLUNTEER 33
FRIEND/RELATIVE 34
438) The last time you had sex did you or your partner use any method (other than a condom) to avoid or prevent a pregnancy?
NO 2 (GO TO 500)
DON'T KNOW 8 (GO TO 500)
439) What method did you or your partner use?
PROBE: Did you or your partner use any other method to prevent pregnancy?
RECORD ALL MENTIONED.
MALE STERILIZATION B
IUD C
INJECTABLES D
IMPLANTS E
PILL F
FEMALE CONDOM G
DIAPHRAGM H
FOAM/JELLY I
LAM J
RHYTHM METHOD K
WITHDRAWAL L
OTHER MODERN METHOD X
OTHER TRADITIONAL METHOD Y
SECTION 5. FERTILITY PREFERENCES
500) CHECK 101A:
DID NOT AGREE TO MEASUREMENT (GO TO 501)
500B) May I measure your blood pressure at this time?
DATE _____
NO, RESPONDENT DOES NOT AGREE 2 (GO TO 501)
500C) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q501.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.
DIASTOLIC ____
REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 509)
MAN STERILIZED (GO TO 509)
503) Is your (wife/partner)/Are any of your (wives/partners) currently pregnant?
NO 2 (GO TO 505)
DON'T KNOW 8 (GO TO 505)
504) Now I have some questions about the future. After the (child/children) you and your (wife(wives)/partner(s)) are expecting now, would you like to have another child, or would you prefer not to have any more children?
NO MORE 2 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)
505) Now I have some questions about the future. Would you like to have (a/another) child, or would you prefer not to have any (more) children?
NO MORE/NONE 2 (GO TO 509)
SAYS COUPLE CAN'T GET PREGNANT 3 (GO TO 509)
WIFE (WIVES)/PARTNER(S) STERILIZED 4 (GO TO 509)
UNDECIDED/DON'T KNOW 8 (GO TO 509)
MORE THAN ONE WIFE/PARTNER (GO TO 508)
WIFE/PARTNER NOT PREGNANT OR DON'T KNOW: How long would you like to wait from now before the birth of (a/another) child?
WIFE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?
YEARS 2 _____ (GO TO 509)
SOON/NOW 993 (GO TO 509)
COUPLE INFECUND 994 (GO TO 509)
OTHER (SPECIFY) _____ 996 (GO TO 509)
DON'T KNOW 998 (GO TO 509)
508) How long would you like to wait from now before the birth of (a/another) child?
YEARS 2 _____
SOON/NOW 993
HE/ALL HIS WIVES/PARTNERS ARE INFECUND 994
OTHER (SPECIFY) _____ 996
DON'T KNOW 998
HAS LIVING CHILDREN: If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?
NO LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?
PROBE FOR A NUMERIC RESPONSE.
NUMBER ____
OTHER (SPECIFY) _____ 96 (GO TO 601)
510) How many of these children would you like to be boys, how many would you like to be girls and for how many would it not matter if it's a boy or a girl?
SECTION 6. EMPLOYMENT AND GENDER ROLES
601) Have you done any work in the last seven days?
NO 2
602) Although you did not work in the last seven days, do you have any job or business from which you were absent for leave, illness, vacation, or any other such reason?
NO 2 (GO TO 607)
603) Have you done any work in the last 12 months?
NO 2 (GO TO 607)
604) What is your occupation, that is, what kind of work do you mainly do?
605) Do you usually work throughout the year, or do you work seasonally, or only once in a while?
SEASONALLY/PART OF THE YEAR 2
ONCE IN A WHILE 3
606) Are you paid in cash or kind for this work or are you not paid at all?
CASH AND KIND 2
IN KIND ONLY 3
NOT PAID 4
NOT CURRENTLY MARRIED AND NOT LIVING WITH A PARTNER (GO TO 612)
OTHER (GO TO 610)
609) Who usually decides how the money you earn will be used: you, your (wife/partner), or you and your (wife/partner) jointly?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
OTHER (SPECIFY) _____ 6
610) Who usually makes decisions about health care for yourself: you, your (wife/partner), you and your (wife/partner) jointly, or someone else?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
611) Who usually makes decisions about making major household purchases?
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER JOINTLY 3
SOMEONE ELSE 4
OTHER (SPECIFY) _____ 6
612) Do you own this or any other house either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
613) Do you own any land either alone or jointly with someone else?
JOINTLY ONLY 2
BOTH ALONE AND JOINTLY 3
DOES NOT OWN 4
614) In your opinion, is a husband justified in hitting or beating his wife in the following situations:
a) If she goes out without telling him?
b) If she neglects the children?
c) If she argues with him?
d) If she refuses to have sex with him?
e) If she burns the food?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
701) Now I would like to talk about something else. Have you ever heard of an illness called AIDS?
NO 2 (GO TO 723)
702) Can people reduce their chance of getting the AIDS virus by having just one uninfected sex partner who has no other sex partners?
NO 2
DON'T KNOW 8
703) Can people get the AIDS virus from mosquito bites?
NO 2
DON'T KNOW 8
704) Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?
NO 2
DON'T KNOW 8
705) Can people get the AIDS virus by sharing food with a person who has AIDS?
NO 2
DON'T KNOW 8
706) Can people get the AIDS virus because of witchcraft or other supernatural means?
NO 2
DON'T KNOW 8
707) Is it possible for a healthy-looking person to have the AIDS virus?
NO 2
DON'T KNOW 8
708) Can the virus that causes AIDS be transmitted from a mother to her baby:
a) During pregnancy?
b) During delivery?
c) By breastfeeding?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
OTHER (GO TO 710A)
710) Are there any special drugs that a doctor or a nurse can give to a woman infected with the AIDS virus to reduce the risk of transmission to the baby?
NO 2
DON'T KNOW 8
710A) Have you heard about special antiretroviral drugs (e.g. ARV, Nevirapine, zidovudine, lamivudine) that people infected with the AIDS virus can get from a doctor or a nurse to help them live longer?
NO 2
DON'T KNOW 8
711) CHECK FOR PRESENCE OF OTHERS. BEFORE CONTINUING, MAKE EVERY EFFORT TO ENSURE PRIVACY.
712) I don't want to know the results, but have you ever been tested to see if you have the AIDS virus?
NO 2 (GO TO 716)
713) How many months ago was your most recent HIV test?
TWO OR MORE YEARS 95
714) I don't want to know the results, but did you get the results of the test?
NO 2
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER 12 (GO TO 718)
GOVT. HEALTH POST/CHPS 13 (GO TO 718)
STAND-ALONE VCT CENTER 14 (GO TO 718)
FAMILY PLANNING CLINIC 15 (GO TO 718)
MOBILE CLINIC 16 (GO TO 718)
FIELDWORKER/OUTREACH/PEER EDUCATOR 17 (GO TO 718)
OTHER PUBLIC (SPECIFY) ______ 18 (GO TO 718)
STAND-ALONE VCT CENTER 22 (GO TO 718)
PHARMACY 23 (GO TO 718)
CHEMICAL/DRUG STORE 24 (GO TO 718)
FP/PPAG CLINIC 25 (GO TO 718)
MATERNITY HOME 26 (GO TO 718)
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ 27 (GO TO 718)
CORRECTIONAL FACILITY 32 (GO TO 718)
716) Do you know of a place where people can go to get tested for the AIDS virus?
NO 2 (GO TO 718)
717) Where is that?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) _____ H
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) _____ O
CORRECTIONAL FACILITY Q
718) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had the AIDS virus?
NO 2
DON'T KNOW 8
719) If a member of your family got infected with the AIDS virus, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
720) If a member of your family became sick with AIDS, would you be willing to care for her or him in your own household?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
721) In your opinion, if a female teacher has the AIDS virus but is not sick, should she be allowed to continue teaching in the school?
SHOULD NOT BE ALLOWED 2
DON'T KNOW/NOT SURE/DEPENDS 8
722) Should children age 12-14 be taught about using a condom to avoid getting AIDS?
NO 2
DON'T KNOW/NOT SURE/ DEPENDS 8
HEARD ABOUT AIDS: Apart from AIDS, have you heard about other infections that can be transmitted through sexual contact?
NOT HEARD ABOUT AIDS: Have you heard about infections that can be transmitted through sexual contact?
NO 2
NEVER HAD SEXUAL INTERCOURSE (GO TO 732)
725) CHECK 723: HEARD ABOUT OTHER SEXUALLY TRANSMITTED INFECTIONS?
NO (GO TO 727)
726) Now I would like to ask you some questions about your health in the last 12 months. During the last 12 months, have you had a disease which you got through sexual contact?
NO 2
DON'T KNOW 8
727) Sometimes men experience an abnormal discharge from their penis. During the last 12 months, have you had an abnormal discharge from your penis?
NO 2
DON'T KNOW 8
728) Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?
NO 2
DON'T KNOW 8
HAS NOT HAD AN INFECTION OR DOES NOT KNOW (GO TO 732)
730) The last time you had (PROBLEM FROM 726/727/728), did you seek any kind of advice or treatment?
NO 2 (GO TO 732)
731) Where did you go?
Any other place?
PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
GOVT. HEALTH CENTER B
GOVT. HEALTH POST/CHPS C
STAND-ALONE VCT CENTER D
FAMILY PLANNING CLINIC E
MOBILE CLINIC F
FIELDWORKER/OUTREACH/PEER EDUCATOR G
OTHER PUBLIC (SPECIFY) ______ H
STAND-ALONE VCT CENTER J
PHARMACY K
CHEMICAL/DRUG STORE L
FP/PPAG CLINIC M
MATERNITY HOME N
OTHER PRIVATE MEDICAL (SPECIFY) _______ O
CORRECTIONAL FACILITY Q
732) If a wife knows her husband has a disease that she can get during sexual intercourse, is she justified in asking that they use a condom when they have sex?
NO 2
DON'T KNOW 8
733) Is a wife justified in refusing to have sex with her husband when she knows he has sex with women other than his wives?
NO 2
DON'T KNOW 8
SECTION 8. OTHER HEALTH ISSUES
801) Some men are circumcised, that is, the foreskin is completely removed from the penis. Are you circumcised?
NO 2 (GO TO 805)
DON'T KNOW (GO TO 805)
802) How old were you when you got circumcised?
DURING CHILDHOOD (YOUNGER THAN 5 YEARS) 95
DON'T KNOW (GO TO 98)
803) Who did the circumcision?
HEALTH WORKER/PROFESSIONAL 2
OTHER 3
DON'T KNOW 8
HOME OF A HEALTH WORKER/PROFESSIONAL 2
CIRCUMCISION DONE AT HOME 3
RITUAL SITE 4
OTHER HOME/PLACE 5
DON'T KNOW 8
805) Now I would like to ask you some other questions relating to health matters. Have you had an injection for any reason in the last 12 months?
IF YES: How many injections have you had?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NONE 00 (GO TO 808)
806) Among these injections, how many were administered by a doctor, a nurse, a pharmacist, a dentist, or any other health worker?
IF NUMBER OF INJECTIONS IS 90 OR MORE, OR DAILY FOR 3 MONTHS OR MORE, RECORD '90'. IF NON-NUMERIC ANSWER, PROBE TO GET AN ESTIMATE.
NO 2
DON'T KNOW 8
807) The last time you got an injection from a health worker, did he/she take the syringe and needle from a new, unopened package?
NO 2
DON'T KNOW 8
808) Do you currently smoke cigarettes?
NO 2 (GO TO 810)
809) In the last 24 hours, how many cigarettes did you smoke?
810) Do you currently smoke or use any (other) type of tobacco?
NO 2
811) What (other) type of tobacco do you currently smoke or use?
RECORD ALL MENTIONED.
CHEWING TOBACCO B
SNUFF C
OTHER (SPECIFY) _____ X
812) Are you covered by any health insurance?
NO 2
812A) Are you registered with the National Health Insurance Scheme (NHIS)?
NO 2 (GO TO 816)
813) What type of health insurance are you (covered/registered) by?
RECORD ALL MENTIONED.
HEALTH INSURANCE THROUGH EMPLOYER B
MUTUAL HEALTH ORGANIZATION/COMMUNITY-BASED HEALTH INSURANCE C
OTHER PRIVATELY PURCHASED COMMERCIAL HEALTH INSURANCE D
OTHER (SPECIFY) ______ X
814) Does you insurance cover any of the following maternity benefits:
a) Antenatal health care?
b) Childbirth health care in health facility?
c) Postnatal health care for the mother?
d) Postnatal health care for the child?
e) Cash benefits during maternity leave?
f) Other?
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
NO 2
DON'T KNOW 8
CODE 'A' FOR NHIS CIRCLED (GO TO 817)
816) Why have not registered with the National Health Insurance Scheme (NHIS)?
RECORD ALL MENTIONED.
CANNOT AFFORD PREMIUM B (GO TO 828)
DO NOT TRUST C (GO TO 828)
DON'T NEED HEALTH INSURANCE D (GO TO 828)
NHIS DOES NOT COVER HEALTH SERVICES I NEED E (GO TO 828)
DON'T UNDERSTANDS SCHEME F (GO TO 828)
DON'T KNOW WHERE TO REGISTER G (GO TO 828)
NO EASY ACCESS TO A HEALTH FACILITY H (GO TO 828)
DO NOT LIKE THE ATTITUDE OF STAFF IN A HEALTH FACILITY I (GO TO 828)
THOSE WITH INSURANCE ARE GIVEN SUBSTANDARD SERVICES AND MEDICINE (GO TO 828)
OTHER (SPECIFY) _____ X
817) Did you pay your NHIS membership yourself?
YES, PAID BY A RELATIVE/FRIEND 2
YES, PAID BY EMPLOYER/SSNIT 3
NO, EXEMPT AS ELDERLY 4
NO, EXEMPT AS PENSIONER 5
NO, EXEMPT AS INDIGENT 7
NO, OTHER (SPECIFY) _____ 6
818) Do you hold a valid National Health Insurance Scheme (NHIS) card?
IF ANSWER IS 'YES', REQUEST TO SEE THE CARD.
YES, CARD NOT SEEN 2 (GO TO 820)
NO 3
819) Why do you not have a valid NHIS card?
REGISTERED, CARD NOT RECEIVED 2 (GO TO 823)
REGISTERED, WAITING PERIOD 3 (GO TO 823)
NOT RENEWED REGISTRATION 4 (GO TO 821)
LOST NHIS CARD 5 (GO TO 823)
OTHER (SPECIFY) _____ 6 (GO TO 823)
820) How many weeks did it take you to obtain your NHIS card?
DON'T KNOW 98 (GO TO 823)
821) Do you plan to renew the NHIS card?
NO 2
DON'T KNOW/NOT SURE 8 (GO TO 823)
822) Why do you not want to renew the NHIS card?
Anything else?
RECORD ALL MENTIONED.
PREMIUM EXPENSIVE B
STILL PAY OUT OF POCKET C
POOR QUALITY CARE WITH CARD D
WAITING TIME FOR CARD LONG E
USED SERVICES NOT COVERED F
DID NOT USE ANY HEALTH SERVICES G
USE CLINICS OR TRADITIONAL PRACTITIONERS WHO ARE NOT COVERED H
OTHER (SPECIFY) _____ X
823) Do you have to pay out of pocket for drugs and services?
NO 2
DON'T KNOW/NOT SURE 8
824) Are there any services that you need from a health provider that are not covered by NHIS?
NO 2 (GO TO 826)
DON'T KNOW/NOT SURE 8 (GO TO 826)
825) What are these services?
Anything else?
RECORD ALL MENTIONED.
LABORATORY INVESTIGATIONS B
ANTENATAL CARE C
POSTNATAL CARE D
CARE FOR NEWBORN FOR UP TO 3 MONTHS E
OTHER (SPECIFY) _____ X
826) In your opinion, do NHIS card holders get better, the same, or worse service than others?
SAME 2
WORSE 3
DON'T KNOW/NOT SURE 8
827) In your opinion, did you receive good service last time you were treated at a clinic or hospital? IF NO, PROBE: "What was the main problem?"
NO, WAITING TIMES TOO LONG 2
NO, STAFF NOT POLITE 3
NO, DID NOT RECEIVE ENOUGH INFORMATION ABOUT ILLNESS AND TREATMENT 4
OTHER (SPECIFY) ______ 6
828) Are you aware of any programs that help pregnant women accessing health services?
NO 2 (GO TO 830)
829) Which ones?
RECORD ALL MENTIONED.
OTHER (SPECIFY) _____ X
830) Are you aware of any programs that help children under age 18 accessing health services?
NO 2 (GO TO 832)
831) Which ones?
RECORD ALL MENTIONED.
OTHER (SPECIFY) _____ X
832) These next questions are about common health problems in Ghana.
Have you ever heard of an illness called tuberculosis or TB?
NO 2 (GO TO 836)
833) How does tuberculosis spread from one person to another?
PROBE: Any other ways?
RECORD ALL MENTIONED.
THROUGH SHARING UTENSILS B
THROUGH TOUCHING A PERSON WITH TB C
THROUGH FOOD D
THROUGH SEXUAL CONTACT E
THROUGH MOSQUITO BITES F
OTHER (SPECIFY) _____ X
DON'T KNOW Z
834) Can tuberculosis be cured?
NO 2
DON'T KNOW 8
835) If a member of your family got tuberculosis, would you want it to remain a secret or not?
NO 2
DON'T KNOW/NOT SURE/DEPENDS 8
836) These next questions are about blood pressure.
Have you ever been told by a doctor or other health professional that you had hypertension or high blood pressure?
NO 2 (GO TO 839)
DON'T KNOW 8 (GO TO 839)
837) Were you told on two or more different occasions by a doctor or other health professional that you had hypertension or high blood pressure?
NO 2
DON'T KNOW 8
838) To lower your hypertension or high blood pressure, are you now:
a) Taking prescribed medicine?
b) Controlling your weight or losing weight?
c) Cutting down on salt in your diet?
d) Exercising?
e) Cutting down on alcohol?
f) Stopping smoking?
NO 2
NOT APPLICABLE 3
NO 2
NOT APPLICABLE 3
NO 2
NOT APPLICABLE 3
NO 2
NOT APPLICABLE 3
NO 2
NOT APPLICABLE 3
NO 2
NOT APPLICABLE 3
839) Have you ever heard about iodized salt?
NO 2 (GO TO 842)
840) Can you mention benefits for consuming iodized salt?
PROBE: Any other benefits?
RECORD ALL MENTIONED.
PROVIDES ENERGY B
PREVENTS STILL BIRTH C
PREVENTS MENTAL RETARDATION D
PREVENTS MISCARRIAGES E
PREVENTS GOITER F
OTHER (SPECIFY) _____ X
DON'T KNOW Z
841) How can you tell iodized salt from non-iodized salt?
RECORD ALL MENTIONED.
IODIZED SALT LOGO B
FINE POWDERED SALT C
OTHER (SPECIFY) _____ X
DON'T KNOW Z
842) During the last 7 days, on how many days did you eat fruits, for example, mangoes, pawpaw, banana, orange, avocados, tomatoes, passion fruit, etc?
NONE 0
DON'T KNOW/NOT SURE 8
844) During the last 7 days, on how many days did you eat vegetables, for example carrots, cabbage, dark green, leafy vegetables (e.g. kontomire), pumpkin, squash, etc?
NONE 0
DON'T KNOW/NOT SURE 8
846) In the last 6 months, did you visit a health facility?
NO 2 (GO TO 859)
847) What type of facility did you visit during your most recent visit?
PROBE TO IDENTIFY THE TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.
PRIVATE 2
OTHER (SPECIFY) _____ 6
DON'T KNOW 8
848) What type of service did you receive during this most recent visit?
ANC/DELIVERY/PNC 02
NEWBORN CARE 03
MALARIA 04
FEVER 05
DIARRHEA 06
HIV/AIDS/STI 07
HIGH BLOOD PRESSURE 08
EAR/NOSE/THROAT INFECTION 09
DIABETES 10
EYE INFECTION 11
CHECKUP/PREVENTIVE CARE 12
ACCIDENT/INJURY 13
OTHER OUTPT. (SPECIFY) _____ 14
CHILD ILLNESS 16
HER OWN ILLNESS 17
ACCIDENT/INJURY 18
OTHER INPT. (SPECIFY) _____ 19
OTHER (SPECIFY) _____ 96
849) How did you pay for the service during this most recent visit?
NATIONAL HEALTH INSURANCE 2
OTHER INSURANCE 3
COMBINATION OF ANY OF THE ABOVE 4
OTHER (SPECIFY) _____ 6
850) Now I want to ask you about the ease of getting care. In your opinion, was it very easy, easy, fairly easy, difficult, or very difficult to see the health provider?
EASY 2
FAIRLY EASY 3
DIFFICULT 4
VERY DIFFICULT 5
851) Is the location of the health facility very convenient, convenient, fairly convenient, not convenient, or very inconvenient for you?
CONVENIENT 2
FAIRLY CONVENIENT 3
NOT CONVENIENT 4
VERY INCONVENIENT 5
852) Are the hours the health facility open during the day very good, good, fair, poor, or very poor for you?
GOOD 2
FAIR 3
POOR 4
VERY POOR 5
853) Now I want to talk about waiting time at the health facility.
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied about:
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
854) Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with the staff at the health facility when they:
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
855) In your opinion, did the health provider spend enough time with you?
NO 2
856) Did the health provider seek your consent before providing treatment?
NO 2
857) Was the health provider friendly to you?
NO 2
858) Now I want to ask you about the condition of the health facility.
Were you very satisfied, satisfied, fairly satisfied, not satisfied, or very dissatisfied with:
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
SATISFIED 2
FAIRLY SATISFIED 3
NOT SATISFIED 4
VERY DISSATISFIED 5
NOT APPLICABLE 6
DID NOT AGREE TO MEASUREMENT (GO TO 901)
861) May I measure your blood pressure at this time?
DATE _____
NO, RESPONDENT DOES NOT AGREE 2 (GO TO 901)
862) TAKE THE BLOOD PRESSURE READING.
RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE. THEN PROCEED TO Q901.
IF YOU ARE UNABLE TO MEASURE THE RESPONDENT'S BLOOD PRESSURE, RECORD THE REASON.
DIASTOLIC ____
REFUSED 994
TECHNICAL PROBLEMS 995
OTHER 996
SECTION 9. AVERAGING BLOOD PRESSURE MEASURES
901) CHECK Q500C AND Q862:
SYSTOLIC AND DIASTOLIC BLOOD PRESSURE MEASURES NOT RECORDED IN BOTH Q500C AND Q862 (GO TO 907)
902) RECORD AND CALCULATE THE AVERAGE OF THE SYSTOLIC AND DIASTOLIC BLOOD PRESSURE FROM Q500C AND Q862.
903) BLOOD PRESSURE MEASUREMENTS FROM Q500C:
904) BLOOD PRESSURE MEASUREMENTS FROM Q862:
905) RECORD THE SUM OF THE SYSTOLIC AND DIASTOLIC MEASURES.
906) CALCULATE THE AVERAGE SYSTOLIC AND DIASTOLIC PRESSURES BY DIVIDING THE SUM IN Q905 BY 2.
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q862 (GO TO 910)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE RECORDED IN Q500C (GO TO 910)
BOTH SYSTOLIC AND DIASTOLIC BLOOD PRESSURE NOT RECORDED IN Q101E (GO TO 913)
910) RECORD THE SYSTOLIC AND DIASTOLIC PRESSURE.
911) USE THE TABLE BELOW TO DETERMINE THE CORRECT CODE TO RECORD ON THE BLOOD PRESSURE REPORT AND REFERRAL FORM.
CIRCLE THE ROW IN WHICH THE VALUE FOR THE SYSTOLIC BLOOD PRESSURE FROM Q906 OR Q910 IS FOUND.
THEN CIRCLE THE COLUMN IN WHICH THE VALUE FOR THE DIASTOLIC BLOOD FROM Q906 OR Q910 IS FOUND.
THE VALUE WHERE THE ROW AND COLUMN YOU HAVE CIRCLED INTERSECT IN THE TABLE WILL BE USED IN COMPLETING Q912.
2 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
2 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
3 AVERAGE DIASTOLIC PRESSURE 85 - 89
3 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
4 AVERAGE DIASTOLIC PRESSURE 85 - 89
4 AVERAGE DIASTOLIC PRESSURE 90 - 99
4 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
5 AVERAGE DIASTOLIC PRESSURE 85 - 89
5 AVERAGE DIASTOLIC PRESSURE 90 - 99
5 AVERAGE DIASTOLIC PRESSURE 100 - 109
5 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
6 AVERAGE DIASTOLIC PRESSURE 85 - 89
6 AVERAGE DIASTOLIC PRESSURE 90 - 99
6 AVERAGE DIASTOLIC PRESSURE 100 - 109
6 AVERAGE DIASTOLIC PRESSURE 110 - 119
6 AVERAGE DIASTOLIC PRESSURE 120 OR MORE
912) RECORD THE NUMBER YOU CIRCLED IN Q911 IN THE CHART BELOW. THEN USE THE INSTRUCTIONS TO THE RIGHT OF THAT NUMBER TO COMPLETE A BLOOD PRESSURE REPORT AND REFERRAL FORM FOR THE RESPONDENT. GIVE THE FORM TO THE RESPONDENT AND ANSWER ANY QUESTIONS HE MAY HAVE.
913) Thank you for taking the time to answer these questions.
RECORD THE TIME.
MINUTES _____
TO BE FILLED IN AFTER COMPLETING INTERVIEW
COMMENTS ON SPECIFIC QUESTIONS: __________________________________
ANY OTHER COMMENTS: _______________________________
SUPERVISOR'S OBSERVATIONS _______________________________________________
DATE: __________
EDITOR'S OBSERVATIONS ________________________________________
DATE: _________